ADHD and Empathy: A Study, Book Excerpt, and Empathy Defined

ADHD and empathy
What is the connection among ADHD, empathy, and dopamine? That’s what this post is all about.

I’ve noticed a remarkable phenomenon over the last 20 years: Stimulant medication enhances empathy for many adults with ADHD. How is this possible?   In this post, I’ll tackle the topic from three angles:

1. Defining empathy (it’s not what most people think).

2. Excerpting a passage on empathy and relationships from Is It You, Me, or Adult A.D.D.?

3. Sharing details from yet another study pointing to a connection between dopamine and cognitive empathy. (I’ll define cognitive empathy  in a minute.)

A sneak preview of the study:  Stimulant medication often enhances empathy in people with ADHD.

But wait. This happens not because the medication creates empathy. Rather, the medication enhances dopamine transmission. That, in turn, allows some people with  ADHD to focus on and access this “higher-order” brain function. In fact, it is one they have always possessed—but haven’t been able to reliably access.

Low Empathy and Narcissism: What’s the Connection?

It’s important to understand: Low empathy sometimes increases with ADHD medication. Until individuals and couples—and mental-health professionals—understand this, the risk is a far more permanent label: narcissist.

My friend Taylor J. wrote of her concerns about her daughter here. ADHD and Empathy: Was I Raising A Narcissist?

We can think of low empathy as fertile ground for narcissistic behavior. Traditionally, narcissism has been seen as a very poor prognosis—that it, it does not respond to treatment. That’s one reason I am sharing important research on that topic.

It is hard for me to over-state how commonly mental-health professionals see narcissism—or even Narcissistic Personality Disorder—where there is instead poorly managed ADHD.

Empathy sounds simple. But it’s really a complex phenomenon. In fact, some people with ADHD have trouble reining in their empathy. They might call themselves empaths, as I explain below.  Stimulant medication often helps them, too. It’s all about the self-regulation:  not over-doing, not under-doing, but finding the middle ground.

Hang in there. The concept should become more clear as you keep reading.  And be sure to read the comments for some illuminating first-person insights.


ADHD, empathy, and dopamine

Empathy is Not Sympathy or Compassion

We often confuse empathy with other behaviors—sympathy, kindness, compassion, and the like. Empathy is not those behaviors or traits—though it might accompany them.

The most commonly accepted understanding of empathy is this: the quality that lets us “get in another person’s head.” When we empathize, we momentarily step outside of our own needs, thoughts, and desires.  We contemplate what another person might be feeling.

There is a difference, though, between empathic and “relating to.”

For example, if you’ve been in a bad car accident, for example, you are probably better able to relate to the experiences of other people who survive crashes. You “know how it feels.” But what if you’ve never been in an auto accident? What is the mental process that allows you to imagine what it is like for someone else?

That is a very simple example, but it is meant to drive home the point: Empathy is what allows us to imagine what another person is feeling, even if we’ve never been in that situation ourselves.

Moreover, empathy can allow us to step back from our own emotions, in trying to understand the mindset of a person who is disagreeing or even opposing us.

The cognitive scientists have terms for various types of empathy. But the one we’re most familiar with is called cognitive empathy. It simply means: Imagining how the other person feels and what they might be thinking. It’s also called perspective-taking. Walking in another person’s moccasins.

To recap:

  • Empathy is not compassion or kindness, not exactly. And it’s not sympathy.
  • Contrary to widespread misperception, having empathy for a person doesn’t necessarily mean forgiving that person or letting someone off the hook.
  • On the simplest level, empathy is simply being able to “understand where that person is coming from. “




Book Excerpt: ADHD and Empathy Regulation Impairments

Being able to empathize is key to successful negotiations, including in personal relationships. It can also help us understand why humans do some of the horrible things they do—and, with any luck, helping them to act in more humane ways.

Impaired empathy often destroys relationships where ADHD symptoms go unrecognized or unaddressed.

But deficits in empathy cut both ways in ADHD-challenged relationships. Typically, both partners become more mutually empathic, once they both start learning about the causes and varied manifestations of ADHD.

Consider this excerpt from my book, Is It You, Me, or Adult A.D.D.?.  In it, I name “low empathy” as one of three common ADHD-related deficits that can derail relationships.

Low empathy: “All take and no give”

“My wife seems to have empathy for movie characters, stray animals, or the grocery store clerk,” Alex offers. “But when it comes to her husband and teenage daughter, she often acts downright self-centered.”

Actually, empathy involves two sets of skills, according to [psychologist Robert] Brooks:

  • The ability to take the perspective of another person
  • The ability to understand and identify emotions

Yet, for many people with ADHD, the world can seem so chaotic and their focus so erratic, they don’t even know what they feel, much less what someone else feels.

Even if an adult with ADHD possesses both sets of empathic skills listed above, the person’s impulsivity or rigidity might obscure seeing the world through another’s eyes.

“And if a person is lacking in empathy,” Brooks adds, “he or she is likely to misread a situation and misunderstand the intentions of others. They often expect others to adapt to them, but they aren’t as willing to change themselves.”

It could be that change seems impossible—and the resulting feeling of powerlessness frustrates them even more.

In general, we can’t assume that all humans are capable of “normal” levels of empathy. Empathy is largely a function of the brain, and we all have different capacities.

Treating ADHD with medication often enhances the ability to act empathically. Certain coexisting conditions, however, such as Asperger’s Syndrome, complicate the picture.

[Don’t worry! Elsewhere in the book, I address the empathy deficits in the partners of adults with ADHD. But remember, some of them have ADHD, too. Moreover, empathy distributes on a continuum among humans; there is no one-size-fits-all.]

The Recent Study: Dopamine and Fair-Mindedness

The study from the University of California, Berkeley, published in Current Biology, isn’t the first to examine the effects of dopamine’s effects in the brain when it comes to empathy.

For example, 0ne 2014 study, The dopamine D4 receptor gene shows a gender-sensitive association with cognitive empathy: evidence from two independent samples, showed that gender plays a role in cognitive empathy.  Interesting, eh?

This study is particularly relevant to ADHD because this D4 gene variant has been associated with (but is not exclusive to) ADHD.

Women carriers of a certain gene variant (the 7R-allele) scored higher in cognitive empathy than female noncarriers.

(I wonder if this might explain the folks who call themselves empaths.   As far as I know, the only empaths are the telepathic Betazoids, on Star Trek.  But I see the term bandied about a lot these days, applying to regular humans.  In my opinion, we only very cautiously assume that we know how another person is feeling. This can also spring from over-confidence and grandiosity.)

In men, however, those with the 7R variant scored lower than than men who did not have it.

The UC-Berkley researchers took a different approach in their paper: Dopamine Modulates Egalitarian Behavior in Humans.

Study Details: Follow the Money

Study participants, on two separate visits, received a pill containing either a placebo or a medication called tolcapone.

(Tolcapone prolongs the effects of dopamine, a neurotransmitter associated with reward and motivation in the brain. Stimulant medications such as Ritalin and Vyvanse also target dopamine; they slow the re-uptake of dopamine at the synapse, the gap between neurons. Tolcapone works a bit differently. This FDA-approved drug is used to treat people with Parkinson’s disease, a progressive neurological disorder affecting movement and muscle control, which are also affected by dopamine.)

This double-blind study of 35 participants, including 18 women.  Neither participants nor study staff members knew which pills contained the placebo or Tolcapone.

ADHD, empathy, and dopamine

Participants then played a game in which they divided the money among themselves and an anonymous recipient.

The result: Participants receiving Tolcapone divided the money with the strangers in a fairer, more egalitarian way, compared to participants who received the placebo.

Medication Increased Sensitivity to Inequality

According to the press release at the UC-Berkley website, “Altering brain chemistry makes us more sensitive to inequality”:

By connecting to previous studies showing that economic inequity is evaluated in the prefrontal cortex, a core area of the brain that dopamine affects, this study brings researchers closer to pinpointing how pro-social behaviors such as fairness are initiated in the brain.

“We have taken an important step toward learning how our aversion to inequity is influenced by our brain chemistry,” said the study’s first author, Ignacio Sáez, a postdoctoral researcher at the Haas School of Business. “Studies in the past decade have shed light on the neural circuits that govern how we behave in social situations. What we show here is one brain ‘switch’ we can affect.”

The researchers also say that future research may lead to a better understanding of the interaction between altered dopamine-brain mechanisms and mental illnesses, such as schizophrenia or addiction, and potentially light the way to possible diagnostic tools or treatments for these disorders.

“Our hope is that medications targeting social function may someday be used to treat these disabling conditions,” said Andrew Kayser, a co-principal investigator on the study, an assistant professor of neurology at UC San Francisco and a researcher in the Helen Wills Neuroscience Institute at UC Berkeley.


This is a small study, one that remains to be replicated.

(I’m not sure what to make of the fact that it was jointly sponsored by the school of business and the neuroscience center, with funding from sources including the Defense Department.)

But the study adds to the increasing body of research around the role of dopamine and so-called “pro-social” behaviors such as fair-mindedness and empathy.

For More On Empathy

To learn about another angle on empathy, read Empathy and Mirror Neurons, Or, Monkey See, Monkey Yawn


My husband and I will be watching a TV show. Suddenly, there’s a surprise twist—a car bashes into a tree, a bullet lands, a fist flies into a face.  Instantaneously, I will react as if that action happened to me. Because, in a sense, that’s how it feels.

Reactions vary: I might yelp or my arm will jump. Whatever my reaction, it both annoys and amuses my husband.

I can suppress this empathic response if I am prepared for the action. But I can hardly anticipate a surprise, right?

Apparently, my mirror neurons are making themselves known.

More on ADHD Relationships

You’ll find many more posts on Adult ADHD here, from all angles, including relationships:

Breaking out of ADHD Relationship Dysfunction — After Not Breaking a Fall

Adult ADHD and the Automatic No — And Automatic Yes

Now, what about you

What has been your experience of empathy as it relates to ADHD?

If you have ADHD, or if your loved one does, have you seen empathy impairments or enhanced abilities to empathize with medical treatment?

Or maybe you’ve seen something else entirely.

—Gina Pera

122 thoughts on “ADHD and Empathy: A Study, Book Excerpt, and Empathy Defined”

  1. I have spent hours reading this site today.

    My husband and I are in couples therapy (EFT) but it just is not making any difference at all. He has untreated ADD, he’s 44.

    I am practicing and he just is not. Just like our last therapy, which then reinforces he cycles we go through. Our therapist said he is ADD informed, but I realise from reading today that our entire cycle is centred around ADD and we are treating it all as attachment based cycles. I have realised so much today!

    Why he blurts out such awful things at really vulnerable moments for me. I lost my job and he said ‘I wouldn’t have moved in with you if I’d have known you might lose your job’. I was paying most of our rent at the time due to his debt.

    I have wanted to understand the WHY of him doing these weird things when he’s such a good kind person. I think I found my answer today.

    He can’t fathom cause and effect so he repeats the same mistakes, forgets promises and breaks his word then defends that as he’s smart as hell so can justify anything, he always has music playing in his head and I’ll say something and he will reply with a line from a song, work drains him totally so he flatlines in front of the TV for the rest of the night, doesn’t come to bed with me as he stays up until 2am, loads of empathy for TV characters but cannot attune emotionally to me, has an automatic no, has OCD, bait and switch hyper focus for the start of our relationship, he can’t plan, can’t finish tasks, 0 to mega frustration and anger in 2 seconds and just gets stuck repeating himself over and over in a way that used to alarm me as it was like a stuck robot and I would get frightened by the lack of human connection.

    He is a beautiful human being with wonderful traits and heart. But this is serious and couples therapy has made me put so much emphasis on me not reacting to him, understanding he is protecting, doing all the work…..but that isn’t going to work I realise now.

    I’m going to get exhausted and it won’t be healthy. We are equal partners and I don’t want him to work ‘harder’ as he’s clearly working his ass off coping in all these ways he has learned to.

    I will read the books and see if there is any better way to suggest assessment/help. I have done before but he said he doesn’t need anything as he likes how he is. I respect that – but it is hard to explain that his ADD impacts me as he has no awareness of it, and has such sensitivity to perceived criticism.

    His daughter now realises she has it too so I hope he can model for her what it’s like to work with our innate processing differences from empowerment not shame. Easier said than done. But I want to see if I can support him to get there. Thank you SO SO SO much for this incredible resource. The time and expertise in here is mind blowing. I appreciate you. N x

    1. Dear Nadia,

      No matter how many times I read “Wrong Therapy” stories, they still make me cringe.

      It’s nothing less than a public health DISASTER.

      Then, even if by some miracle, couples happen upon a truly ADHD-savvy couple therapist, they must then identify a prescriber who won’t throw Adderall at the ADHD partner.

      These problems in the mental-health system are deeply entrenched and insidious. When mental health workers rely on Psychology Today PR pieces by self-promoters, the various “health” sites that milk ADHD “keywords” to boost their traffic, when one pharma has way too much influence over what we see online….it’s not going to end well for individuals struggling with these issues.

      I encourage you to learn all you can. Read my first book. The more you become educated, the less of a block your husband’s apparent “denial” can be.

      Denial is complicated. I would not take his reflexive responses as his true perspective. He might want help but doesn’t know how to get it, is afraid of medication, afraid of being diagnosed “crazy” and so much more. It’s why I devoted three chapters to denial in the book.

      Soon, I will launch my online training. I am well and truly exhausted but this will be a game-changer for individuals and couples. If you’re subscribed to my blog, you’ll receive notification.

      Best of luck to you two. You are on your way!


  2. Hello,

    Thanks for your response. I agree with absolutely everything you’ve said. I actually realised my impulsivity got the better of me when I wrote that, I feel a lot of it and have nowhere really safe to put it. But I also believe entirely with what you are doing and saying… I do want to really drive home how absolutely valuable your book is.

    I am just terrified daily, about (as you say touch on) the fact that my experience of therapy, and seeking help, was so utterly traumatic and I believe uninformed, as well as the awareness and popular opinion I’ve met on the other side. I understand completely that we must not do the narcissistic supply thing of stroking egos with giftedness, or create an expectation that partners must shirk their needs to appease dysregulated, forgetful other half’s. I wholeheartedly believe this is all true.

    And… that shirking your needs, was my realty growing up, as I say I strongly believe both my parents have ADHD, (and can see it in past partners so also know the feeling from the partners side of being ignored etc) my childhood was one of double standards and confusion, but paradoxically sensing somewhere that everyone was doing their best… and then I met therapists and experienced these growing societal narrative around narcissism which initially perpetually eroded my faith in almost everyone around me and in myself… And I’m so scared of this… lack of nuance. Stephen Covey says, ‘you have to believe in the people’ and its something I hold in my heart… I chose to believe there is a grain of good, and a want to be compassionate and empathetic in almost every human being… I get lost at the point of psychopathy, and i’m still on a journey of learning and growth.

    But knowledge about deficits in the brain, and neurotype have helped me see the best in people. All people. I might not be able to cope with ever type of person, all the time, day to day… but I can process our exchange… and find their way of relating… and appreciate the good that exists in them and see where they are coming from, if not in the moment, then when I step away.

    My reality, I felt, was the opposite yet the same as yours, rather than having to deal with someone who was dysregulated when I was not, in my romantic relationships (though yes this happened and in my childhood) I moreover felt a pressure to hide and curb myself, which of course you are aware of… I felt exactly that thing of having to deal with other peoples emotional landscape, prioritise them, and meet them where they’re at, I felt the onus was on me to change, and I could only manage it for so long, until I would break and become dysregulated. I now have insight and hold the core value, that has existed in me since childhood that I expect no-one to accommodate me in the sacrifice of their own needs, only to meet me somewhere manageable for us both, and communicated in a way that we can manage together… and journey together towards improving that… and I know that’s what you are all about and giving to people.

    I hope so much my words were not exhausting (and these, conciseness still my area of feeling at odds with the world)

    But … I am myself exhausted on an inherent soul and body level. By the collective unawareness, which you are cutting through as best you can with the relative blunt knife available… the problem needs a chain saw! So I thank you for that. I very likely did write, from a place of emotional knee jerk pain… and I totally invite and am glad you held your ground in your response, it’s what I want for all people… I thought I would share a piece of prose. To say how traumatic I have found my experience of being me, of trying to seek help, and of feel mislabeled in my life:

    “You know in school when a popular kid engraves something horrible about you onto a desk… so the whole class can see, and it becomes some sort of collective shared truth, that lives both at war inside you and as fact in everyone else who sees it…

    I think being misread or misdiagnosed by a therapist, or judged due to popular inaccurate and outdated stereotypes, feels the same…

    Due to the power, and importance of these experts and their ideas and the prevelence of them in mass social awarenss… it’s like these notions about what you are at your very core, have been carved onto the fabric of the universe…

    … a place it should not have been written, and deep down, both you and the universe know, it was not meant to be carved there, the assessment was dehumanising, crude and lacking in compassion

    … the universe does not think you are that thing any more than the desk did… it is not a fundamental truth, but the population of the world will see it that way, they will interpret everything you do through that lens, just like the class did, and there’s nothing you can do about it…

    If you try to defend yourself, or prove your self, change yourself or choose yourself, whether you keep to yourself, or try to make connections and friends, it is pointless, anything you do will only affirm the carving… so, you are stuck with it, it is almost impossible to move beyond the identity you’ve been given without inadvertently reinforcing it, it is with you in every moment, it is branded onto your very soul, even though the act of branding you… defies nature, it has already been done… so it might as well be true”

    Thanks for all you do, for your patience and thorough enquiries, I’m still on my path, with an open mind and heart… the first step for me is knowing I don’t know… and from that I will keep learning x

    1. Dear Amy,

      Thank you for understanding my intentions.

      I find you express yourself beautifully and sensitively. Writing is not easy on any level, so I admire that.

      I am about to launch my online training — many years in the making. For too many years, I’ve fielded e-mail and blog comments…”can you refer me to someone.” Too often, I cannot. And even when I can, too often, I’m disappointed in the experience they report.

      Dr. Robin and I spent 4 hard years producing the couple therapy guide — years that were largely uncompensated given the nature of clinical guides (not blockbuster sellers….but this one is doing far, far better than most).

      I regret not “taking it to the people” earlier. Therapists aren’t exactly falling over themselves to learn and practice the rigors of Adult ADHD-Focused Couple Therapy .

      But I do things the old-fashioned way: I work extremely hard and responsibly to earn my credentials.

      Stay tuned for notice of the launch. Within days.

      Limping to the finish line…..

      take care, Amy,

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