The Hidden Physiology of ADHD: What a Sensational Headline Accidentally Got Right

What if ADHD is not only a diagnosis of attention, but a whole-body pattern?

ADHD is a whole-body condition. Brain, nerves, hormones, and the unexpected places physiology tells the story. (iStock credit jitendrajadhav)

The [Daily Mail reported that “bigger bottoms” could be a sign of ADHD](https://www.dailymail.co.uk/sciencetech/article-15419529/Scientists-shape-butt-ADHD-autism.html). I saw the headline near the end of last year and I did what most of us probably do when a tabloid takes science at face or bottom value. I rolled my eyes, snorted into my coffee, and kept scrolling.

Now I do have ADHD and my bum is, genuinely, on the generous side, so I was still curious and thought I would be missing a trick if I didn’t check out the claim. What bothered me was not the body reference. It was the way the headline was framed like a joke, as this can make real patterns feel too silly to investigate.

I am a clinical psychologist and a yoga teacher, and I also live in a body that has never been purely brain-based. I have low blood pressure, without a formal diagnosis of postural orthostatic tachycardia syndrome (POTS).

I do have polycystic ovary syndrome (PCOS), diagnosed in my twenties. I have an anterior pelvic tilt that changes my posture and my gait. I have joint hypermobility in my arms and legs, the kind that can feel like freedom on a yoga mat and feel achy as hell when I have sat still for too long.

None of this is visible on a school report or an attention checklist. It lives in tissue and sensation, in the tiny negotiations between gravity and muscle tone.

Language matters

When clinicians talk about ADHD, they often mean cognition. Attention. Impulsivity. Time-blindness. But when I live it, I notice the body long before I have the vocabulary. Executive functioning is a useful umbrella term for the brain’s ability to organise and direct your life, including planning, prioritising, starting tasks, regulating emotion, and inhibiting impulses. It is the mental conductor, but the conductor does not live in isolation from the orchestra.

The brain that struggles to coordinate focus can also struggle to coordinate movement, internal signals, hormones, and autonomic stability. The autonomic nervous system runs the automatic stuff you do not consciously control, like heart rate, blood pressure, breathing rhythm, digestion, temperature control, sweating, and the stress response. When it is stable, the body adjusts smoothly when you stand up, eat, get overheated, feel stressed, or need to recover. When it is less stable or dysregulated, you can get dizziness on standing, racing heart, fatigue, heat intolerance, gut issues, and that wired but depleted feeling.

Once I began to explicitly see ADHD as an embodied pattern, the headline stopped feeling ridiculous and started feeling like a badly worded clue. If the nervous system is involved, one of the first places it shows itself is in the way the body holds itself upright.

Posture is neurology made visible

A study using three-dimensional motion analysis found that children with ADHD showed a significantly greater anterior pelvic angle than controls, and the pelvic angle increased with ADHD symptom severity (Naruse et al., 2017). This suggests that posture differences can reflect underlying motor regulation differences, not simply laziness, weak muscles, or a lack of willpower.

Let’s go back to the “bigger bottom” claim. Anterior pelvic tilt does not magically create extra tissue. It changes angles. It shifts how the pelvis sits and how the spine curves. It can make the gluteal region look more prominent, even when body composition has not changed. It is biomechanics, which is governed by the nervous system.

This is validating for me. I have been corrected about my pelvis and my lower back in more yoga classes than I can count. My lower back grips, my hip flexors do too much, my deep core muscles arrive too late to the party, and it can look like laziness or poor training when it is often motor organisation.

In the brain, the cerebellum and basal ganglia help coordinate movement, posture, balance, timing, and automatic motor patterns. These regions are repeatedly implicated in ADHD research, not just in attention but in motor control and coordination. If the systems that calibrate movement run differently, the body often shows it. Sometimes that looks like restlessness. Sometimes it looks like clumsiness. Sometimes it looks like a pelvis that sits forward and a spine that compensates.

This is also where proprioception enters the story. Proprioception is your internal sense of where your body is in space, the silent background signal that lets you know where your foot is on a step without looking, or how far your arm has reached without a mirror. When proprioception is less reliable, you can feel oddly disconnected from your own shape. It is like living in a body that updates a second too late.

I remember being at a friend’s wedding and tripping down a short run of stairs. I was embarrassed and laughing it off when my friend’s brother looked at me and said, with total certainty, “Oh, you must be Tracy.” He had never met me. He simply knew, because my reputation for falling, had arrived before I had.

Sometimes our nervous systems announce themselves before our names do. It is the unexpected trip, the odd sense of not quite catching yourself, the body that looks capable on the outside while working overtime to hold itself together. Once I started following that thread, it led me straight into the world of connective tissue and hypermobility.

Flexible joints

Joint hypermobility means that joints move beyond the typical range. It can sit within hypermobility spectrum disorders and it is also a feature of hypermobile Ehlers-Danlos syndrome (hEDS), a connective tissue condition.

Research has found that joint hypermobility is more common in adults with ADHD than in people without ADHD. It also suggests that the link is strongest in the group whose hypermobility is not just “being bendy,” but comes with real-life consequences like pain, fatigue, and frequent sprains or instability. I include this because it moves the conversation from “maybe it is just me” to “this is a recognised pattern,” and it supports taking body symptoms seriously during ADHD assessment and care (Glans et al., 2021).

This echoes what I notice anecdotally in my own clinical practice. The ADHD body is often a flexible, pain-prone body, a body that compensates. It is not only the mind that masks.

A broader neurodivergence study found an elevated prevalence of hypermobility and showed something even more interesting. Hypermobility mediated the link between neurodivergence and symptoms of dysautonomia and pain (Csecs et al., 2021). I include this because it gives a plausible bridge between joints and symptoms like dizziness, fatigue, and pain, which are often treated as unrelated or psychosomatic when they show up alongside ADHD.

When you have hypermobility, your body may spend a lot of energy trying to find stability. Muscles grip. Fascia, the body’s connective tissue web, adapts. Micro-movements become exhausting. You can look calm on the outside while your system is working overtime.

That is an invisible illness experience in a sentence, because what looks fine from the outside can still feel like your body is negotiating gravity all day long. For me, that negotiation becomes most obvious when blood pressure enters the story.

Low blood pressure and the autonomic layer

Low blood pressure is one of those symptoms that gets minimised because it sounds, on paper, like a good problem to have. The lived experience is not charming. Standing up too fast and feeling your vision narrow. Hot showers that make you light-headed. A body that needs to sit down before it technically “needs” to sit down.

POTS is one form of autonomic nervous system dysfunction, characterised by a substantial increase in heart rate on standing, alongside symptoms like dizziness, palpitations, fatigue, and cognitive fog. The overlap between ADHD, autonomic dysregulation, and orthostatic symptoms is increasingly discussed in the literature. A study in the Journal of Neurology, Neurosurgery and Psychiatry explored inattention and psychiatric profile in POTS, noting that patients often report attentional difficulties and appear anxious, and compared these features with ADHD and controls (Raj et al., 2009). This lends further support to the idea that dismissing physical symptoms as anxiety can mean missing a whole chapter of the nervous system story.

When the body’s automatic regulation is wobbly, the mind often feels wobbly too, and that is the point I keep coming back to. These are not random side quests happening alongside ADHD. They can be different expressions of the same underlying nervous system pattern showing up across multiple systems, through shared pathways like norepinephrine and dopamine that influence attention, stress response, heart rate, blood pressure, and arousal.

Seeing the links matters because it changes the clinical conversation. Instead of treating symptoms as isolated problems, a holistic view invites a more accurate map of what is actually happening in the person.

Many ADHD assessments still focus narrowly on behaviour and cognition and do not routinely ask about joint hypermobility, orthostatic symptoms, chronic pain, endocrine conditions like PCOS, or severe cyclical mood shifts like premenstrual dysphoric disorder (PMDD). When those questions are not asked, people are left thinking they are complicated, unlucky, or exaggerating, when they may simply be living in a body where neurodevelopment, connective tissue, hormones, and autonomic regulation are deeply intertwined.

For many women, the next bridge is not a new diagnosis. It is time. The body changes across a month, across a year, across a decade. Hormones are one of the clearest places the nervous system story becomes clearer.

Hormones and why some women unravel in cycles

In women, ADHD often becomes more apparent around hormones, and this is not just psychology. It is neuroendocrinology. Oestrogen influences dopamine systems and dopamine is central to attention, motivation, reward, and executive function. Reviews of oestrogen receptors in the brain describe their presence in regions involved in dopamine-dependent cognition, including the prefrontal cortex and striatum (Almey et al., 2015).

This helps explain why changes in oestrogen can translate into real shifts in attention, motivation, and emotional regulation. When oestrogen drops, dopamine signalling tends to be less supported. If you already have an ADHD brain with lesser amounts of dopamine, that drop can feel like someone turned the volume down on your capacity to cope.

This matters for PMDD, a severe, impairing form of premenstrual mood disturbance. A 2025 study in The British Journal of Psychiatry found markedly higher rates of provisional PMDD among females with ADHD compared with a non-ADHD reference group, with ADHD groups showing substantially elevated prevalence and risk (Broughton et al., 2025). This lends support to the claim that for many women, the monthly crash is not overreaction or poor coping, but a hormonally sensitive nervous system interacting with an ADHD brain.

PCOS also belongs in this conversation. PCOS is an endocrine condition involving hormonal imbalance, often with elevated androgens, cycle irregularity, and metabolic changes. There is evidence that maternal PCOS is associated with increased risk of ADHD in offspring, suggesting that neurodevelopment and endocrine environments may intersect across generations (Kosidou et al., 2017). When I look at my own family tree, I see patterns repeating, not as fate, but as biology meeting environment over and over again.

Then there is perimenopause. Perimenopause is not just hot flushes and missed periods. It is a neurological transition as much as a reproductive one, because fluctuating and then declining oestrogen affects brain networks involved in mood, cognition, and executive functioning. For many ADHD women, perimenopause is the moment the system cannot keep holding the mask up. Structure stops working. Stamina drops. Emotional regulation becomes harder. Coping strategies that used to function through force of will and high vigilance begin to fail.

This was the point of my own diagnosis. I call it involuntary unmasking, not because you become less capable as a person, but because the physiology that helped you compensate starts to shift. You cannot keep gripping forever if the neurotransmitter support that buffered you before has changed.

Perimenopause taught me something else as well. If decline can expose symptoms, then rise can sometimes soften them. That is part of why pregnancy can highlight some changes for women with ADHD.

Pregnancy, postpartum, and the oestrogen elevator

Pregnancy is one of the most dramatic endocrine changes a human body can go through. Oestrogen rises substantially during pregnancy compared to the menstrual cycle. Many women with ADHD report a surprising period of cognitive steadiness during pregnancy, and I was one of them.

When I was pregnant with my first daughter, I completed a Mensa IQ test and scored 154. I am not saying pregnancy made me smarter. I am saying pregnancy made it easier for me to sit still, focus, and sustain mental effort without my nervous system trying to wriggle away from the task. At the time, I did not know I had ADHD, which carries its own pang of shame for a clinician, even though I would never judge another woman for missing her own pattern. I simply thought I had finally become the kind of person who could concentrate.

Then the postpartum period arrived, and the physiology shifted again. With delivery and removal of the placenta, oestrogen and progesterone drop sharply, reaching pre-pregnancy levels by around the fifth postpartum day (Hendrick and Suri, 1998). I remember after my three daughters were born that the postpartum period felt like a neurological cliff, and why it makes sense that ADHD symptoms can rebound hard when the hormonal buffering disappears overnight. From feeling so sharp and clear when pregnant, the fog soon descended in the hills.

For some women with ADHD, that fog lands on top of sleep deprivation, sensory overload, identity shift, and the relentless cognitive load of caring. It can look like confusion, tearfulness, rage, panic, disorganisation, and a sudden inability to do the simplest administrative task. It can also look like a return of symptoms that you did not know were symptoms because you had been compensating for decades.

If this resonates, it is not “just hormones” in the dismissive sense. It is hormones in the most literal sense, hormones acting on neurotransmitters, receptors, and circuits that shape how you think, feel, and function.

At this point of a story, I always find myself asking a bigger question. If these patterns cluster, if they echo across generations, and if they can be amplified by modern life, why might they persist at all? What is their purpose?

Why might these patterns persist

Evolutionary stories can offer a frame that reduces shame and expands curiosity. The evolutionary mismatch hypothesis (Eaton et al.,, 1996) suggests that traits can be advantageous in one environment and problematic in another. Novelty-seeking, rapid attention shifting, high alertness, and energetic bursts may have been useful in contexts requiring vigilance, mobility, and fast response.

In hunter-gatherer life, attention was not meant to stay locked on one task for hours. It needed to move. Scanning the environment and noticing small changes could help you spot danger, track animals, find food, or read weather shifts. Rapid attention shifting could be protective, not a flaw, because it meant you were less likely to miss the rustle in the grass or the movement at the edge of the group.

Novelty seeking could push exploration, which matters when resources change and you need to find new water sources, new plants, new routes. High alertness could support vigilance during travel or at night. Energetic bursts could help with short, intense demands like sprinting, climbing, carrying, hunting, or responding quickly to threat.

The key point is context. In our world, where rewards are given for long periods of sustained focus on repetitive tasks, those same traits can look like a deficit. In a world that required constant situational awareness and rapid adaptability, they could have been an advantage. A study of Ariaal men in Kenya explored dopamine receptor variants more common in some nomadic populations, and discussed the possibility that certain behavioural traits linked to dopamine signalling may carry context-dependent advantages (Eisenberg et al., 2008). Traits only look like deficits when the environment demands the opposite of how we are wired.

Hypermobility may have conferred advantages in environments demanding climbing, squatting, reaching, carrying, and rapid adaptation to uneven terrain. Greater range of motion can support manoeuvrability and functional versatility, even though it can also come with injury risk.

If I bring this back to that Daily Mail hook, what I think they were clumsily bumping into is that in some ADHD bodies, there are overlapping factors that can make the gluteal area look more prominent without it being as simple as “more tissue.”

A forward-tilted pelvis can change the angle of the spine and the way the glutes sit in space, so the silhouette reads differently even if body composition has not changed. When you add in motor control differences, plus the compensations that often come with hypermobility, the body can end up bracing and stacking itself in ways that emphasise certain shapes. In other words, what the headline calls “bigger” may sometimes be posture, tension patterns, and the way a nervous system organises stability.

The Daily Mail headline did something many academic papers fail to do. It made people look up from their lives and ask, even for a moment, whether ADHD might be visible in the body. That matters, because the most persistent misunderstanding about ADHD is that it is “just behaviour” or “just attention,” as if the brain sits neatly above the neck and the rest is irrelevant. A sensational question can be irritating, but it can also act like an accidental doorway.

Once you step through it, you start noticing the physiology that so many people have been living with quietly for years, the posture differences, the joint instability, the dizziness, the pain, the hormone sensitivity. The better outcome is not that we keep repeating the headline. It is that we use the attention it generated to widen the frame, so ADHD is understood as an embodied nervous system pattern not something that is resides in the mind.

What I invite readers to take from this

If you have ADHD and your body feels confusing, you are living with a whole-system neurodevelopmental profile that touches movement, connective tissue, autonomic regulation, and hormones. This does not mean you need to pathologise everything. It means you get to take your symptoms seriously. It means you get to ask questions in medical appointments. It means you get to seek support that treats you as an integrated human being, not a floating brain.

In my own life, the most helpful interventions have been the ones that respect that integration. Strength work that stabilises hypermobile joints, not as punishment but as protection. Yoga that emphasises proprioception, slow control, and nervous system safety rather than extreme flexibility. Hydration, electrolytes, and pacing strategies for orthostatic symptoms. Cycle tracking and honest recognition that luteal days are not a character flaw. Menopause literacy that treats cognitive and emotional shifts as physiological, not personal failure.

The Daily Mail asked an attention-grabbing question, but here are the headlines I actually want us to sit our larger rears upon.

What if ADHD is not only a diagnosis of attention, but a whole-body pattern that shows up in posture, joints, blood pressure, hormones, pain, and the quiet daily work of regulation? What if the real story is not about the shape of anyone’s body, but about how many of us have been living with physical symptoms in plain sight, dismissed as clumsy, dramatic, unfit, hormonal, or anxious, when our nervous systems were telling the truth all along? If we take that seriously, the clickbait headline turns into a care question, and the punchline becomes a prompt. How do we assess ADHD in a way that asks about the body too, and how do we build support that finally treats the person as one integrated system?

This article shares personal experience and draws on published research. It is not a substitute for individual medical advice. If you recognise these patterns in yourself, consider discussing them with a neurodivergence-informed healthcare professional.

I have a passion for rewriting narratives and giving a voice to the unheard. As a Chartered Clinical Psychologist, Clinical Hypnotherapist, and Jungian Life Coach, I bridge science and spirit, conscious and unconscious, working holistically to help others navigate healing and transformation. My personal experiences with neurodivergence, trauma, women’s health issues, parenting, spiritual awakenings, and relationship challenges, deeply inform my work. I regularly provide expert testimony in courts and commentary to the media and strive to make psychological insights accessible, weaving together evidence-based science with holistic and spiritual wisdom. Learn more about my work at www.drtracyking.co.uk.