On April 29, the Trump administration announced it was cutting $1 billion in funding for federal grants used to hire and train 14,000 mental health professionals in 260 public school districts across 49 states.

The grants originated in 2022’s Bipartisan Safer Communities Act, a bill that passed the Senate with unanimous consent following the school shooting in Uvalde, Texas, where 22 people died, including 19 elementary school children. The bill was largely seen as important recognition of and support for an escalating mental health crisis among American youth.

In April, the Trump administration eliminated all funding for these grants, blaming Diversity, Equity and Inclusion (DEI) initiatives associated with them. Specifically, the administration objected to grant money being used to train and recruit diverse mental health counselors who reflect the demographic make-up of the students they serve.

Meanwhile, research shows that BIPOC students benefit from access to a diverse cohort of mental health professionals¹, and the inverse is true as well.

“We see studies that show a bias in the way that Black children, in particular, are treated in the health care system compared to white children,” said Tumaini Rucker Coker, M.D., during the ADDitude webinar “Equity in ADHD Care.” “It is directly related to racial bias. Black families are less likely than white families to have concordance or a shared lived experience with their healthcare providers, and studies have shown that Black adults are more likely than white adults to report lower levels of trust in their providers as well.”

[Read: “As Inclusion Disappears, My Mask Reappears”]

Furthermore, “studies show that Black families tend to have worse outcomes with white doctors,” said Napoleon B. Higgins, Jr., M.D., during his ADDitude webinar “Health Equity in ADHD.” “That is that is a sad thing to hear, but if we can educate more providers, maybe we could change that.”

Recently, ADDitude invited its readers’ reflections on news of the $1 billion in cuts to youth mental health services. Nearly 200 people responded, and many of them expressed concern that all students’ mental health may suffer because of the cuts, but especially those with autism, ADHD, and learning differences, who may benefit from seeing school counselors with similar lived experiences.

[Read: “DEI – and Neurodivergence – Are Under Attack”]

ADDitude Readers React to Mental Health Funding Cuts

“As a school social worker and the parent of a child who has an IEP, I consider Trump’s cuts to funding for public school mental health to be gross negligence. I think that it highlights his ignorance on the issues plaguing our youth. I also find it irresponsible. Our kids still are not okay ever since COVID. I believe that it will impact the services that my son receives.”

“Students need to feel safe and be OK within themselves before they can take in the knowledge to learn anything. Cutting access to mental health services means that students who are at-risk learners due to factors outside a school’s or educator’s control may become disengaged learners. This leads to more problematic and potentially anti-social behavior.”

“As a former teacher of students with disabilities, I am concerned. Students need safe places to go and get mental health support. Parents are doing their best but don’t always have the resources to support their children.”

“All three of my children are neurodiverse, and this can take a toll on their mental health. Having supports like counselors, DEI programs, and other accessibility programs is vital. I now have two children in college and one entering high school.”

“I am a school counselor and my son has ADHD. We’re already incredibly behind on providing mental health services to students. These cuts are only going to significantly increase the percentage of students whose health needs are hardly or never addressed.”

“Every child should have the support they need to excel in school. School mental health services are critical for this.”

“I don’t understand why we are defunding mental health awareness, advocacy, and resources. It really doesn’t make any sense to me. It seems like we had made such strides forward in mental health, but now we’re going backward for some reason. I understand cutting expenses to cut spending and improve the national deficit, but it seems like we are cutting very vital and necessary things. It’s like trying to cut back on your own budget by deciding to not buy groceries anymore.”

Understanding Trump’s Funding Freeze: Next Steps

• Read: Generation AnXiety — Findings on ADHD & the Mental Health Crisis
• Learn:Youth Mental Health Care Is Vital. And Hard to Access.
• Watch: Mental Health Out Loud Webinar

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
McGuire, TG., Miranda, J. (March-April 2008). New evidence regarding racial and ethnic disparities in mental health: policy implications. Health Affairs.https://doi.org/10.1377/hlthaff.27.2.393

Six weeks ago, the autistic community sounded the alarm when U.S. Health and Human Services Secretary Robert F. Kennedy, Jr., called autism a “preventable disease” caused by unknown “environmental toxins,” and vowed to root out its causes within six months. Shortly thereafter, the head of the National Institutes of Health (NIH) announced that it would begin amassing private medical records from commercial and federal databases, including those operated by the Centers for Medicare and Medicaid Services (CMS), to provide health data for Kennedy’s proposed autism study, according to NPR.

This proposed NIH-CMS database would reportedly include information from wearable health devices, insurance claims, and online medical records. An NIH official said, “The real-world data platform will link existing datasets to support research into causes of autism and insights into improved treatment strategies.”

Kennedy initially said the NIH-CMS database would fuel a series of research studies to “identify precisely what the environmental toxins are that are causing” autism by September; he recently pushed back that date by six months or more. Meanwhile, autism scientists, medical practitioners, and advocates have expressed concern and even outrage over Kennedy’s apparent dismissal of existing autism research and the recent resignation of a top NIH scientist who accused the Kennedy-run organization of research censorship.

Though Kennedy insists the database is not an “autism registry,” privacy concerns remain high. Currently, autism databases do exist in seven U.S. states, including Delaware, Indiana, North Dakota, New Jersey, Rhode Island, Utah, and West Virginia. However, rules of consent for these state databases set them apart from the NIH-CMS database, which reportedly pulls in medical information from insurance claims and medical records without first securing patient consent.

In its May 22 MAHA Report, Kennedy’s MAHA Commission confirmed its plans to “expand the NIH-CMS autism data initiative into a broader, secure system linking claims, EHRs, and environmental inputs to study childhood chronic diseases.” Details remain unclear, however ADDitude recently asked readers to share their thoughts and reactions to this news.

Overall, a majority of the 194 respondents expressed privacy concerns, citing possible violations of HIPAA laws in relation to the NIH-CMS database. They also remained largely unconvinced that this database could unlock answers about the causes of autism within 6 to 12 months, considering that global researchers have been working to solve that puzzle for decades.

Some respondents reported experience with state-level databases and expressed a desire for the NIH to institute a nationwide support network for autistic people and their families, but most expressed skepticism that this database would achieve that goal. Following are more than a dozen comments shared by ADDitude readers.

“Nothing About Us Without Us!”

“I believe that collecting and studying medical records related to autism can be valuable — but only if it is done ethically, with full transparency, and with the informed consent of individuals and families. Trust, privacy, and the protection of autistic people’s rights should be at the center of any such effort.”

“I have not knowingly participated. But being AuDHD and on Medicaid for ADHD makes me very much a part of this. This makes me very nervous. I feel more anxiety about discrimination than I do hope about research breakthroughs.”

“I understand the exceptional possibilities of researching, connecting, and resourcing families touched by autism. However, (this database) must be paired with mandatory ethical guidelines and government-backed regulations to ensure that families, students, job applicants, etc. are not discriminated against if their status can be ‘looked up.'”

“Voluntary registration to connect with others: Great idea. Government oversite of such a registry? No way. Every administration has its own agenda, and you have no way of knowing how the information will be used. It smacks of lack of privacy, lack of safety, lack of internet security, and especially the possibility for abuse of power over the vulnerable.”

“Both my college-aged and teenage children who are autistic are against the idea of a registry. They feel it could be used to track them and their personal information without their consent. They also feel this is preferred more by parents than actual autistic people, who often do not get to voice their experiences to professionals. Many teenage and adult autistic people are begging for a voice in this conversation!”

“Connecting to supports is important but a nationwide registry is not necessary to facilitate this. It could (and in my opinion, would) be used for purposes that would not benefit and could cause major harms to the families and/or the children who are on the ‘list.’ This is a major moral, ethical, and privacy issue. What kinds of data management would be put in place to ensure that individuals as well as families and communities (especially Indigenous peoples and other vulnerable communities) have control over how, when, where, and why the data is accessed?”

“How about a voluntary registry? Long-term data is good, but there needs to be consistency and confidentiality. This should not be done without full consent of the people being studied. Nothing about us without us!”

“I am fearful that a national registry of those identified on the autism spectrum could be used against them rather than to help link them to supports.”

“I am horrified as I fear for an unjust use of this data. As a clinical therapist, I am almost reluctant to record ADHD and ASD as diagnoses. This is a frightful reversal to our cultural values in which I grew up.”

“I feel like the idea of an ‘autism registry’ is being created for the wrong reasons. While it may be presented as a tool for research or support, it raises serious concerns about privacy and potential misuse. A centralized list of autistic individuals could easily be weaponized — whether intentionally or through systemic bias — and used to deny people opportunities in areas like employment, housing, education, or even healthcare. It could lead to increased surveillance, reinforce harmful stereotypes, and deepen the stigma that already exists around autism.”

“Most of the current communities that provide services to autistic individuals are the de facto registries and are also (in theory) under HIPPA disclosure standards. I do not trust that setting up a brand-new registry would be up to that standard of protecting the rights and privacy for individuals and families.”

“I support the opportunity for connections, but the availability for others to use personal medical data without consent is abominable. I fear this information will be used against people in hiring and in obtaining benefits. I have several autistic co-workers, and I am scared for them.”

“If this was for research only, or to sign up for some valid benefit, it wouldn’t feel so ominous. But the way this is being handled, it feels like a target list, and I don’t trust that those added to these lists won’t suffer in some way or another, like loss of economic opportunities.”

“It feels like an invasion of privacy to force individuals into a registry. It also further perpetuates the narrative that autistic and neurodivergence is a problem or needs to be ‘fixed’. It truly brings me despair. We deserve better, and everyone deserves education on things they don’t personally relate to/are directly related to.”

“The amassing and studying records are steps of good science. But I don’t trust the intentions, the word, or the medical judgement of the people who want to do the amassing and studying in this case. I hope those with legal standing will try to stop these actions.”

Autism Registry Proposed by the MAHA Commission: Next Steps

• Analysis: MAHA Report – 3 Takeaways for the ADHD Community
• Read: RFK Jr., Is Spreading a Dangerous, Ignorant Myth About Autism
• Learn: MAHA Commission Means Fear, Stigma, Health Threats for Two-Thirds of ADDitude Readers
• Background: MAHA Commission Draws Swift Criticism, Condemnation

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.

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

Defiant behavior may manifest as a child easily (and frequently) losing their temper, arguing with adults because of rules, or acting out violently. Reports suggest that 40% of children with ADHD experience oppositional and/or defiant behavior. ¹

[Free Download: Why Is My Child So Defiant?]

Behavioral disorders may stem from the deficits in executive functioning so commonly seen in ADHD, which can affect individuals’ abilities to plan, prioritize, and execute. All of this impacts the individual’s life — and the lives of those around them.

Family dynamics may be caught in the crossfire as children get frustrated with their caregivers, and caregivers tire of scaffolding a routine of daily tasks that their kids have difficulty sticking to, leading to nagging, frustration, and defiant behavior.

[Free Resource: Is It More Than Just ADHD?]

Studies suggest that some parenting techniques are more effective than others in addressing defiant behavior among children with ADHD, specifically. Such techniques can be especially useful in helping parents establish routines with their children.

Prescription ADHD medication used in conjunction with behavioral parent training helps many families learn how to best stem and respond to defiant behavior, as outlined in the ADDitude article, “ Why Is My Child So Angry and Defiant? An Overview of Oppositional Defiant Disorder” and in the recent webinar, “The Power of Behavioral Parent Training .”

In a recent survey, ADDitude asked its readers whether their children with ADHD displayed defiant behaviors and, if so, how those behaviors affected family dynamics. Several respondents said have felt a significant impacted and that they are struggling to develop productive and healthy responses.

Life with My Defiant Child

“Everyday, every request is a battle. A simple request such as, ‘Please brush your teeth’ or ‘Let’s finish your homework,’ turns into a fight. We are all on edge and really dread homework time, dinner time, and bedtime.”

“Having a child with ADHD often comes with some oppositional defiance challenges. Things can be going smoothly, and then, out of nowhere, something that seems minor to you can trigger a reaction, setting off a chain of events.”

“It takes a lot of mental energy to get through the days, especially when you also have ADHD and the emotional dysregulation is tough. Your other kids suffer because you are always focused on getting the child with ADHD through the day. My daughter is nearly 18, and I think we are slowly coming out the other side. It isn’t a straight path, and we have tried many different things — different schools, sports, medication, psychiatrists, psychologists. I think you just have to hold on for the ride and get through each day.”

“It is so hard. No matter what we do, our daughter pushes us away and refuses to do simple necessary activities, like brushing her teeth and getting dressed. She’s 8 years old, and I wonder if this behavior is ever going to end. It is very taxing when everyone else is ready, and we still have a defiant child refusing to get ready.”

Parenting Techniques to Address Defiant Behavior

“Both of my ADHD kids appear defiant when they are anxious and trying to control the situation, or when they feel overwhelmed. In those circumstances, they return a reflexive ‘no’ to every question before they have the chance to think about it. This has impacted our lives far less since we learned to slow down and figure out what is happening in their heads rather than let the behavior shake us.”

“Telling them to do something will never result in it getting done. You need to gently ask and convince them to do it.”

“Almost every time I ask my son to do something, even if it is something he likes or a simple request, he instinctively says no. It took a while, but I realized I could wait a few minutes for him to actually process what I said, and then gently repeat my request. He would usually have no problem complying once given the time to mentally process and transition. This break means he can communicate his thoughts, and we can discuss with cool heads.”

“My daughter has a history of oppositional defiance since a young age. It often looks like her needing to do something opposite of what we ask for the sake of being opposite. With the help of a child psychologist, we’ve worked hard as a parenting team to praise/reinforce following rules, and this has worked well to stem this behavior.”

My Defiant Child: Next Steps

• Read: “The Parents’ Guide to Dismantling Oppositional, Defiant Behavior“
• Watch: ““From Battles to Bonding: A Parent’s Guide to Trading Defiance for Cooperation“
• Free Download: “Why Is My Child So Defiant?“

Sources

¹ Riley M, Ahmed S, Locke A. “Common Questions About Oppositional Defiant Disorder.” American Family Physician (Apr. 2016). https://www.ncbi.nlm.nih.gov/pubmed/27035043

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

ADHD symptoms are impacted by changes in sex hormone levels in females across the lifespan, finds a new systematic review published in the Journal of Attention Disorders.¹ The review included 11 studies that investigated puberty, pregnancy, postpartum, and the menstrual cycle and tracked changes in symptomology and in the efficacy of ADHD medication during these times.

“There is an ADHD experience that is unique to females,” the study’s authors concluded. “Recognizing potential influences of sex hormones on ADHD symptoms in females may have key implications to clinical management and treatment of ADHD.”

The study included several key findings.

Sex Hormones and ADHD During Menstrual Cycle

The research reviewed four studies that explored the fluctuation of ADHD symptoms during the menstrual cycle. The following associations were identified:

• Early luteal phase: increased impulsivity and hyperactivity²
• Mid-luteal phase: increased emotional dysregulation, executive dysfunction, inattention³
• Late luteal phase: increased inattention and executive dysfunction, and mental health symptoms such as depression, irritability and anxiety⁴

Linking these symptom trends to increase and decrease of specific female hormones, the authors wrote: “Inattention symptoms may be related to decreasing estrogen and moderated by progesterone, whereas hyperactive/impulsivity symptoms may similarly be driven by reducing estrogen levels, though without effect of progesterone.” ⁵

These significant shifts in symptom severity were vividly described by Chloe, an ADDitude reader, in an article titled “Menstrual Cycle Phases and ADHD.” “The entire week leading up to my period is where my ADHD symptoms get even more intrusive than usual,” she wrote. “My executive functioning dips even lower, distractibility and difficulty focusing is increased, and my mood/energy level is much lower, causing me to feel badly about all the things I’m not being successful at that week.”

The review found that increasing stimulant dosage premenstrually resulted in improvement of ADHD and mood symptoms, including emotional dysregulation. This point was echoed in the lived experience of many ADDitide readers, who reported that their typical medication dosage seems less effective in the luteal phase of their cycle. Norma, a reader from Wisconsin wrote: “The week leading up to my cycle, I might as well not even take my ADHD meds. It’s like my body overrides them.”

Sex Hormones and ADHD in Pregnancy and Postpartum

The review included one study investigating ADHD in pregnancy.⁶ Three groups of pregnant women were included: those who discontinued ADHD medication, those who continued, and those who took medication as needed.

The study found hyperactivity symptoms were significantly lower and both mood and family functioning were better among the women who continued medication compared to those who discontinued. Other ADHD symptoms did not differ between the groups, leading researchers to theorize that, for some, the high estrogen of pregnancy may ameliorate certain ADHD symptoms. Because just one study was reviewed, and its sample size was small, the authors stressed that more research is required to contextualize the results.

Allison Baker, M.D., lead author for the study included in the review, wrote about her findings in an article for ADDitude, “Treating for Two:” “Women who discontinued stimulant treatment during pregnancy were more likely to experience conflict within their family, rate parenting as more difficult, and report feeling more isolated. Those who discontinued stimulants but did not stop taking their antidepressant medication, experienced a clinically significant increase in depression.”

While the study did not investigate an association between ADHD and postpartum depression, other studies have found that 17% of women with ADHD experience PPD compared to 3.3% of women without ADHD. and 25% experience postpartum anxiety disorders, compared to 4.61% of women without ADHD.⁷

“New mothers with ADHD face distinct postpartum challenges that are as ubiquitous as they are unstudied,” wrote Baker in “Postpartum Care for Mothers with ADHD.” “The months following the birth of a baby are uniquely difficult, and women with ADHD do not usually receive the medical support and treatments they need during this time.

Future Research on Hormones and ADHD

Understanding the role that sex hormones play on ADHD symptoms in women has far-reaching implications for diagnosing the condition and treating it. The review’s authors put forth the following interventions as possible ways to improve ADHD symptoms exacerbated by female hormones:

• premenstrual adjustment of stimulant dose ⁸
• use of hormonal therapies to stabilize estrogen and progesterone levels during menopause⁹ for those who struggle with PMDD ¹⁰

The main limitation of the review, authors acknowledged, is the small number of studies included, many of which include small sample sizes. “To advance our understanding of ADHD in females, research that seeks to understand the mechanisms underlying how sex hormones may influence ADHD symptoms is essential,” they wrote, calling for a multi-disciplinary approach that combines assessments of hormone levels with neurocognitive, brain imaging, genetic, or neurophysiological investigations.

This call for research was echoed in the ADDitude magazine article “Hormonal Changes in Women with ADHD: 4 Gaping Holes in Research,” written by five leading experts on ADHD in women, including Michelle M. Martel, Ph.D., a lead author of several of the studies included in the review. “We know that hormones collide with ADHD to cause heightened mood dysregulation, memory problems, and impulsivity each month,” the authors explained. “But 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.”

Sources

¹Osianlis, E., Thomas, E. H. X., Jenkins, L. M., & Gurvich, C. (2025). ADHD and Sex Hormones in Females: A Systematic Review. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547251332319

²Roberts B., Eisenlohr-Moul T., Martel M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015

³Bürger I., Erlandsson K., Borneskog C. (2024). Perceived associations between the menstrual cycle and Attention Deficit Hyperactivity Disorder (ADHD): A qualitative interview study exploring lived experiences. Sexual & Reproductive Healthcare, 40, Article 100975. https://doi.org/10.1016/j.srhc.2024.100975

⁴de Jong M., Wynchank D. S. M. R., van Andel E., Beekman A. T. F., Kooij J. J. S. (2023). Female-specific pharmacotherapy in ADHD: Premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, 14, Article 1306194. https://doi.org/10.3389/fpsyt.2023.1306194

⁵Eng A. G., Nirjar U., Elkins A. R., Sizemore Y. J., Monticello K. N., Petersen M. K., Miller S. A., Barone J., Eisenlohr-Moul T. A., Martel M. M. (2024). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and Behavior, 158, Article 105466. https://doi.org/10.1016/j.yhbeh.2023.105466

⁶Baker, A. S., Wales, R., Noe, O., Gaccione, P., Freeman, M. P., & Cohen, L. S. (2020). The Course of ADHD during Pregnancy. Journal of Attention Disorders, 26(2), 143-148. https://doi.org/10.1177/1087054720975864

⁷Andersson, A., Garcia-Argibay, M., Viktorin, A., Ghirardi, A., Butwicka, A., Skoglund, C., Bang Madsen, K., D’onofrio, B.M., Lichtenstein, P., Tuvblad, C., and Larsson, H. (2023). Depression and Anxiety Disorders During the Postpartum Period in Women Diagnosed with Attention Deficit Hyperactivity Disorder. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.01.069

⁸de Jong M., Wynchank D. S. M. R., van Andel E., Beekman A. T. F., Kooij J. J. S. (2023). Female-specific pharmacotherapy in ADHD: Premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, 14, Article 1306194. https://doi.org/10.3389/fpsyt.2023.1306194

⁹Herson M., Kulkarni J. (2022). Hormonal agents for the treatment of depression associated with the menopause. Drugs & Aging, 39(8), 607–618. https://doi.org/10.1007/s40266-022-00962-x

¹⁰Appleton S. M. (2018). Premenstrual syndrome: Evidence-based evaluation and treatment. Clinical Obstetrics and Gynecology, 61(1), 52–61. https://doi.org/10.1097/GRF.0000000000000339

The anticipated MAHA Commission report released yesterday misrepresents ADHD causes and care in the U.S., misinterpreting studies and disregarding compelling new research and patient voices to suggest that ADHD is contributing to a “crisis of overdiagnosis and treatment” in American children.

The MAHA Report, spearheaded by Health and Human Service (HHS) Secretary Robert F. Kennedy, Jr., equates ADHD with obesity, heart disease, and diabetes in calling these harmful contributors to the “childhood chronic disease crisis” in the U.S. It disregards the genetic underpinnings of ADHD to suggest it is solely caused by environmental factors and foods, twists data to stoke fear over rising diagnosis rates, and excludes a wealth of studies that link stimulant medication use to improved health outcomes.

It assumes ADHD is a disease caused and cured by environmental factors. And it suggests that curing ADHD will “make America healthy again.” We disagree, and so does the research.

Should the U.S. government take a long, hard look at the impact of ultra-processed foods, environmental chemicals, and declining physical activity on American children? Absolutely. Should it invest in programs to provide healthy foods, affordable health care, and screen-free activities for all children, regardless of socioeconomic status or means? Yes. Do we support efforts to eliminate toxins from our kids’ food, water, and air? To protect them from unhealthy screen use? To help them live longer, healthier lives? 100%.

Will any of these efforts “cure” ADHD, as the MAHA Report suggests? No, the research does not support that notion. But these efforts, if undertaken by Kennedy, do stand to improve quality of life for many children, and so they should be seriously considered by HHS through investment in the FDA, CDC, and NIH.

Do you know what else improves quality of life for kids? Less stigma and shame, and more investment and solutions. The MAHA Report, sadly, increases ADHD stigma by claiming the condition is overdiagnosed and disparaging its treatment as ineffective without any credible evidence to support these claims. On the flipside, it makes no mention of the proven, life-saving benefits of ADHD treatment or the risks associated with undiagnosed, untreated ADHD. It makes no mention of behavioral parent training, cognitive behavioral therapy, dialectical behavior therapy, or classroom interventions for ADHD, all of which are shown to improve outcomes for individuals with ADHD. Instead, the report’s “solutions” for ADHD suggest more scrutiny of and restricted access to stimulant medication.

Finally, it is notable that the commission included few scientists or experts in pediatric health care. The commission conducted no new research and it apparently did not seek comment or insight from the American Professional Society of ADHD and Related Disorders (APSARD), the American Academy of Pediatrics (AAP), or the World Federation of ADHD regarding the established science on ADHD causes and treatments. No patients were interviewed for or quoted in the report.

The next steps outlined in the report are vague and we expect the commission to propose more detailed strategies in August, but here are three takeaways from the May 22 MAHA Report that may impact the ADHD community.

#1: The Report Misrepresents the Causes of ADHD

ADHD is a highly genetic condition, as confirmed by brand-new research that identified measurable genetic traits that essentially act as biomarkers for ADHD. Lifestyle factors such as nutrition, exercise, and sleep exert epigenetic changes on DNA that influence how strongly or weakly ADHD genes are expressed. However, diet, physical activity, sleep, or screen use alone do not cause — and have not been shown to “cure” — ADHD.

Scientific research has established no causal link between consumption of sugar, food additives, or food dyes and ADHD, though some studies show a heightened sensitivity among children with ADHD to these foods, which may exacerbate existing symptoms. Likewise, scientific research has established no causal link between excessive screen time, video game play, or social media use and ADHD.

Despite clear evidence to the contrary, the MAHA Report claims that ADHD is caused by all of the following, but it never mentions genetic factors:

• Antibiotics: The report cited as evidence a study that “could not disentangle the effects of antibiotics from those of the underlying conditions” and “could not verify adherence to antibiotic prescriptions.” Other recent studies have found gut microbiome alterations in children with ADHD but no causal link between antibiotic use and ADHD in humans.
• Food additives: Research shows that food dyes may worsen symptoms of inattention or hyperactivity in children with ADHD, however there is no evidence of a causal relationship.
• Environmental toxins: This article by Joel Nigg, Ph.D., contains a thorough overview of all existing research on environmental toxins and ADHD, but the bottom line is this: “Genes and environments work together to shape development of the brain and behavior throughout life, but especially — and most dramatically — in very early life. ADHD, like other complex conditions, doesn’t have a single cause. Both nature and nurture influence its development.”

#2: The Report Casts Doubt on the Validity of an ADHD Diagnosis

The MAHA Report claims that “research shows ADHD has the strongest evidence of overdiagnosis,” however no such research is cited in the report. Perhaps that is because there is no definitive evidence that ADHD is overdiagnosed in America today. ADHD diagnosis rates have increased over the last few decades, however this may be a result of any of the following, and other factors:

• The high diagnosis rate cited in the report comes from a problematic and misleading CDC study that is “terribly designed to assess the prevalence of the disorder,” says Russell Barkley, Ph.D., a leading authority on ADHD. “In this survey, there is one question about ADHD: ‘Has a doctor or other healthcare provider ever told you that this child has ADD or ADHD?’ That could be anybody associated with the healthcare profession who has no training in ADHD… and there is no effort in this study to follow up to see if these children were, in fact, diagnosed.” Barkley goes on to say that meta-analyses of better-conducted studies that apply diagnostic criteria to their research populations find that the prevalence of ADHD among children ranges from 5 to 8 percent, not 10 to 11 percent.
• Revised diagnostic criteria published in the DSM-5 changed the age of onset from 7 to 12 and added the first-ever qualifier symptoms for ADHD in adulthood
• With ongoing research and clinician training on ADHD, education and symptom recognition have improved
• Twenty years ago, ADHD was viewed as a disorder that affected young males. As research on females began to take hold, girls and women were able to secure ADHD evaluations for the first time
• Likewise, as mental health stigma dissipates within time, historically underserved populations are seeking care for the first time

The report further suggests that “the harms associated with an ADHD diagnosis may often outweigh the benefits” without naming those supposed harms or acknowledging the many health risks associated with undiagnosed ADHD. Research shows that undiagnosed and untreated individuals face a higher risk for fatal car accidents, unwanted pregnancies, serious injury and hospitalizations, job loss, academic interruptions, self-harm, anxiety, depression, eating disorders, and more. The harms associated with undiagnosed ADHD are too severe to ignore, yet the MAHA Commission does just that.

#3: The Report Misrepresents the Efficacy and Risks of ADHD Medication

The MAHA Report draws faulty conclusions from the ​​Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) study to argue that ADHD medication use offers no benefits “in grades, relationships, achievement, behavior, or any other measure” after 14 months of use. This is untrue.

In reality, the MTA study ended after 14 months, so the control group members with ADHD who did not initially receive medication were free to seek it out after 14 months. As many of the controls began treating their ADHD symptoms with medication, the differences between the control and treatment groups faded because the control group members began to improve on medication, not because the treatment group began to do worse. It is wrong and irresponsible to suggest that no patients experienced benefits from ADHD medication use after 14 months.

“The groups became very contaminated after that 14-month follow-up,” Barkley says in a video on his YouTube channel. “Therefore, we can’t make comparisons at years 2, 3, or 4 between or among the treatment groups and draw any conclusions about them because the treatments were mixed up among all the groups.”

The report claims that stimulants, “when stopped, often lead to disabling and prolonged physical dependence and withdrawal symptoms.” This is untrue. The research cited in the report was a study of antidepressants, not stimulants. There is no evidence to support this assertion regarding stimulant medication. In addition, we know that half of teens and adults with ADHD stop taking stimulant medication within one year of starting it, often due to stigma or access problems. This suggests that it is not addictive. In fact, stimulant medication has been used safely and effectively for nearly 100 years — more than enough time for long-term adverse outcomes to come to light, yet none has.

Finally, the report’s claim that stimulant medication use does “not improve outcomes long-term” is also false.

Research dating back more than 40 years has documented the positive impact of ADHD treatment on specific symptoms like inattention and hyperactivity, and on life expectancy overall. Recently, a Swedish study, published in JAMA Network Open, documented these findings:

• ADHD medication use reduced overall risk of death by 19%. Among people with ADHD who did not receive medication, there were 48 deaths for every 10,000 people, contrasted with 39 deaths per 10,000 people within the medicated cohort.
• ADHD medication use reduced the risk of overdose by 50%. Medication use also reduced the risk of death from other unnatural causes, including accidental injuries, accidental poisoning such as drug overdoses, and suicide.
• ADHD medication use reduced the risk of death from natural causes, such as medical conditions, for women.

People with childhood ADHD are nearly twice as likely to develop a substance use disorder as are individuals without childhood ADHD. However, research suggests that patients with ADHD treated with stimulant medications experience a 60% reduction in substance use disorders compared to those who are not treated with stimulant medication. Considerable evidence also suggests that children taking ADHD medication experience improvements in academic and social functioning, which translates to improved self-esteem, lower rates of self-medication with drugs or alcohol, and decreased risk of substance abuse.

Given all of the above, it’s difficult to view the increase in stimulant medication use flagged by the MAHA Report as anything but positive. “Why isn’t that evidence of improvement in good public mental health?” Barkley asks. “The fact that there is a rise in the occurrence of a particular treatment does not provide prima facie evidence that there is something bad, wicked, evil, wrong going on here; it simply means that, over time, we are getting closer and closer to identifying conditions that produce harm in individuals, and that we try to alleviate that harm and suffering.”

The Threat to ADHD Care Access

The MAHA Commission plans to release its recommended strategies in August, but it’s easy to see the writing on the wall now. The arguments presented in Thursday’s MAHA Report, based largely on outdated or poorly interpreted research, suggest that Kennedy may seek to restrict access to ADHD care and that he’s building a foundation of doubt and misinformation now to support that action.

We fear efforts to dissuade physicians from diagnosing and treating ADHD may be forthcoming from the Drug Enforcement Administration (DEA) with support from the CDC, which Kennedy oversees. Of course, we hope we are proven wrong. We hope that, instead, HHS chooses to fully restore funding for ADHD research efforts through the National Institutes of Mental Health, for mental healthcare initiatives through the CDC, and for nationwide nutrition assistance programs through the FDA.

ADDitude supports an investment in unbiased research into the root causes of and effective treatments for ADHD to support, not ‘cure,’ individuals living with neurodivergent brains. We welcome the opportunity to engage in transparent dialog with the MAHA Commission and to introduce the voices and viewpoints of individuals and families living with ADHD, which were excluded from this report. And we hope that this administration will fund initiatives to improve food quality and access, eliminate harmful food additives, provide mental health services to all children, and crack down on the industries and companies contributing toxins to our environment.

We also stand ready to defend the legitimacy of the robust library of credible, science-backed research studies that confirm ADHD’s genetic underpinnings, that validate its diagnostic tools, and that confirm the benefits of its uninterrupted treatment.

Reactions from the ADHD Community

Mark Bertin, M.D., PLLC, of Developmental Pediatrics

“Lifestyle changes that promote child health are a wonderful idea. However, the MAHA paper ignores the reality of ADHD, a common medical disorder with genetics nearly as strong as the inherited trait of height. Undertreated ADHD is a public health concern that affects school performance, relationships, and driving; increases the risk of substance abuse; and shortens lifespans. Research and clinical experience show clear benefits to ADHD medication, which has been used for a century without evidence of chronic side effects. Supporting individuals with ADHD requires more understanding, not less, while making medical, educational, psychological, and health-related supports affordable and easily available. The MAHA document completely misrepresents ADHD in ways that are judgmental, demeaning, and will be harmful to individuals, our health care system, and society.”

Russell Barkley, Ph.D.

The ADHD Evidence Project, Founded by Stephen Faraone, Ph.D.

“ADHD is one of the most discussed neurodevelopmental disorders in the MAHA Report, but many of its claims about ADHD are misleading, oversimplified, or inconsistent with decades of scientific evidence, much of which is described in the International Consensus Statement on ADHD, and other references given here.”

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.

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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

ADHD and schizophrenia are distinct neurodevelopmental disorders with some overlapping symptoms, such as inattention, impulsivity, weak working memory, and emotional dysregulation. Symptoms of schizophrenia may also include hallucinations, delusions, and paranoia. Understanding how ADHD fits into this diagnostic picture, and untangling overlapping symptoms, leads to better treatment approaches and outcomes.

While most people with ADHD will never develop schizophrenia, these factors increase risk: family history of schizophrenia, adverse childhood experiences or trauma, and abuse of psychoactive substances, such as marijuana that contains elevated levels of THC.

Schizophrenia typically emerges in the late teens through early thirties. ADHD can be diagnosed at any age, though it usually emerges in the early grade school years.

[Watch: “Understand How ADHD and Schizophrenia Overlap”]

ADHD and Schizophrenia: Treatment Options

When treating comorbid schizophrenia and ADHD, a priority must be to treat any psychosis with first-generation antipsychotics such as Haldol and Trilafon, or second-generation antipsychotics such as Abilify and Risperdal. Antipsychotics can be taken orally in the form of daily pills or as injectables. Recent innovations have yielded exciting new medications, such as injectables effective for as long as three months, and other promising new interventions are on the horizon. Antidepressants, mood stabilizers, or anti-anxiety drugs may also help in treating associated symptoms of schizophrenia, as do adjunctive therapies such as cognitive behavioral therapy and family therapy.

Only after the psychosis is under control can clinicians clearly identify symptoms associated with ADHD and prescribe treatment. ADHD is associated with low dopamine levels in the brain, and most ADHD medications are intended to increase these. Patients with schizophrenia tend to have high dopamine levels, so doctors must exercise caution when prescribing stimulants to them. If medication increases dopamine levels further, this may exacerbate schizophrenia by worsening psychosis.

[Read: Why ADHD Brains Crave Stimulation]

Under the consistent care of a clinician, patients with schizophrenia who adhere to their medication regimen tend to do very well. No matter a condition’s treatment challenges, I understand a patient and their symptoms more fully every time I see them. I learn from what we’ve tried, bringing us closer to getting a medication combination just right. This kind of treatment takes trial and error, thoughtfulness, and time spent with a doctor.

ADHD and Schizophrenia: Next Steps

• Read: When It’s Not Just ADHD – Symptoms of Comorbid Conditions
• Read: ADHD Comorbidity – An Overview of Dual Diagnoses
• Read: A Clinician’s Guide to Impulsive Aggression

Napoleon B. Higgins, Jr., M.D., is a child, adolescent, and adult psychiatrist in Houston, Texas. He is the owner of Bay Pointe Behavioral Health Services and Kaleidoscope Clinical Research.

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.

Misdiagnosis is a significant barrier to care. Black children and adolescents with ADHD are more likely to be labeled with oppositional defiant disorder and to have their ADHD symptoms misunderstood as defiance. Also, cultural stigma surrounding mental health can prevent Black families from seeking care and from using ADHD medication when it is prescribed. Black parents report a preference for interventions like parent training and executive function skills training, to which their access is often limited.

One possible solution: integrated primary care, in which behavioral health services are embedded within primary care practices. When children go to a pediatrician appointment, they may also see a behavioral health care specialist for common concerns like depression, anxiety, and a range of disruptive behaviors from failing to follow caregivers’ directions to disrupting the classroom.

[Read: ADHD Clinicians Must Consider Racial Bias in Evaluation and Treatment of Black Children]

Integrated primary care can address the treatment disparities in Black youth by enabling more personalized, collaborative treatment for ADHD and its co-occurring difficulties. Parents should ask their pediatrician whether an in-office behavioral health specialist is available. Additionally, many primary care practices affiliated with academic medical centers or children’s hospitals have integrated primary care clinics.

Mental Health Stigma in ADHD Care: Next Steps

• Learn: Why We Need Clinicians of Color to Normalize ADHD in BIPOC Communities
• Read: Evaluating and Treating ADHD in African American Children: Guidance for Clinicians
• Watch: “Health Equity in ADHD: Addressing Racial Disparities in Diagnosis and Treatment” [Video Replay & Podcast #495]

Heather A. Jones, Ph.D., is an associate professor of psychology at Virginia Commonwealth University.
Alfonso L. Floyd, Ph.D., is a postdoctoral fellow in the Department of Child & Adolescent Psychiatry and Behavioral Sciences at The Children’s Hospital of Philadelphia.

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.

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

As many as 62% of kids with ADHD receive a diagnosis and a prescription for medication without a recommendation for any type of parent behavior training or family therapy, according to the American Academy of Pediatrics. In a recent ADDitude survey, 57% of parents said they had participated in parent training. Of those, an astounding 93% recommended it.

Caregivers exert the greatest influence on their kids’ lives, and, let’s be honest, raising a child with ADHD can be extremely challenging. Parents may become frustrated, lose their temper, make allowances for inappropriate behaviors, or just give up in the face of relentless negative habits and attitudes. This is where parent behavior training, also called behavioral parent training (BPT), can help.

Moving from Reactivity to Proactivity

Parent training refers to a series of interventions designed to help caregivers learn effective strategies to manage their own emotions as well as their child’s behavior. The goals revolve around using positive reinforcement, setting effective boundaries, and providing scaffolding to increase positive connections, reduce negativity, and enhance a child’s successes.

This type of training helps parents learn to be proactive rather than reactive. The reactive parent responds to a child’s behaviors with threats of punishment based on intense feelings rather than logical thinking. Punishment fails to work in the long term because children with ADHD will need other options in their toolkit.

[Free Download: Your Guide to Parent Training Programs]

A good parent behavior training program can do the following:

• Teach parents real-world strategies for positive reinforcement and consistent discipline.
• Teach self-regulation, de-escalation, and calming strategies.
• Improve parent-child communication through reflective listening and accountability.
• Help parents set realistic expectations and routines based on their child’s skills and abilities.
• Replace reactive parenting with proactive strategies that rely on incentives rather than threats.

6 Popular Training Programs

The most effective parent training programs increase positive parent-child interactions by elevating the quality of attachment, the ability to communicate effectively, and the willingness to set and enforce boundaries. Here are six programs popular among families living with ADHD.

Parent-Child Interaction Therapy

Format: A therapist in an observation room watches parents interact with their child in real time. Parents wear an earpiece to receive in-the-moment parenting strategies from the therapist.

Goals:

• To help your child feel calm, confident, and secure in your relationship
• To learn how to be confident and calm in the face of your child’s most difficult behaviors

The Incredible Years

Format: Trained facilitators use video vignettes to present content and stimulate discussion. Separate programs are offered for parents of toddlers, preschoolers, and school-age children.

Goals:

• To strengthen parent-child interactions
• To foster parents’ ability to promote kids’ social and emotional development
• To reduce school dropout rates and delinquent behaviors
• To promote academic success

[Free Webinar: “The Power of Behavioral Parent Training for ADHD”]

Positive Parenting Program (Triple P)

Format: This online program is designed for two groups: parents of children ages 12 and under, and parents of children ages 10 to 16. The program provides a mix of videos, worksheets, tips, and activities that take 30 to 60 minutes to complete.

Goals:

• To set discipline guidelines
• To build parent confidence
• To raise happy children

Helping the Noncompliant Child

Format: Training sessions for parents and children ages 3 to 8. Skills are taught using active teaching methods, such as extensive demonstration, role play, and real-time practice.

Goals: To foster positive interaction by:

• Reducing parental coercive behaviors
• Giving positive attention to the child for appropriate behavior
• Setting limits and consequences

Parent Management Training

Format: Parents of children with moderate to severe behavioral difficulties work with a certified trainer online, in person, or over the phone.

Goals:

• To teach parents how to help their children cultivate positive behavior
• To learn how to effectively deal with anxiety and negative behavior

GenerationPMTO

Format: GenerationPMTO is an intervention program that is provided to individual families or parent groups, in person or via telehealth. The structure of individual training programs differs by location, both nationally and internationally.

Goals:

• To promote social skills that reduce delinquency, deviant peer associations, and mood disorders in parents and youths

Tips for Finding a Provider

Ask these key questions when interviewing a prospective therapist, coach, or program administrator:

1. What is your education in a particular parent behavior training model? Do you hold a certificate, license, or other accreditation in your field?
2. What is your training in ADHD and child development?
3. How do you monitor and support your clients’ progress?
4. What additional support is available after the program ends?

Behavioral Parent Training (BPT): Next Steps

• Free Download: 5 Ways to Improve Emotional Control at Home
• Read: How Does Behavior Therapy Work?
• Read: When Behavioral Parent Training is Working — But Tough to Maintain
• Sign Up: Parenting Class for ADHD Families

Sharon Saline, Psy.D., is a clinical psychologist and author.

Ryan Wexelblatt, LCSW, is a school social worker, camp director, and father to a son with ADHD and learning differences.

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