Dr. Sanil Rege offers a powerful metaphor for burnout in Burnout Isn’t Laziness—It’s a Hidden Brain Shutdown Called Performance Debt—not as a mental failure, but as performance debt.
His argument is clear: high-achieving individuals don’t collapse because they’re weak. They collapse because the brain’s nervous system has been quietly racking up interest on their effort, and one day, biology demands repayment.
It starts with sleepless nights, adrenaline-fueled productivity, and relentless goal-chasing. But over time, this comes at a neurobiological cost: cortisol rhythms flatten, dopamine stops spiking, inflammation sets in, and serotonin overwhelms motivation.
Eventually, the system hits a tipping point—not out of choice, but out of necessity. The brain powers down for survival. This shutdown often looks like depression, but Rege notes a crucial difference: in burnout, the desire is still there—it's the energy that's gone.
His recovery model includes behavioral rewiring (like sleep, activity regulation, and emotional tracking), biological resets through diet and pacing, and—if needed—short-term pharmacological support.
It's structured, evidence-based, and biologically grounded. But if you live with ADHD, you might be wondering: Why doesn’t this model necessarily work for me?
When Performance Debt Meets Neurodivergence
This is where we need to shift lenses.
For many with ADHD, particularly those who identify as high achievers or were late-diagnosed, burnout doesn't arrive as a sharp tipping point. It creeps in quietly—because the system has never run with a stable foundation to begin with.
As explored in this earlier piece, success in ADHD is often built on sand: coping mechanisms, pressure-fueled urgency, and hyperfocus-driven sprints. All of which look like performance, until the crash.
Let’s critically examine two areas in Rege’s framework that feel antithetical to ADHD experience:
Dopamine Burnout Isn’t the Same in ADHD
Rege describes dopamine burnout as the result of high performance demands over time. But in ADHD, dopamine dysfunction is baseline, not a side effect.
The brain often starts with low tonic dopamine and inefficient reward signaling, which leads to ineffective motivation even when no burnout is present.
So when people with ADHD “burn out,” it’s not from depleting high dopamine—it's more like running an engine with a sputtering fuel line that was never efficient in the first place.
This means ADHDers may crash earlier, and their recovery can’t rely on re-establishing a reward system that never worked optimally.
Resetting the Default Mode Network? Easier Said Than Done
Rege recommends using short periods of structured boredom to reset the Default Mode Network (DMN), the part of the brain active during rest and self-reflection. But here’s the rub: the DMN is chronically overactive and poorly regulated in ADHD.
Mind-wandering for someone with ADHD is not just common—it’s intrusive.
Boredom doesn’t reset the system. It destabilizes it.
ADHD brains often require active rest—low-demand novelty, tactile stimulation, movement—to find any sort of regulation.
So instead of 10 minutes of stillness, a slow walk with music, a Lego set, or structured low-stakes creative play might better serve the same restorative function without triggering dysregulation.
A Need for Adaptation, Not Abandonment
Dr. Rege’s framework is valuable, but like many burnout models, it assumes a baseline level of neurotypical functioning. For ADHDers, we need adaptations that account for disrupted interoception, motivation shaped by interest rather than importance, and reward systems that defy typical reinforcement strategies.
That doesn’t mean the model fails—it means it needs to evolve.
A PACES™ Model adjusted for ADHD might include:
Perception: Use of interoceptive awareness tools, sensory check-ins, or gamified mood logs.
Activity: rotate novel, low-pressure movement—not just intensity pacing.
Cognition: replace boredom with structured creative rest.
Emotion: combine naming feelings with sensory grounding.
Sleep: scaffold transitions and build tolerance for bedtime rituals rather than enforce rigid windows.
Recovery is Not Just Rest—It’s Rewriting the Contract
For ADHDers, recovery isn’t about returning to a balanced system. It’s about building one for the first time.
Burnout in ADHD doesn’t always stem from ambition gone too far.
Sometimes, it’s the long-term cost of functioning in a world that demands consistency from a brain wired for fluctuation. Understanding that difference—acknowledging the unique biology behind both the crash and the recovery—isn’t just clinically important.
It’s deeply human.
