Boom and bust: doing everything on a good day, then crashing

The pattern goes like this: on a day when things are working, you do far more than usual, and the next day or two you can barely function. People call it boom and bust. People with ADHD often describe it, but the research on it comes almost entirely from other conditions.

What the evidence says

In ADHD, capacity varies from day to day. When 166 adolescents rated their ADHD symptoms on eight evenings, the ratings moved considerably within the same person ¹. In a 30-day diary study of adolescents, raised symptoms drifted back to the person’s usual level over time ². A good day followed by a worse one is partly what ordinary variation looks like.

Absorption may play a part. Among 310 gamers with ADHD traits, hyperfocus predicted burnout, while flow predicted confidence ³. That is one study in one setting.

Pacing has been studied in pain and fatigue conditions. In chronic pain, a meta-analysis found that pushing on with activity to the point of severe pain was linked to worse outcomes ⁴. In a five-day observation study, people who reported more overactivity had bigger daily swings in pain and in measured activity, with pain spiking after long bouts ⁵. Pacing programmes reduced fatigue moderately in ME/CFS, where physical function also improved ⁶. Across six studies of fatigue-related chronic illness they also reduced fatigue, with little effect on physical function ⁷.

What we don’t know

Nobody has tested pacing for ADHD. Everything above about pacing is borrowed from conditions with different causes, and it may not transfer.

Even where it has been studied, the story is not simple. In a longitudinal study of chronic pain, overactivity did not predict later pain severity or interference with daily life ⁸.

Things to try

Treat these as ideas borrowed from other fields.

• Find a level you can repeat. UK guidance for ME/CFS recommends finding a baseline level of activity that does not make things worse, starting below it, holding that lower level, and only then increasing activity ⁹. The transferable idea is to plan for the ordinary day, not the best one.
• Notice the day after. If a big day is reliably followed by a lost one, the two days together are the real unit to plan.
• Choose your own recovery. In an analysis of 249 Reddit threads about autistic burnout, people described recovery as depending on fewer social obligations, time alone, and being able to choose how to recover ¹⁰. That is lived experience from a different group, offered as a prompt and not as evidence of what works.

If crashes are severe or frequent, or come with low mood, that is worth raising with a clinician.