The ramifications of abuse are dire and, in some cases, life-threatening: half of female homicide victims are killed by current or former partners.² The consequences of psychological abuse — the most frequent kind of IPV and often a precursor to physical violence — are no less critical. Research shows that psychological abuse is an even stronger predictor of post-traumatic stress disorder and depression than is physical abuse.³

Though intimate partner violence is startlingly common and harmful, many avenues can lead victims to help and health care providers are instrumental in connecting patients to these paths. Though traditional IPV screening is an effective intervention, it’s not the only one. For some providers, distributing safety cards may be a better fit.

The size of business cards, these safety cards contain information about the red flags and health consequences of IPV. They share contact information for hotlines as well as guidance for safely seeking help, and they let people know they’re not alone.

“It takes 30 to 45 seconds to share the card, and it can change someone’s life,” says Tami Sullivan, Ph.D., director of Family Violence Research and Programs and professor at Yale University’s School of Medicine. “We hear from women with lived experience of violence: ‘Why didn’t anyone ever give me something like this? It could have made all the difference to me.’”

[Read: Why Do Toxic Relationships Swallow People with ADHD?]

Obstacles to IPV Screening

With traditional IPV screening, a provider uses a survey like the HITS (Hurt, Insult, Threaten, Scream) to detect if a patient is experiencing violence. This can be transformative.

“If you trust your provider, it can be a very empowering experience to connect with someone who can listen, make you feel less alone, talk to you about making decisions,” Sullivan says.

But several significant obstacles stand in the way of effective screening for IPV. Survivors may be hesitant to disclose their experiences of violence, fearful of retaliation by their partners, or of being reported to police and potentially losing custody of their children. They may worry they’ll be judged, blamed, or shamed. These concerns may be particularly salient for women with ADHD who receive near-constant criticism, correction, and judgement.

[Watch: “How to Avoid Toxic Relationships and Find Your Ideal Match”]

These obstacles contribute to relatively low rates of disclosure in IPV screenings; less than a quarter of women who have experienced IPV report disclosing this to a health care provider.⁴

The efficacy of screenings also relies on a meaningful response from the provider. Many providers don’t feel comfortable addressing such a sensitive and personal revelation because they’ve not received training in IPV.

“We shouldn’t expect people to develop expertise in responding,” Sullivan explains. “But we want the provider to feel comfortable enough so that they’re not being judgmental, so they can let the person know they’re heard, and connect them to someone who does have expertise.”

If a survivor reveals abuse on a survey and her disclosure is never addressed, or if it’s met with judgement, Sullivan explains, it can discourage her from revealing the abuse to others in the future.

Safety Cards: A Universal Approach

The part of IPV screening that helps survivors most, research has found, is the engagement with support services that happens after disclosure.⁵ This is where safety cards come in.

IPV safety cards, which are distinct from screening methods, bypass surveys altogether and take a direct path to offering help.

The method is simple: Providers order safety cards like these for free and hand them out to every female patient they see (without their partner present). The cards come in 10 languages and contain information about the red flags and health consequences of IPV. They also connect patients to support and resource hotlines

For providers looking for guidance on how to distribute the cards, Sullivan suggests the following language:

“We’ve started talking with all of our patients about relationship health and abuse in relationships, in case it’s ever an issue for them or for their friends and family. This card talks about healthy and safe relationships, ones that aren’t — and how relationships affect your health.”

Safety cards offer myriad benefits, including:

• Getting help to the people who need it, no questions asked. Offering resources to everyone, a universal education model, ensures that the women who need help will get access to it – regardless of whether they disclose abuse.
• Empowering women to help others. Many of the patients who receive cards may not be experiencing IPV, but they may know people who are. Safety cards enable these individuals to recognize abuse in the lives of loved ones, and empower them to offer helpful resources. Research found that people who received universal education were twice as likely as those who did not to share the number for an IPV hotline to someone in need.⁶
• De-stigmatizing conversations about IPV. Broaching the topic of intimate partner violence to all patients helps to break the taboo which often keeps women silent about their experience.
• Planting a seed for future action. It’s important for providers to distribute safety cards at every visit because it may take more than one interaction for patients to recognize abuse in their own lives, or to prepare themselves to consider next steps.  “Often, the cards plant a seed for future action. You give it to patients every time they come in so that it’s routine and becomes comfortable,” Sullivan says. “They come to understand that their relationships affect their health.”

While disclosures aren’t necessary in this IPV intervention, they may happen. When responding, providers should use non-judgmental, validating language, and avoid directing patients to take specific action. “It should never be a provider, trained or not, telling people what they should do,” Sullivan explains. “Though it’s likely well-intentioned, this prescriptive approach mimics the dynamics of abuse and disempowerment.”

Instead, follow the patient’s lead. “Let people know the supports available to them and listen to them,” suggests Sullivan. “You might ask: ‘Have you thought about what you want to do? Do you want help thinking about what makes sense? Would you like to call a helpline from this office?’”

What survivors of abuse need from providers, Sullivan explains, is autonomy, empathy, and information about their options for getting help.

To Order Free Safety Cards

• Visit Futures Without Violence.

Get Help

If you, or someone you love, is experiencing intimate partner violence, these resources may help

• National Domestic Violence Hotline, Call 800-799-7233 or text START to 8878
• Love Is Respect, for people aged 13-26, Call 866-331-9474 or text LOVEIS to 2252
• National Sexual Assault Helpline, Call 1-800-656-HOPE

Abusive Relationships and IPV Screening: Next Steps

• Read: “What Are the Signs of a Controlling Relationship?”
• Quiz: “Is My Relationship Toxic?” A Quiz for Adults with ADHD
• Read: How to Respond to Gaslighting — In Your Relationship and In Yourself

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.

²Jack SP, Petrosky E, Lyons BH, et al. Surveillance for Violent Deaths — National Violent Death Reporting System, 27 States, 2015. MMWR Surveill Summ 2018;67(No. SS-11):1–32.

³Mechanic MB, Weaver TL, Resick PA. Mental health consequences of intimate partner abuse: a multidimensional assessment of four different forms of abuse. Violence Against Women. 2008 Jun;14(6):634-54. doi: 10.1177/1077801208319283. PMID: 18535306; PMCID: PMC2967430.

⁴Black MC, Basile KC, Breiding MJ, et al. The national intimate partner and sexual violence survey: 2010 summary report. Atlanta, GA Natl Cent Inj Prev Control Centers Dis Control Prev. 2011;19:39-40.

⁵US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Grossman DC, Kemper AR, Kubik M, Kurth A, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: US Preventive Services Task Force Final Recommendation Statement. JAMA. 2018 Oct 23;320(16):1678-1687. doi: 10.1001/jama.2018.14741. PMID: 30357305.

⁶Miller E, Tancredi DJ, Decker MR, et al. A family planning clinic-based intervention to address reproductive coercion: a cluster randomized controlled trial. Contraception. 2016;94(1):58-67. doi:10.1016/j.contraception.2016.02.009

ADHD raises the risk of obesity, but its effect is dampened for people living in large cities, according to two new studies.

Young adults with combined-type ADHD are more likely than their non-ADHD peers to carry excess weight around their midsection and to have an unhealthy waist-to-height ratio (known as the body mass index or BMI), according to a new cross-sectional study published in American Journal of Human Biology. ¹ Obesity-related health conditions, such as heart disease and Type 2 diabetes, are tied to excess abdominal fat.

“The effect of ADHD on obesity intensified with age,” however, “no significant association was found with blood pressure, but trends suggested hypertension may escalate with age among ADHD individuals,” the study’s authors wrote.

ADHD’s Behavioral and Biological Links to Obesity

The biological link between ADHD and obesity, and the influence of environment on this relationship, was the focus of another new study led by researchers from the Tandon School of Engineering at New York University and the Italian National Institute of Health. ²

The study, published in PLOS Complex Systems, proposed that ADHD influences obesity along two pathways:

1. Behavioral: Difficulties with motivation, planning, and sustained attention may lead people with ADHD to engage in less physical activity, increasing the likelihood of weight gain.
2. Biological: ADHD affects areas of the brain responsible for impulse control, decision making, and reward processing, making people with ADHD more susceptible to impulsive eating behaviors, such as bingeing or choosing high-calorie snacks.

“A lot of people I work with complain about using food for stimulation,” said Nicole DeMasi Malcher, M.S., R.D., CDES, during the ADDitude webinar “Eating with ADHD: Improving Your Relationship with Food.” “They are constantly looking for food to deliver a quick fix rather than thinking about the long-term effects.”

Malcher attributes this behavior, in part, to poor interoception, the ability to sense what’s happening inside the body, including cues such as thirst, hunger, and fullness. “People with ADHD are unable to recognize these cues until they feel really ravenous,” she said. “Then it’s too late, and they make more impulsive eating and food choices.”

ADHD and the City

Living in a city environment may mitigate the risk of obesity for individuals with and without ADHD. The research found that living in a large city offers more opportunities for physical activity, better access to mental health care, and higher overall levels of education, which could buffer the effects of ADHD that lead to obesity.

The NYU/Italian research team analyzed 915 cities in the United States using an urban scaling mathematical model to examine how rates of ADHD and obesity changed as cities grew. Their analysis showed that, in larger urban areas, ADHD and obesity become relatively less common as population grows. At the same time, access to education and mental health services tends to grow faster than the population. In short, bigger cities aren’t just more populated — they’re often better equipped to handle public health issues like ADHD and obesity. In contrast, cities with fewer opportunities for physical activity or more food insecurity demonstrated stronger links between ADHD and obesity.

“Our research reveals a surprising urban advantage: as cities grow, both obesity and ADHD rates decrease proportionally,” says Tian Gan, a co-author of the PLOS study. “Meanwhile, mental health services become more accessible, helping combat physical inactivity — a key link between ADHD and obesity. This pattern suggests larger cities offer protective factors against these interconnected health challenges.”

Similar patterns emerged when the researchers analyzed survey data from 19,428 children across the U.S. as part of the National Survey of Children’s Health. Children with more severe ADHD symptoms were more likely to be obese, especially if they lived in homes with fewer opportunities for physical activity or lower parental education levels.

The researchers also measured the differences between each city’s rates of ADHD and obesity, and those expected for its population, identifying several regional discrepancies. Cities in the Southeastern and Southwestern U.S. displayed greater disparities in ADHD and obesity prevalence, mental health access, and food insecurity than other regions. Neighboring cities often differed significantly, suggesting that local policies and resources could either amplify or reduce these health risks.

“These findings underscore the importance of city-level interventions in mitigating the impact of impulsivity disorders on the obesity epidemic,” says Dr. Maurizio Porfiri, Ph.D., senior author on the PLOS study. “It’s not just about how big a city is — it’s about how it uses its resources. With this kind of insight, policymakers can target investments in mental health care, education, and physical activity to break the link between ADHD and obesity where it’s strongest.”

Intuitive Eating for ADHD

Both studies suggest that effective management of ADHD symptoms can help reduce the risk of obesity and its complications, and that obesity management programs must take into account a patient’s ADHD diagnosis.

The practice of intuitive eating (IE), for example, may help address the underlying neurological traits that influence the eating habits of people with ADHD.

“Intuitive eating, when adapted for the ADHD brain, provides an evidence-based framework that works with rather than against ADHD traits,” Malcher said. “This approach helps reduce overwhelm, prevent binge eating, and create sustainable eating habits without triggering the restriction-binge cycle common in ADHD.”

Sources

¹Mishra, S., Choudhury, O., Chaudhary, V., Saraswathy, K.N., Shekhawat, L.S., and Devi, N.K. (2025). Attention deficit hyperactivity disorder in obesity and hypertension: A study among young adults in Delhi NCR, India. Am J Hum Biol. https://doi.org/10.1002/ajhb.70022 

²Gan, T., Succar, R., Macrì, S., Porfiri, M. (2025). Investigating the link between impulsivity and obesity through urban scaling laws. PLOS Complex Syst. https://doi.org/10.1371/journal.pcsy.0000046

A complex condition requires a thoughtful treatment approach, and multiple diagnoses often require treatment with more than one medication. Unraveling the answers takes time, plus trial and error. Thanks to years of research, however, clinicians are now equipped with highly effective options for addressing tough-to-treat cases of ADHD plus comorbidities.

Use this evidence-based information to begin a conversation with your doctor about treating complex ADHD with combination therapy.

Is Combination Therapy Safe?

The stimulants used to treat ADHD generally have no major drug-to-drug interactions, so they don’t increase the levels of other medications you may be taking, and vice versa. They are safe to use in combination with other medications, including non-stimulants, antidepressants, and antipsychotics. However, some of the non-stimulants, such as atomoxetine (brand name Strattera) or viloxazine (brand name Qelbree), may affect the blood levels of other medications.

Which Condition Do I Treat First?

We generally recommend treating the more sever condition first. If untreated, the symptoms of severe conditions like bipolar or panic disorder can undermine or hijack ADHD treatment. If a patient has mild anxiety, for example, it makes sense to address the ADHD first and then assess any remaining anxiety. Sometimes, anxiety improves when the ADHD is addressed.

Even the most optimized treatment regimen may need to be adjusted over time. After feeling quite stable, a person with ADHD and depression, for example, may feel as though their ADHD is suddenly worse. Worsening depression may worsen the ADHD response. Treating the depression may enhanced the effectiveness of ADHD treatment. Clinicians must take time to sort out such issues when dealing with multiple diagnoses.

[Free Course: The Adult’s Guide to ADHD Treatment]

Anxiety and ADHD

Generally, stimulants don’t worsen anxiety, but they may for some patients. If ADHD symptoms are causing anxiety, stimulants may lessen the anxiety. If the anxiety is unrelated to ADHD, if won’t be improved by stimulants and may, in fact, be exacerbated. A meta-analysis of studies concluded that, in the aggregate, treatment with stimulants significantly reduced the risk of anxiety compared to a placebo.³ The first-line treatment for anxiety is a selective serotonin reuptake inhibitor (SSRI), such as Lexapro, Prozac, or Zoloft.

Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) that can effectively treat both anxiety and ADHD with a single medication. There is a caveat: For reasons we don’t yet understand, atomoxetine is not as effective in patients who have already tried a stimulant. If you’re a new patient, talk with your doctor about trying atomoxetine first to treat both the ADHD and the anxiety.

Autism and ADHD

Addressing ADHD in autistic patients may improve functioning dramatically. However, studies show that ADHD medications may cause more side effects and be less effective for autistic people, particularly those with lower intellectual functioning.⁴ Research has found that autistic patients taking ADHD medication experienced a 50% response rate for symptoms including hyperactivity and emotional regulation, which is lower than the 70 to 80% response rate found in children with ADHD who do not have autism.⁵

Begin slowly and monitor closely when increasing the dosage of ADHD medications in autistic patients. It is not uncommon to see an autistic child or adult have a good response to a particular dose of medication, whereas a slightly higher dose may cause many side effects and lessens response. Rather than seeking the “best” ADHD treatment, doctors may aim for good treatment with manageable side effects.

[Read: Interventions for Adult Autism and ADHD]

When severe irritability, aggression, and acute outbursts occur, it may be necessary to stabilize these episodes before addressing ADHD symptoms. Second-generation antipsychotics, such as risperidone or aripiprazole, can work very well to create a calm and controlled context before introducing stimulants or non-stimulants.

OCD and ADHD

Untreated OCD can significantly impede treatment of ADHD, so most practitioners initially prescribe medication and/or psychotherapies like exposure response prevention for OCD, and then tackle the ADHD with stimulant or non-stimulant medication. Both SSRIs and SNRIs are indicated for the treatment of OCD, though SSRIs appear to be more effective. Most medications for ADHD can be used safely in combination with SSRIs/SNRIs.

Depression and ADHD

For children with depression and ADHD, treatment options are limited to an SSRI plus a stimulant or non-stimulant. Adults may benefit from bupropion (brand name Wellbutrin), an antidepressant that is used off-label for ADHD. While depression in adults is commonly treated with SSRIs/SNRIs, some patients report that tricyclic antidepressants help with symptoms of depression and are also quite effective for ADHD.

Eating Disorders and ADHD

Clinicians sometimes hesitate to prescribe ADHD medications to patients with eating disorders due to the common side effect of appetite suppression. These patients’ weight and eating patterns should be monitored closely during treatment, but fear of the side effects should not preclude ADHD treatment, which is shown to improve overall health outcomes.

Though non-stimulants like atomoxetine or viloxazine may be tried first, stimulants need not be ruled out. In fact, the stimulant lisdexamfetamine (brand name Vyvanse) is FDA-approved for the treatment of binge eating disorder as well as ADHD.

Executive Dysfunction and ADHD

The executive function deficits that come with ADHD – difficulties with organization, time management, and sequential thinking – are often burdensome and impairing. For these patients, non-stimulants such as atomoxetine or viloxazine may be used in combination with a stimulant for treating both ADHD and executive function deficits.

Adding an extended-release form of an alpha agonist, like guanfacine or clonidine, to a stimulant is another option that can be useful for executive dysfunction. These medication combinations (e.g., clonidine or guanfacine plus a stimulant) are FDA-approved for treating ADHD in children under 17. They are sometimes used off-label in adults with ADHD.

Research suggests that the Alzheimer’s medication memantine added to the stimulant methylphenidate may improve executive functioning and social cognition, or the capacity to read verbal cues.⁶ This can be especially helpful for autistic children with ADHD.

Comorbid Conditions with ADHD: Next Steps

• Free Tool: The ADDitude Symptom Checker
• Read: What Is Complex ADHD?
• Read: Stimulant, Non-Stimulant, or Both? Combination Therapy for ADHD

Timothy E. Wilens, M.D., is a professor of psychiatry at Harvard Medical School.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry, 17(1), 302. https://doi.org/10.1186/s12888-017-1463-3

²Danielson, M. L., Claussen, A. H., Bitsko, R. H., Katz, S. M., Newsome, K., Blumberg, S. J., Kogan, M. D., & Ghandour, R. (2024). ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 53(3), 343–360. https://doi.org/10.1080/15374416.2024.2335625

³Coughlin, C. G., Cohen, S. C., Mulqueen, J. M., Ferracioli-Oda, E., Stuckelman, Z. D., & Bloch, M. H. (2015). Meta-Analysis: Reduced Risk of Anxiety with Psychostimulant Treatment in Children with Attention-Deficit/Hyperactivity Disorder. Journal of child and adolescent psychopharmacology, 25(8), 611–617. https://doi.org/10.1089/cap.2015.0075

⁴Joshi, G., & Wilens, T. E. (2022). Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder in Individuals with Autism Spectrum Disorder. Child and adolescent psychiatric clinics of North America, 31(3), 449–468. https://doi.org/10.1016/j.chc.2022.03.012

⁵Joshi, G., Wilens, T., Firmin, E. S., Hoskova, B., & Biederman, J. (2021). Pharmacotherapy of attention deficit/hyperactivity disorder in individuals with autism spectrum disorder: A systematic review of the literature. Journal of psychopharmacology (Oxford, England), 35(3), 203–210. https://doi.org/10.1177/0269881120972336

⁶Biederman, J., Fried, R., Tarko, L., Surman, C., Spencer, T., Pope, A., Grossman, R., McDermott, K., Woodworth, K. Y., & Faraone, S. V. (2017). Memantine in the Treatment of Executive Function Deficits in Adults With ADHD. Journal of attention disorders, 21(4), 343–352. https://doi.org/10.1177/1087054714538656

Listening to music while practicing mindfulness exercises may improve focus, mood, and emotional wellbeing in people with symptoms of ADHD, anxiety, and depression, according to two new studies.

A systematic review examining the relationship between music and ADHD found that music listening activates brain regions involved in sensory processing, motor control, and motivation — networks that are often dysregulated in individuals with attention deficit.¹

Traditional thinking suggests that quiet environments help sustain attention; however, the opposite may be true. The review, published in Behavioral Science, indicated that music, especially calm music with or without lyrics, can improve focus and performance in individuals with ADHD, especially when it is heard before or during tasks. Listening to music can also help filter out distractions, leading to improved learning and mood.

“People with ADHD benefit from ‘rhythmic entrainment,’ using strong, steady rhythms to imprint structure and consistency. This assists with regulation of attention and behavior,” said Roberto Olivardia, Ph.D., Clinical Instructor of Psychology at Harvard Medical School, during his presentation titled, “We Got the Beat: The Impact of Music on ADHD,” at the 2024 Annual International Conference on ADHD.

Listening to music could become counterproductive if it causes overstimulation or if the listener is doing a challenging task that requires significant cognitive resources, the researchers noted.

Music Therapy Boosts Emotional, Social Skills

Music listening may be self-directed or facilitated by a trained music therapist, as part of music therapy. Music therapy sessions often incorporate active music listening, playing instruments, songwriting, or singing, as well as passive music listening.

The review made a compelling case for using music therapy to complement ADHD medications and other recommended therapies, citing evidence for the efficacy of music therapy in reducing symptoms of ADHD. For example, active music-making can enhance working memory and social skills while decreasing aggression. Conversely, passive music listening may improve learning and reduce disruptive behaviors.

“These insights highlight the potential for music to contribute to more holistic, non-pharmacological approaches, offering individuals with ADHD new avenues for enhancing cognitive functioning and overall wellbeing,” the study’s authors wrote.

The systematic review included 20 studies published between 1981 and 2023, reflecting data from 1,170 participants aged 2 to 56 years. Several limitations exist: The studies primarily focused on children and adolescents, rather than adults. Variations in study methods and design also resulted in some inconsistent findings.

“Despite these limitations, this review provides a valuable foundation for future research on the interaction between ADHD and music,” the study’s authors wrote.

Mindfulness Paired with Music Reduces Stress, Improves Mood

Another recent, smaller study, published in Frontiers in Neuroscience, suggests that listening to music while performing mindfulness exercises activates areas of the brain and body related to stress and emotional regulation that could reduce moderate symptoms of anxiety and depression in adults.sup>2

The study, led by a team of researchers from the Yale School of Medicine, assessed the physiological impact of music mindfulness by recording heart rates and EEGs from 38 participants, aged 18 to 65, as they engaged in a bilingual, two-week mindfulness program centered on “focus” and “mindfulness.”

“Anxiety and depression reduce autonomic system activity, as measured by Heart Rate Variability (HRV), and exacerbate cardiac morbidity, while both music and mindfulness have been shown to increase HRV,” wrote the researchers.

They found that music mindfulness quickly improved HRV — a sign of better stress regulation — and changed brain wave patterns (measured by EEG) in areas of the brain linked to emotion, awareness, and decision-making.

Both virtual and in-person sessions incorporated similar guided mindfulness exercises, accompanied by live improvised music, music listening, or no music at all. In addition to wearing mobile heart rate and EEG monitors during each session, participants completed surveys regarding their stress levels, degree of mindfulness, state of consciousness, and level of social connection before and after each session.

The virtual group exhibited a significant decrease in stress and a significant increase in altered states of consciousness during the “focus” sessions, but not the “motivation” sessions. This contrasted with the in-person sessions, where stress decreased and mindfulness and altered state of consciousness increased during both Focus and Motivation sessions.

The researchers said that the differences in music composition features (tempo, key, mode) between “focus” and “motivation” sessions may explain the physiological differences observed in heart rate variability.

In-person sessions with music boosted feelings of social connection more than the virtual sessions did, underscoring the value of live, shared experiences in therapeutic settings.

“Our results imply that, while virtual sessions reduce stress, they do not have as extensive an effect on psychological states as in-person sessions do,” the researchers wrote. “Important aspects of live social interaction may drive feelings of social connection and serve as a key differentiator between live and virtual sessions.”

The researchers also observed gender-specific effects via HRV; women appeared to benefit more physiologically from music mindfulness than men.

While the findings from the Behavioral Science and Frontiers in Neuroscience studies contribute to a growing body of evidence supporting the use of music as a viable adjunct treatment for ADHD and mood disorders, both research teams emphasize the need for further investigation. Future studies would include randomized controlled trials, long-term outcome assessments, and greater representation of adult populations.

Sources

¹Saville, P., Kinney, C., Heiderscheit, A., Himmerich, H. (2025). Exploring the intersection of ADHD and music: A systematic review. Behav. Sci. https://doi.org/10.3390/bs15010065

²Ramirez, C., Alayine, G.A., Akafia, C., Selase, K., Adichie, K. et al. (2025). Music mindfulness acutely modulates autonomic activity and improves psychological state in anxiety and depression. Frontiers in Neuroscience. https://doi.org/10.3389/fnins.2025.1554156

Amid this dearth of research, men* are becoming increasingly interested in testosterone’s suspected benefits on strength, energy, and mood. Testosterone replacement therapy, approved to treat hypogonadism (testosterone deficiency), has become more common among men with typical hormone levels. In the last five years, testosterone replacement prescriptions have risen dramatically, from 7.3 million to more than 11 million, and a third of these recipients have not been diagnosed with testosterone deficiency, according to the American Urological Association.

Besides being potentially ineffective at achieving desired outcomes, testosterone supplementation without a medical indication can be harmful for men, and may lead to side effects such as fertility problems, acne, sleep apnea, breast swelling, benign prostatic hyperplasia, and high red blood cell counts, which could increase the risk of blood clots

As these very real risks emerge from a murky landscape, here is a summary of what’s known — and not yet known — about the impact of testosterone on the bodies and brains of men, both with and without ADHD.

Testosterone and ADHD: Is There a Connection?

Is there an association between an individual’s testosterone level and their likelihood of developing ADHD. Is symptom severity impacted by hormones? The answer is: we don’t know. There’s no conclusive evidence to suggest an association, however research is extremely scarce.

[Read: For Men With ADHD — and Those Who Love Them]

Estrogen’s impact on mood and cognition is well-established. It plays a key role in modulating neurotransmitters, increasing dopamine and serotonin, which leads to elevated mood and focus. Recently, researchers have begun to explore the influence of estrogen on ADHD, which is thought to be significant. Women with ADHD experience premenstrual dysphoric disorder, postpartum depression, and perimenopausal challenges at far higher rates than do women without ADHD. Additionally, ADHD symptoms are often more severe and ADHD medication less effective during the luteal phase of the menstrual cycle, when estrogen is low.

Testosterone’s implications on ADHD are far less clear.

In the past, ADHD was thought to be a disorder affecting mostly boys, leading some to speculate that testosterone played a role in the development of ADHD symptoms. Some studies have explored whether prenatal exposure to high testosterone is associated with an elevated risk of ADHD. The results were mixed, with some studies finding a link between high prenatal exposure to testosterone and development of ADHD, and some finding no association.^1,2

[Read: When ADHD and Puberty Collide]

No research has been conducted investigating whether testosterone levels are related to ADHD symptom severity.

Research has investigated the influence of testosterone on mood and behavior more generally, including several studies that have tested a potential association between testosterone and depression, with conflicting results. Some studies have found an association between low levels of testosterone and depressive symptoms ^3,4 while others have found that both low and high levels of testosterone are linked to risk of depression.^5,6 Because of confounding factors, these studies have failed to show a causal relationship between hormone levels and depression. Studies regarding testosterone’s impact on cognition have been similarly inconclusive. ^7,8

Even research on testosterone’s most famous behavioral trait — aggression — fails to find a direct cause-and-effect relationship. Experts believe testosterone plays a role in the regulation of aggression, however the exact function it serves remains unclear. Testosterone fluctuates in response to cues of challenge in the environment, and it interacts with other fluctuating hormones such as cortisol, making the tangle of factors very difficult to unknot.^9,10

Testosterone research is inconclusive, in part, because testosterone is difficult to measure. Variability in testing and analysis methods, fluctuations in the hormone over the course of the day, and inconsistencies among labs regarding the parameters of “normal” levels all add to the challenge of studying testosterone.¹¹

Testosterone Over the Lifespan

Hormone levels in women rise and fall dramatically on a constant basis for the whole of their reproductive years. This regular menstrual cycle exists in stark contrast to the hormonal experience of men, for whom testosterone levels change significantly during two periods: puberty and in mid-life. While testosterone levels fluctuate slightly throughout the course of the day, their levels remain stable from the end of adolescence until roughly age 40.

Challenging Conventional Wisdom About “Hormonal” Teens

During puberty, testosterone levels in males increase exponentially. Research has found that the average total testosterone level of a male rises from 3 ng/dl to 355 ng/dl over the course of adolescence ¹² Testosterone levels reach their peak in late adolescence or early adulthood and remain stable until ages 35 to 40, when they begin to decrease very gradually.
The explosion of hormone production in puberty causes:¹³

• development of the male sex organs
• deepening of the voice
• appearance of facial and pubic hair
• muscle size and strength
• sex drive
• sperm production

Puberty is also a time of significant emotional, social, and behavioral changes — changes that are generally attributed to the dramatic hormonal escalation. But drawing a direct line between pubertal hormones and mood, behavior, and cognitive changes is an over-simplification of a complex developmental period, says Ben Balzer, M.D., pediatrician in Sydney, Australia, and Conjoint Lecturer at the University of New South Wales.

Balzer and colleagues conducted a systematic review of 27 studies in order to assess what evidence exists on the effects of testosterone on mood and behavior in teen boys. The review concluded that there was insufficient data to confirm a significant association.¹⁴

“Hormones are an easy culprit to go after,” says Balzer. “But their role may potentially be small because of the overall cognitive changes and neurological maturation that occurs in that period of life.”

Similar results were found in a 2024 systematic review of 55 studies investigating the role of pubertal hormones on mental health conditions. The review concluded that most of the studies that exist on hormones and mental health outcomes were at high risk for bias and involved many confounding factors. They determined that there wasn’t solid evidence that pubertal hormones cause mental health problems.¹⁵

The challenge of conducting this kind of research, Balzer says, is that hormones don’t act in isolation.

“When we study hormones in mice, we can control every aspect of their life,” he explains. “But when you’re looking at adolescents in the community, you’ve got to factor in their genetics, family environment, living environment, school situation, their social media use. It’s a really complicated thing to tease out.”

When Testosterone Tapers Later in Life

Testosterone levels remain more or less steady until midlife, when they begin to decline very gradually, approximately 1% a year. ¹⁶

While this decrease in testosterone is sometimes compared to menopause in women, the decline for men is far more gradual and happens over a much longer period of time. While men on average, lose 30% of the testosterone by age 75,¹⁷ women on average lose 65% of their estrogen by age 51.

No evidence exists to demonstrate that declines in testosterone due to normal aging cause mood or cognitive issues, as declines in estrogen often do for women in menopause.

Normal declines of testosterone due to aging are distinct from hypogonadism, a condition in which problems with the pituitary gland or the testicles result in the body failing to produce normal amounts of testosterone. Men with hypogonadism may suffer from chronic fatigue, low libido, erectile dysfunction, muscle loss, and weight gain, as well as mood symptoms including irritability and depression. Several studies have found a higher incidence of depression in men with hypogonadism, however research has not shown a causal link between the lack of testosterone and depression.

“The association between depression, testosterone levels, and sexual symptoms in males is difficult to assess, due to numerous confounding factors, such as medical conditions, obesity, smoking, alcohol use, diet, and stress,” according to the authors of a recent study in Frontiers in Endocrinology.¹⁸

Testosterone and ADHD in Men: Next Steps

• Read: ADHD Symptoms in Men Manifest Differently
• Watch: “ADHD and Puberty – How Hormones Shape Behavior and Mental Health in Adolescents”
• Read: Men with ADHD Are Asking: “Why Am I So Angry?”

*ADDitude is dedicated to honoring gender diversity and fluidity. For the purposes of this reporting, the terms “men” and “boys” refer to individuals assigned male at birth.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Wang LJ, Chou MC, Chou WJ, Lee MJ, Lee SY, Lin PY, Lee YH, Yang YH, Yen CF. Potential role of pre- and postnatal testosterone levels in attention-deficit/hyperactivity disorder: is there a sex difference? Neuropsychiatr Dis Treat. 2017 May 16;13:1331-1339. doi: 10.2147/NDT.S136717. PMID: 28553119; PMCID: PMC5439987.

²Kocaman O, Aydoğan Avşar P, Kara T, Kuru T. The 2D:4D ratios in the mothers of children with attention deficit hyperactivity disorder. Early Hum Dev. 2025 Feb;201:106203. doi: 10.1016/j.earlhumdev.2025.106203. Epub 2025 Jan 20. PMID: 39855032.

³Joshi D, van Schoor NM, de Ronde W, Schaap LA, Comijs HC, Beekman AT, Lips P. Low free testosterone levels are associated with prevalence and incidence of depressive symptoms in older men. Clin Endocrinol (Oxf). 2010 Feb;72(2):232-40. doi: 10.1111/j.1365-2265.2009.03641.x. Epub 2009 May 25. PMID: 19486021.

⁴McIntyre RS, Mancini D, Eisfeld BS, Soczynska JK, Grupp L, Konarski JZ, Kennedy SH. Calculated bioavailable testosterone levels and depression in middle-aged men. Psychoneuroendocrinology. 2006 Oct;31(9):1029-35. doi: 10.1016/j.psyneuen.2006.06.005. Epub 2006 Sep 5. PMID: 16908107.

⁵Booth A, Johnson DR, Granger DA. Testosterone and men’s depression: the role of social behavior. J Health Soc Behav. 1999 Jun;40(2):130-40. PMID: 10467760.

⁶Määttänen I, Gluschkoff K, Komulainen K, Airaksinen J, Savelieva K, García-Velázquez R, Jokela M. Testosterone and specific symptoms of depression: Evidence from NHANES 2011-2016. Compr Psychoneuroendocrinol. 2021 Mar 10;6:100044. doi: 10.1016/j.cpnec.2021.100044. PMID: 35757365; PMCID: PMC9216439.

⁷Emmelot-Vonk MH, Verhaar HJ, Nakhai Pour HR, et al. Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial. JAMA. 2008;299:39–52. doi: 10.1001/jama.2007.51.

⁸Cherrier MM, Asthana S, Plymate S, et al. Testosterone supplementation improves spatial and verbal memory in healthy older men. Neurology. 2001;57:80–88. doi: 10.1212/wnl.57.1.80.

⁹Geniole SN, Bird BM, McVittie JS, Purcell RB, Archer J, Carré JM. Is testosterone linked to human aggression? A meta-analytic examination of the relationship between baseline, dynamic, and manipulated testosterone on human aggression. Horm Behav. 2020 Jul;123:104644. doi: 10.1016/j.yhbeh.2019.104644. Epub 2019 Dec 28. PMID: 31785281.

¹⁰Armstrong, T., Wells, J., Boisvert, D. L., Lewis, R. H., Cooke, E. M., Woeckener, M., & Kavish, N. (2021). An exploratory analysis of testosterone, cortisol, and aggressive behavior type in men and women. Biological Psychology, 161, Article 108073. https://doi.org/10.1016/j.biopsycho.2021.108073
[11] Tyagi V, Scordo M, Yoon RS, Liporace FA, Greene LW. Revisiting the role of testosterone: Are we missing something? Rev Urol. 2017;19(1):16-24. doi: 10.3909/riu0716. PMID: 28522926; PMCID: PMC5434832.

¹¹Yao Q, Zhou G, Xu M, Dai J, Qian Z, Cai Z, Zhang L, Tan Y, Hu R. Blood metal levels and serum testosterone concentrations in male and female children and adolescents: NHANES 2011-2012. PLoS One. 2019 Nov 7;14(11):e0224892. doi: 10.1371/journal.pone.0224892. PMID: 31697766; PMCID: PMC6837506.

¹²Duke SA, Balzer BW, Steinbeck KS. Testosterone and its effects on human male adolescent mood and behavior: a systematic review. J Adolesc Health. 2014 Sep;55(3):315-22. doi: 10.1016/j.jadohealth.2014.05.007. PMID: 25151053.

¹³Luo D, Dashti SG, Sawyer SM, Vijayakumar N. Pubertal hormones and mental health problems in children and adolescents: a systematic review of population-based studies.
EClinicalMedicine. 2024 Oct 1;76:102828. doi: 10.1016/j.eclinm.2024.102828. PMID: 39403116; PMCID: PMC11472636.

¹⁴Cheng H, Zhang X, Li Y, Cao D, Luo C, Zhang Q, Zhang S, Jiao Y. Age-related testosterone decline: mechanisms and intervention strategies. Reprod Biol Endocrinol. 2024 Nov 14;22(1):144. doi: 10.1186/s12958-024-01316-5. PMID: 39543598; PMCID: PMC11562514.

¹⁵Decaroli MC, Rochira V. Aging and sex hormones in males. Virulence. 2017 Jul 4;8(5):545-570. doi: 10.1080/21505594.2016.1259053. Epub 2016 Nov 10. PMID: 27831823; PMCID: PMC5538340.

¹⁶Indirli R, Lanzi V, Arosio M, Mantovani G, Ferrante E. The association of hypogonadism with depression and its treatments. Front Endocrinol (Lausanne). 2023 Aug 10;14:1198437. doi: 10.3389/fendo.2023.1198437. PMID: 37635965; PMCID: PMC10449581.

Stimulant medications (amphetamine or methylphenidate) reduce ADHD symptoms better than non-pharmacological interventions, according to a meta-analysis published in The Lancet Psychiatry, which included 113 randomized clinical trials (RCTs) and 14,887 participants aged 19 to 44. ¹

The researchers analyzed self-reports and clinician-reported rating scales submitted at 12, 26, and 52 weeks regarding the efficacy of medication and non-medication treatment for ADHD.

“Stimulants were the only intervention supported by evidence of efficacy in the short term (i.e., at time points closest to 12 weeks) for core symptoms of ADHD in adults (both self-reported and clinician-reported) and were associated with good acceptability (all-cause discontinuation),” they said. (Amphetamines and methylphenidate showed no notable difference in effectiveness.)

Atomoxetine, a selective norepinephrine reuptake inhibitor (SNRI), benefited adults with ADHD during the measured time periods, but atomoxetine had worse overall acceptability compared to placebo.

A small body of evidence suggested that non-medication treatment [i.e., cognitive behavioral therapy (CBT), neurofeedback, and relaxation therapy] benefited people with ADHD over longer periods. However, those studies, the researchers noted, had inconsistent results with variations depending on whether the individual with ADHD or their clinician rated the core symptoms.

“Our findings highlight how both individuals with ADHD and clinicians should be considered as sources of evidence, with ratings of symptoms by both groups measured in RCTs,” the researchers said. “Participants in RCTs might report positive effects of the active intervention to please the interviewer (the Hawthorne effect), or might not correctly report the perceived effects of interventions (especially when they feel under pressure from the clinicians and have difficulties with executive function, as is often the case in people with ADHD).”

Neurofeedback Therapy for ADHD Not Effective

A separate meta-analysis published in JAMA Psychiatry examined the results of neurofeedback treatment in 2,472 people with ADHD aged 5 to 40 years from 38 RCTs. ²

The review, led by the University of Southampton, King’s College London, and the University of Zurich, found insufficient evidence to recommend neurofeedback as a front-line treatment for ADHD. According to the researchers, neurofeedback did not significantly reduce ADHD symptoms of inattention, hyperactivity, and impulsivity, and it did not improve cognitive performance in adults. Their findings did show that adults who used neurofeedback gained a slight improvement in their processing speed.

In addition, the researchers did not identify any differences between neurofeedback and other non-pharmacological treatments, such as physical exercise or cognitive training. Newer neurofeedback techniques, such as functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS), also lack the evidence to support their efficacy at treating ADHD symptoms.

Neurofeedback is a distinct form of biofeedback that uses electroencephalography (EEG) to help patients train their brains to improve focus, impulse control, and executive function.

“The effects of neurofeedback don’t really last in the long term,” Stephanie Sarkis, Ph.D., said during the ADDitude webinar “Dispelling Myths About Supplements for ADHD.” “I know people who have used it say they felt more focused after sessions, but then they returned to baseline quickly. Neurofeedback is expensive to get that kind of a result, and insurance doesn’t cover it.”

A 2023 ADDitude survey of more than 11,000 caregivers and adults with ADHD found that 9% of adults and 14% of children have tried neurofeedback for ADHD. Of those respondents, caregivers rated the efficacy of neurofeedback as 2.9, and adults rated it as 2.88, on a five-point scale. In contrast, medication was rated 3.57 by caregivers and 3.52 by adults who responded to the ADDitude survey.

Indeed, the formal effect sizes for ADHD medication are .8 to 1.0, which are among the strongest in all of psychiatry.³ Clinical practice guidelines recommend medication as the first-line treatment for ADHD due to its overwhelming efficacy; for children with ADHD ages 4 to 6, parent behavior training is recommended by the American Academy of Pediatrics (AAP). ⁴

“Despite continuing progress in our scientific understanding of ADHD, little has changed for decades in terms of treatment,” said Edmund Sonuga-Barke, a professor of developmental psychology, psychiatry and neuroscience at King’s College London and joint senior author on the JAMA Psychiatry report. “Effective alternatives to medication as the front-line treatment for core symptoms are still lacking. The development of new, science-driven, and more effective non-pharmacological approaches for the treatment of ADHD, therefore, remains a priority for our field.”

Sources

¹ Ostinelli, E.G., Schulze, M., Zangani, C., Farhat, L.C., Tomlinson, A., Del Giovane, C., et al. (2025). Comparative efficacy and acceptability of pharmacological, psychological, and neurostimulatory interventions for ADHD in adults: a systematic review and component network meta-analysis. Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(24)00360-2

² Westwood, S.J., Aggensteiner, P., Kaiser, A., Nagy, P., Donno, F. et al. (2025). Neurofeedback for attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2024.3702

³Faraone, S. V., & Buitelaar, J. (2010). Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis. European Child & Adolescent Psychiatry.  https://doi.org/10.1007/s00787-009-0054-3

⁴Centers for Disease Control and Prevention. (2022, March 8). Treatment recommendations for healthcare providers. https://www.cdc.gov/adhd/hcp/treatment-recommendations/index.html

We know that hormones collide with ADHD to cause heightened mood dysregulation, memory problems, and impulsivity each month, but we don’t know how hormonal transitions over a lifetime impact ADHD symptoms, comorbid conditions, and treatment outcomes. We don’t yet see the big picture of how symptoms manifest during different reproductive stages because research is scant and leaves more questions than answers. Here are four high-priority areas in need of study and advancement.

ADHD and Hormones in Women: Research Priorities

Priority #1: Improved Assessments

When conducting assessments, clinicians should ask about patients’ reproductive events (e.g., puberty, pregnancy/postpartum, menopause) and hormonal profiles (e.g., menstrual cycle phase, use of hormonal medications and contraceptives). Women in the latter half of their menstrual cycle or who are in menopause are more likely to present with ADHD symptoms. Evaluations conducted at other times (e.g., first half of menstrual cycle, before menopause) may lead clinicians to underestimate the probability that a woman has or is at risk for ADHD.

[Get This Free Download: Hormones and ADHD in Women]

Overall, adult ADHD evaluations today rely largely on self-reported questionnaire data, and they do not utilize objective testing, such as biological assays of hormone levels or reproductive indicators (e.g., urine tests for ovulation or blood or saliva samples for hormones). Using these tests would improve care and begin to build empirical connections between hormonal data and observed ADHD symptoms.

Priority #2: Studies on Pivotal Developmental Periods

During puberty, why are depression and self-harm more common in girls with ADHD than boys with ADHD?² We can surmise that the hormonal fluctuations of puberty and adolescence exert a more profound effect on the mood of girls with ADHD; however, we don’t know for certain.

Estrogen rises during pregnancy and declines rapidly through the postpartum stages. This hormonal decline is thought to place women at risk for anxiety and mood problems, like postpartum depression; however, it is extremely understudied in neurodivergent women. Similarly, perimenopause and menopause are thought to intensify ADHD symptoms and affective problems in women, but they are largely overlooked in the literature. Studies on these pivotal developmental periods are long overdue.

Priority #3: Formal Consideration of Comorbid Conditions

Truly personalized assessments and treatment plans should not only factor in hormonal effects, but also consider the cognitive, affective, and comorbid profiles associated with ADHD. A deep understanding of coexisting conditions across various life stages would also improve evaluation and diagnoses of disorders that often co-occur with ADHD.

[Read: Why Do Comorbid Conditions Uniquely Impact Women with ADHD?]

Depression, substance use, premenstrual dysphoric disorder, eating disorders, and borderline personality disorders all appear alongside ADHD and are also likely impacted by hormonal shifts. Determining how these effects influence ADHD symptoms, and vice versa, will be important for refining our broad understanding of cognition, affect, motivation, and impairment.

Priority #4: Testing Interventions in Women

Leading clinicians suggest that adjusting psychostimulant dosages across the menstrual cycle, with potentially higher doses during the second half, might be especially effective in easing ADHD symptoms. Hormone therapies, including contraceptives, may be another useful treatment choice during the reproductive and post-reproductive years. Anecdotal evidence is encouraging; however, these interventions have not been subject to scientific scrutiny.

Hormonal Changes in Women with ADHD: Next Steps

• Free Download: Managing Menopause and ADHD
• Read: We Demand Attention! A Call for Greater Research on Women with ADHD
• Read: The Menstrual Cycle Impacts ADHD Symptoms in Disparate Ways
• Read: Complex ADHD Is More Common in Women and Girls, Leading to Later Diagnoses

Michelle M. Martel, Ph.D., is the Chair and University Research Professor in the Department of Psychology at the University of Kentucky.

Madeline K. Petersen, M.S., Miranda P. Ramirez, M.S., Carleigh A. Letteral, M.S., and Layne E. Robinson, M.S., are graduate students in the Psychology Department at the University of Kentucky.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Peters, J. R., Schmalenberger, K. M., Eng, A. G., Stumper, A., Martel, M. M., & Eisenlohr-Moul, T. A. (2025). Dimensional Affective Sensitivity to Hormones across the Menstrual Cycle (DASH-MC): A transdiagnostic framework for ovarian steroid influences on psychopathology. Molecular psychiatry, 30(1), 251–262. https://doi.org/10.1038/s41380-024-02693-4

² Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., Schrodek, E., & Swanson, E. N. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of consulting and clinical psychology, 80(6), 1041–1051. https://doi.org/10.1037/a0029451

A growing body of research points to an association between neurodivergence, joint hypermobility, chronic pain, and anxiety, though this link is not well understood. Health care providers have recognized for years that people with ADHD and autism experience physical symptoms, such as migraines, gut disorders, and pain sensitivity, at a rate higher than the general population. But researchers are now gaining a deeper understanding of how and why hypermobility, which is much more prevalent among people with ADHD and autism, may be a mediating factor in linking neurodivergence, pain, and chronic conditions.

In one study led by Dr. Jessica Eccles, and published in The British Journal of Psychiatry, key brain mechanisms were thought to explain these connections. The study found that differences in the amygdala in people with hypermobility made them more sensitive to pain and anxiety, and it noted that their autonomic functions (symptoms include fatigue, fainting, and gut problems) were disrupted.

In this webinar, Dr. Eccles will explain:

• The link between ADHD, autism, joint hypermobility, and chronic pain, and why these are more common in neurodivergent populations
• The mechanisms of chronic pain, joint hypermobility, inflammatory disorders, and fatigue in autistic children and adults with ADHD
• Findings from the latest research on chronic pain, joint hypermobility, and other inflammatory disorders and processes that are more common in ADHD and autism.
• Treatment options and strategies for managing these conditions.

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Joint Hypermobility, Pain, & Neurodivergence: Resources

• Read: ADHD at the Center: A Whole-Life, Whole-Person Condition
• Read: How ADHD Can Intensify Physical Health Conditions
• Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus
• Read: Comorbid Conditions with ADHD: What Is Your Primary Diagnosis?
• Read: The Gut-Brain Axis Could Accelerate Autism Understanding
• Study: Chronic Fatigue Twice as Likely Among Children with ADHD
• Watch: The Surprising Association Between ADHD & Inflammation
• Slideshow: 6 Types of Anxiety

Obtain a Certificate of Attendance

If you attended the live webinar on May 29, 2025, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Dr. Jessica Eccles is a researcher at the department of Neuroscience at Brighton and Sussex Medical School in the United Kingdom. Her areas of expertise include brain-body interactions, joint hypermobility, liaison psychiatry, and neurodevelopmental conditions.

Dr. Eccles trained in medicine at the University of Cambridge and the University of Oxford, which sparked a keen interest in philosophy and brain-body interactions. She completed her PhD in the relationship between joint hypermobility, autonomic dysfunction, and psychiatric symptoms. She is a recognized expert in brain-body medicine and a researcher and educator, and is chair of the Neurodevelopmental Psychiatry Special Interest Group at The Royal College of Psychiatrists.

Dr. Eccles and her team have published papers on the brain-body interactions between neurodivergence, emotion regulation and proprioception (the body’s ability to sense its own position and movements without having to rely on visual input alone), and the role of neurodivergence and inflammation on chronic fatigue in adolescents.

Dr Eccles also led a study which found that neurodivergent people are more than twice as likely as the general population to have hypermobile joints and are far more likely to experience pain on a regular basis.

In 2024, Dr. Eccles was the winner of the Research Pioneer Award conferred by The Ehlers Danlos Society for her hypermobility research.

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
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Women are raising their voices against long-established male-centric thinking about ADHD and demanding diagnostic criteria that reflect the female experience of ADHD. Most diagnostic tools have been developed by men and screen for symptoms seen in boys with ADHD, a huge impediment to proper care and treatment for girls and women with the condition. Even the questionnaires that are considered gender normed — meaning adjusted to ensure equal rates across genders — ask male-centric questions but require fewer points for a female to meet the threshold for a clinical diagnosis.

For example, the Adult ADHD Self-Report Scale (ASRS) is widely accepted as a standard screener for identifying adults with ADHD. This questionnaire, like many others, was developed by males to identify traits consistent with the male-centric Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria.

How Screeners Fail Women

All six of the most salient items on the ASRS describe most men with ADHD, while only three pertain to most females. Individuals must respond with “sometimes,” “often,” or “very often” to at least four of the questions to warrant further assessment for an ADHD diagnosis, causing an obvious problem for women.

[Get This Free Guide: ADHD Diagnosis for Women]

Here’s my analysis of the three problematic questions:

1. How often do you have trouble wrapping up the final details of a project once the challenging parts have been done?

This question implies that an intellectually challenging project becomes difficult to complete after it’s no longer interesting. The “projects” many women face are mountains of laundry, dishes piled in the sink, managing kids’ schedules, and grocery shopping. Completing these tasks is not related to losing interest; these projects were never interesting to begin with.

2. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
Because many women fall into the predominantly inattentive category, they are less likely to routinely fidget or squirm.

3. How often do you feel overly active and compelled to do things, like you were driven by a motor?
Again, because women are predominantly inattentive, they are not “driven by a motor.”

Due to the working of these questions, few women with ADHD would ever reach the “four or more” requirement to indicate that further ADHD investigation is warranted. Even when follow-up does take place, no clear guidelines exist to tell clinicians how ADHD impacts females. When ADHD is misdiagnosed or undiagnosed and untreated, the consequences can be extremely serious.

[Get This Free Download: Hormones and ADHD in Women]

Better Training = Accurate Diagnoses

Clinicians need better training to recognize the unique ways that ADHD impacts and manifests in women. For example, women are more likely than men to experience:

• co-occurring anxiety and depression that can be viewed inaccurately as the primary cause for their inattention and feelings of overwhelm
• feelings of overwhelm and failure in response to unreasonable societal expectations that they are unable to meet
• intense reactions to social rejection
• social isolation
• hidden symptoms due to masking and strong efforts to compensate
• emotional regulation problems
• hormone-related symptom variation
• self-harm, psychiatric hospitalization, and suicidality
• domestic abuse

One of the most urgent needs in the ADHD community is more gender-appropriate diagnostic criteria and treatment approaches for females. We must continue to speak out until the medical community responds appropriately and effectively.

Diagnostic Criteria for ADHD: Next Steps

• Learn: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.
• Symptom Test: Signs of ADHD in Girls and Women
• Understand:Why We Need U.S. Guidelines for Adults with ADHD

Kathleen Nadeau, Ph.D., is the author of more than a dozen ADHD-related books, including her most recent, Still Distracted After All These Years: Help and Support for Older Adults with ADHD. (#CommissionsEarned)

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Deficits in working memory, response inhibition, and processing speed are present not only in individuals with ADHD but also in their family members without the condition, according to a new study published in the Journal of Psychopathology and Clinical Science that suggests these shared cognitive deficits may be “endophenotypes,” or measurable genetic traits that essentially act as biomarkers for ADHD. 1

The multilevel meta-analysis found that “unaffected first-degree relatives” (parents, siblings, or children) of individuals with ADHD performed significantly worse than non-ADHD controls in working memory, processing speed, response time variability, temporal processing, and cognitive flexibility. However, unaffected first-degree relatives did not display significant differences in inhibition, arousal, motor functioning, planning, or delay aversion compared to the control group.

“This is an incredibly important study,” Russell A. Barkley, Ph.D., said recently on his YouTube channel. “This study suggests that there is a larger endophenotype within families of people with ADHD, such that first-degree relatives show some symptoms and signs of the disorder. Think of it as an iceberg; underneath the surface lies the variability in the genetic endophenotype within these families. Then above the surface is a smaller peak, that’s the diagnosed people with ADHD.”

The researchers said that more studies focusing on basic cognitive functions, like working memory and cognitive flexibility, are needed to better understand how genes predispose someone to ADHD and how these genetic factors interact with other influences to cause ADHD symptoms.

Subthreshold ADHD

Identifying and studying potential ADHD endophenotypes may help researchers better understand subthreshold ADHD, which may be experienced by individuals who display ADHD symptoms but not to the severity or frequency required for a formal ADHD diagnosis.

“People with subthreshold ADHD may not exhibit impairing symptoms before age 12, as required in the current DSM-5 for a diagnosis. However, these undiagnosed, untreated adults may experience significant distress later in life and face an elevated risk for substance abuse, burnout, and professional and personal problems as a result,” said Maggie Sibley, Ph.D., a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, during the 2024 American Professional Society of ADHD and Related Disorders (APSARD) conference.

Sibley cited research from the 2022 Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) study showing that 63.8% of people with ADHD experienced symptom fluctuations throughout their lives. “We need to recognize that ADHD symptoms are not stable; they wax and wane over the lifespan,” she said. “Even individuals with mild, non-clinical symptoms can experience fluctuations that temporarily send their symptoms or impairment severity into the clinical range.”2

Sibley expanded on the MTA data in “ADHD’s Vanishing (and Reappearing) Act,” an article in the Spring 2025 issue of ADDitude magazine. “Most adults today with new diagnoses of ADHD probably did not develop their symptoms in adulthood,” she wrote. “Instead, they were likely missed, or they had mild, non-clinical symptoms in childhood that became more impairing as life’s demands multiplied. The study suggested that ADHD is more likely to be missed in childhood in females and minorities. People with intellectual gifts or supportive environments are more likely to compensate for their ADHD in childhood, so symptoms appear milder.”

Sources

¹ de la Paz, L., Whitney, B.M., Weires, E.M., Nikolas, M.A.(2025). A meta-analytic evaluation of cognitive endophenotypes for attention-deficit/hyperactivity disorder: Comparisons of unaffected relatives and controls. J Psychopathol Clin Sci. https://doi.org/10.1037/abn0000985

² Sibley, M.H., Arnold, L.E., Swanson, J.M., Hechtman, L.T., Kennedy, T.M., Owens, E., Molina, B.S.G., Jensen, P.S., Hinshaw, S.P., Roy, A., Chronis-Tuscano, A., Newcorn, J.H., Rohde, L.A. (2022). MTA Cooperative Group. Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD. Am J Psychiatry. https://doi.org/10.1176/appi.ajp.2021.21010032

Music exerts powerful, and largely positive, forces on the brain regions responsible for decision-making, memory, mood, and comprehension, according to decades of research. ^{1, 2, 3, 4, 5} But what types of music work best for individuals with ADHD? Two new studies suggest that stimulating music, and specifically songs with strong, targeted amplitude modulations, promotes attention and improves cognition in adults with ADHD symptoms.

Why ADHD Brains Prefer Stimulating Music

A peer-reviewed study published in the journal Communications Biology found that music with strong, targeted amplitude modulations (AM + Music) sustains attention for people with ADHD symptoms by engaging the brain regions responsible for cognitive control. ⁵

“We were interested to see if music with different acoustic properties would affect people differently depending on their attentional capacity,” the researchers wrote. “If so, people with attentional deficits, such as symptoms of ADHD, may need specifically designed focus music.”

For the study, researchers conducted four experiments that measured participants’ sustained attention while completing tasks and listening to either AM + Music, control music (with slow amplitude modulations), or pink noise.

The amplitude-modulation music in the research was provided by Brain.fm, a functional music app that combines original compositions with audio technology developed through a collaboration with researchers at MIND lab and funded, in part, by the U.S. National Science Foundation, Brain.fm’s music includes targeted amplitude modulation — rhythmic pulses not typically found in music — designed to impact the brain patterns associated with cognitive control. The music does not contain any vocals or strong melodies.

Participants who received AM + Music as the first music condition significantly outperformed those who received other music conditions first during the initial experiment. The researchers measured the sustained attention of the 83 participants with ADHD using the Sustained Attention to Response Task (SART), a computerized task that tests and measures consistent focus.

“People with ADHD benefit from ‘rhythmic entrainment,’ using strong, steady rhythms to imprint structure and consistency,” said Roberto Olivardia, Ph.D., a clinical psychologist and Clinical Instructor of Psychology at Harvard Medical School. “This assists with regulation of attention and behavior.” Olivardia discussed the Communications Biology study in a presentation at the 2024 Annual International Conference on ADHD titled “We Got the Beat: The Impact of Music on ADHD.”

The researchers then reproduced the same task and background conditions in two neuroimaging experiments using fMRI and EEG to study the brain’s response to the different types of music and task-related activities. These results showed significantly higher activation in multiple brain regions related to executive function during the AM + Music condition than in the other two conditions.

Forty participants had their EEGs recorded while they performed the SART task under the same three background music conditions. The EEG measurements revealed greater stimulus brain-coupling (where two or more brains exhibit synchronized neural activity) during the presence of AM + Music.

“These results suggested that amplitude modulation could underlie the difference in performance observed in the first experiment and the differences in functional network activity observed in the second experiment,” the researchers wrote.

What Is Amplitude Modulation?

Amplitude modulation is a technique for creating sounds and effects, such as tremolo, vibrato, or phasing (when multiple musicians perform the same musical pattern at different times).

“All music contains modulation to some degree, but it isn’t controlled to impact brainwaves systematically,” Psyche Loui, Ph.D., Associate Professor of Creativity and Creative Practice and Director of the Music, Imaging, and Neural Dynamics Laboratory (MIND Lab) at Northeastern University, told ADDitude.

Loui describes low modulation levels as barely perceptible, “like a gentle thrumming,” and high levels might be quite noticeable, like a “distant helicopter.”

“Higher levels of modulation will have a stronger effect on the brain but may be considered intrusive or annoying to neurotypical people,” says Loui, a lead researcher on the study.

The study’s final experiment included music that differed only in the rate or depth of amplitude modulation. Brain.fm’s music includes targeted amplitude modulation — rhythmic pulses not typically found in music — designed to impact the brain patterns associated with cognitive control. The music does not contain any vocals or strong melodies.

The researchers found that participants who were more likely to have ADHD, based on self-reported symptoms, performed significantly better over time listening to heavily modulated music than did participants without ADHD symptoms.

“We know that these modulations in music drive neural oscillations (brainwaves) at the same fast rates, namely, Beta waves (12-20Hz),” Loui says. “Our current hypothesis as to why this helps is that ADHD brains need a boost in these brainwaves to function best. The ADHD brain needs strong stimulation to really kick it into gear, so to speak.

“Brain.fm adds modulation to music that is strong, regular, and most importantly, faster than modulation you would find naturally in music,” she continues. “The music consistently encourages your brainwaves to stay in a pattern associated with focus.”

While the study’s results suggest that listening to heavily modulated music could increase focus and sustained attention in people exhibiting ADHD symptoms, it does not rule out alternative types of music.

“All types of music can sustain attention for someone with ADHD,” Olivardia says. “It is really an individual decision and depends on context. When reading, I listen to instrumental music. When trying to go to sleep, Enya is my go-to. When writing, it is often loud, cacophonous punk music. It is whatever grounds someone.”

Charting Differences in Music Preferences

A recent study published in Frontiers in Psychology found that the music listening habits of young adults with ADHD symptoms differ from those of their neurotypical peers during both less cognitively demanding activities (e.g., cleaning, cooking, or engaging in sports) and more cognitively demanding activities (e.g., studying, learning, writing, problem-solving, etc.). ⁶

The study found that young adults with ADHD symptoms listen to significantly more background music (BM) while studying and engaging in sports and other less cognitively demanding activities than do their neurotypical peers. The amount of time spent listening to BM while participating in more cognitively demanding activities did not significantly differ between the two groups.

Based on online survey responses, researchers found significant differences between the study’s control group (316 young adults) and its ADHD group (118 young adults likely to have ADHD based on self-reports) regarding preferences for certain musical characteristics and styles. The ADHD group had a significantly stronger preference for stimulating music compared with the control group during more and less cognitively demanding activities; a higher percentage of the control group reported preferring relaxing music.

“Young adults screened with ADHD may seek additional stimulation to maintain their cognitive engagement, especially during activities like studying, where mind wandering can be more common due to its boring and monotonous nature,” the researchers wrote.

During More Cognitively Demanding Activities

The ADHD group preferred listening to:

• classical or opera (36.4%)
• pop (32.2%)
• alternative or indie (25.4%)

The control group preferred listening to:

• pop (44.9%)
• classical or opera (34.8%)
• jazz or blues (27.2%)

During Less Cognitively Demanding Activities

The ADHD group preferred listening to:

• pop (53.3%)
• rap or hip-hop (33.9%)
• popular songs from their culture (30.5%)

The control group preferred listening to:

• pop (57.9%)
• dance/techno/electronic music (34.5%)
• popular songs from their culture (28.8%)

Select Your Soundtrack

Check out the ADDitude Spotify channel for playlists by and for ADHD brains based on suggestions from ADDitude readers and editors.

Brain.fm is offering a free 30-day trial to ADDitude readers at https://go.brain.fm/additude
Yearly ($5.83/month, $69.99/year) and monthly ($9.99) subscriptions are available.

Sources

¹ Park, J.I., Lee, I.H., Lee, S.J. et al. (2023). Effects of music therapy as an alternative treatment on depression in children and adolescents with ADHD by activating serotonin and improving stress coping ability. BMC Complement Med Ther 23, 73. https://doi.org/10.1186/s12906-022-03832-6

² Kraus, N. and B. Chandrasekaran. (2010). Music training for the development of auditory skills. Nature Reviews Neuroscience 11(8): p. 599-605. https://doi.org/10.1038/nrn2882

³ Chanda, M.L., Levitin, D.J. (2013). The neurochemistry of music. Trends Cogn Sci. 17(4):179-93. https://doi.org/10.1016/j.tics.2013.02.007

⁴ Zimmermann, M. B., Diers, K., Strunz, L., Scherbaum, N., and Mette, C. (2019). Listening to Mozart improves current mood in adult ADHD – a randomized controlled pilot study. Front. Psychol 10:1104. https://doi.org/10.1016/j.tics.2013.02.007

⁵ Woods, K.J.P., Sampaio, G., James, T. et al. (2024). Rapid modulation in music supports attention in listeners with attentional difficulties. Commun Biol. 7, 1376. https://doi.org/10.1016/j.tics.2013.02.007

⁶ Lachance, K., & Gosselin, N. (2025). Listening habits and subjective effects of background music in young adults with and without ADHD. Frontiers in Psychology15, 1508181. https://doi.org/10.1016/j.tics.2013.02.007

ADDitude magazine asked practitioners who specialize in ADHD about their clients’ toughest problems, and the strategies that move them in the right direction. Here is what they said.

Identify the Benefits

Ari Tuckman, Psy.D.

As Russell Barkley, Ph.D., has famously said, ADHD is not about knowing but about doing. This is especially true with co-occurring conditions that make it even harder to get going. I have engaged in some great conversations in session about what to do and how to do it, but then faced disappointing weeks when clients struggled to follow through – again.

It’s easy with ADHD to feel like too much of life is about avoiding negatives, so I make a point of talking about the positives that clients will gain from doing what we discuss. For example, walking into a work meeting feeling confident rather than hoping to be ignored. Or getting into bed earlier tonight so you’ll be more effective tomorrow and then have time after work to meet up with friends.

We all benefit from working toward something that is important and meaningful. Anxiety and depression can steal this sense of purpose, so you need to figure out what that is for you. This will become your source of real, lasting motivation.

Value Persistence Over Perfection

Sharon Saline, Psy.D.

I really enjoy the outside-the-box thinking that people bring to our sessions – their humor, their intelligence, their candor about their strengths and limitations, and their sensitivity. In my office, laughter is often mixed with personal insights, curiosity, and tears.

[Get This Free Download: Get the Adult’s Guide to Treating ADHD]

The main challenges I see in my work with clients with ADHD: consistently inconsistent motivation, a hallmark of ADHD, mixed with perfectionism and helplessness. All of my clients sincerely want to change but wrestle with how. They are willing to try a new technique or take a risk, but they struggle with persistence, unrealistic standards, and self-esteem. They become discouraged and give up.

When this occurs, we begin by exploring the obstacles they face, patterns that might be recurring, and any past successes that could be applied to this situation. We work together to adjust their expectations about “success,” look for something to re-engage them, and then pivot to trying again with new tweaks and a different perspective. This process helps them regroup, aim for steadiness instead of perfectionism, and feel empowered.

Determine the Conditions at Play

Roberto Olivardia, Ph.D.

ADHD rarely travels alone. Yet many patients are unaware of the hand that ADHD plays in the etiology, presentation, and/or course of their other conditions – which may be unidentified or misdiagnosed. This is particularly true of ADHD in adults, since many symptoms mimic and overlap with traits of other disorders.

Patients are perceived as complicated when previous treatment methods seem ineffective. However, a primary reason for this is the clinical underappreciation of ADHD. Even when ADHD has been diagnosed, many patients are told that ADHD treatment is secondary to treatment of “more serious” problems. Meanwhile, untreated ADHD often undermines the treatment of other conditions. Patients feel unfixable.

[Read More from Dr. Olivardia]

My role is to empathically work with a patient to place all the pieces of the diagnostic puzzle on the table. You have to inquire about each of the problems to capture the story of the symptoms. For example, not sleeping for three consecutive days could be a symptom of a manic episode, a cocaine-fueled bender, a depressive episode, or because you were writing your senior honors thesis (and I have experience in this) after your ADHD had you put it off until 72 hours before the deadline.

As clinicians, we always have to ask, “What diagnosis is driving the bus?” – especially when multiple diagnoses are present. Only then can we properly put the puzzle pieces together and deliver to our patients the heartfelt message that they are not broken but simply needed more time and examination for the proper treatment to be effective.

Put On Your Own Oxygen Mask First

Dawn K. Brown, M.D.

Women of color with ADHD carry an immense load. They balance careers, family life, and societal expectations while managing ADHD, not to mention other conditions like anxiety or hormonal imbalances. I always tell my patients that taking care of themselves is not optional. In a world that often expects them to be last, they must intentionally choose to put themselves first. Without that, everything else falls apart.

I begin by helping them create a personal roadmap for managing life with ADHD. For instance, I had a patient who was a single mother with a demanding career. She felt overwhelmed, always chasing her to-do list but never catching up. We started by breaking down her day, prioritizing tasks, and integrating time for self-care. I introduced her to time-blocking: setting specific times for work, family, and herself. She also used organization apps, like Todoist, to break down tasks into smaller, manageable steps. Over time, she learned to delegate more responsibilities at home and let go of the pressure to do everything perfectly.

We also focused on setting boundaries. For many women of color, there’s pressure to be everything to everyone. I encourage my patients to set limits and say “no” without guilt. This might mean communicating with family about their need for quiet time or asking for help at work to lighten the load.

Unite and Conquer

Paul Mitrani, M.D., Ph.D.

My adult clients report frequent problems in relationships, especially when they have ADHD and their partner does not understand the difficulties it brings, like forgetting to do things or neglecting to share responsibilities. When must-dos fall by the wayside, that’s when trouble begins. It’s important for individuals and their partners to think about how to delegate – this is my strength, this is yours, and this is how we’ll partner up. I also work to educate the partner that this is a medical condition and not just the other person forgetting or not seeming to be as interested in things.

How to Set Emotional Boundaries: Next Steps

• Free Download: Who Can Treat ADHD?
• Read: Realistic Solutions for Managing Life, Time & Emotions
• Read: 33 Ways to Prioritize Your Mental Health

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What if we could more accurately predict someone’s response to a medication and use that information to prescribe a personalized ADHD treatment plan, instead of going through unnecessary trial and error?

These are among the exciting possibilities associated with epigenetic research. As scientists uncover and better understand the epigenetic markers associated with ADHD, the hope is that this information will contribute to the development of new precision medicine toolkits for better detection, monitoring, and treatment formulation. Still, today, we have more questions than answers about epigenetics and its potential utility for ADHD care.

A 101 on Epigenetics

Reading Genes

Genes play an important role in shaping a wide range of traits and characteristics, from hair and eye color to susceptibility to mental health conditions. Yet, genetic influences are less ‘fixed’ than one might think. Epigenetics refers to the study of the biological processes that regulate gene activity during our lifetime, and the array of factors that can impact it.

Think of epigenetic processes as collections of chemical “tags” that regulate where, when, and to what extent genes are activated or deactivated in the body. One of these types of tags, called methyl groups, can stick to the DNA sequence (a process called DNA methylation) and affect how cells “read” genes, without changing the underlying DNA sequence itself.

[Read: Preconception Experiences of Moms — and Dads — May Influence Babies’ Development]

Consider cell differentiation. All cells have access to the same DNA sequence, yet over 200 cell types exist in the body that look and work very differently from one another. Epigenetic tags allow each of these cells to “read” only the parts of the DNA sequence that are relevant to them, in order to become skin cells, liver cells, brain cells, muscle cells, and other unique cells with the right structure and functions for their specific role.

Environment Matters

Our environment and what we experience in life affects where and how many of these tags attach to our DNA, impacting gene expression. Though identical twins share the same DNA sequence, research shows that they become less and less similar in their epigenetic patterns over time, partly because of unique environmental experiences. As twins get progressively exposed to different environments and make different lifestyle choices, for example, these accumulated experiences become “embedded” at the level of gene functioning.

We care about epigenetics because changes in the ways cells read genes can cause lasting effects on an individual’s development, functions and behaviors. Epigenetic alterations have been linked to numerous poor health outcomes. The field of environmental epigenetics is exploding as researchers race to determine what kind of factors might modulate the way our genes work.

ADHD and Epigenetics: What Could the Future Hold?

Could We Detect ADHD Before Symptoms Emerge?

Today, we are only able to detect ADHD through the subjective evaluation of symptoms, which limits opportunities for very early or even preventive interventions. Far off into the future, we could reach a point where ADHD and epigenetics research will offer us ways to detect risk for the condition well before symptoms emerge. Hypothetically, we’d combine information on epigenetic markers with other genetic and environmental information to build more sensitive risk-prediction models that could be used in clinical settings.

[Read: Prenatal and Early Life Risk Factors of ADHD]

We’re not there yet, but we are developing an ever-growing understanding of epigenetic factors associated with an increased risk for ADHD, including but not limited to the following:

• maternal metabolic conditions in pregnancy^{1 2 3 4 5}
• lower gestational age and birth weight^{6 7}
• stress exposure^{8 9}
• inflammation^{10 11}
• smoking¹²
• nutritional factors such as folate exposure¹³
• exposure to lead and other chemicals^{14 15}

The extent to which these factors are causal – and mediated by epigenetic changes – remains unclear. Another complication is that these risk factors are not exclusive to ADHD; they are associated with other cognitive and neuropsychiatric outcomes.

Findings from recent epigenome-wide studies point in exciting directions. One study found that epigenetic patterns at birth associate prospectively with the severity of ADHD symptoms in mid to late childhood.¹⁶ That is, at birth, there appears to be a relationship between the chemical tags present on certain genes, including those involved in neurodevelopment and cognition, and the severity of ADHD symptoms 6 to 10 years later — an “epigenetic signal” that warrants further exploration for its potential in detecting ADHD, including its course and chronicity, before symptoms emerge.

Could We Prevent or Reverse ADHD?

Even if scientists can map the epigenetic markers associated with ADHD well enough to build sophisticated risk-prediction models, there are important ethical considerations. As with any form of prediction, risk of false positives exists. It’s also possible that an existing risk factor may not materialize into any impairment.

The big question is one of action: What should we actually do if there is a positive screen for ADHD? And what obligation to act may exist for parents, clinicians, and the ADHD community at large, among other stakeholders?

Some studies show evidence that lifestyle interventions — improvements to diet, exercise, and sleep — might help to generally restore epigenetic patterns.^{17 18} Animal studies also show interesting findings: enriching environments and appropriate care can help reverse some epigenetic changes in animals that were exposed to severe stress in early life.^{19 20} Might we be able to target and reverse the chemical tags on DNA through similar interventions? Perhaps, but there’s a lot to consider first, like the high potential for off-target effects. Because the constitution of normal epigenetic patterns remains somewhat unclear, manipulating tags could have unintended consequences.

Could Epigenetics Unlock Precision Treatment for ADHD?

Identifying ADHD Subtypes

To say that ADHD is a heterogeneous condition is an understatement; there is huge variability in onset, clinical presentation, presence of comorbidities, developmental course, level of impairment, and chronicity among individuals. While we’ve attempted to specify presentations of ADHD — predominantly inattentive, predominantly hyperactive/impulsive, and combined presentation — we are simply not yet good at separating and understanding why individuals with ADHD follow such different courses and clinical presentations. Future findings on epigenetic patterns may help to identify more narrow subgroups or subtypes and stratified interventions.

Predicting Treatment Response

Today’s ADHD medications work well for many patients, but a sizable minority — up to 35% — don’t respond to them at all.²¹ The current approach across psychiatry — a trial-and-error process that starts with first-line treatments before moving into second-line approaches — can be tremendously burdensome, time-intensive, and stressful.

In the future, epigenetic profiling may help clinicians predict and monitor therapeutic responses to different types and classes of medications and with greater specificity. What’s more, if epigenetic markers can point to potential causal mechanisms for ADHD, future research could lead to entirely new types of interventions for ADHD.

ADHD and Epigenetic Research: Early Days, Great Potential Ahead

Epigenetics offers a promising, unifying framework for understanding how genes and environment come together at the biological level to shape development and health. Thanks to recent research, we know more about particular genes that might be responsive to the environment and implicated in ADHD. We also know that these are dynamic processes; the specific time during which epigenetic marks are measured might make a huge difference in determining if such marks serve as signals of future ADHD.

As we continue to unravel the epigenetic landscape that contributes to ADHD, we remain hopeful that this knowledge will lead to better strategies for diagnosis and treatment, ultimately improving the lives of those affected by this complex condition.

Epigenetics and ADHD: Next Steps

• Read: The Future of ADHD Research Looks Like This
• Read: Mapping the ADHD Brain — MRI Scans May Unlock Better Treatment and Even Symptom Prevention
• Read: Epigenetics and ADHD — The Impacts of Environment, Lifestyle, and Stress
  

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “Epigenetics: Understanding its Role in ADHD and Future Applications” [Video Replay & Podcast #473] with Charlotte Cecil, Ph.D., which was broadcast on September 28, 2023.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Edlow AG. Maternal Metabolic Disease and Offspring Neurodevelopment—An Evolving Public Health Crisis. JAMA Netw Open. 2021;4(10):e2129674. doi:10.1001/jamanetworkopen.2021.29674

²Perea, V., Simó-Servat, A., Quirós, C., Alonso-Carril, N., Valverde, M., Urquizu, X., Amor, A. J., López, E., & Barahona, M. J. (2022). Role of Excessive Weight Gain During Gestation in the Risk of ADHD in Offspring of Women With Gestational Diabetes. The Journal of Clinical Endocrinology and Metabolism, 107(10), e4203–e4211. https://doi.org/10.1210/clinem/dgac483

³Franz, A. P., Bolat, G. U., Bolat, H., Matijasevich, A., Santos, I. S., Silveira, R. C., Procianoy, R. S., Rohde, L. A., & Moreira-Maia, C. R. (2018). Attention-Deficit/Hyperactivity Disorder and Very Preterm/Very Low Birth Weight: A Meta-analysis. Pediatrics, 141(1), e20171645. https://doi.org/10.1542/peds.2017-1645

⁴MacKinnon, N., Kingsbury, M., Mahedy, L., Evans, J., & Colman, I. (2018). The Association Between Prenatal Stress and Externalizing Symptoms in Childhood: Evidence From the Avon Longitudinal Study of Parents and Children. Biological psychiatry, 83(2), 100–108. https://doi.org/10.1016/j.biopsych.2017.07.010

⁵Dunn, G. A., Nigg, J. T., & Sullivan, E. L. (2019). Neuroinflammation as a risk factor for attention deficit hyperactivity disorder. Pharmacology, biochemistry, and behavior, 182, 22–34. https://doi.org/10.1016/j.pbb.2019.05.005

⁶He, Y., Chen, J., Zhu, L. H., Hua, L. L., & Ke, F. F. (2020). Maternal Smoking During Pregnancy and ADHD: Results From a Systematic Review and Meta-Analysis of Prospective Cohort Studies. Journal of Attention Disorders, 24(12), 1637–1647. https://doi.org/10.1177/1087054717696766

⁷Nigg, J. T., Elmore, A. L., Natarajan, N., Friderici, K. H., & Nikolas, M. A. (2016). Variation in an Iron Metabolism Gene Moderates the Association Between Blood Lead Levels and Attention-Deficit/Hyperactivity Disorder in Children. Psychological science, 27(2), 257–269. https://doi.org/10.1177/0956797615618365

⁸Neumann, A., Walton, E., Alemany, S., Cecil, C., González, J. R., Jima, D. D., Lahti, J., Tuominen, S. T., Barker, E. D., Binder, E., Caramaschi, D., Carracedo, Á., Czamara, D., Evandt, J., Felix, J. F., Fuemmeler, B. F., Gutzkow, K. B., Hoyo, C., Julvez, J., Kajantie, E., … Tiemeier, H. (2020). Association between DNA methylation and ADHD symptoms from birth to school age: a prospective meta-analysis. Translational psychiatry, 10(1), 398. https://doi.org/10.1038/s41398-020-01058-z

⁹Fitzgerald, K. N., Hodges, R., Hanes, D., Stack, E., Cheishvili, D., Szyf, M., Henkel, J., Twedt, M. W., Giannopoulou, D., Herdell, J., Logan, S., & Bradley, R. (2021). Potential reversal of epigenetic age using a diet and lifestyle intervention: a pilot randomized clinical trial. Aging, 13(7), 9419–9432. https://doi.org/10.18632/aging.202913

¹⁰Abraham, M. J., El Sherbini, A., El-Diasty, M., Askari, S., & Szewczuk, M. R. (2023). Restoring Epigenetic Reprogramming with Diet and Exercise to Improve Health-Related Metabolic Diseases. Biomolecules, 13(2), 318. https://doi.org/10.3390/biom13020318

¹¹Gapp, K., Bohacek, J., Grossmann, J., Brunner, A. M., Manuella, F., Nanni, P., & Mansuy, I. M. (2016). Potential of environmental enrichment to prevent transgenerational effects of paternal trauma. Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology, 41(11), 2749–2758. https://doi.org/10.1038/npp.2016.87

¹²Leshem, M., & Schulkin, J. (2012). Transgenerational effects of infantile adversity and enrichment in male and female rats. Developmental Psychobiology, 54(2), 169–186. https://doi.org/10.1002/dev.20592

¹³Childress, A. C., & Sallee, F. R. (2014). Attention-deficit/hyperactivity disorder with inadequate response to stimulants: approaches to management. CNS Drugs, 28(2), 121–129. https://doi.org/10.1007/s40263-013-0130-6

January 24, 2025

Life expectancy for people with ADHD is 7.5 years shorter than it is for those without the condition, according to a new U.K. study published in The British Journal of Psychiatry¹.

This study is the first of its kind to examine the life expectancy of adults with ADHD using mortality data from a large population. It examined the health records of more than 9.5 million people from the IQVIA Medical Research Database and used the life-table method to compare the mortality rates of 30,039 people diagnosed with ADHD to 300,390 people without ADHD.

“Adults with diagnosed ADHD are living shorter lives than they should,” the researchers wrote. “We believe that is likely caused by modifiable risk factors and unmet support and treatment needs in terms of both ADHD and co-occurring mental and physical health conditions.”

Study participants with ADHD were more likely than members of the general population to have co-occurring conditions like autism spectrum disorder, anxiety, depression, and personality disorder — a finding that supports existing research on ADHD’s high comorbidity rate. The U.K. study did not examine the causes of death associated with ADHD or the level of treatment that patients received for ADHD or comorbid conditions.

Gender Disparities in Life Expectancy

Women with ADHD die 8.6 years younger than women without ADHD, while the life expectancy of men with ADHD is 6.8 years shorter than that of their peers, the study found.

“[This] is sort of the inverse of what we would’ve expected given that males engage in more risk-taking, especially males with ADHD, than females, and we know that accidental injuries are one of the biggest causes of early mortality in individuals with ADHD,” said Russell Barkley, Ph.D., a clinical scientist, educator, and practitioner who has published research on ADHD’s impact on life expectancy, in a video on his YouTube channel.

Research shows that women with ADHD experience more psychological distress, anxiety, depression, insomnia, and eating disorders than their male counterparts. They are also more likely than men with ADHD to suffer with low self-esteem, self-harming behaviors, poor social relationships, and emotional dysregulation.

Barkley suggested that the elevated risk for postpartum depression and intimate partner violence among women with ADHD may contribute to the gender disparity seen in mortality rates. Research findings presented by J.J. Sandra Kooij, Ph.D., at last week’s annual meeting of the American Professional Society of ADHD and Related Disorders (APSARD) suggest that elevated rates of heart disease among women with ADHD may also be a factor.

Research cited by Kooij² found that 35% of women at a Dutch cardiovascular clinic had ADHD symptoms throughout their lifetime. Studies on ADHD, heart health, and gender are scarce, and Kooij argued that the high comorbidity of cardiovascular disease with ADHD requires attention.

“Untreated ADHD means stress for several reasons,” Kooij said in the presentation. “Stress of having ADHD and being forgetful, stress of having anxiety and depression, stress of maybe inflammation and immune disorders that are accompanying ADHD.”

Why Does ADHD Reduce Life Expectancy?

A 2019 study published in the Journal of Attention Disorders³ examined factors impacting the life expectancy of people with ADHD. This longitudinal study predicted participants’ life expectancy when they reached 27 years using preexisting data on different behaviors and their relation to life expectancy.

“We found that, overall, people who had ADHD in childhood and were followed up to adulthood had reduced life expectancy of about 8.5 years,” said Barkley, a lead researcher in the 2019 study. “Very similar to what the study in the U.K. found.”

According to Barkley’s study, “behavioral disinhibition,” or impulsivity, was at the root of many variables found to reduce life expectancy among adults with ADHD, including:

• years of education
• income
• alcohol use
• smoking
• exercise
• nutrition
• sleep
• risky driving
• and more.

“What’s important here is you’ve got to treat the behavioral inhibition problems before you tackle these other first-order risk factors,” Barkley said. “ADHD treatments, particularly with medications, could be used to reduce this background risk factor, and then we can get on with helping people change these lifestyle and other factors.”

Existing research has also documented the positive impact of ADHD treatment on life expectancy. One Swedish study⁴ found that taking medication for ADHD can lower the risk of mortality by 19%.

“Life expectancy is malleable,” Barkley said. “These factors, virtually all of them, can be changed. Change the factor, change the life expectancy.”

Sources

¹ O’Nions, E., El Baou, C., John, A., Lewer, D., Mandy, W., McKechnie, D. G. J., … Stott, J. (2025). Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study. The British Journal of Psychiatry, 1–8. https://doi.org/10.1192/bjp.2024.199

² Ter Beek LS, Böhmer MN, Wittekoek ME, Kooij JJS. Lifetime ADHD symptoms highly prevalent in women with cardiovascular complaints. A cross-sectional study. Arch Womens Ment Health. 2023 Dec;26(6):851-855. https://doi.org/10.1007/s00737-023-01356-7

³ Barkley, R. A., & Fischer, M. (2019). Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors. Journal of Attention Disorders, 23(9), 907-923. https://doi.org/10.1177/1087054718816164

⁴ Li L, Zhu N, Zhang L, et al. (2024). ADHD Pharmacotherapy and Mortality in Individuals With ADHD. https://doi.org/10.1001/jama.2024.0851