Mindpath Health’s Zishan Khan, M.D. discusses whether ADHD can affect empathy.

Can ADHD Affect Empathy It’s Complicated — Here’s What Experts Say_Zishan Khan, M.D._Mindpath Health

Empathy is a key component of emotional intelligence (EQ), which refers to the ability to recognize, understand, and hold space for your own and others’ emotions.

Certain habits, behaviors, or personality traits could make it seem as if you or your child have less empathy — regardless of how much empathy you actually have.

For instance, some symptoms associated with attention deficit hyperactivity disorder (ADHD) may suggest a lack of empathy, explains Zishan Khan, MD, a child, adolescent, and adult psychiatrist with Mindpath Health.

These symptoms might include restlessness, impulsive behavior, and difficulty paying attention or staying on task.

If you live with ADHD, for example, you might catch yourself interrupting others often, get distracted easily, or seem impatient with others

You might also react to other people or situations before you take time to consider your response, which could lead to words or actions that come across as less than empathetic, Khan says.

You or your child might also miss opportunities to share connections with others due to other traits often associated with ADHD, like hyperfocus, he adds.

Of course, none of this means that you don’t share, understand, or care about others’ feelings. In fact, Khan emphasizes that many people with ADHD are highly empathetic.

When it comes to the link between ADHD and empathy, there’s a lot to consider. You’ll find an in-depth exploration below.

What does it mean to have low empathy?

To better understand empathy and how it might show up, it can help to have some background knowledge of how it differs from related responses like sympathy and compassion:

Sympathy: An emotional reaction to someone’s pain and distress, like pity or sorrow. You feel for them, in other words.

Empathy: The ability to acknowledge and understand someone’s emotions. Empathizing with someone means you feel with them.

Compassion: An understanding of someone else’s pain and the desire to ease that distress in some way. Having compassion means you both feel for someone and want to take action to help them.

Experts consider empathy both a trait you’re born with and a skill — or social response — that you can cultivate. They’ve also identified two different types: cognitive and affective empathy.

Cognitive vs. affective empathy

Cognitive empathy refers to a basic understanding of other people’s feelings. This type of empathy allows you to pick up on changes in voice, facial expression, or body language that might suggest what someone else thinks or feels.

Affective empathy, also called emotional empathy, is what allows you to share another person’s emotional experiences or feel “with” them. This type of empathy may help fuel acts of compassion and kindness.

Having less empathy could show up as:

  • tending to criticize others
  • finding it difficult to understand how other people feel
  • having a hard time forgiving mistakes
  • considering other people “too sensitive”
  • blurting things out without considering the potential impact of your words
  • acting on impulse without thinking about how your behavior might affect other people
  • having little interest in other people’s opinions or perspectives
  • feeling frustrated or confused by other people’s emotional reactions

People have varying degrees of empathy. While it’s certainly true that lower levels of empathy could make it harder for you to understand other people’s emotions and experiences, simply having less empathy doesn’t make you a “bad” person.

Keep in mind, too, that empathizing with someone means you can understand their feelings and consider things from their perspective.

So, stopping to think, “I feel so bad for interrupting my mom earlier. I do that a lot, even though I don’t mean to. It must be frustrating for her” demonstrates your empathy.

Does ADHD cause low empathy?

For many people with ADHD, the world can feel chaotic, overwhelming, and difficult to navigate, Khan says. Symptoms like impulsivity and difficulty focusing on tasks can make it harder to understand and process your own feelings, let alone try to appreciate what others experience.

“Sometimes ADHD can lead to ‘foot in mouth’ situations where you don’t realize what you said came off as rude,” Khan explains.

Of course, this doesn’t automatically translate to low empathy. Sure, you might get caught up in the moment and completely forget about picking up the pizzas for your friend’s birthday party. But when you arrive with the (cold) pizza for the hungry crowd, you feel awful for making everyone wait, and you worry that you completely ruined the part.

Research findings

Some limited evidence does suggest a potential link between ADHD and lower emotional (affective) empathy.

Authors of a 2018 study divided 112 older teen and adult participants into two groups: 56 people with subclinical ADHD (they had ADHD traits but no official diagnosis) and 56 people who reported no or very few ADHD traits. They matched participants by student status, gender, and age

All participants completed several questionnaires designed to measure empathy, social cognitive style, and friendship behaviors.

Those who self-reported more ADHD symptoms — the group with subclinical ADHD — earned significantly lower scores on measures of emotional empathy. Importantly, though, these scores still fell within the typical range for empathy.

Researchers also didn’t find any significant difference in scores of cognitive empathy.

They did find the participants with subclinical ADHD were more likely to have a “systemizing” cognitive style. This style, which involves having more attention to detail and a high capacity for analysis, is more common in men and people on the autism spectrum.

The researchers suggested lower empathy scores in people with ADHD may relate to inattention, impulsivity, and difficulty with executive function tasks, like planning, time management, and organization.

All the same, it’s important to note that none of these participants had an actual clinical diagnosis of ADHD. What’s more, 112 people is quite a small number in terms of scientific research.

To sum up, experts need to explore the connection between empathy and ADHD, particularly in adults, in more depth before they can come to any conclusions

How to cope

Difficulty understanding or relating to others may contribute to tension or conflict in your relationships.

Good communication skills, however, can help you let your loved ones know they matter, which can improve your bonds and help you create lasting connections.

For example, it may help to:

  • Explain how your symptoms show up: This could mean telling friends and loved ones you don’t mean to cut them off or take over a conversation — you just get extremely focused on what you’re saying. Or, you might say you have a hard time keeping track of things that people tell you, but you do fine with written dates and plans.
  • Ask more questions: Communication involves listening as well as speaking. Pausing to ask someone what they think gives you the chance to connect, learn their perspective, and practice active and reflective listening.
  • Pay attention to body language cues: Body language can offer a lot of insight into what someone thinks and feels. Someone who nods along and faces you with an open, relaxed posture is likely pretty interested in what you’re saying. On the other hand, you might consider asking a question or changing the subject if the person is half-turned away or playing with their phone.
  • Share your needs: This might involve letting your loved ones know how they can help. For instance, you might say, “I usually run late because I get caught up in something and lose track of time, not because I forgot our plans. When we make plans where time really matters, could you please tell me to come 30 minutes early?”
  • Practice getting vulnerable: Do you tend to keep your own thoughts and feelings to yourself? Getting more comfortable expressing your emotions could help you connect more deeply with others and improve your relationships.

There’s also the spotlight effect to consider: The people around you usually don’t notice as much about your actions or perceived “flaws” as you imagine they do.

So, even if they do notice you tend to run 5 minutes late to everything or often jump into conversations when you get excited, they probably won’t automatically assume you’re unempathetic.

How therapy can help

If you live with ADHD, therapy can go a long way toward helping you understand how specific symptoms show up in your life.

ADHD that goes undiagnosed and untreated can have a major impact on your life and relationships, but a trained therapist can offer specialized guidance with:

  • identifying specific symptoms and their impact
  • learning ways to manage those symptoms more effectively
  • practicing communication skills to bring up share your needs with the people in your life
  • exploring ideas to connect with others in meaningful ways
  • unpacking any concerns that you have about a lack of empathy

Sandra Calzadilla, LMHC, explains, “Think of it this way: Can you go to the gym and work out on your own? Sure, but if you feel you need more assistance in what exercises you need to do, how often, and for how long, an expert can keep you on track to meeting your goals.”

For instance, if you frequently run late, a therapist might help you explore potential triggers, like getting distracted by things around the house, and identify a few changes you could make to stick to your schedule.

Rejection sensitive dysphoria

A therapist can also help you explore and work through rejection sensitive dysphoria (RSD), which is often associated with ADHD and autism.

RSD involves experiencing intense and overwhelming emotional distress after you receive criticism or negative reactions from others or believing that you’ve somehow failed yourself or disappointed others.

This sensitivity to rejection can make it difficult to process and express emotions. It might also lead you to avoid situations where you worry about rejection, negative feedback, or criticism around what you perceive as your lack of empathy.

Could medication make a difference?

A small 2021 study suggests that methylphenidate (Ritalin), a stimulant medication often used to treat ADHD, may enhance emotional (affective) empathy in adolescents and children with ADHD.

According to the study authors, this medication increases levels of the brain chemicals dopamine and norepinephrine, helping decrease impulsiveness and increase attention in people with ADHD

Methylphenidate won’t automatically boost empathy, since empathy is a learned skill. But treating ADHD symptoms could then make it easier to consider potential consequences of your words and actions or help you emotionally connect with others without getting distracted.

Where does high empathy fit in?

Hypersensitivity is a common trait in people with ADHD, according to Zoe Martinez, MD, a board certified psychiatrist and clinical leader at Done.

More specifically, you might be hypersensitive to information in your environment or find it harder to filter sensory input you receive from others — including subtle emotional cues, like changes in facial expressions or tone of voice. Some experts have linked this increased sensitivity to greater empathy and emotional reactivity.

This higher sensitivity to emotional energy can quickly drain you in stimulating social situations. It might also mean you:

  • feel intensely affected by others’ emotions and moods and have difficulty in situations where others express strong emotions
  • feel detached when another person shows an intense emotional reaction
  • try to avoid overly emotional situations
  • have trouble setting boundaries when people share intense emotions
  • withdraw from others to protect yourself
  • find it difficult to manage or control your emotions when you feel overwhelmed

If you’re trying to navigate heightened empathy and sensitivity, Khan and Calzadilla advise:

  • making time to journal about your emotions
  • practicing mindfulness techniques to help you identify and manage emotional discomfort effectively
  • learning to set boundaries in relationships to protect yourself emotionally and preserve your energy
  • using exercise, deep breathing, or meditation to ease stress in emotionally charged situations

The bottom line

The ability to put yourself in someone else’s shoes and understand their feelings can allow you to respond in a kind, loving, and compassionate way, which can ultimately strengthen your relationships.

If you find it tough to relate to others emotionally, acknowledge their feelings, and express your own emotions, professional support can make a difference.

A therapist can offer more guidance with navigating any ADHD symptoms you experience, plus teach communication techniques and strategies to cultivate greater empathy.

To view the complete article with sources and learn more from experts about whether or not ADHD can have an impact on empathy, click here. 

Zishan Khan, MD

Frisco, TX

Dr. Zishan Khan is board-certified in child, adolescent, and adult psychiatry. Dr. Khan primarily treats children, adolescents, and young adults suffering from ADHD, anxiety, depression, and behavioral issues that often keep them from reaching their full potential. He works with patients of various cultural and professional backgrounds, helping people improve their lives and conquer their struggles. He prides himself on ... Read Full Bio »

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