Introducing DANDORI: A productivity system for neurodivergents

Essy Knopf DANDORI executive functions
Reading time: 3 minutes

For many autistics and ADHDers, daily life is like trying to juggle too many balls at once—except those balls are constantly changing shape, and some vanish the moment you reach for them. Executive dysfunction makes it hard to organize, prioritize, and complete tasks, leading to frustration and a feeling of being stuck.

Common struggles include:

  • Knowing what needs to be done but struggling to start (task initiation issues)
  • Hyperfixating on one task while ignoring everything else (time blindness)
  • Forgetting appointments, deadlines, or important responsibilities (working memory challenges)
  • Feeling overwhelmed by big tasks because breaking them down seems impossible (task chunking difficulties)
  • Struggling with transitions or shifting focus between activities (attention-switching issues)

The world often expects neurodivergents to simply “try harder,” but effort alone isn’t enough when the brain’s executive functions work differently. Instead, structured strategies—designed with neurodivergent needs in mind—can create pathways to success. Enter the DANDORI system.

Introducing DANDORI: A Productivity System for Neurodivergents

DANDORI is a structured framework for improving executive function. Borrowing from a Japanese term meaning “procedure for carrying out a plan,” DANDORI helps break tasks into manageable steps, boost motivation, and increase accountability. Each letter in DANDORI stands for a key principle:

D – Do More, Keep Busy (With Intention)

For many neurodivergents, motivation swings between extremes—either hyperfocus or complete inertia. By balancing activity levels, we can regulate motivation more effectively. Strategies include:

  • Chunking: Breaking tasks into smaller, achievable steps to reduce overwhelm.
  • Task Batching: Grouping similar activities together (e.g., answering emails in one session) to improve efficiency.
  • Active Transitioning: Using short physical activities (e.g., stretching, walking) between tasks to maintain momentum.

A – Accountability

Having external accountability structures can make all the difference when motivation wanes. Some ways to maintain accountability include:

  • Using Habit-Tracking Apps: Apps like HabitShare allow you to log progress and even involve friends in your goals.
  • Body Doubling: Working alongside a friend (virtually or in-person) can help increase focus and follow-through.
  • Public Commitments: Sharing your goals with a trusted person can create a sense of responsibility and increase follow-through.

N – Nurture Motivation (Success Stacking)

Motivation thrives on small wins. By creating early successes, we can build momentum and confidence. Strategies include:

  • Success Stacking: Starting with small, easy tasks before tackling harder ones.
  • Rewarding Progress: Giving yourself incentives (e.g., a break, a snack, or watching a favorite show) after completing tasks.
  • Pomodoro Technique: Working in 25-minute focus sprints followed by 5-minute breaks to maintain motivation.
Essy Knopf DANDORI executive dysfunction

D – Define Goals

Clear goals prevent tasks from feeling overwhelming and directionless. Tools to help with goal-setting include:

  • The Eisenhower Matrix: Categorizing tasks based on urgency and importance.
  • SMART Goals: Ensuring goals are Specific, Measurable, Achievable, Relevant, and Time-bound.
  • Reverse Planning: Working backward from a deadline to map out necessary steps.

O – Optimize Tracking & Organization

Creating an organized system minimizes cognitive overload. Some helpful approaches include:

  • Numbered Folders & Labels: Keeping digital and physical spaces structured.
  • Task Boards & Planners: Using tools like Trello, Notion, or a simple bullet journal to track progress.
  • Automated Reminders: Setting up notifications for tasks and deadlines.

R – Remind Yourself

Memory aids are crucial for managing executive dysfunction. Strategies include:

  • Using Sticky Notes & Whiteboards: Placing visible reminders in key areas.
  • Voice Notes & Digital Assistants: Recording quick notes or using smart home devices for reminders.
  • Visual Timers & Clocks: Displaying countdowns for task completion.

I – Implement Time Management

Neurodivergent time perception can be inconsistent, making it essential to develop time management techniques:

  • Time Blocking: Allocating fixed time slots for specific activities.
  • Flexible Scheduling: Allowing buffer time between tasks to accommodate energy fluctuations.
  • Gradual Adaptation: Starting with shorter work periods and increasing as focus improves.

Final Thoughts

No system works perfectly for everyone, so it’s essential to tailor these strategies to your unique needs. Be flexible, experiment, and most importantly, practice self-compassion. The key to managing executive dysfunction isn’t perfection—it’s persistence.

Would you try the DANDORI system? What strategies have worked for you? Share your thoughts in the comments below!

Why neuroaffirming therapy is essential for autistic and ADHDers

Essy Knopf neuroaffirming therapy
Reading time: 4 minutes

If you’ve ever explained your autistic or ADHD-related challenges to a therapist, only to have them dismiss or misunderstand you, you’re not alone. Many neurodivergent (ND) individuals experience therapy that is based on neurotypical (NT) standards, failing to recognize their unique experiences and needs. This disconnect can be disheartening and even harmful, reinforcing feelings of alienation, self-doubt, and shame.

This is where neuroaffirming therapy (NAT) comes in. Unlike traditional therapeutic approaches that may view neurodivergence as a disorder to be fixed, NAT respects autism and ADHD as natural variations of human cognition. It focuses on validation, self-acceptance, and working with clients’ strengths rather than against their neurology.

NAT promotes an approach that acknowledges both the challenges and strengths of being ND, ensuring that therapy is tailored to the individual rather than forcing conformity to NT norms.

What is Neuroaffirming Therapy?

NAY is an attachment-based, trauma-informed, and strengths-focused approach that centers the lived experiences of autistic and ADHD clients. It acknowledges that many mental health struggles among NDs stem not from their neurotype itself, but from a world structured around NT expectations.

The stress of trying to navigate an environment that is not designed for them can lead to anxiety, depression, burnout, and masking—all of which NAT seeks to address with compassion and understanding.

Instead of forcing NDs to conform, NAT helps clients navigate the world while honoring their authentic selves. It challenges ableism, prioritizes self-compassion, and fosters empowerment. This approach helps clients build self-esteem, set boundaries, and advocate for accommodations that allow them to thrive.

How Neuroaffirming Therapy Differs from Traditional Therapy

Many traditional therapies operate within a deficit-based model, which assumes that NDs need to be “fixed” or trained to behave in NTs ways. This can result in harmful practices such as:

  • Masking Encouragement – Encouraging NDs to suppress stimming, force eye contact, or change their communication style to fit neurotypical expectations.
  • Pathologization of Traits – Viewing hyperfocus, sensory sensitivity, or direct communication as problematic rather than inherent ND traits.
  • Invalidation of Experiences – Dismissing the impact of ableism and minority stress, attributing distress solely to the ND rather than their environment.
  • Overemphasis on Social Norms – Prioritizing NT communication and behavior rather than helping NDs express themselves in ways that feel natural and comfortable.

NAT takes the opposite approach, recognizing that neurodivergence is a natural and valid way of being. Instead of trying to change the client, it seeks to support their unique needs and challenges by addressing external barriers, internalized ableism, and self-perception.

Core Principles of Neuroaffirming Therapy

Every ND is Unique

The saying “If you’ve met one autistic person, you’ve met one autistic person” holds true. Autism and ADHD manifest differently in everyone, meaning that therapy must be personalized to the individual’s needs, strengths, and intersectional identities (e.g., gender, race, sexuality, disability status).

Neurodivergence is Dynamic

Traits associated with autism and ADHD can fluctuate over time due to environmental factors, trauma, personal growth, and changing life circumstances. NAT recognizes that neurodivergence is not static but shaped by both genetics and lived experiences.

Pathology Often Co-Occurs

NAT does not pathologize neurodivergence itself, but it does acknowledge that conditions such as anxiety, depression, trauma, executive dysfunction, sensory processing disorder, and sleep disorders often co-occur and require compassionate, informed support.

Ableism is Pervasive and Harmful

Society is structured around NT norms, leading to systemic barriers that disadvantage NDs. NAT actively works to dismantle these barriers by advocating for accommodations, self-advocacy, community support, and radical acceptance.

Essy Knopf neuroaffirming therapy

Ableist Standards Are Internalized

Many NDs experience self-doubt and shame due to lifelong messaging that they are “wrong” or “deficient.” NAT helps clients unlearn internalized ableism, recognize their inherent worth, and embrace neurodivergence as part of their identity.

Ableism Creates Minority Stress

Living in a world that stigmatizes neurodivergence leads to chronic stress, burnout, and trauma. NAT provides a space where NDs can process these experiences without judgment and develop resilience through self-advocacy, community connection, and personal empowerment.

Complex PTSD is Common

Many NDs develop complex post-traumatic stress disorder (C-PTSD) due to chronic social rejection, bullying, masking, gaslighting, and misunderstandings. NAT helps clients recognize and heal from these traumas while rebuilding self-trust, emotional regulation skills, and coping mechanisms.

Rigidity is a Natural Response

NDs often develop rigid routines, preferences, and coping mechanisms as a way to navigate an unpredictable and often overwhelming world. Rather than labeling rigidity as a problem, NAT explores its origins and helps clients develop flexible, self-supportive strategies without forcing NT expectations.

Challenges Are Biopsychosocial

NAT acknowledges that difficulties faced by autistics and ADHDers arise from a combination of biological, psychological, social, and environmental factors—not just their neurotype. A comprehensive approach is necessary for effective support, which includes changing the environment, advocating for accommodations, building self-awareness, and challenging societal norms.

Why Neuroaffirming Therapy Matters

Traditional therapy often forces NDs to fit into NT frameworks, leading to further distress. NAT, however, takes an empowering, strengths-based approach that validates clients’ experiences and identities.

Therapists practicing NAT help clients understand that they are not broken or deficient—they are simply navigating a world not built for them. With the right support, they can learn to self-advocate, set boundaries, and cultivate a life that aligns with their authentic selves.

If you’re looking for a therapist, consider seeking out someone trained in NAT. And if you’re a therapist working with ND clients, integrating NAT principles can make a world of difference in your clients’ lives.

Want to Learn More?

Check out my book, The Neuroaffirming Therapy Handbook, or browse my blog for more insights into neurodiversity and mental health. If this post resonated with you, share it with others who might benefit!

Friendships can be so challenging for autistics and ADHDers. Here’s why.

Essy Knopf friendships
Reading time: 2 minutes

Friendships are built on shared interests, trust, and mutual support. But for autistics and ADHDers, the journey to meaningful social connections is often fraught with obstacles. These challenges may include:

1. Different Social Expectations

Many neurotypical (NT) people engage in frequent small talk, spontaneous socializing, and indirect communication. For neurodivergents (NDs), these norms can feel exhausting or even confusing. If you prefer deep, structured conversations or struggle with picking up unspoken social rules, maintaining friendships can become difficult.

2. The ‘Friends for a Reason, Friends for a Season’ Phenomenon

Some friendships last only for a specific phase of life—like school, work, or a shared activity. While NT people may transition between relationships more smoothly, autistics and ADHDers often struggle with these changes, feeling hurt or rejected when they fade away.

3. Burnout from Socializing

Many NDs experience social fatigue. If you need extended time to recharge after interactions, you may unintentionally withdraw. This can lead to feelings of isolation and confusion, both for you and your friends.

4. Object Consistency vs. People Consistency

Some NDs find comfort in objects and hobbies over people. Objects provide stability—books, collections, and passions won’t suddenly change or reject you. This preference can make forming and maintaining friendships with unpredictable humans more challenging.

5. Struggles with Communication and Rejection

Misunderstandings can arise when ND communication styles clash with NT expectations. A direct comment may be misinterpreted as rude, or an info-dump on a passion might overwhelm someone. Over time, repeated social mishaps can lead to a fear of rejection, making it harder to engage in new friendships.

Essy Knopf friendships

Strategies for Navigating Friendships as an ND

If you’ve struggled with friendships, know that you are not alone. Here are some ways to navigate social connections:

1. Seek Like-Minded People

Look for friendships in ND-friendly spaces, whether online communities, shared interest groups, or local meetups that encourage structured social interactions.

2. Accept That Some Friendships Are Temporary

It’s okay if some friendships naturally fade. Instead of seeing it as a personal failure, recognize that relationships ebb and flow for everyone.

3. Set Boundaries for Social Energy

Allow yourself to take breaks from socializing when needed. Communicate your boundaries clearly with friends so they understand when you need space.

4. Find Alternative Forms of Connection

If in-person socializing feels overwhelming, consider text-based friendships, pen pals, or hobby-focused groups where interaction is structured around a shared interest.

5. Work on Self-Compassion

Friendship struggles are not a reflection of your worth. Many NDs feel isolated simply because society isn’t structured to accommodate different social needs. Be kind to yourself and celebrate the connections you do have, no matter how small.

Final Thoughts

Friendships for autistics and ADHDers can be challenging, but understanding these struggles can help foster self-acceptance and guide us toward meaningful connections. By embracing alternative ways of socializing and finding people who truly appreciate us, we can build relationships that feel supportive and authentic.

Why sleep is a challenge for neurodivergents

Essy Knopf sleep
Reading time: 3 minutes

If you’ve ever found yourself staring at the ceiling long after bedtime, mind racing with thoughts, or tossing and turning from discomfort, you’re not alone. Sleep can be elusive for many neurodivergents (NDs), particularly those with autism, ADHD, or hypermobile spectrum disorders. Despite exhaustion, falling and staying asleep can feel impossible.

The reasons for these struggles vary. A heightened sensory system might make every little sound or flicker of light feel intrusive. A restless mind, common in ADHD, can keep a person awake with an endless stream of thoughts. And for those with hypermobility conditions like Ehlers-Danlos syndrome, physical discomfort can make finding a comfortable sleeping position a nightly challenge.

Why Sleep Matters More Than We Realize

We all know sleep is important, but for NDs, poor sleep can amplify existing challenges. Lack of rest can increase anxiety, make emotional regulation harder, and reduce focus and executive functioning. If you already experience sensory sensitivities, sleep deprivation can heighten them, making the world feel even more overwhelming.

And for those with hypermobility, exhaustion only compounds chronic pain and fatigue, making day-to-day activities feel even more draining. In short, getting enough quality sleep isn’t just about feeling rested—it’s crucial for mental and physical well-being.

Why Standard Sleep Advice Often Falls Short

Many people struggling with sleep are given the same advice: avoid screens before bed, maintain a consistent bedtime, or drink chamomile tea. While these tips may help to some extent, they often don’t address the deeper issues that NDs face.

Instead of relying solely on traditional sleep hygiene practices, it’s important to explore solutions tailored to the specific needs of NDs.

Rather than forcing yourself into a rigid sleep routine that doesn’t align with your brain or body, consider experimenting with approaches that accommodate your unique needs.

Creating a Sensory-Friendly Environment

For those sensitive to stimuli, reducing sensory overload before bed is key. Try using a weighted blanket for deep-pressure comfort, adjusting room temperature to avoid discomfort, or incorporating white noise machines to drown out background distractions. Even small changes—like switching to softer bedding or blackout curtains—can make a big difference.

Easing a Restless Mind

If your brain refuses to slow down at bedtime, structured relaxation techniques might help. Journaling before bed can provide an outlet for racing thoughts, while guided meditation or breathing exercises can shift your focus from mental chatter to physical calm. Reducing stimulating activities, like intense conversations or fast-paced video games, in the hour leading up to bedtime can also help ease the transition to sleep.

Finding the Right Sleep Position

For those with hypermobility, joint pain and discomfort can make it difficult to find a comfortable sleeping position. Experimenting with different mattress types, pillows for joint support, or even compression garments might help reduce nighttime pain and improve sleep quality.

Working with Your Natural Rhythms

NDs often have unique circadian rhythms, which means forcing an early bedtime may not be realistic. Instead of fighting your body’s natural patterns, consider gradually shifting your bedtime in small increments or allowing for flexibility in your sleep schedule when possible.

Essy Knopf improving neurodivergent sleep

Seeking Professional Guidance

If sleep struggles persist despite your best efforts, seeking support from professionals familiar with neurodivergence may be beneficial. A sleep specialist, occupational therapist, or doctor knowledgeable about autism, ADHD, and hypermobility can provide more personalized interventions. In some cases, options like melatonin, cognitive-behavioral therapy for insomnia (CBT-I), or physical therapy for pain management may be helpful.

Sleep Isn’t One-Size-Fits-All

Ultimately, there’s no single magic fix for sleep struggles, but understanding your unique challenges is the first step toward finding solutions that work for you. By making small, tailored adjustments—whether through sensory modifications, relaxation techniques, or flexible sleep schedules—you can begin to improve your sleep quality and, in turn, your overall well-being.

Have you found any strategies that help you sleep better? Share your experiences in the comments!

My body hates me! Living with hypermobile autism and ADHD

Essy Knopf hypermobile spectrum disorders
Reading time: 3 minutes

Many autistics and ADHDers experience more than just neurodivergence. For some, their bodies seem to betray them—resulting in pain, instability, and exhaustion. One such hidden struggle is hypermobile spectrum disorders (HSD) and Ehlers-Danlos syndrome (EDS), conditions that affect connective tissue and, consequently, almost every system in the body.

For those with hypermobility, something as simple as taking off a shirt can become a painful ordeal. Joints can sublux (partially dislocate) or fully dislocate with minimal effort, leading to intense pain and long recovery periods. Hypermobile individuals may also experience fragile skin, slow wound healing, chronic fatigue, and circulation issues, such as postural orthostatic tachycardia syndrome (POTS).

The Hypermobile Diagnostic Struggle

Despite the serious implications of HSD and EDS, diagnosis is often a long and frustrating journey. Many medical professionals misattribute symptoms to anxiety, fibromyalgia, or simply growing pains, leading to years of confusion and untreated suffering. Since the medical field is still catching up with research on hypermobility, many doctors are unaware of the condition’s full impact, especially in neurodivergents (NDs).

Like autism and ADHD, hypermobility disorders exist on a spectrum. Some people may experience mild joint instability, while others face life-altering pain and frequent dislocations. The lack of general awareness means that many NDs are left undiagnosed, struggling to piece together their symptoms.

The Neurodivergence Connection

Research has begun to uncover an interesting overlap between neurodivergence and hypermobility disorders. Many autistics and ADHDers report hypermobile joints, fragile skin, and chronic pain. Scientists suspect that whatever genetic factors contribute to autism and ADHD may also play a role in connective tissue disorders.

This link adds another layer of difficulty for NDs already navigating a world designed for neurotypicals (NTs). When combined with executive dysfunction, sensory sensitivities, and motor coordination challenges, hypermobility can make daily life feel like an uphill battle.

The Daily Challenges of Hypermobility

People with hypermobility often experience:

  • Frequent joint dislocations and subluxations – Even basic movements can lead to sudden, sharp pain.
  • Chronic fatigue – The body has to work extra hard to stabilize weak joints, leading to exhaustion.
  • Slow wound healing and fragile skin – A simple scrape can take weeks to heal.
  • Digestive issues – Many individuals with HSD/EDS develop irritable bowel syndrome (IBS) and food sensitivities.
  • Dysautonomia and POTS – Blood pooling in the legs causes dizziness and fainting when standing.

Strategies for Managing Hypermobile Autism & ADHD

Although hypermobility presents unique challenges, there are ways to manage symptoms and improve quality of life:

  1. Physical Therapy – Strengthening muscles around weak joints can reduce dislocations and long-term damage.
  2. Joint Supports & Braces – Using compression sleeves, braces, and KT tape can help stabilize joints.
  3. Low-Impact Exercise – Activities like swimming, Pilates, or yoga (with modifications) help maintain strength without excessive strain.
  4. Dietary Adjustments – Following a low-histamine or low-FODMAP diet may help manage digestive issues related to HSD.
  5. Hydration & Salt Intake – Increasing both can help manage POTS symptoms.
  6. Medication & Supplements – Antihistamines, pain management medications, and specific supplements can help alleviate symptoms.
  7. Pacing & Spoon Theory – Learning to conserve energy throughout the day can prevent excessive fatigue and flare-ups.
Essy Knopf hypermobility health challenges

The Importance of Recognition and Advocacy

For NDs with hypermobility, receiving a proper diagnosis can be life-changing. It provides validation and opens the door to appropriate accommodations and treatments. Advocating for oneself in the medical system is essential, but it can also be exhausting. Seeking out knowledgeable specialists, such as a rheumatologist or geneticist, can make all the difference.

There’s still much to learn about the relationship between autism, ADHD, and hypermobility, but awareness is growing. If you suspect you might have HSD or EDS, researching resources like The Ehlers-Danlos Society and connecting with online communities can be incredibly helpful.

Final Thoughts

Living with hypermobile autism and ADHD comes with unique struggles, but knowledge and the right strategies can make a significant impact. If your body feels like it’s working against you, know that there are ways to improve your daily life. Seeking support and making small but meaningful adjustments can lead to greater stability, less pain, and a better overall quality of life.

Do you struggle with connective tissue-like symptoms? Sound off in the comments!

Living in an ableist dystopia: The daily struggles of being neurodivergent

Essy Knopf ableism
Reading time: 3 minutes

Have you ever wondered why dystopian fiction resonates so deeply? Why so many neurodivergent (ND) folks find themselves drawn to these stories of oppression, survival, and rebellion? Perhaps it’s because, for many of us, dystopia isn’t fiction—it’s a daily reality.

As an autistic and ADHD therapist, I’ve seen firsthand how ableism structures our world in a way that excludes, punishes, and marginalizes NDs. The struggle to exist in a system designed for neurotypicals (NTs) often forces us to mask, suppress, and overcompensate, leading to exhaustion, anxiety, and internalized shame.

But before diving into these parallels, let me share a short fictional excerpt that reflects the lived experiences of many NDs.

A Dystopian Reflection

Imagine a future where a pandemic has erased humanity’s capacity for empathy. Society becomes a place where deception and manipulation are survival skills, and those who remain kind are outcasts. One individual struggles to navigate a world that sees their honesty as foolishness and their empathy as weakness.

At home, their parents criticize them for failing to conform. At school, they’re ostracized. Attempts to challenge injustice result in punishment. Seeking refuge in books and video games, they create their own worlds to escape the cruelty of the one they live in.

Sound familiar?

For many autistics and ADHDers, this isn’t just a story—it’s life. We grow up painfully aware that we are different but unable to explain why. Our deep empathy, sense of justice, and unique way of experiencing the world often make us targets rather than allies. And when we speak up, we’re told we’re too rigid, too emotional, or too much.

Ableism as the Silent Oppressor

Ableism—the belief that NT functioning is superior—permeates every aspect of society. Schools, workplaces, and social spaces are structured to accommodate NT needs while dismissing those of NDs.

Most office spaces are sensory nightmares. Open-plan environments are overwhelming, social interactions are forced, and expectations around communication favor NT norms. Employers often expect ND employees to “just deal with it” rather than making reasonable accommodations.

Schools demand that ADHDer children sit still, remain silent, and suppress their natural learning styles. Autistic students are punished for stimming or struggling with social interactions. Instead of adapting the environment to meet diverse needs, institutions enforce compliance, leading many ND students to associate learning with trauma.

Because NDs behaviors are often viewed as problematic, many of us learn to mask. We camouflage our traits to fit in, suppressing stims, forcing eye contact, and mimicking NT speech patterns. But masking comes at a high cost—leading to burnout, identity erosion, and mental health struggles.

The Double Standard of Accommodation

Consider this: When an ND requests an accommodation—like adjusting the room temperature or asking for a seat change—it’s considered reasonable. But when an ND asks for a quiet workspace, flexible deadlines, or sensory-friendly environments, it’s often met with resistance.

Even something as simple as requesting a classroom change due to a noisy air conditioning unit can feel like an undue burden. This reluctance to provide accommodations reinforces the idea that our needs are “too much.”

Essy Knopf inclusive schools workplaces

Breaking the Silence: The Power of Self-Advocacy Amid Ableism

Many NDs internalize shame, believing they are burdensome for needing accommodations. But advocating for ourselves isn’t just about personal survival—it benefits everyone.

When we challenge ableist structures, we create ripple effects that help others. Speaking up about sensory issues in a classroom, for example, can lead to changes that improve the learning environment for all students, ND or not.

Here’s how we can start dismantling this dystopia:

  • Reject the shame: Recognize that needing accommodations is not a failure, but a right.
  • Speak up: Whether at school, work, or in medical settings, advocate for what you need.
  • Find community: Connect with others who understand your struggles. Shared experiences build resilience.
  • Educate others: The more people understand neurodivergence, the harder it becomes to justify exclusion.

Final Thoughts

In dystopian stories, oppression is often met with rebellion. The rise of the neurodiversity movement is our rebellion—an effort to dismantle ableism and demand a society that values ND people for who we are, rather than who we’re forced to pretend to be.

Little by little, we are chipping away at this dystopia, advocating for change, and refusing to be silent. And one day, when these rigid structures crumble, we will build in their place a world where all minds are valued equally.

What has been your experience navigating an ableist world? Share in the comments!

We need ADHD medication parity NOW

Essy Knopf ADHD medication
Reading time: 2 minutes

Accessing ADHD medication isn’t just about filling a prescription—it’s a constant battle. Unlike many other mental health challenges where medications are more readily available, ADHD medication is burdened with extra hoops to jump through. These barriers disproportionately affect those who rely on stimulant medications, leaving many without the treatment they need to function.

The process is exhausting: prior authorizations, frequent refill requirements, and the stigma surrounding stimulant medications all contribute to the problem. Add to that the ongoing stimulant shortage, and what should be a simple, routine healthcare matter becomes a frustrating and even disabling ordeal.

ADHD Medication Shortages: A Crisis with No End in Sight

For several years now, the U.S. has been experiencing a shortage of medication like Adderall and Ritalin. The reasons are complex, involving manufacturing limits, increased demand, and regulatory constraints. But the outcome is simple: ADHDers are left scrambling to find their prescribed medication, often having to switch to alternatives that may not work as well or even going without entirely.

Imagine needing medication daily to function, only to be told month after month that your pharmacy is out. For many, this can lead to worsened executive dysfunction and a severe drop in quality of life.

Insurance and Prescription Barriers

Even when ADHD medication is available, insurance restrictions can create additional roadblocks. Many ADHDers must navigate:

  • Prior authorizations, where doctors have to prove the necessity of ADHD medication before insurance covers it.
  • Quantity limits, requiring multiple pharmacy visits for a single prescription.
  • Frequent reassessments, even for adults who have had a stable diagnosis for years.

These barriers assume that ADHD medication is inherently more dangerous or prone to abuse than other mental health treatments, reinforcing stigma and making care unnecessarily difficult.

The Call for ADHD Medication Parity

Other mental health conditions do not face these same restrictions. If someone with anxiety, depression, or bipolar disorder can access their medication without excessive red tape, why should ADHDers be treated differently?

Parity means equal treatment. It means that ADHD medication should be covered and dispensed as easily as any other psychiatric medication. It means that stimulant shortages should be taken seriously as a public health issue, not dismissed as a minor inconvenience.

Essy Knopf ADHD medication access challenges

What Can We Do?

The fight for ADHD medication parity starts with awareness and advocacy. Here’s how we can push for change:

  • Call on policymakers to enforce parity laws and remove unnecessary restrictions on ADHD medication.
  • Raise awareness about the impact of ADHD medication shortages and advocate for improved pharmaceutical regulations.
  • Support ADHD advocacy organizations that work to improve healthcare access for neurodivergents.

Final Thoughs

If you’ve struggled to access ADHD medication, you’re not alone. It’s time for healthcare systems to recognize ADHD as a legitimate medical challenge deserving of equal treatment. Let’s demand ADHD medication parity—because no one should have to fight this hard for basic care.

A psychologist compared my autism to a fatal condition

Essy Knopf ableism psychologist
Reading time: 3 minutes

When I decided to pursue an autism diagnosis, I was hoping for clarity, self-understanding, and maybe even a bit of support. What I wasn’t expecting was to have my neurodivergence compared to a fatal, degenerative disease.

The psychologist I spoke with didn’t offer validation or encouragement. Instead, he presented a hypothetical scenario involving Huntington’s disease, a terminal neurological condition. “Would you even want to know?” he asked, as if discovering I was autistic would be akin to receiving a death sentence.

My stomach sank. I wasn’t calling for a philosophical debate—I was trying to book an appointment for my autism diagnosis.

The Harm of Medical Ableism

Experiences like mine are, unfortunately, not uncommon. Many autistics face skepticism, dismissal, and outright ableism from medical professionals when seeking an autism diagnosis, especially later in life. This can take the form of:

  • Gatekeeping autism diagnoses by making the process unnecessarily difficult or discouraging individuals from seeking answers.
  • Invalidating autistic experiences by questioning the legitimacy of self-identification or framing autism as an inherently negative condition.
  • Perpetuating harmful stereotypes that paint autism as a tragedy rather than a natural variation of neurodivergence.

The psychologist’s comparison to Huntington’s disease wasn’t just offensive—it was wildly inaccurate. Autism is not a degenerative illness. It is not a death sentence. It is a different way of experiencing and interacting with the world. Yet, the way some medical professionals handle autism diagnoses can make it feel like a burden rather than an empowering revelation.

Why an Autism Diagnosis Matters

For many, receiving an autism diagnosis is not about seeking a label—it’s about gaining access to understanding, accommodations, and community. Knowing I was autistic allowed me to:

  • Identify my sensory sensitivities and social communication differences as valid, rather than as personal failings.
  • Advocate for my own needs in work and social settings.
  • Connect with other autistics who shared similar experiences.

Not knowing, on the other hand, often leads to years of struggling with unidentified challenges, self-doubt, and unnecessary hardship. An autism diagnosis can be a transformative moment, allowing individuals to understand their experiences in a new light.

The Importance of Perseverance

After my frustrating encounter, I didn’t give up. I kept calling around until I found a professional who was willing to listen. Eventually, I got my autism diagnosis—and it was life-changing. It validated what I had known deep down but had struggled to articulate.

If you are seeking an autism diagnosis and face similar roadblocks, don’t let one dismissive professional deter you. Your experiences are real, and your struggles deserve recognition. Keep pushing forward. The right support exists—you just have to find it.

Essy Knopf benefits autism diagnosis

The Need for Change

That said, medical professionals must do better. They need to:

  • Approach autism diagnoses with compassion and respect.
  • Recognize that autistics are the best experts on their own experiences.
  • Dispel outdated, harmful misconceptions about autism.

Autistics shouldn’t have to fight for their autism diagnoses, nor should they be made to feel like their existence is a tragedy. Neurodivergence is a part of human diversity, and it’s time the medical field treated it as such.

Final Thoughts

An autism diagnosis is not a label—it is a tool for empowerment. It helps autistic people navigate the world with greater understanding and access to the support they need. By fostering a more inclusive and neuroaffirming approach, medical professionals can ensure that autistics are met with dignity, respect, and the care they deserve.

If you have been met with resistance or ignorance in your pursuit of an autism diagnosis, know that your experience is valid. Your struggles are real, and you are not alone. Keep advocating for yourself, seek out supportive professionals, and remember—your neurodivergence is not a flaw. It is a part of who you are, and you deserve to be seen and heard.

Have you faced challenges in getting an autism diagnosis? Share your story in the comments.

Why I hate going outside as an autistic ADHDer

Essy Knopf sensory overload
Reading time: 2 minutes

For many autistics and ADHDers, stepping outside isn’t a simple task—it’s an exercise in endurance. From unpredictable noises to overwhelming crowds, the world outside can be exhausting and even painful. Here’s why sensory overwhelm makes going out so difficult, and how it impacts daily life.

The Unseen Battle of Going Outside

For neurotypicals, stepping outside might seem effortless. For me, it’s a calculated risk. The moment I leave my house, I brace myself for a wave of sensory overwhelm—the bright, flickering lights, honking cars, and the endless chatter of people.

It’s not just annoying. It’s exhausting.

Every sound, smell, and visual detail seems to crash into my brain at once, with no filter. My ADHD means I struggle to tune out irrelevant stimuli, and my autism makes everything feel too much, too fast, too loud. The result? I burn out before I even reach my destination.

The Chaos of Public Spaces

Public spaces are an unpredictable sensory minefield. One moment, I’m fine. The next, a sudden noise—an ambulance siren, a child screaming, or harsh sunlight—sends my nervous system into overdrive.

Shops, train stations, and crowded streets all come with their own brand of overstimulation. The sheer number of people moving unpredictably about can be stressinducing.

I’m constantly on edge, trying to manage the discomfort while also masking—pretending I’m “fine” so I don’t stand out. But masking takes energy, and before long, I’m mentally and physically drained.

The Exhaustion of Social Expectations

Going outside also means navigating unspoken social rules. Eye contact, small talk, dodging people on sidewalks—it’s all an exhausting mental game. Unlike neurotypicals, who instinctively follow these social norms, I have to consciously process every interaction.

If I miscalculate—speak too bluntly, react too slowly, or misread a situation—I risk being judged. The stress of trying to “act normal” adds another layer of exhaustion on top of the sensory overwhelm.

Managing neurodivergent sensory needs

Why Staying Inside Feels Safer

At home, I control my environment. I can keep the lighting soft, the noise minimal, and avoid unpredictable social interactions. There’s no pressure to mask, no overwhelming sensory input, and no need to constantly adjust to a world that wasn’t built for me.

But the downside? Isolation. Avoiding the outside world means missing out on experiences, friendships, and opportunities. It’s a constant tug-of-war between self-preservation and the desire to engage with life.

Finding Ways to Cope

While I can’t change the world, I can adapt. Here are a few ways I manage:

  • Noise-canceling headphones – Blocking out overwhelming sounds helps me focus and stay calm.
  • Sunglasses or tinted lenses – Bright lights are a major trigger, so I reduce the strain however I can.
  • Planned outings – Knowing exactly where I’m going, when, and for how long helps me prepare mentally.
  • Sensory-friendly breaks – Finding quiet spaces to recharge mid-trip prevents burnout.

Final Thoughts

Going outside as an autistic/ADHDer isn’t a simple task—it’s a sensory endurance test. From chaotic public spaces to social expectations, every outing requires energy that I don’t always have.

If you relate to this struggle, know you’re not alone. It’s okay to set boundaries, to take breaks, and to advocate for environments that support neurodivergent needs. When feeling dysregulated, consider trying some of these self-care techniques.

Do you experience sensory overwhelm when going outside? How do you cope? Let’s talk in the comments!

Neurodivergents mask to survive systemic ableism—but at what cost?

systemic ableism autism masking Essy Knopf
Reading time: 6 minutes

Autistic/ADHD individuals learn early on that if they want to survive in a society shaped by systemic ableism, they have to mask their true selves.

But over time, masking damages our self-worth. And it may fuel internalized ableism. So why then do we persist in doing it?

While accommodations are sometimes made for people with disabilities/who are neurodivergent (ND), they are by far the exception to the rule.

In the case of autism and ADHD, accommodations can be even less likely, due to what clinicians call “disguised presentation”. That is, neurodivergence isn’t always that obvious, in some cases because the autistic/ADHDer is working very hard to keep their struggles hidden.

Neurotypicals (NTs) as a result may expect NDs to meet the same standards as people just like them, setting the bar for acceptance impossibly high.

When NTs expect ND folk to think and behave as they do, the moment the ND individual drops their mask—for example, by being overly direct or failing to read social cues—the NT will attribute that lapse to another cause, such as them being “selfish” or “rude”.

They may even respond by criticizing, judging, punishing, and excluding the ND.

Systemic ableism & microaggressions

The issue here is not merely that NTs are intolerant of neurodiversity and the differences it presents. It’s that NTs, in general, operate from baseline expectations that are ableist.

Most are oblivious to the extent to which this ableism informs their thinking, resulting in microaggressions: the “commonplace daily verbal, behavioral or environmental slights, whether intentional or unintentional, that communicate hostile, derogatory, or negative attitudes toward stigmatized or culturally marginalized groups” (see Microaggressions in Everyday Life).

Microaggressions can happen even within the families of ND folk. For instance, I remember my own parents calling me “antisocial” for my tendency to choose the company of books and computers over that of other human beings.

They also play out at school, with kids slapping all kinds of hurtful labels upon their ND peers.

I recall even teachers telling me that I lacked “common sense”, and that my handwriting was “poor” and “sloppy”. Turns out, all of these traits were part and parcel of my being ND. 

But even having a diagnosis doesn’t necessarily guarantee understanding and compassion. 

Shortly after I was told I was autistic, I had a friend suddenly touch me from behind. When I reacted with shock and explained my reasons, this friend responded by cussing out my “Asperger syndrome”. (Note: This was my diagnosis at the time. It is now considered to be an outdated term and no longer exists in the Diagnostic and Statistical Manual of Mental Disorders).

Rather than apologizing for having startled me, this friend did what so many NTs did and called out my autism as being the problem.

Miscommunications & Theory of Mind

These misunderstandings are compounded by issues related to a skill called “Theory of Mind”.

Theory of Mind (ToM) has been defined as: “the ability to recognize and understand thoughts, beliefs, desires and intentions of other people in order to make sense of their behaviour and predict what they are going to do next”.

Researchers have claimed many ND folks have impaired ToM. What I’ve noticed however is that our unusual thinking style and behavior can also general a kind of temporary ToM impairment among NTs. 

That is, NTs tend to ascribe NT motives to everyone, but doing this to ND folk can lead to confusion and misunderstanding. Turns on, there’s a name for this: the double empathy problem.

To give an example: when I got into trouble as a child, I would usually be upfront about the truth, believing that my confession would be taken at face value. 

But protesting my innocence or admitting to my naivety would rarely win me favors. In one case, an adult suggested I was “stupid” for expecting them to believe my story. 

What happened here was that this individual couldn’t fathom my intentions, and thus concluded my being honest had to be an act of deception.

Another example of this misattribution occurred during a visit to my parents. My mother told me she was going to fetch a can of tomatoes to make pasta sauce. With her fingers, she indicated that the can would be about the size of a bucket.

Knowing my mother had a tendency to bulk-buy, I assumed she indeed meant the can would be the size she suggested. Because of my impaired ToM, I interpreted her gesture literally. 

When I expressed my confusion over why she wanted to use such a big can, it didn’t occur to my parents that I was genuinely confused. Instead, they accused me of being a smart aleck.

We mask because authenticity is risky

As I’ve mentioned, this tendency of NTs to not adjust expectations when dealing with an ND individual can sometimes be the result of the disguised presentation.

Specifically, when NDs present themselves as NT. In some cases, this camouflaging is deliberate, with the ND trying to mask their struggles for fear of being judged, attacked, or marginalized.

Like NTs, autistics want above all to be accepted for their authentic selves. But when ND authenticity collides with ableist expectations, as in the situations I’ve described, disaster can result.

Due to the double empathy problem, it can be hard to understand NTs and anticipate how they might react to our actions. So we become master imitators and concealers. 

We mask, knowing that by hiding our neurodiversity, we are shielding ourselves against a perplexing and often hostile world.

Sometimes these compensations can be positive and adaptive, such as wearing headphones whenever out in public to compensate for sound sensitivities.

Other times, they are maladaptive. For example: avoiding talking about one’s interests, for fear of misreading social cues and rambling on.

But masking is self-defeating

NDs will often tell themselves that they need to change in order to fit NT expectations. But this really is an expression of internalized ableism.

Furthermore, ignoring your needs and hiding your differences as an ND is almost always self-defeating. 

Years ago I had a friend who would invite me to the movies. Personally, I find sitting in a movie theater to be sensory torture, with people constantly rustling bags and crunching on popcorn.

Rather than explaining this to my friend, I went along with her invitations, usually at great discomfort to myself.

Feeling shame over my sensory problems, I refused to tell her about the issue. Eventually, I started making excuses for not being able to join my friend, who came to believe I was intentionally avoiding her.

Difficulties with executive function are common among ND folk. Personally, in the past, as a result of my ADHD, I have struggled with self-organizing, managing my time, and staying on track.

One time, a manager unloaded on me over this, accusing me of being self-absorbed and irresponsible.

Rather than reacting defensively, I admitted my mistakes and asked this manager how I could improve certain executive function skills. She replied by telling me that my request was “beyond the scope of her role”.

It was one thing to turn professional feedback into a personal attack, but to then deny me support was quite another.

This is, unfortunately, a common experience for NDs. Often we’re told that we have done wrong, without being told how to course correct.

Systemic ableism creates internalized ableism

Until I was diagnosed as autistic and ADHD, I didn’t have a framework by which to explain or defend my difference. Having long been challenged and attacked over my ND traits, defenses have usually felt necessary.

Of course, even without having fully understood the whys and hows of my challenges, I could have still spoken up and tried to negotiate accommodations.

What stopped me, however, was the belief that I was somehow choosing to be difficult. Having internalized ableism, I had come to feel inferior and ashamed of my differences. 

My self-esteem consequently became conditional upon the approval of others. This led to me adopting a workaholic lifestyle in a bid to prove my worth to myself, and to others.

Personal boundaries blurred, to the point that I feared I was always somehow responsible when something went wrong.

Such was my shame that even after my diagnosis, I shied from the company of other NDs.

I convinced myself that the people who frequented autism and ADHD support groups weren’t like me, that I was somehow more “high functioning”—a term I’ve since realized is ableist.

What I feared—but dared not acknowledge—was that to be in their company might make me “one of them”. 

Ableism creates so much stigma around disability/neurodivergence, that despite everything I knew, I still believed my autism and ADHD to be a kind of flaw or personal shortcoming.

Wrap up

Systemic ableism oppresses NDs by demanding we abandon our identities and silence our needs.

We can start countering it by leaning into authenticity, the practice Brené Brown defines as “letting go of who we think we’re supposed to be and embracing who we are”.

One immediate way we can embrace our authentic ND selves is by seeking out fellow NDs around whom masking isn’t necessary.

The ND community exists to normalize individual experiences and to combat the stigma that can make being disabled/neurodivergent such an isolating experience.

ND readers, how does ableism show up in your life? Do you recognize any of the forms of internalized ableism I’ve described here? Drop a comment below.