Neurodivergent Brains & Bodies: How Hormones Impact ADHD

Author: Kerry Mulgrew, Occupational Therapist, Witherslack Group

ADHD is often talked about in terms of attention, behaviour or focus. But what is actually happening inside the brain? And why can changes such as puberty make everyday challenges feel even more significant for children and young people with ADHD?

How hormones affect ADHD

Current research suggests that people with ADHD do not necessarily produce different hormones from their peers. However, hormonal changes can have a greater impact because of the way the ADHD brain processes information, motivation, emotion and regulation. Hormones can influence, dopamine sensitivity, reward processing, sleep patterns, emotional regulation, energy levels and stress responses.

ADHD is more than just attention

Attention is not a single skill. It relies on several different systems within the brain working together to help us focus on important tasks, filter out distractions, organise and plan, regulate emotions, manage impulses and stay motivated. For many children and young people with ADHD, these systems can work differently, making everyday tasks more challenging.

The three key brain systems in ADHD

1. The control system

The control system helps us stay focused on a goal and manage our behaviour to achieve it. Whether it's brushing our teeth, completing homework or getting ready for school, the brain is constantly organising actions, filtering distractions and helping us stay on task. For children with ADHD, this system can become overwhelmed more easily, making planning, organisation and task completion much harder.

2. The reward system

The reward system helps us decide what feels worthwhile and worth our effort. This system relies heavily on dopamine; a neurotransmitter linked to motivation and reward. Many children with ADHD find it much easier to engage in activities that feel interesting, novel or rewarding. Tasks that don't immediately provide a sense of achievement can feel much harder to start, even when they understand their importance. This helps explain experiences such as:

• Difficulty starting homework

• Struggling with routine tasks

• Strong interests and periods of hyperfocus

• Seeking novelty and excitement

3. The state system

The state system controls our level of alertness and readiness. It helps regulate:

• Sleep

• Hunger and thirst

• Energy levels

• Stress responses

• Emotional arousal

When this system is under-active, a child may appear tired, distracted or foggy. When it is over-active, they may feel anxious, restless or overwhelmed. Finding the right balance is essential for focus, learning and emotional wellbeing.

Why dopamine matters

Dopamine is often referred to as the brain's "motivation chemical". It helps us begin tasks, stay motivated, experience reward and maintain attention. Research suggests that in ADHD, dopamine signalling can be less efficient. This may mean children need stronger levels of interest, novelty or reward before their brain fully engages with a task. This is not about laziness or a lack of effort. Instead, it reflects differences in how the brain processes motivation and reward.

The link between ADHD and hyperfocus

Many parents are familiar with the apparent contradiction of ADHD. A child may struggle to complete a five-minute task but spend hours focused on a favourite activity. Hyperfocus often occurs when an activity strongly activates the reward system, helping the brain access the motivation needed to sustain attention.

ADHD, sleep and regulation

Sleep plays a huge role in ADHD. Many children and young people experience:

• Difficulty settling at bedtime

• Delayed sleep patterns

• Waking during the night

• Struggling to wake in the morning

When sleep is disrupted, attention, emotional regulation and executive functioning become even more difficult. Poor sleep can also increase stress levels and reduce access to the motivation and regulation systems children rely on throughout the day.

ADHD through the developmental stages

Ages 5 to 8

At this stage, children's brains are developing rapidly and require significant amounts of sleep. Children may experience:

• Increased tiredness

• Big emotional responses

• Greater sensitivity to stress

• Fluctuations in focus and attention

Calm environments, predictable routines and quality sleep are particularly important during these years.

Ages 9 to 11

For some children, early hormonal changes begin during this stage. Parents may notice:

• Bedtime becoming more difficult

• Increased independence

• Challenges with organisation and routines

• Greater difficulty starting less preferred tasks

Executive function demands at home and school increase significantly during this period.

Ages 12 to 14

Puberty brings major changes to sleep, emotions and motivation. Many young people experience:

• Later sleep patterns

• Increased sensitivity to reward

• Greater emotional intensity

• Stronger need for novelty and engagement

This can be a particularly important time to focus on positive motivation, meaningful rewards and supportive routines.

Ages 15 to 18

As hormone patterns become more established, young people begin to move towards adult rhythms. However, ADHD-related difficulties often remain because the underlying differences in brain function are still present. Young people may continue to need support with:

• Sleep routines

• Time management

• Emotional regulation

• Motivation

• Managing stress

• Practical strategies that can help

While every child is different, there are several approaches that many families find helpful. To make mornings easier, try prepare clothing and equipment the night before, reduce decision-making where possible, offer a protein-rich breakfast or snack, and use natural light or daylight alarm clocks to support waking.

Support task initiation

Starting a task is often harder than completing it. Try:

• Breaking tasks into smaller steps

• Focusing on just the first two minutes

• Making progress visual through checklists

• Building in rewards and positive feedback

• Support emotional regulation

When emotions run high, co-regulation can be incredibly effective. This might include, staying calm and connected, acknowledging how the child feels, maintaining clear but supportive boundaries, offering comfort and reassurance. Children often regulate more effectively when they feel understood and supported. Create a predictable bedtime routine. Many young people with ADHD benefit from, consistent bedtime routines, reduced stimulation before bed, suitable lighting in the evening, regular wake-up times, access to natural light in the morning. The goal is not perfection but finding a routine that works for your child and family.