“I Can’t Do One More Thing”: Demand Avoidance ADHD, Perimenopause, and ADHD Burnout
- Kiesa Kelly
- 3 days ago
- 8 min read
Last reviewed: 02/12/2026
Reviewed by: Dr. Kiesa Kelly
If you’re in midlife and living with ADHD, you might recognize the moment when your brain says “I can’t do one more thing,” and your whole system shuts down. Demand avoidance adhd can show up as procrastination, irritability, or a sudden need to escape, even when you care deeply about the task. When perimenopause and long-term overfunctioning enter the mix, the “avoidance” often isn’t about attitude, it’s about nervous system overload.
🧠 Key takeaway: When demands feel like danger, your brain will prioritize relief over productivity. That response can be protective, even when it creates real-life consequences.
In this article, you’ll learn:
What demand avoidance can look like in adults and why it’s not simple “defiance”
How perimenopause can lower stress tolerance and intensify overwhelm
Why ADHD burnout makes everyday demands feel impossible
Practical, low-pressure strategies that reduce threat without power struggles
When it’s worth getting extra support (including Tennessee telehealth therapy)
What Demand Avoidance ADHD Can Look Like in Adults
Demand avoidance is a pattern where a request, expectation, or “should” triggers strong discomfort, shutdown, or pushback. Some people use the term “PDA profile” (pathological or extreme demand avoidance), especially in autism communities, but it’s not a formal diagnosis in DSM or ICD and research is still evolving. It can be more helpful to treat it as a descriptive pattern and then ask, “What makes demands feel threatening for this person?” [1]
It’s not defiance, it’s threat response
When a demand lands like a threat, your body may flip into fight, flight, freeze, or fawn. In adults, that can look like:
Avoiding emails, calls, forms, or appointments until the last minute
Feeling instantly irritated when someone asks for “one quick thing”
Shutting down, numbing out, or scrolling because your brain can’t initiate
Over-explaining, negotiating, or finding loopholes to reduce pressure
This often overlaps with ADHD challenges like task initiation, time blindness, and emotional reactivity. It’s not a character flaw. It’s a mismatch between demand load and available capacity.
Internal demands count (self-expectations, guilt)
A big misconception is that demand avoidance only comes from other people. Internal demands can be just as activating:
“I should be able to handle this.”
“If I don’t do it perfectly, it’s pointless.”
“I can’t let anyone down.”
“I have to catch up because I’m behind.”
For many women with ADHD, years of masking and overcompensating can raise internal pressure. That “menopause masking” layer can make rest feel unsafe, like you’re failing, even when your body is begging for recovery. [2,3]
Why “just try harder” backfires
If the problem is threat, more pressure usually increases the threat. “Try harder” can add urgency, shame, and performance anxiety, all of which make the nervous system more reactive.
Common misconceptions to unlearn:
Myth: “Avoidance means you don’t care.” (Often, you care a lot.)
Myth: “If you had the right planner, you’d be fine.” (Tools help, but capacity matters.)
Myth: “Motivation is missing.” (Often, safety and energy are missing.)
🔁 Key takeaway: More pressure rarely creates more follow-through when the system is overloaded. It usually creates more avoidance.
Why Perimenopause Can Intensify Demand Avoidance
Perimenopause is a transition, not a personality change. Fluctuating hormones can affect sleep, mood, and cognition, which then affects how “doable” life feels. [4,5]
Lower stress tolerance and reduced recovery
Many people notice that stress hits harder and lingers longer in perimenopause. Sleep disruption, vasomotor symptoms, and shifts in mood can chip away at resilience and recovery time. [5,6]
Sleep disruption increases nervous system reactivity
Sleep is one of the strongest buffers for emotional regulation and executive function. During the menopausal transition, insomnia and fragmented sleep are common, and poor sleep can amplify anxiety, irritability, and sensory sensitivity. [5,6]
🌙 Key takeaway: When sleep is disrupted, the nervous system becomes more reactive, and “small” demands can feel huge.
Overwhelm turns even small tasks into “too much”
In perimenopause, many people report “brain fog” or feeling less sharp. Research suggests that hormone fluctuations and lower estrogen phases can be associated with mild, often transient changes in attention and memory, especially when stress and sleep are also in play. [7]
That means the task itself might be simple, but the steps feel slippery:
Find the email
Remember what you’re replying to
Decide what to say
Hit send
When each micro-step costs more, avoidance becomes a short-term survival strategy.
How ADHD Burnout Feeds the Cycle
ADHD burnout isn’t an official diagnosis, but it’s a useful description for a common experience: long-term overexertion, chronic stress, and feeling like your coping strategies have stopped working.
Executive dysfunction makes demands feel impossible
ADHD isn’t a willpower problem. Executive functions are the brain’s “management system,” and when they’re taxed, demands can feel unstartable. Studies link ADHD-related executive function difficulties with increased burnout and fatigue, especially in work contexts. [8]
Shame + urgency = nervous system overload
A familiar sequence:
You avoid a task because it feels too big
Time passes
The task becomes urgent
Shame spikes (“What’s wrong with me?”)
That shame-urgency combo is gasoline on the nervous system. In qualitative research, adults with ADHD describe chronic stress, difficulty meeting expectations, and mental health strain related to work demands and self-management. [9]
🔥 Key takeaway: Burnout is often a signal that your coping strategies have been running on borrowed energy for too long.
Avoidance → consequences → more stress
Avoidance brings quick relief, but consequences stack:
Missed deadlines
Financial stress
Relationship friction
More self-criticism
The goal isn’t to “eliminate avoidance.” It’s to reduce the perceived threat, lower the demand load, and rebuild capacity.
Example 1 (midlife overload): You’re running on broken sleep. Your boss asks for a status update. Your brain hears “judgment,” not “question,” and you freeze. A low-threat start can be: open the email and write one sentence you do not send yet. Then step away. You’re teaching your nervous system: “We can approach without collapsing.”
Common Triggers in Midlife
Demand avoidance often spikes when life becomes relentlessly non-negotiable.
Caregiving and invisible labor
Caregiving, family scheduling, medical appointments, and emotional labor create constant “background demands.” When your nervous system is already maxed out, even enjoyable tasks can start to feel like obligations.
Workplace pressure and constant switching
ADHD brains often do worse with frequent context shifts. Meetings, Slack pings, quick turnarounds, and “asap” requests can keep you in a constant state of activation, which increases burnout risk. [8,9]
Household “mental load” and decision fatigue
When you’re the default “project manager” at home, your brain is always running a to-do list. Decision fatigue can make starting anything feel impossible.
Example 2 (the mental load spiral): You try to plan dinner, remember an overdue bill, think about a parent’s doctor visit, and then your brain shuts down. A “good enough” plan might be: rotate 5 default dinners, keep one “emergency meal,” and let the rest be flexible.
🧩 Key takeaway: In midlife, it’s rarely one demand. It’s the accumulation, especially when recovery time disappears.
What Helps Without Power Struggles
If demands feel threatening, the best strategies reduce threat first, then build structure.
Reducing threat: choice, collaboration, low-pressure starts
Try shifting from “must” to “can”:
Offer yourself two options (A or B), not a full menu
Use collaborative language: “What would make this 10% easier?”
Start with a tiny, reversible step (open the doc, write a header, set a timer for 2 minutes)
This is also where therapy can help, especially when demand avoidance is tied to trauma, anxiety, or chronic shame. ScienceWorks offers specialized therapy services designed to reduce stuckness without escalating pressure.
“Good enough” systems and external supports
When executive dysfunction is high, external supports matter more than internal motivation:
Body doubling (work alongside someone quietly)
Visual timers and one-step checklists
Simplified routines that lower daily decision-making
Coaching support for planning and follow-through
If you want skills-based structure, executive function coaching can help you build systems that don’t rely on perfect energy.
🤝 Key takeaway: Supports that live outside your head (timers, checklists, coaching, accommodations) can lower demand load immediately.
Repairing self-trust and reducing shame
Shame tells you you’re broken. Self-trust says, “My system is signaling overload, and I can respond with care.” A few self-trust repairs:
Track patterns (sleep, cycle changes, workload) without judgment
Replace “I’m failing” with “My capacity is lower right now”
Practice “repair statements” after avoidance (e.g., “That was hard, and I’m re-entering now.”)
If sleep is part of the loop, targeted support for insomnia can be a game changer. See our insomnia services and support options.
When to Get Extra Support
Sometimes the most compassionate move is to stop trying to muscle through alone.
When avoidance is causing major impairment
Consider extra support if you’re consistently unable to meet basic responsibilities (work, safety, health), or if avoidance is shrinking your life.
A structured evaluation can clarify what’s driving the pattern and what type of support fits best. Learn more about psychological assessments at ScienceWorks.
Ruling out depression, anxiety, sleep issues
Perimenopause and burnout can mimic (or worsen) depression and anxiety, and chronic sleep loss can look like ADHD symptoms. Screening tools can be a first step, but they don’t replace a full evaluation.
You can explore our mental health screening resources and, if ADHD is part of the question, the Adult ADHD Self-Report Scale (ASRS) screener can help you organize what you’re noticing before you talk with a clinician. [4,5,9]
Finding affirming care in Tennessee (telehealth)
If you’re in Tennessee and demand avoidance is tangled with perimenopause ADHD changes, burnout, or chronic stress, you deserve care that understands the whole picture, not just “time management.” ScienceWorks offers telehealth across Tennessee, which can reduce the barrier of “one more thing” just to get support.
📍 Key takeaway: The right support lowers demands, builds capacity, and reduces shame. It doesn’t escalate pressure.
A gentler way forward
Demand avoidance in adults often makes sense when you view it through a nervous system lens: capacity drops, demands rise, and your brain protects you by pushing away what feels threatening. Perimenopause can add sleep disruption and cognitive “slipperiness.” ADHD burnout adds exhaustion, shame, and reduced executive bandwidth.
A calmer next step is to pick one lever you can move this week:
Reduce demand load (drop, delay, delegate)
Improve recovery (sleep support, pacing, breaks)
Add one external support (timer, checklist, body double)
Get guided help (therapy, coaching, or assessment)
If you’re ready for support, you can reach out through our contact page to request a free consult and learn about Tennessee telehealth options.
About the Author
Dr. Kiesa Kelly, PhD, is a neuropsychologist by training with a PhD in Clinical Psychology (neuropsychology concentration). She has provided psychological and neuropsychological assessment services for more than 20 years and completed an NIH-funded postdoctoral fellowship focused on ADHD.
At ScienceWorks Behavioral Healthcare, Dr. Kelly works with a wide range of concerns including ADHD, autism, OCD, trauma (including EMDR), and complex clinical presentations. She also provides telehealth services in multiple states, including Tennessee.
References
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Disclaimer
This article is for informational purposes only and is not medical or mental health advice. It does not replace diagnosis or treatment by a qualified healthcare professional. If you are in crisis or concerned about your safety, call 988 (U.S.) or seek immediate emergency support.
