The One with the ADHD Tax: Part 1 - The Individual ADHD Tax

Living with ADHD comes with a bunch of hidden costs – often referred to as the "ADHD tax." These costs add up over time and can really hit your wallet hard. But here’s the good news: getting a better grasp of your ADHD (e.g., investing in ADHD coaching) could save you more money in the long run than you might think. Let’s break down what the individual ADHD tax looks like and how understanding the neurobiology behind ADHD can help.

Why ADHD Coaching is Worth It

ADHD coaching has a cost, and some people hesitate because of that. But let’s get real. Have you ever calculated how much your unmanaged ADHD is costing you each year? Imagine how much you spend annually on late fees, replacing lost items, and higher insurance premiums. Investing in coaching could help you cut these costs significantly. For instance, avoiding just one car accident could offset the entire cost of coaching by saving on repairs and insurance premiums.

Coaching can help you get a handle on these issues, save you money, and improve your quality of life. Think about it as an investment. Yes, I’m obviously biased, but I also have a number of clients who will confirm that ADHD coaching has helped them better understand how their ADHD traits show up and how to design a life around this that will minimise its emotional and financial toll.

Not convinced? Keep reading.

Late Payment Fees and Forgotten Subscriptions

The ADHD brain has impaired executive function, a set of cognitive skills that include working memory, planning, and prioritisation. These skills are crucial for managing daily tasks, long-term goals, and remembering to pay bills.

When these functions are impaired, it becomes challenging to keep track of deadlines, and bills often get paid late, racking up fees. Subscriptions renew because we forget to cancel the automatic renewal. I should be owning shares in Duolingo by now – they took my money for years (correction: I let them take my money for years), and I progressed a lot less than proportionally to that cost in both Turkish and Hebrew.

Replacing Lost Items

Misplacing items is all too common with ADHD due to issues with working memory and attention.

As I write this, I’m in the Swiss Lounge at Zurich Airport, listening to my Spotify playlist out of my left ear only because I somehow lost my right AirPod between Boston and here. And as I review draft, I have my new pair of freshly replaced AirPods charging. They are now connected to my iPhone, proudly displaying as “Alexia’s AirPods #3” (see below) because yes, I had lost another pair before that.

Constantly replacing things like keys, phones, and yes, AirPods, becomes a significant expense. The ADHD brain often has trouble with working memory, which is the ability to hold and manipulate information over short periods, leading to frequent instances of losing and forgetting items.

Misplaced (Not Lost!) Items

ADHD impairment in working memory can also make it difficult to remember where items were placed. Technically, those are not lost items, but time spent looking for misplaced items can lead to lost productivity and frustration. This is a direct result of the ADHD brain's difficulty in encoding and recalling information. Many of my clients say they spend money on replacing items that they will find again, creating those special ADHD “collections.”

Car Repairs and Increased Insurance

ADHD-related challenges during driving are linked to sustained inattention, impulsivity, and distraction, making it harder to focus on the road and react appropriately to changing conditions.

In Sweden, a study found that having ADHD increases the risk of being in an accident by 47% for men and 45% for women. According to another study, the list of adverse driving outcomes found in ADHD individuals vs those who do not have ADHD is long, and so is the list of academic research findings in that vein. In the US, the National Institutes of Health found that people with ADHD are 1.45 times more likely to be involved in serious traffic accidents, leading to higher repair costs and increased insurance premiums.

While there isn’t, to my knowledge, a jurisdiction that has made it a legal requirement to disclose your ADHD to your car insurer, the UK now makes it compulsory to disclose the ADHD diagnosis to the Driver and Vehicle Licensing Agency (DVLA). You can be fined up to ￡1,000 and may be prosecuted if you don’t. Many of my UK clients found out from me and were not very happy about it.

Poorer Health and Lifestyle Choices

Anxiety, poor sleep, and unhealthy routines contribute to chronic health issues and lead to increased medical expenses. ADHD often makes it much harder to stick to healthy habits, resulting in conditions like obesity, diabetes, and hypertension. The neurological underpinnings of ADHD include dysregulation of dopamine and norepinephrine, which affect mood, energy levels, and the ability to maintain routines.

Impulsivity linked to ADHD can also lead to risky behaviours and addiction, increasing healthcare costs. Studies have found a higher risk of substance use disorders among people with ADHD. This happens because the ADHD brain seeks immediate rewards, often at the expense of long-term consequences. The brain's reward system, which relies heavily on dopamine, is less responsive, leading individuals to seek out more intense stimuli to feel satisfied.

While it follows that this will have consequences on the quantity and cost of medical care and support that an ADHD person might need throughout their lifetime. Insurance issues around this can be unclear, especially in countries that lack a specific framework for ADHD or who haven’t fit ADHD into an existing nomenclature. While working for the Luxembourg ADHD association, I remember hearing the grievances of a resident who had been denied complementary health insurance on the basis of his ADHD diagnosis. Not only that: the person's children, who had no such diagnosis, could therefore not be covered by that insurance either.

Indebtedness

Impulsive spending and poor financial planning can lead to significant debt. ADHD impacts the brain's reward system, making it hard to resist immediate gratification, resulting in unnecessary purchases and financial instability. The prefrontal cortex, responsible for decision-making and impulse control, is often underactive in ADHD brains, leading to difficulties in financial planning and control. Also, because ADHD brains are less sensitive to dopamine, ADHDers are more likely to engage in risky or excessive behaviours, like buying something expensive on a whim, to boost dopamine levels.

Sensory overwhelm in shopping environments can also affect ADHD individuals, leading to impulse purchases or incomplete shopping lists (and subsequent extra trips to the store) which are more often than not an attempt to quickly end the overwhelming experience and escape discomfort. We are slowly becoming familiar with “neurodivergent-friendly” shopping hours in IKEA (not very “dayjob-friendly” hours, but that’s another story), which are more commonly associated with autism spectrum disorder (ASD) individuals. But this overwhelm can affect some ADHD people to a very comparable degree, and combined with too many options (remember ADHD people are often maximisers) and difficulty being and staying patient, will make the most simple decision feel overwhelming.

Cost of Delegating or Getting Help

Hiring assistants, professional organisers, or mental health professionals can be pricey but necessary to stay organised and productive. These services help individuals with ADHD manage their time, tasks, and responsibilities more effectively. The brain's executive function deficits make it challenging to stay organised without external support.

Employment Challenges

ADHD often leads to unemployment or underemployment. According to the Attention Deficit Disorder Association, adults with ADHD face higher rates of unemployment and job instability. This happens because the ADHD brain struggles with maintaining attention, meeting deadlines, and following through on tasks, all of which are crucial for job stability and advancement.

The impulsivity and need for new stimuli associated with ADHD can make it challenging to stay engaged in a single job for long periods, leading to frequent job changes. Constantly changing jobs as a result of unmanaged ADHD carries additional cost in the form of lost opportunities, such as missing out on promotions because we couldn’t perform in a linear way for a long enough time.

I've heard this story too many times: a brilliant and innovative ADHDer working in a high-stakes financial job gets stuck at early/middle management. They are appreciated by teammates, excel in sales, engage well with clients, and bring creative solutions. They come up with unique, market-relevant ideas and are praised for their energy and ideation skills, but… they are chronically late handing in their timesheets. Yes. There apparently comes a point in many fee-earning careers where what makes the future leaders stand out from the crowd is how diligently they hand in their timesheets. And at this game, my ADHD clients often lose. At yet another big financial cost.

Time Blindness, Chronically Late… and Chronically Early

Speaking of being chronically late, there is another less known ADHD trait: being chronically early. People with ADHD have difficulty gauging the passage of time. This is known as time blindness and leads to poor (financial) planning, poor scheduling, missed deadlines, or a chronic underestimation of how long tasks will take, even tasks they may have completed many times before. This skews the sense of time and urgency, making any normal day feel like a succession of mental contortions for the ADHD brain. People with ADHD often overcompensate for their time management difficulties by arriving extremely early, which can also be inefficient and wasteful. This compensation mechanism is now officially accepted as part of the ADHD symptomatology.

Out of Sight, Out of Mind

The ADHD brain struggles with maintaining focus on tasks that are not directly in front of them. This is an additional reason for ADHD individuals forgetting about bills, responsibilities, or even food because the items/reminders are not immediately visible or actionable, leading to waste and disorganisation.

Cost of ADHD Medication

Medication costs can be substantial, especially without insurance. These medications are often very helpful in managing symptoms, but they add a significant cost to living with ADHD. The cost depends greatly on where you purchase them, what insurance you have, and whether you were diagnosed in childhood or adulthood. Until recently, some ADHD medications in Luxembourg were only reimbursed by the national health system if you had been diagnosed before age 18. Thankfully, this is changing.

To give you a few ballpark figures, in the United States, monthly prices range from about €60 for generic methylphenidate to €450 for Vyvanse (Elvanse). In the UK, costs are roughly €35 to €60 for generic methylphenidate and around €80 to €90 for Elvanse (Vyvanse). In Germany, generic methylphenidate is priced at about €35 to €60, and Elvanse/Vyvanse costs roughly €100 to €120 per month.

These variations underscore the importance of understanding local healthcare systems and insurance coverage when managing ADHD. Many of my clients spend a lot of time (cost!) doing their own research and often experimenting with multiple medications until they find one that helps.

How Coaching Helps

ADHD coaching helps develop personalised strategies to manage your ADHD traits, improve time management, and reduce financial burdens. Coaches help develop routines, set goals, and create systems to stay organised and focused. The accountability and support from a coach can be instrumental in developing effective strategies to mitigate the ADHD tax.

- Improving Financial Management: Coaches help establish better financial habits like automatic bill payments, realistic budgets, and spending tracking, reducing late fees and impulsive spending.

- Enhancing Time Management: Coaching builds skills in planning, prioritisation, and scheduling to address lateness and time blindness, improving productivity and reducing costs from missed deadlines.

- Boosting Organisation: Coaches create systems for tracking important items, reducing time and money spent on replacing lost items with consistent storage places, digital tools, and reminders.

- Supporting Healthier Lifestyle Choices: Coaching helps establish routines for exercise, diet, and sleep, addressing ADHD's neurological effects and reducing long-term health costs.

- Career Development: Coaches support workplace challenges, improving job performance and stability with strategies for meeting deadlines, focusing on tasks, and effective communication.

- Medication Management: Coaches aid in managing treatment plans with reminders, tracking effects, and communicating with healthcare providers, reducing trial-and-error costs.

Conclusion

The individual ADHD tax is a significant burden, but by understanding its components and implementing strategies to manage it, individuals can improve their financial stability and well-being. Investing in ADHD coaching can make a meaningful difference, helping to mitigate these costs and create a supportive environment for those with ADHD.

References

1. JAMA Psychiatry. (2017). Substance Use Disorders in ADHD. [JAMA Psychiatry](https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1814941).

2. Fuermaier ABM, et al. (2017). Driving and attention deficit hyperactivity disorder. [NIH](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5281661/).

3. American Psychological Association. (2014). ADHD and Driving: Research Studies. [APA](https://psycnet.apa.org/record/2014-57877-011).

4. WebMD. (2023). ADHD and Substance Abuse: Is There a Link? [WebMD](https://www.webmd.com/add-adhd/adhd-and-substance-abuse-is-there-a-link).

5. Hetzel, A. (2022). One of the Perfectionism MVPs. [LinkedIn](https://www.dhirubhai.net/pulse/one-perfectionism-mvps-alexia-hetzel-5bibe/?trackingId=39%2BfXcgwzsCDDgcoJyoWpQ%3D%3D).

6. SingleCare. (2023). ADHD Medication Cost. [SingleCare](https://www.singlecare.com/blog/adhd-medication-cost/).?