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

Children and adolescents with avoidant restrictive food intake disorder (ARFID) are more likely to have comorbid neurodevelopmental and psychiatric disorders like autism, ADHD, and anxiety, according to a new study¹ published in The Journal of Child Psychology and Psychiatry.

Among the 30,795 children included in the large-scale study, those with ARFID (n=616) were 14 times more likely to have autism and nine times more likely to have ADHD than were children without ARFID. They also demonstrated an increased risk for OCD, separation anxiety, generalized anxiety disorder (GAD), depression, learning disorders, conduct disorder, and more.

These results stand out amid the relatively scarce research data on ARFID, an eating disorder added to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) in 2013.

“This study is one of the few large-scale epidemiological investigations of ARFID comorbidities in a general population sample,” the researchers wrote. “The findings emphasize the importance of incorporating routine screening for neurodevelopmental disorders, anxiety, and depression into ARFID assessments.”

Individuals with ARFID avoid foods based on sensory characteristics, a lack of interest in eating, and/or fear-related concerns over adverse eating experiences — not due to the body image concerns that compel other eating disorders like anorexia nervosa. ARFID is characterized by a “failure to meet appropriate nutritional and/or energy needs.”

Despite affecting 1-2% of children and adolescents², ARFID is often excluded from eating disorder discourse and clinical examinations. ARFID’s high comorbidity can complicate symptom identification, according to researchers.

“It’s important to really think about those with ADHD being at risk for a variety of eating disorder thoughts and behaviors, not just binge eating,” said Christine Peat, Ph.D., in a 2024 ADDitude webinar, “Eating Disorders Comorbid with ADHD: What You Need to Know About ARFID, Anorexia, and Others.” “In clinical contexts, ARFID and atypical anorexia nervosa may be overlooked, even in very routine eating disorder screenings.”

The study’s results emphasize the importance of identifying ARFID, the diagnosis of which may shed light on comorbidities.

“Early identification of these comorbidities can facilitate timely, targeted interventions and improve treatment outcomes,” the researchers wrote.

One ADDitude reader, Tiffany Bird, suffered decades of poor health before being diagnosed with ARFID in her late 20s. “For the first time, a doctor fully examined me and determined that I’ve been severely malnourished my entire life, no matter what ‘the numbers’ might have said. It made complete sense,” wrote Bird in an ADDitude guest blog post, “I went Over 25 Years Without Consuming a Vegetable.”

ARFID and Neurodevelopment Disorders

The study examined parent reports for 30,795 children born between 1992 and 2008, at 9 or 12 years old (depending on their cohort), from the Child and Adolescent Twin Study in Sweden. The parents rated their child using three measures of neurodevelopmental and psychiatric disorders: the A-TAC inventory, the Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Short Mood and Feelings Questionnaire (SMFQ). The researchers examined the relationship between having ARFID and showing symptoms of other disorders using linear and logistic regressions.

The link between ADHD and ARFID found in the study reflects preliminary research in this area. According to Peat, one study found that 25% of adults with ARFID also had ADHD, and another reported that 10% of children and adolescents with ARFID had been diagnosed with ADHD at some point in their lives.

“We are so far from having causal explanations for this overlap,” Peat said. “But maybe kids and adults with ADHD are just sort of more biologically predisposed to have difficulty with sensory characteristics with food, so maybe that makes them more vulnerable to going on to develop something like ARFID.”

The study’s results regarding autism and ARFID also mirror prior research. One meta-analysis reported that autism was present in 16% of individuals with ARFID³.

People with ARFID are more likely to have autism than those without, and vice versa, possibly due to heightened sensory issues and inflexibility due to anxiety around change, both symptoms of autism, according to an article in ARFID Awareness UK.

ARFID and Psychiatric Disorders

According to the study, children with ARFID were four to six times more likely to have a psychiatric disorder, with OCD and anxiety presenting the greatest risks.

The most common type of anxiety found in the study was separation anxiety, which contrasts previous research that found GAD to be more common. This could be because of the younger age of onset characteristic of separation anxiety or younger age of the sample, the researchers wrote. However, they also hypothesize another reason their results differed.

“One hypothesis worth exploring is that separation anxiety is increased in ARFID because children fear separation from caregivers due to the potential for unanticipated exposure to feared foods or feeding-related situations,” the researchers wrote.

The study also found a higher rate of oppositional defiant disorder (ODD) (19.4%) than reported in previous studies, suggesting a possible overlap of symptoms between the two disorders.

“Our findings suggest that food-related conflicts may underlie the observed risk of ODD in ARFID, but further research is needed to confirm this association,” the researchers wrote.

Children with ARFID were found to face a higher risk for anxiety than depression. Depression is common among children with other eating disorders, according to the researchers. This discrepancy in comorbidities highlights the differences between ARFID and other eating disorders.

“The defining feature [of ARFID] is a persistent and pervasive eating or feeding disturbance in which someone is simply not meeting all of their nutritional needs,” Peat said. “In ARFID, these people don’t necessarily have that fear of fat or fear of weight gain.”

Gender and ARFID

Prior research may suggest that ARFID is more common in young males. However, this study found no gender-based differences in comorbidity rates associated with ARFID, meaning that the likelihood of having symptoms of another disorder in conjunction with ARFID did not significantly differ based on sex.

The results did indicate that, overall, boys had higher odds of developing a neurodevelopmental disorder, depression, and sleep problems; girls had higher rates of anxiety disorders (except for panic disorder).

“Unlike other eating disorders, the distribution of males and females with ARFID has been reported to be approximately equal,” the researchers wrote. “Given the sex differences observed in the prevalence of (neurodevelopmental disorders) and psychiatric conditions, it is important to investigate whether these sex differences are also present in individuals with ARFID.”

The study’s sample did not include transgender and nonbinary youth, a major limitation considering that transgender, nonbinary, and gender-expansive kids are at higher risk for eating disorders compared with their cisgender peers.

“There remains an urgent need to develop integrated treatment approaches that address both ARFID and its co-occurring conditions,” the researchers wrote.

Sources

¹ Nyholmer, M., Wronski, M.-L., Hog, L., Kuja-Halkola, R., Lichtenstein, P., Lundström, S., Larsson, H., Taylor, M.J., Bulik, C.M. and Dinkler, L. (2025), Neurodevelopmental and psychiatric conditions in 600 Swedish children with the avoidant/restrictive food intake disorder phenotype. J Child Psychol Psychiatr. https://doi.org/10.1111/jcpp.14134

² D’Adamo, L., Smolar, L., Balantekin, K.N., Taylor, C.B., Wilfley, D.E., & Fitzsimmons-Craft, E.E. (2023). Prevalence, characteristics, and correlates of probable avoidant/restrictive food intake disorder among adult respondents to the National Eating Disorders Association online screen: A cross-sectional study. Journal of Eating Disorders, 11, 214. https://doi.org/10.1186/s40337-023-00939-0

³ Sader M, Weston A, Buchan K, Kerr-Gaffney J, Gillespie-Smith K, Sharpe H, Duffy F. (2025) The Co-Occurrence of Autism and Avoidant/Restrictive Food Intake Disorder (ARFID): A Prevalence-Based Meta-Analysis. Int J Eat Disord. 58(3):473-488. https://doi.org/10.1002/eat.24369

ADHD is not a prerequisite for social anxiety, but many adolescents, teens, and young adults with ADHD do suffer from hidden fears about being embarrassed or humiliated in social situations. These worries about what others think of them appear in the diagnostic criteria for social anxiety disorder as described in the Diagnostic and Statistical Manual of Mental Disorders.

However, this definition of social anxiety excludes other ways in which some people suffer with fears, such as how others may perceive or disapprove of them. These fears are not tied to how they perform in social situations. Instead, these fears relate to aspects of their behavior, thoughts, or wishes that may be seen as inappropriate by others. These fears, sometimes fueled by shame, sound like this: “What would other people think about me if they knew what I was thinking?” This type of social anxiety isn’t talked about much and less than half of those affected seek treatment.

What does research say about the causes and effects of social anxiety among those with and without ADHD? Which treatments and interventions work best to help and support students in social situations?

In this webinar, you will learn:

• About the genetic, family, and environmental factors that contribute to social anxiety
• How to recognize social anxiety through real-life examples and case studies
• About common fears at different ages and stages
• Why students are often reluctant to seek help for excessive worries
• How untreated social anxiety can lead to higher risk of dropping out of school, higher rates of unemployment, and suffering a decreased sense of wellbeing
• About effective treatments and interventions for social anxiety

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Social Anxiety: More Resources

• Free Download: Social Anxiety Facts and Falsehoods
• Self-Test: Social Anxiety Test for Teens
• Read: “Help! My Child Won’t Go to School.”
• Read: You’re Not Shy or Stuck Up. You Have Social Anxiety Disorder.
• Read: 6 Cognitive Distortions That Fuel Anxiety in ADHD Brains

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Meet the Expert Speaker

Thomas E. Brown earned his Ph.D. in Clinical Psychology at Yale University and served on the clinical faculty of the Department of Psychiatry at Yale School of Medicine for 20 years while operating a clinic in Connecticut for children and adults with ADHD and related problems. In May 2017, he relocated to California where he opened the Brown Clinic for Attention and Related Disorders in Manhattan Beach.

He has taught continuing medical education courses on ADHD for the American Psychiatric Association for 18 years and has given lectures and workshops in hospitals, medical schools, universities and for professional and advocacy groups throughout the United States and in more than 40 other countries.

Dr. Brown is Clinical Professor of Psychiatry and Neuroscience at the University of California Riverside School of Medicine and is an elected Fellow of the American Psychological Association, The APA Division of Psychopharmacology and Substance Abuse, and the Society of Clinical Child and Adolescent Psychology. He has published 30 articles in professional journals and seven books on ADHD, including Smart, but Stuck: Emotions in Teens and Adults with ADHD; Outside the Box: Rethinking ADD/ADHD in Children and Adults-A Practical Guide, and ADHD and Asperger Syndrome in Smart Kids and Adults: Twelve Stories of Struggle, Support and Treatment; and Social Anxiety: Hidden Fears and Shame in Teens and Adults.

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Leaded gasoline and exposure to its exhaust may help explain an estimated 151 million U.S. cases of psychiatric disorders, including ADHD, depression, and anxiety, according to a new cross-sectional study spanning the last 75 years published in the Journal of Child Psychology and Psychiatry.¹

Exposure to leaded gasoline from car exhaust was tied to population-wide cases of mental health disorders from 1940 to 2015 by researchers from Duke University, Florida State University, and the Medical University of South Carolina. They estimated that more than half of the current U.S. population was exposed to harmful levels of lead in childhood, resulting in profound effects on their mental health, personality traits, and overall well-being. People born between 1966 and 1986 (referred to as Generation X) experienced the highest rate of lead exposure and are at the greatest risk for anxiety, depression, ADHD, and personality changes.

“Research on lead as a developmental neurotoxicant is robust,” says Joel Nigg, Ph.D., a clinical psychologist and a professor in the departments of psychiatry and behavioral sciences at Oregon Health & Science University. “Its correlation with ADHD is also well established. Even low levels of exposure have an effect on ADHD.”², ³

Nigg was the principal investigator on several studies suggesting that lead exposure has a causal role in ADHD. One study published in Psychological Science found that children with ADHD who had the HFE C282Y gene mutation exhibited significantly more symptoms of hyperactivity and impulsivity than did children with ADHD who lacked the mutation.⁴

“Because the C282Y gene helps to control the effects of lead in the body, and the mutation was spread randomly in the children, it is difficult to explain these findings unless lead is, in fact, part of the cause of ADHD, not just associated with it. Numerous animal studies also support a link,” he says.

Leaded Gasoline Exposure Is a Public Health Crisis

Nigg’s study and others have linked lead exposure to life-long mental, physical, and behavioral issues; lowered IQ points; and personality changes.⁵, ⁶, ⁷, ⁸ However, the findings from the Journal of Child Psychology and Psychiatry’s study highlight the historic and pervasive effects of lead exposure on the cognitive and psychological health of a staggering slice of the U.S. population.

“Lead’s potential contribution to psychiatry, medicine, and children’s health may be larger than previously assumed,” the researchers wrote.

The study analyzed lead levels in children’s blood collected for the CDC’s National Health and Nutrition Examination Surveys (NHANES) and correlated that with historic leaded-gasoline data. The researchers calculated “mental illness points” based on the fraction of changes in the mental health of Americans born in different years and the population elevations of mental health symptoms associated with lead exposure.

The researchers identified a cumulative increase of 602 million general psychopathology points across the population, corresponding to an estimated 151 million additional mental disorders. They found that lead exposure heightened the risks for anxiety, depression, and ADHD; increased neuroticism, associated with negative emotionality; and decreased conscientiousness, reflecting less self-control and goal-oriented behavior.

While the study’s results do not prove causation, the researchers say that their findings will provide doctors with insights about their patients’ symptoms and underscore the need for expanded lead testing in patients and the recognition of lead poisoning as a neurodevelopmental disorder within a psychiatric diagnostic framework.

Leaded Gasoline Exposure: Next Steps

Lead was added to gasoline in the 1920s to improve engine performance. During the early childhood years of Generation X, leaded gasoline became the predominant fuel type in the U.S. In the mid-1970s, the U.S. Environmental Protection Agency (EPA) began phasing out leaded gasoline, but a U.S. ban did not go in effect for on-road vehicles until 1996. Lead is still found in some paints, children’s toys, and deteriorating water pipes.

According to The CDC, high levels of lead exposure can lead to seizures, vomiting, memory loss, and even death. Exposure to even small amounts of lead can be harmful. Children 6 years or younger are most vulnerable to lead poisoning, which can cause development and growth delays, hearing and speech problems, difficulty learning and paying attention, and serious illness and death.

Symptoms of lead poisoning can be hard to recognize in children. The CDC recommends discussing possible lead exposure with a child’s healthcare provider and testing children ages 1 to 5 for lead if they:

• Live in a home built before 1978
• Receive Medicaid services
• Are an immigrant, refugee, or adopted from another country
• Live near a known source of lead, such as a lead smelter or mine

Sources

¹McFarland, M.J., Reuben, A. and Hauer, M. (2024). Contribution of Childhood Lead Exposure to Psychopathology in the US Population Over the Past 75 Years. J Child Psychol Psychiatr.https://doi.org/10.1111/jcpp.14072

²Sanders, T., Liu, Y., Buchner, V., Tchounwou, P.B. (2009). Neurotoxic Effects and Biomarkers of Lead Exposure: A Review. Rev Environ Health. https://doi.org/10.1515/reveh.2009.24.1.15

³Nigg, J. T., Knottnerus, G. M., Martel, M. M., Nikolas, M., Cavanagh, K., Karmaus, W., & Rappley, M. D. (2008). Low Blood Lead Levels Associated with Clinically Diagnosed Attention-Deficit/Hyperactivity Disorder and Mediated by Weak Cognitive Control. Biological Psychiatry. 63(3), 325–331. https://doi.org/10.1016/j.biopsych.2007.07.013

⁴Nigg, 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.https://doi.org/10.1177/0956797615618365

⁵Reuben, A., Schaefer, J.D., Moffitt, T.E., Broadbent, J., Harrington, H., Houts, R.M., Ramrakha, S., Poulton, R., Caspi, A. (2019). Association of Childhood Lead Exposure With Adult Personality Traits and Lifelong Mental Health. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2018.4192

⁶Heidari, S., Mostafaei, S., Razazian, N. et al. (2022). The Effect of Lead Exposure on IQ Test Scores in Children Under 12 Years: A Systematic Review and Meta-Analysis of Case-Control Studies. Syst Rev. https://doi.org/10.1186/s13643-022-01963-y

⁷Roy, A., Bellinger, D., Hu, H., Schwartz, J., Ettinger, A.S., Wright, R.O., Bouchard, M., Palaniappan, K., Balakrishnan, K. (2009). Lead Exposure and Behavior Among Young Children in Chennai, India. Environ Health Perspect. https://doi.org/10.1289/ehp.0900625

⁸Schwaba, T., Bleidorn, W., Hopwood, C.J., Gebauer, J.E., Rentfrow, P.J., Potter, J., Gosling, S.D. (2021). The Impact of Childhood Lead Exposure on Adult Personality: Evidence from the United States, Europe, and A Large-Scale Natural Experiment. Proc Natl Acad Sci USA. https://doi.org/10.1073/pnas.2020104118

Teens with social anxiety disorder experience persistent and excessive fear in social settings that goes beyond shyness or nervousness. They worry so much about being judged, embarrassed, or humiliated in front of others that they avoid activities they would otherwise enjoy. Social anxiety often manifests as physical symptoms like sweating, trembling, or a racing heart, as well as emotional signs like irritability, self-doubt, and withdrawal from social interactions.

Social anxiety disorder is associated with other mental health conditions, including ADHD. “Many teens and young adults with ADHD are susceptible to social anxiety due to executive functioning challenges that impair emotional control, working memory, and self-awareness (metacognition),” writes Sharon Saline, Psy.D. “They may avoid specific triggering situations such as in-person classes or feel intensely nervous and uncomfortable in any social environment.”

Recognizing the signs of social anxiety disorder in your child is crucial for early intervention and support. Answer the questions in this self-test to help you assess whether your teen may be showing symptoms of social anxiety disorder. Share the results with your child’s doctor.

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The questions in this social anxiety test for teens are informed, in part, by criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). This social anxiety test for teens is designed to screen for the possibility of SAD symptoms, and it is intended for personal use only. This social anxiety test for teens is not intended as a diagnostic tool.

Social Anxiety Test: Next Steps

• Get This Free Download: Social Anxiety Facts and Falsehoods
• Subscribe to ADDitude magazine
• Read: Where Does ‘Introvert’ End and Social Anxiety Begin?
• Read: 5 Ways to Reframe Anxiety for Your Worried Teen
• Find: Specialists or Clinics Near You

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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.

¹ National Institute of Mental Health. Social Anxiety Disorder. https://www.nimh.nih.gov/health/statistics/social-anxiety-disorder#part_2642

Social anxiety disorder (SAD) is characterized by an intense fear of scrutiny and judgment by others in social situations. Individuals with social anxiety fear that they will be negatively evaluated — judged as anxious, weak, boring, weird, or unlikeable. They fear being observed and/or performing in front of others, and they worry that their nervousness and anxiety will show through.

Everyone experiences social anxiety occasionally. For individuals with social anxiety disorder, the fear of social scrutiny — often out of proportion to the actual threat posed by the social situation — is immensely distressing. It can interfere with work, school, and other daily activities, and make it difficult to meet people and maintain friends.

Social anxiety (among other anxiety disorders) commonly occurs with ADHD. “Experiences common to ADHD, like rejection sensitive dysphoria, shame, and emotional dysregulation, may exacerbate social anxiety,” writes writes Sharon Saline, Psy.D. “ADHD symptoms like hyperactivity and inattention may also undermine social skills and cause difficulties.”

Take this social anxiety test and share your results with a licensed mental health professional.

The questions in this social anxiety test are informed, in part, by criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). This social anxiety test is designed to screen for the possibility of SAD symptoms, and it is intended for personal use only. This social anxiety test is not intended as a diagnostic tool.

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Can’t see the self-test questions above? Click here to open this test in a new window.

Social Anxiety Test: Next Steps

• Take this Test: Generalized Anxiety Disorder in Adults
• Take this Test The RSD Self-Test for Adults
• Free Download: Social Anxiety Facts and Falsehoods
• Subscribe to ADDitude magazine
• Read: You’re Not Shy or Stuck Up. You Have Social Anxiety Disorder.
• Read: Where Does ‘Introvert’ End and Social Anxiety Begin?
• Read: “How Exposure Therapy Reduced My Social Anxiety”
• Find: Specialists or Clinics Near You

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.

Undergraduate college students are more likely to experience depression and anxiety today than ever before. Among those students, non-binary and LGBQ+ individuals have recently experienced a particularly significant increase in diagnoses for depression and anxiety compared to their heterosexual peers.¹

According to new research published in the Journal of Affective Disorders, about one-third of students in the 2011-2012 school year said they felt “so depressed it was hard to function.” By 2017-2018, this number grew to 42% — a 13% annual increase, according to the study authors. Among LGBQ+ students — defined as lesbian, gay, bisexual, queer, and others — the rate of diagnosis and treatment for depression rose 23% per year during the same time frame.

Further, the number of non-binary BIPOC (Black, Indigenous, and People of Color) students diagnosed with or treated for depression rose 61% between 2016 and 2019; among non-binary non-Hispanic white students, depression diagnoses rose 49% over the same period.

The study reported a notable rise in the number of students diagnosed with or treated for anxiety. Among LGBQ+ students, the incidence of anxiety increased 22% each year; for heterosexual students, it rose 12% each year.

The number of students who seriously thought about suicide nearly doubled from 7.4% to 13% over the study period, with a more pronounced increase among LGBQ+ and BIPOC students, especially women.

“These results indicate that it is imperative to better address the mental health challenges faced by non-binary and LGBQ+ students while avoiding actions that may lead to their alienation, isolation, and oppression,” the study’s authors wrote.

They attribute the rising mental health challenges in college students to factors such as academic stress and burnout, poor social support, poor sleep, less in-person social interaction, and more isolation.¹

For the study, researchers analyzed data from the American College Health Association and National College Health Assessment II: 2016–2019, which included a sample of 228,640 undergraduate students, ages 18-24, from 442 campuses.

Poor Mental Health Reported in Non-Binary Transgender Adults

A February 2024 study of 1.5 million people, including nearly 8,000 transgender people aged 16 or older in England, reported similar results. The study, published in The Lancet Public Health journal, found that gender-diverse adult populations experience a much higher prevalence of mental health conditions compared to cisgender adult populations, with inequalities concentrated in patients younger than 35 years.²

The study revealed that long-term mental health conditions impact approximately one in two non-binary transgender adults and one in six transgender men, women, and cisgender non-binary adults; in contrast, just one in ten cisgender men and women were diagnosed with a mental health condition.

The English research team suggests that mental health outcomes for this patient population could benefit from practitioners who conduct better training for their medical staff, adopt inclusive language, and standardize electronic healthcare record systems to include transgender, non-binary, and gender-diverse identities, which would “reduce the psychological burden associated with repeated explaining or being misgendered, again reducing minority stress and potentially improving mental health.”

Sources

¹ Samek, D.R., Akua, B.A., Crumly, B., Duke-Marks, A. (2024). Increasing Mental Health Issues in College Students from 2016-2019: Assessing the Intersections of Race/Ethnicity, Gender, and Sexual Orientation. J Affect Disord.354:216-223.https://doi.org/10.1016/j.jad.2024.03.068

²Watkinson, R. E., Linfield, A., Tielemans, J., Francetic, I., & Munford, L. (2024). Gender-Related Self-Reported Mental Health Inequalities in Primary Care in England: Cross-Sectional Analysis Using the GP Patient Survey. The Lancet Public Health. 9(2), E100-E108.https://doi.org/10.1016/S2468-2667(23)00301-8

Episode Description

School refusal and avoidance have grown more prevalent and problematic since the quarantine of 2020. The reasons behind school refusal and avoidance are different for every student, but the goal is typically the same: to stay at home and miss tests, class work, and homework. From elementary school through high school, absenteeism is growing — and pushing students further and further behind.

Underlying anxiety often propels and compels this behavior, which can present differently in different students — from stomachaches and headaches in some to signs of depression in others. For some students, this anxiety may stem from academic struggles. Students with ADHD may feel overwhelmed if they’re unable to keep up with teacher instruction, class work, and homework. They may also be worn down by years of criticism and correction at school. For others, social difficulties, such as bullying or peer rejection, may cause anxiety and the desire to avoid school.

It’s important for caregivers and educators to understand the underlying causes for each student’s school avoidance and absenteeism so that their individual needs can be addressed, and they can return to school feeling hopeful in a positive environment.

In this webinar, you will learn:

• About the underlying factors that contribute to school avoidance and absenteeism
• How these factors may affect students with ADHD, in particular
• How symptoms of school avoidance can look different across elementary school-age children and teens
• How to identify and meet the needs of struggling students
• About the evidence-based strategies that parents and educators can utilize to support students with school refusal behaviors
• Therapy options to help students transition back to the academic environment

Watch the Video Replay

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Download or Stream the Podcast Audio

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School Avoidance & ADHD: More Resources

– Download: The School Avoidance Alliance’s Free Guide to Working with Your School
– Enroll: The School Avoidance Alliance’s Master Class for Parents (use discount code: Additude)
– Share: The School Avoidance Alliance’s Course for Educators (use discount code: Additude)
– Read: Why School Stress Is Toxic for Our Children
– Sign Up: Free Back-to-School Master Class from ADDitude
– Read: 6 Good Reasons to Change Your Child’s School
– Download: Social Anxiety Facts and Falsehoods

Obtain a Certificate of Attendance

If you attended the live webinar on July 9, 2024, 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

Alana Cooperman, LCSW, is a senior social worker for the Anxiety Disorders Center at the Child Mind Institute. She has extensive experience delivering evidence-based treatment to children and families with a range of anxiety disorders including generalized anxiety disorder, social anxiety, selective mutism, and phobias. She also works with individuals with ADHD, autism spectrum disorder, and those struggling with emotion dysregulation. Mrs. Cooperman has provided individual and group therapy to children and adolescents in school settings for over 15 years.

Mrs. Cooperman has received training in cognitive behavior therapy (CBT), functional behavior assessments (FBA), parent-child interaction therapy for selective mutism (PCIT-SM), and exposure and response prevention (ERP).

Mrs. Cooperman’s experience includes working on a multidisciplinary team, alongside school administrators, teachers, families, and other clinicians, to create student goals and individualized behavior plans. She has led numerous workshops for both teachers and families, teaching strategies to support children struggling with emotion regulation, anger, and anxiety. Mrs. Cooperman also has experience conducting comprehensive family intakes and child and adolescent risk assessments.

Listener Testimonials

“Great presentation – she was very knowledgeable.”

“This was a terrific webinar with a good amount of information presented in an understandable format without being overwhelming. Thank you!”

“I like how reasonable, manageable, and relatable the presenter was. It was motivating to access the cycle of interventions that she suggested. This will be very useful for my client in the upcoming months!”

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Females are more likely than males to have complex presentations of ADHD, potentially leading to delayed diagnosis and treatment, according to new research published in the Journal of Attention Disorders. The study found that females with ADHD are more likely than males to have inattentive ADHD, are diagnosed at older ages, and have higher rates of anxiety and depression diagnoses both before and after their ADHD diagnoses. ¹

The retrospective observational study was conducted using data from four U.S. health databases. The researchers sought to explore the relationship between sex as well as ADHD subtype and diagnosis timing. They also hoped to assess whether receiving an ADHD diagnosis had an impact on pre-existing diagnoses of depression and anxiety in women and girls, who receive treatment for these comorbidities at higher numbers.

Age of ADHD Diagnosis Rates by Sex and Subtype

The study revealed:

• The average age of ADHD diagnosis by gender:
  • Females:16 to 29 years
  • Males: 11 to 23 years
• Across both sexes, the average age of diagnosis by ADHD type:
  • Inattentive Type: 17 years to 27 years
  • Hyperactive impulsive Type: 10 years to 20 years
• Females were substantially more likely than males to be diagnosed with inattentive ADHD

How Mood Disorders Fit Into the Diagnostic Picture

• Females were twice as likely as males to have depression or anxiety diagnoses and treatments in the year before their ADHD diagnosis.
• Females were more likely than males to receive new diagnoses or treatments for depression or anxiety in the year following an ADHD diagnosis.
• The number of females with pre-existing depression or anxiety diagnoses with symptoms that did not continue after their ADHD diagnosis was higher than the number of males. In these cases, ADHD may have been misdiagnosed as anxiety or depression.
• Patients with inattentive ADHD were more likely to receive a prior diagnosis of depression or anxiety:
  • Inattentive ADHD: 13% to 18% (depression) and 17% to 26% (anxiety)
  • Hyperactive impulsive ADHD: 5% to 12% (depression) and 9% to 20% (anxiety)

Repercussions of Delayed Diagnosis

The study’s finding that females are diagnosed five years later than males, on average, together with other key data points lead researchers to conclude that diagnoses in females tend to occur “only once ADHD symptoms become more severe,” and underscores the importance of addressing this gap in health equity.

The consequences of undiagnosed ADHD are dire, especially for women.

“Women who live undiagnosed until adulthood experience significant negative outcomes in the areas of self-esteem, social interaction, and psychosocial wellbeing beginning in childhood and continuing into adulthood,” concluded the authors of a systematic review of research published in March 2023. “Women in these studies engaged in less task-oriented coping and more emotion-oriented coping and often turned to recreational drugs, alcohol, nicotine, and sex to self-medicate for symptoms of undiagnosed ADHD.” ²

A female ADDitude reader explains the lived experience of late diagnosis this way: “I have lived with the misleading belief that I was a loser, lazy, incompetent. What are the long-term impacts of these self-defeating beliefs?”

The Complicating Presence of Mood Disorders

The connection between ADHD and mood disorders, including depression, is well-established. According to a recent study in BMJ Mental Health: ³

• People with ADHD are 9% more likely to have MDD
• An MDD diagnosis increases the risk for ADHD by 76%

These findings are echoed in the responses to a recent ADDitude survey of 6,810 adults, which found that 72% reported having anxiety and 62% having reported depression.

In addition to the over-representation of mood disorders among individuals with ADHD, previous research has documented that women in general are twice as likely as men to suffer from MDD and General Anxiety Disorder (GAD).

While rates of mood disorders are unequivocally higher among women with ADHD than either men with ADHD or women without the condition, the new study lends credence to what many women have reported anecdotally: They are also more likely than men to have ADHD initially misdiagnosed as depression or anxiety.

“Because of stigma and thoughts related to gender role presentations, when females do present with ADHD symptoms, it can be thought that it’s more likely due to anxiety or depression, because those are presentations that people are used to seeing in females early on,” explained Dave Anderson, Ph.D., in the ADDitude webinar “ADHD Then and Now: How Our Understanding Has Evolved.” “So, people say, ‘She’s distracted because she’s anxious or sad,’ not because she has ADHD. That’s something that we’re actively trying to fight, even in clinician bias.”

The new study, and research like it, helps shed light on the unique toll exacted on women by ADHD. More investigation is desperately needed, explains Dawn K. Brown, M.D., in the ADDitude article, We Demand Attention! A Call for Greater Research on Women with ADHD.

“Further research regarding these topics is indeed crucial,” Brown explains. “By conducting in-depth investigations into the gender-specific nuances of ADHD presentation and impact, healthcare professionals, policymakers, and advocates can promote greater awareness, understanding, and tailored support for women with ADHD.”

Read on to learn about the Top 10 research priorities detailed in ADDitude’s groundbreaking, cross-platform initiative : We Demand Attention! A Call to Action for Greater Research on Women with ADHD.

We Demand Attention: A Call for Greater Research on ADHD in Women

Intro: Top 10 Research Priorities

1. Sex Difference in ADHD
2. The Health Consequences of Delayed ADHD Diagnoses on Women
3. How Hormonal Changes Impact ADHD Symptoms in Women
4. How Perimenopause and Menopause Impact ADHD Symptoms, and Vice Versa
5. The Elevated Risk for PMDD and PPD Among Women with ADHD
6. The Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing
7. How ADHD Medication Adjustments During the Monthly Menstrual Cycle Could Improve Outcomes for Women
8. The Long-Term and Short-Term Implications of Hormonal Birth Control and Hormone-Replacement Therapy Use Among Women with ADHD
9. How and Why Comorbid Conditions Like Anxiety, Depression, and Eating Disorders Uniquely Impact Women with ADHD
10. Early Indicators of Self-Harm, Partner Violence, and Substance Abuse Among Girls and Women with ADHD

Sources

¹  Siddiqui, U., Conover, M. M., Voss, E. A., Kern, D. M., Litvak, M., & Antunes, J. (2024). Sex Differences in Diagnosis and Treatment Timing of Comorbid Depression/Anxiety and Disease Subtypes in Patients With ADHD: A Database Study. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547241251738

²  Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of Attention Disorders, 27(7), 645-657. https://doi.org/10.1177/10870547231161533

³  Meisinger, C. & Freuer, D., (2023) Understanding the Causal Relationships of Attention Deficit/Hyperactivity Disorder with Mental Disorders and Suicide Attempt: A Network Mendelian Randomisation Study. BMJ Mental Health. doi.org/10.1136/bmjment-2022-300642

When administered at carefully selected dosages in clinical settings, and combined with therapy before and after treatment, psychedelics have been found to provide rapid relief from some of the most painful and difficult-to-treat mental health conditions. Ketamine is being used for depression and suicidality in clinical trials. MDMA is treating severe post-traumatic stress disorder (PTSD), and psilocybin is being used for treatment-resistant depression, alcohol use disorder, and more.

However, important questions remain about the long-term efficacy and safety of psychedelics, as well as patient suitability. Several large-scale studies are now under way to address these concerns, including the first-ever phase 3 clinical trial on psilocybin-assisted therapy — the largest randomized, controlled, double-blind study on the drug, with more than 800 participants. Initial results are expected this summer.

How Do Psychedelics Work?

Research shows that psychedelics improve many neuropsychiatric disorders, but the way they work is less clear. Functional MRIs and laboratory studies offer possible explanations:

• Ketamine binds to NMDA receptors in the brain, increasing levels of a mood-regulating neurotransmitter called glutamate.¹
• MDMA increases oxytocin, dopamine, and other chemical messengers related to positive emotions.²
• Psilocybin stimulates the brain’s serotonin 2A receptors, appearing to decrease activity across the default mode network.³

But these biochemical explanations don’t tell the full story, says Gül Dölen, M.D., Ph.D., professor of psychology and researcher at University of California Berkeley’s Center for the Science of Psychedelics. Psychedelics only reliably improve psychiatric conditions when administered with therapy. “Therapy is the context to get the cure,” Dölen explains. “You can’t take MDMA and go to a rave and expect it to cure your PTSD.”

Indeed, when taken on their own, psychedelics aren’t hugely effective, according to studies; therapy unlocks the drugs’ enduring benefits. Also, there are serious risks to taking the drugs without medical supervision.

[Read: The Truth About Lion’s Mane, Psychedelics & Caffeine]

A Brand-New Framework

Most psychiatric medications must be taken daily, often for a lifetime. By contrast, a single dose of certain psychedelics paired with therapy can result in full-blown remission. This claim appears too good to be true when viewed through the traditional “biochemical imbalance” model of neuropsychological disease that has dominated the field for the past 50 years. “The idea is that depression, for example, is a biochemical imbalance in serotonin,” Dölen says. “So, we’ll restore serotonin levels with a pill, and you’ll get better.”

But what if there were an approach that treated depression by restoring the fundamental ability to learn (and unlearn) behaviors and ways of thinking, and not by raising serotonin levels? It’s an entirely different framework for understanding neuropsychiatric disorders — the learning model — and Dölen says it’s the best way to comprehend how psychedelics work.

Psychedelics act like master keys unlocking what scientists call “critical periods” of learning—specific times when individuals have a heightened ability to soak in new information. During brain development, these are the critical windows in which we acquire vision, language, motor development, and more. And after these critical windows close, they remain locked.

Or so we thought.

Psychedelics Restore Child-Like Learning

In a study that involved giving mice MDMA, Dölen found that the drug unlocks a critical period for social reward learning, restoring adult mice to child-like levels of openness for social development.⁴ Dölen’s next study uncovered the potential of all psychedelics—including LSD, psilocybin, ketamine, and ibogaine—to open these critical periods.⁵

[Watch: “Psychedelic Therapy for Mood Disorders: Research & Potential”]

“This is a big deal,” says Dölen. “And if it’s true, it’s going to revolutionize things, but only if we understand what a critical period is. It’s not that you take a pill and you speak Japanese. It’s that you take a pill and you restore the ability to learn Japanese.”

The drugs open the mind to learning. The therapy provides the learning itself.

“Patients talk about how they had an epiphany, how the trip enabled them to see how they’d built their lives around a foundational myth that wasn’t true, whether about their relationship to other people, their personality, their deserving to be in the world,” Dölen says. The post-trip therapy, in turn, allowed them to identify how that myth led to maladaptive ways of interacting with the world, and understand how to integrate that knowledge into their daily lives.

The potential of psychedelics to re-open critical periods has far-reaching implications. Dölen’s lab is exploring the possibilities of treating conditions like stroke and blindness with psychedelics through a project called PHATHOM (Psychedelic Healing: Adjunct Therapy Harnessing Opened Malleability).

“Psychedelics are not going to be the magic bullet that fixes everything, but we’re excited about the possibilities,” Dölen says. “Being able to restore child-like learning is a major therapeutic opportunity.”

Psychedelics Therapy and Mental Health: Next Steps

• Self-Test: Symptoms of Depression in Adults
• Free Download: Signs of Depression That May Surprise You
• Read: Real Stories of Using Ketamine for Depression, Anxiety, PTSD

Nicole C. Kear is Consumer Health Editor at ADDitude.

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 Matveychuk D, Thomas RK, Swainson J, Khullar A, MacKay MA, Baker GB, Dursun SM. Ketamine as an antidepressant: overview of its mechanisms of action and potential predictive biomarkers. Ther Adv Psychopharmacol. 2020 May 11;10:2045125320916657. doi: 10.1177/2045125320916657. PMID: 32440333; PMCID: PMC7225830.

² Mitchell, J.M., Bogenschutz, M., Lilienstein, A. et al. MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med 27, 1025–1033 (2021). https://doi.org/10.1038/s41591-021-01336-

³ Smausz R, Neill J, Gigg J. Neural mechanisms underlying psilocybin’s therapeutic potential – the need for preclinical in vivo electrophysiology. J Psychopharmacol. 2022 Jul;36(7):781-793. doi: 10.1177/02698811221092508. Epub 2022 May 30. PMID: 35638159; PMCID: PMC9247433.

⁴ Nardou, R., Lewis, E.M., Rothhaas, R. et al. Oxytocin-dependent reopening of a social reward learning critical period with MDMA. Nature 569, 116–120 (2019). https://doi.org/10.1038/s41586-019-1075-9

⁵ Nardou, R., Sawyer, E., Song, Y.J. et al. Psychedelics reopen the social reward learning critical period. Nature 618, 790–798 (2023). https://doi.org/10.1038/s41586-023-06204-3

ADHD doesn’t travel alone. Most teens with ADHD also have a co-occurring condition like anxiety or depression. Sometimes the co-existing condition is a result of the ADHD, and other times it operates alongside ADHD.

When a patient presents these conditions together, it can create a varied clinical picture because each diagnosis impacts, and is impacted by, the other. This can sometimes lead to misdiagnosis or inadequate treatment for at least one condition. The challenge in diagnosis and treatment can also be complicated by puberty.

In this webinar, you will learn:

• The symptoms of depression and anxiety disorders, and how to distinguish them from ADHD and normal child and adolescent development
• How depression or anxiety affects ADHD symptoms
• How ADHD can actually lead to, or affect, depression and anxiety
• How to devise a treatment plan when ADHD exists alongside anxiety or depression

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.

Download or Stream the Podcast Audio

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Depression, Anxiety, & ADHD in Teens: More Resources

• Download: A Parent’s Guide to Depression in Teens
• Replay: The ADHD-Depression Connection in Adults with Dr. Roberto Olivardia
• Learn: Why Anxiety Disorder Is So Often Misdiagnosed
  
• Q&A: New Approaches to Treating Depression and ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on April 9, 2024, 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

Roberto Olivardia, Ph.D., is a Clinical Psychologist and Clinical Instructor of Psychology at Harvard Medical School. He maintains a private psychotherapy practice in Lexington, Massachusetts, where he specializes in the treatment of attention deficit hyperactivity disorder (ADHD), executive functioning issues, and issues that face students with learning differences.

He also specializes in the treatment of Body Dysmorphic Disorder (BDD), Obsessive-Compulsive Disorder (OCD) and in the treatment of eating disorders in boys and men. He is co-author of The Adonis Complex, a book which details the various manifestations of body image problems in men. (#CommissionsEarned) Read more here.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“All of the webinars are very good. This was one of the best!”

“A fantastically rich and engaging presentation! I firmly believe that I’m now significantly better informed of the interaction and distinctions between anxiety, depression, and ADHD. Thank you, Dr. Olivardia and ADDitude!”

“Good info and good mention of cannabis findings at the end as a surprise inclusion. Did not know any of that.”

Webinar Sponsor

The sponsor of this ADDitude webinar is…

Play Attention: ADHD and Executive function challenges can lead to anxiety, and this anxiety can further impair executive functioning by affecting the brain’s processing and decision-making abilities. That’s why Play Attention offers a personalized program designed to enhance executive function and improve self-regulation. Backed by research from Tufts University School of Medicine, Play Attention empowers individuals to improve attention, emotion regulation, and overall performance. Our NASA-inspired technology ensures tailored support for every aspect of life. Take our ADHD test or schedule a consultation to start your journey toward improved executive function and emotion regulation with Play Attention. Call 828-676-2240. www.playattention.com

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

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The number of clinics offering infusions of ketamine — the only psychedelic that is legal nationwide — has exploded. Research on the drug known as ecstasy, or MDMA (3,4-methyl-enedioxymethamphetamine), has shown such promise for treating severe PTSD that pharmaceutical companies are preparing to seek FDA approval.¹ Experts say psilocybin, the psychoactive ingredient in magic mushrooms that has shown efficacy for treatment-resistant depression,² may not be far behind.

Used under medical supervision and paired with pre- and post-drug therapy, these psychedelics have been life-changing in alleviating symptoms for many patients. Bob, an ADDitude reader in Arizona, took part in a clinical trial involving psilocybin for obsessive-compulsive disorder (OCD). “I have not had OCD symptoms since I finished the trial over a year ago,” he says.

Bob has also been receiving ketamine treatments for depression, anxiety, ADHD, and complex PTSD. He says the treatments have been more effective than cognitive behavioral therapy and prescription antidepressants, and without the “difficult side effects.”

While many patients like Bob report profound benefits from psychedelics, some psychiatrists and researchers fear that the pharmaceutical industry is moving too quickly toward legalization, while important questions about long-term efficacy and safety remain.

[Read: Real Stories of Using Ketamine for Depression, Anxiety, PTSD]

Psychedelic Therapy: A Blast from the Past

Psychedelics have an ancient history of medicinal use by the Aztecs and other civilizations. In Western culture, the groundbreaking potential of psychedelics to heal disorders of the mind took root around 1950, when the first English-language paper citing their therapeutic benefits was published. By 1960, Sandoz Pharmaceuticals had begun manufacturing psilocybin and LSD, substances later popularized, in part, by iconic Harvard psychologist Timothy Leary, Ph.D.

For years, he and other therapists embraced these experimental drugs for their potential to aid patients. At the same time, LSD played a major role in the counterculture movement of the 1960s. When then-President Richard Nixon outlawed all psychedelics in 1970, the drugs became associated with criminality. That effectively ended most research into psychedelics’ therapeutic value for 30 years.

In 2000, a new era of research began when scientists from Johns Hopkins University secured regulatory approval to study the effect of psychedelics on behavior, brain function, learning and memory, and mood. In 2020, Johns Hopkins opened a psychedelics research center. Since then, most of the country’s elite universities have followed suit. Researchers at Yale, Stanford, Universities of California Berkeley and San Francisco, and New York University have conducted clinical trials investigating the therapeutic benefits of psychedelics on mental health disorders.

[Read: LSD, MDMA, Magic Mushrooms Clinical Trial Guidelines Released by FDA]

“Monumental Results”

For patients diagnosed with depression and in acute distress, waiting six weeks for commonly prescribed antidepressants to begin working may not be feasible, says Gregory Barber, M.D., a psychiatrist in Bethesda, Maryland, and author of “Ethical and Practical Implications of Psychedelics in Psychiatry,” a scientific review that was published recently in the American Psychiatric Association’s Psychiatric Services journal.³ Ketamine, however, has been shown to improve mood sometimes after only one or two infusions.

“With psychedelics, there is some evidence to suggest that even single doses have medium- to long-term effects,” Barber says. “The ability to simplify treatment in this way would be a real paradigm shift.”

Karlyn, an ADDitude reader, knows this first-hand. Diagnosed with bipolar disorder and ADHD, she had been taking antidepressants for 16 years. “My psychiatrist recommended ketamine infusions in 2021 when I was acutely suicidal. It was the best drug that I have ever used for depression. By the fourth infusion, I felt relief,” she says.

Eight percent of Americans suffer from major depressive disorder (MDD). While a majority of individuals seek treatment, about 30 percent find no relief from antidepressants.⁴ This means that millions of Americans struggle with troubling symptoms like sadness, hopelessness, and suicidality.

Elizabeth Wolfson, Ph.D., a California psychotherapist who has been in practice for 30 years, says she has integrated ketamine into her therapy with “monumental” results. “It augments and deepens the work that people do in psychotherapy and accelerates the process in a way that I see as transformative,” she says.

Psychedelic Therapy: Investigating Risks

Psychedelics’ powers to heal have been heralded in countless headlines, so it’s no surprise that the drugs have recently enjoyed a surge in popularity. According to the National Survey on Drug Use and Health, 7.1 million Americans used hallucinogens in 2020. Proof of a changing public perception is apparent in Oregon and Colorado, where citizens have voted to legalize psilocybin.

The drugs, however, are not without risk. When psychedelic use takes place outside therapeutic settings, the symptoms people are trying to improve may actually worsen. The “therapy” part of psychedelic-assisted therapy is essential to positive outcomes.

In clinical trials and at carefully selected doses, ecstasy, ketamine, and psilocybin have produced generally mild side effects. When taken at higher doses, these drugs can cause disorientation, paranoia, and panic, which can lead to dangerous behavior, accidents, self-harm, and even suicidality. Other adverse effects include the potential for hallucinogen persisting perception disorder (a rare condition in which patients previously exposed to hallucinogenic drugs continue to experience distorted perceptions of the world around them months or years later), misuse, and abuse.

“The clinical trials have had very exciting results, but those results came in carefully controlled research settings with mental health professionals who have hundreds of hours of training,” Barber says. “It doesn’t mean that you will get similar benefits in other settings.”

Important Questions Remain

Experts agree that large-scale research on the long-term effects of psychedelics is needed. Many aspects of how the drugs work, their long-term outcomes, safety concerns, and patient suitability for treatment are still not known.

“I’ve seen psychedelics transform people positively very quickly, but I’ve also seen it be very challenging for people both in the moment and after the experience,” Barber says. “Psychedelics are not going to be for everyone nor solve every problem.”

Patient Suitability

People who have the following conditions or history are not considered good candidates for psychedelic-assisted therapy:

• a personal or family history of psychosis
• unstabilized bipolar disorder
• high blood pressure
• heart disease
• thyroid disease

Psychedelics Research Timeline

1943: LSD’s psychoactive effects are discovered by Swiss chemist Albert Hoffman.

1950: First English-language publication suggests LSD may aid psychotherapy.

1957: The term “psychedelic” is coined. Life magazine publishes “Seeking the Magic Mushroom.”

1960: Harvard psychologist Timothy Leary begins experiments with psilocybin.

1963: LSD is sold on the street in sugar cubes. Timothy Leary is fired by Harvard.

1965: Sandoz stops manufacturing LSD and psilocybin.

1997: Swiss scientists publish new research on the effects of psilocybin on humans.

2000: Johns Hopkins researchers secure regulatory approval to resume psychedelics research.

2017: FDA grants “breakthrough” status to MDMA and psilocybin, putting the drugs on a fast track for approval.

2023: Findings of Phase 3 clinical trials on MDMA for PTSD are published.

Psychedelic Therapy & Mental Health: Next Steps

• Self-Test: Symptoms of Depression in Adults
• Read: Treatments for Depression and ADHD-New and Forthcoming Approaches
• Read: The Relationship Between PTSD and ADHD

Nicole C. Kear is Consumer Health Editor at ADDitude.

Sources

¹Mitchell, J.M., Bogenschutz, M., Lilienstein, A. et al. MDMA-Assisted Therapy for Severe PTSD: A Randomized, Double-Blind, Placebo-Controlled Phase 3 Study. Nat Med. 2021(27),1025–1033.

²Goodwin, G., Aaronson, S., Alvarez, O. et al. Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression. N Engl J Med. 2022 Nov 3.; 387:1637-1648. DOI: 10.1056/NEJMoa2206443

³Barber GS, Dike CC. Ethical and Practical Considerations for the Use of Psychedelics in Psychiatry. Psychiatr Serv. 2023 Aug 1;74(8):838-846. doi: 10.1176/appi.ps.20220525. Epub 2023 Mar 29. PMID: 36987705.

⁴Zhdanava M, Pilon D, Ghelerter I, Chow W, Joshi K, Lefebvre P, Sheehan JJ. The Prevalence and National Burden of Treatment-Resistant Depression and Major Depressive Disorder in the United States. J Clin Psychiatry. 2021 Mar 16;82(2):20m13699. doi: 10.4088/JCP.20m13699. PMID: 33989464.

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.

I just want to validate how hard this is and the importance of advocating for your student by moving him to a different school and trying to set him up for success.

Sometimes, smaller-group social interaction, even with one or two other peers who have similar interests, is better than trying to jump into a larger group or sports team. So, if your student likes basketball and he meets another student who likes the sport, your son might invite them to shoot hoops after school. You also might want to think about less competitive activities, like musical performances, that encourage positive peer interactions.

It gets more complicated in high school. Teachers typically don’t recognize shared interests among students like elementary school teachers do, but after-school clubs and activities can help your child identify and interact with like-minded peers in a safe space. Sometimes, once they gain confidence from a successful club or online interaction, a teen can move on to a one-on-one friendship.

Bullying Risk Factors

School bullying remains a serious problem in U.S. schools, particularly for students with ADHD, autism, learning differences, and other comorbidities. In an ADDitude survey, 61% of more than 1,000 caregivers said their neurodivergent child was bullied at school.

[Free Guide: Help Your Child Make Friends]

Children are at greater risk of becoming a bully, or being bullied, if they have:

• ADHD, anxiety, and/or autism
• Poor inhibition
• Developmental delays
• Difficulty making friends
• Poor self-regulation

In an ADDitude survey, 61% of more than 1,000 caregivers said their neurodivergent child was bullied at school. Children were bullied beyond school in the following environments:

• Social media 32%
• School bus 30%
• Text messages 27%
• Club/sports team 19%

Bullying was perpetrated by:

• Child’s classmate 66%
• Multiple students 49%
• A friend 29%
• A teacher, school staff member, or coach 26%

While bullies target neurodivergent children, few are punished at school, ADDitude readers say.

“The school always blamed my child for causing issues,” says one reader. “His peers knew how to wind my son up, and then he would get the blame. He had no control over his emotions.”

Says another reader, “Once a teacher starts to bully a child, it becomes open season for peer social abuse and torment.”

Most survey respondents (71%) were unsatisfied with the school’s response to bullying, which included:

• Never acknowledged the bullying 37%
• Gave a verbal warning to the bully 30%
• Spoke to the child about being bullied 28%
• Punished the child who was bullied 15%
• Disciplined the bully 12%
• Provided support services for the child 9%

“I work with my child to resolve the conflict himself first, and then if the bullying continues, we involve the school,” says a reader.

[Free eBook: Time to Change? Great Schools for ADHD Kids]

Q2: “My teen won’t open up to me about what’s happening at school. I know there has been drama with her friends. How can I help her when she refuses to talk?”

Let your teen come to you when she’s ready; don’t force it. That dreaded question, “How was your day at school?” is not a good way to encourage openness. Try to find times when talking happens naturally, like during car rides or while making dinner. Open those conversations by asking, “What are you looking forward to today?” or “Is there anything that you’re worried about today?”

Over time, when she does come to you with problems, make sure that you’re providing supportive responses and not trying to just jump in and fix things. Sometimes, teens just want to be heard and validated. You might say, “What do you need right now? Do you just want me to listen? Do you want me to help you solve this? Do you just want to vent?” Being able to meet her where she’s at, in that moment, is key.

School Bullying and Social Anxiety: Next Steps

• Read: Bullying Is the Norm. So Is an Inadequate Response.
• Read: Will My Child Find a Best Friend This School Year?
• Download: Free Guide: Social Anxiety Facts and Falsehoods
• Watch: “My Child Is Being Bullied at School!” Strategies for Parents

Rosanna Breaux, Ph.D., is a licensed clinical psychologist, director of the Virginia Tech Child Study Center, and assistant professor of psychology.

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Anxiety is one of the most common comorbidities in teens and college students with ADHD, especially for girls. More than half of girls with ADHD will have some level of anxiety.

When I’m considering how to proceed with treating comorbid ADHD and anxiety, I always think: “What’s driving the bus?”

[Read: ADHD and Anxiety – Symptoms, Connections & Coping Mechanisms]

For some people, the anxiety is a true, primary diagnosis. This would include cases where the anxiety takes the form of OCD or panic disorder. In those cases, I would likely start by treating the anxiety, and then move on to treating the ADHD.

Then there are other situations where the anxiety may be directly related to the ADHD. In these cases, the anxiety may arise because the patient is feeling out of control, unable to manage time, unable to keep all these different balls in the air. Is the patient anxious because they’re overwhelmed by these things? If so, treatment of ADHD can help quite a bit with anxiety.

[Self-Test: Generalized Anxiety Disorder in Adults]

In these cases, I’ll usually start by treating the ADHD. While stimulants can sometimes exacerbate anxiety in some patients, this can typically be avoided by using long-acting, smooth-release formulations of stimulants and by starting low and going slow as you titrate dosage, monitoring anxiety throughout. Atomoxetine or viloxazine can also be effective at treating ADHD in people with co-occurring anxiety disorders. If other options don’t prove effective, guanfacine is an ADHD treatment option that doesn’t exacerbate anxiety.¹

Anxiety and ADHD Medication: Next Steps

• Read: 5 Ways to Reframe Anxiety for Your Worried Teen
• Read: What If You Are Enabling Your Child’s Anxiety?
• Watch: Anxiety in Children: Overlooked Signs and Effective Supports
• Read: 6 Types of Anxiety

The content for this article was derived from a webinar presented by The American Professional Society of ADHD and Related Disorders (APSARD) titled “ADHD Treatment in the Primary Care Setting: The Teenage Years” with Greg Mattingly, M.D., which was broadcast on October 13, 2023.

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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

¹Mattingly, G., Wilson, J., Ugarte, L., & Glaser, P. (2021). Individualization of attention-deficit/hyperactivity disorder treatment: Pharmacotherapy considerations by age and co-occurring conditions. CNS Spectrums, 26(3), 202-221. doi:10.1017/S1092852919001822