THOUGHTFUL TANGENTS · THOMAS BECK, MD

ADHD and the Fires

August 10, 2026

On August 1st, wildfire crossed the Spokane River and burned into our city. Over 900 structures have been damaged or destroyed. Tens of thousands of people evacuated. Whole neighborhoods are gone. Some of you reading this lost your homes. Some of you are still displaced.

Our thoughts are with each of you that has been impacted in this tragedy. Our family has been impacted as well, though we were so much more fortunate than so many in our broader community. But even with the comparatively minor impact that we experienced, I have noticed that my own ADHD has been rather more difficult. This made me reflect on the ways in which this sort of disaster impacts those of us with ADHD beyond what we might expect.

Because a disaster like this takes away many of the things that make ADHD manageable at exactly the same time that it asks more of your attention than almost anything else could.

When the scaffolding burns

Most people think of ADHD as something that exists entirely inside the brain. In reality, much of successful ADHD management exists outside it.

The calendar. The pill bottle beside the toothbrush. The same desk every morning. The alarm that goes off at the same time. The pharmacy that knows you. The commute that tells your brain the workday is beginning. The spouse who remembers the thing you forgot.

These are not trivial conveniences. They are scaffolding. External structure carries some of the work that attention, working memory, sequencing, and initiation would otherwise have to do internally.

Then a disaster removes the scaffolding.

The desk may literally be gone. You may be sleeping in someone else’s house. Your pharmacy may be closed. School may be interrupted. The morning sequence disappears. Every ordinary cue that quietly told your brain what happens next has changed.

At the same time, the number of things you have to manage explodes.

Insurance claims. FEMA forms. Temporary housing. Lost documents. Prescriptions. Contractors. Schools. Pets. Work. Family members. Twelve urgent problems, all competing to be first.

Disaster recovery is an executive-function stress test.

There is limited research specifically studying people with ADHD after wildfires, so I do not want to pretend we know more than we do. But we do know that people with pre-existing behavioral and neurodevelopmental conditions can have particular difficulty when disasters disrupt routines, medications, services, and other supports.

And several other things are happening at the same time.

Your attention has somewhere else it wants to be

There is a fire. Of course your brain is paying attention to it. You check the evacuation map again. You smell smoke and walk outside. Your phone buzzes and you reach for it immediately. You refresh the news. You wonder whether the wind has shifted.

Then you try to return to an email from work.

That competition for attention is real and not a failure. Threat and uncertainty demand attention. So if your ADHD seems dramatically worse right now, some of what you are experiencing may indeed be ADHD under unusual demands. Some may be the normal response of a human brain to an extraordinary event.

And then there is the smoke

The smoke deserves more attention than most people give it.

Wildfire smoke contains enormous amounts of fine particulate matter, especially PM2.5: particles small enough to penetrate deeply into the respiratory tract. Wildfire PM2.5 produces oxidative stress and inflammation, and wildfire-derived particulate pollution may produce greater respiratory harm than comparable concentrations of PM2.5 from other sources.

That explains some of what you feel physically: irritated eyes and throat, coughing, nasal congestion, and aggravated asthma or other respiratory symptoms.

But this is not only a respiratory story.

It also affects the nervous system. Proposed pathways include systemic inflammation and oxidative stress, vascular effects, and communication between the respiratory system and brain. Fine and ultrafine particles may also interact with the nervous system through the nasal and olfactory pathways.

And there is experimental evidence that short-term particulate exposure can affect cognition. In a controlled human study published in 2025, one hour of high particulate exposure was followed four hours later by measurable deterioration in selective attention compared with clean-air exposure. The study was of particulate pollution, not wildfire smoke specifically, and it did not study people with ADHD. But it gives us another reason not to dismiss the cognitive fog people describe during severe smoke events.

The pileup is the point

This is the part I think matters most for ADHD.

There probably is not one explanation for why your brain feels less functional right now. There are several.

And at the exact moment your available cognitive capacity has fallen, disaster recovery requires planning, prioritization, sustained attention, working memory, emotional regulation, and initiation all day long.

These effects do not have to represent one biological pathway to matter clinically. They converge on the same outcome: There is less attention available, and more competing for it.

A few patterns to expect

Routine collapse. If the environmental cues that used to start your day have disappeared, familiar tasks may suddenly require conscious effort. Do not interpret that as evidence that you have somehow lost skills you had two weeks ago. The context that helped trigger those skills changed.

Attentional capture. You may sit down to work and find yourself checking fire maps, messages, insurance updates, and news repeatedly. Some vigilance is appropriate during an active emergency. The problem is expecting yourself to switch instantly from threat monitoring back into deep work.

The shame spiral. There may be painful reminders of things you wish you had handled earlier: insurance paperwork, emergency supplies, backed-up records, medications, documents. Shame about yesterday consumes attention needed for today. It is cognitively expensive and solves none of the problem in front of you.

Emotional flooding. Irritability, fear, grief, anger, tearfulness, and numbness can all occur after a disaster. Do not automatically label every emotional change as ADHD. Acute stress reactions are common after disasters, and, fortunately, most people exposed to disasters do not go on to develop enduring PTSD.

Medication disruption. You may have evacuated without medication or your medicine supply may have burned in your lost home. Replacing controlled medications can involve additional time and effort.

What to do right now

Shrink the field. Do not carry the entire recovery plan in working memory. Put it somewhere outside your head. Choose the next actionable task, not the next twelve.

Rebuild one piece of scaffolding. You do not need to recreate your old life while displaced. Pick one repeatable anchor: medication at the same place, coffee at the same table, one written task list, one time each morning when you decide what comes next. External structure still works even when it is temporary.

Borrow executive function. If insurance forms or phone calls have become impossible to start, ask someone to sit with you while you do them. They do not have to solve the problem. Sometimes another person can provide enough structure to get the sequence moving.

Prioritize the basics. Disaster mental-health guidance starts with safety, shelter, medical needs, practical assistance, connection with other people, and access to services, not with asking you to process every emotion immediately. Psychological First Aid is deliberately practical for this reason.

Protect your air. When smoke levels are high, reducing exposure matters. Pay attention to local air-quality guidance and create cleaner indoor air when possible. This is not merely about protecting your lungs. There is enough evidence connecting particulate pollution with inflammation and cognition that clean air belongs on the list of things protecting your ability to function.

Lower the expected cognitive load. If your brain is simultaneously monitoring danger, adapting to a new environment, sleeping poorly, breathing polluted air, and managing recovery logistics, this may not be the week to measure yourself against your normal productivity.

Not everything after a fire is ADHD

There is one final distinction worth making. Difficulty concentrating after a disaster does not automatically mean your ADHD has permanently worsened. Problems with attention and memory can accompany acute stress, grief, anxiety, depression, sleep disruption, and trauma-related conditions. Those symptoms can overlap substantially.

For many people, acute reactions gradually improve as safety returns and routines are rebuilt.

But if you are becoming less able rather than more able to function, cannot sleep for a sustained period, are having intrusive memories or severe panic, are increasingly using alcohol or other substances to cope, or are having thoughts of harming yourself, that deserves attention. (If you are in crisis outside of business hours or need to talk to someone right now, call or text 988. That is the Suicide and Crisis Lifeline, available 24 hours a day.)

The goal is not to get your old brain back by Tuesday

Recovery after a disaster takes time. The immediate goal is safety. Then stabilization. Then rebuilding.

And for someone with ADHD, rebuilding does not only mean replacing a house, a computer, or a prescription. It means rebuilding the invisible structures that helped your brain function before the fire.

One piece of scaffolding at a time.

References: Faherty et al., Nature Communications, 2025. Cleland et al., Environmental Health Perspectives, 2022.

Thomas Beck, MD
Winston Integrative ADHD

Thoughtful Tangents is a blog from Winston Integrative ADHD, written by Thomas Beck, MD. It is not medical advice for your individual situation. If you need clinical support, contact our office directly.

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