ADHD is often misunderstood as a static diagnosis, but what if there’s more to it? Could the symptoms of ADHD be linked to the states of our nervous system? In this post, we’ll explore ADHD through the lens of Polyvagal Theory, breaking down how sympathetic arousal might underpin many ADHD behaviors.
A Sympathetic Game: Flight, Fight, or Both?
When we think of ADHD, terms like inattention, hyperactivity, and impulsivity come to mind. But these aren’t isolated behaviors—they emerge from our nervous system’s state. As you read, ask yourself: are these behaviors more indicative of a fight response, a flight response, or both?
Let’s explore the two core symptom clusters:
1. Inattention: Sympathetic Activation or Shutdown?
ADHD’s inattention symptoms include:
Failing to pay close attention to details.
Trouble holding attention on tasks or play.
Not listening when spoken to directly.
Trouble organizing tasks or activities.
From a Polyvagal perspective, inattention could stem from either sympathetic activation (flight/fight) or shutdown. For example:
A flight state might lead to distraction or an inability to focus, driven by hypervigilance.
Shutdown, however, presents as a checked-out, dissociative state—often mistaken for “daydreaming.”
But ADHD isn’t typically marked by the lethargy of shutdown. Instead, there’s an energy to ADHD inattention, suggesting a sympathetic root.
2. Hyperactivity and Impulsivity: A Sympathetic Overflow
Symptoms of hyperactivity and impulsivity include:
Fidgeting or squirming.
Leaving seats when it’s inappropriate.
Excessive talking or interrupting others.
These behaviors clearly suggest sympathetic arousal—a body in flight or fight mode. For instance:
Flight might appear as a constant need to move, such as pacing or fidgeting.
Fight could manifest in interrupting others or blurting out answers—behaviors tied to impatience or defensiveness.
The Polyvagal Ladder: A Guide to Understanding ADHD
According to Polyvagal Theory, our nervous system exists along a ladder of states:
Safe and Social: Calm, connected, and present.
Sympathetic (Flight/Fight): Energized and activated.
Shutdown: Collapsed, disconnected, or dissociative.
ADHD behaviors often occur in the sympathetic zone, where the energy to focus is scattered. When safety and mindfulness are added, this energy can transform into motivation, productivity, creativity, and play.
Recommended free resource: Polyvagal Ladder
ADHD and Polyvagal Theory: Practical Tips to Help Manage
ADHD isn’t just about managing symptoms; it’s about understanding the nervous system. Here’s how mindfulness and movement can help:
Fidget with Awareness: Tools like stress balls or infinity cubes can help discharge energy, but the key is mindfulness. Pay attention to how your body feels as you use them. Focus on the sensory experience of fidgeting.
Structured Movement: When done mindfully, physical activity can release stuck energy. For example, walking while focusing on the sensation of your feet can ground and calm you.
Cues of Safety: Safe environments with supportive co-regulation—like therapy or engaging with a trusted person—can help passively regulate ADHD symptoms.
The Role of Co-Regulation in ADHD
Cues of safety can help reduce ADHD symptoms. In therapy, I’ve observed children and adults diagnosed with ADHD calm significantly during sessions, suggesting their environment and co-regulation play a key role in reducing symptoms.
Why is this? The cues of safety from the environment and the co-regulation from a therapist activate the ventral vagal safety pathways, reducing the impact of sympathetic activation.
ADHD or Sympathetic Arousal?
While ADHD is often labeled as a disorder, understanding its connection to Polyvagal Theory opens new pathways for compassion and management. Whether symptoms lean toward flight or fight, mindfulness and safe relationships can help shift behaviors toward a more regulated state.
Further reading
Complete DSM and Polyvagal Theory episode list
Reference
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013
AD/HD Criteria from the CDC - https://www.cdc.gov/ncbddd/adhd/diagnosis.html
Author Bio:
Justin Sunseri is a licensed Marriage and Family Therapist and Coach who specializes in trauma relief. He hosts the Stuck Not Broken podcast and is the author of the Stuck Not Broken book series. Justin is also a member of the Polyvagal Institute's Editorial Board.
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