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.

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

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

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

Is Combination Therapy Safe?

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

Which Condition Do I Treat First?

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

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

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

Anxiety and ADHD

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

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

Autism and ADHD

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

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

[Read: Interventions for Adult Autism and ADHD]

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

OCD and ADHD

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

Depression and ADHD

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

Eating Disorders and ADHD

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

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

Executive Dysfunction and ADHD

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

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

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

Comorbid Conditions with ADHD: Next Steps

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

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

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

Sources

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

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

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

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

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

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

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.

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

First, I would encourage you not to be defensive during your visit. Clinicians have to follow a process to give you a diagnosis. This may seem like a waste of time, but a full differential diagnosis requires more than just asking neurodivergent-related questions. You may be asked questions that you feel are irrelevant, but that are important nonetheless.

There might be something you can learn, and something that you can teach the clinician. I have thanked patients for correcting me about certain things and I think that those interactions have been transformative for them too. I know I’ve learned from them.

[Take the Autism in Women Self-Test]

Having said that, it is important for all of us to feel respected, and that includes respect from your clinician. If you feel your provider is cynical or not listening to you, or they’re not acting in a collaborative way, then you can say thank you and move on.

Q: “What are the common misdiagnoses given to girls and women with ADHD and autism?”

Autistic girls and women with ADHD are often diagnosed with borderline personality disorder. This is a difficult differential diagnosis because it entails so much — dichotomous thinking, emotional reactivity, and fears of rejection and abandonment.

They also get misdiagnosed with bipolar disorder and, more commonly, with obsessive-compulsive disorder (OCD). This is because many neurodivergent individuals like repetitiveness, or like to systematize things, and have trouble interrupting a sequence, but that doesn’t necessarily mean they have OCD. It’s also not uncommon to have co-occurring conditions.

Q: “Are autistic girls with ADHD more likely to experience emotional dysregulation than their neurotypical peers?”

Emotional dysregulation is not part of the diagnostic criteria for ADHD or autism, but it is very much a part of the lived experience for both conditions — and it can be very impairing. Rejection sensitivity (the tendency to intensely react to real or perceived rejection), along with spiraling emotions or thoughts, impairs a person’s functioning and ability to interact and listen.

[Get This Free Download: Your Autism Evaluation Checklist]

According to society’s gender roles, girls and women are not supposed to get upset or display anger. When faced with rejection, we may hold it in and mask — only to eventually explode. So being unable to understand our emotions and know when we need to breathe, or step away, is important.

AuDHD Diagnosis: Next Steps

• Take These Self-Tests:
  • ADHD in Women
  • Autism in Women
• Learn: How to Get Evaluated for Autism as an Adult
• Read: Autism and ADHD in Adults
• Read: “Women Need Better, More Accurate Diagnostic Tools for ADHD”
• Read: “What to Expect After Your AuDHD Diagnosis”
• Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus
• Read: “A Living Contradiction” — The AuDHD Experience
• Free eBook: The Truth About Autism in Adults
  

Karen Saporito, Ph.D., is a licensed clinical psychologist who has been in private practice for more than 20 years.

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.

In research examining eating disorder symptoms among women aged 45 to 61, body dissatisfaction was cited as a key risk factor.¹ I have seen this firsthand. In 2024, more than 21% of calls to the National Alliance for Eating Disorders, a support and advocacy organization I founded in 2000, were from individuals (primarily women) age 40 and older.

Eating disorders are serious, brain-based mental illnesses with a strong genetic link.² They have the second-highest mortality rate among all psychiatric disorders.³ Yet many middle-aged and older women may not even recognize that they’re struggling with eating disorders due to misconceptions about these conditions and who they affect.

[Self-Test: Do I Have an Eating Disorder?]

An adult might have an eating disorder if they:

• experience extreme weight loss or dramatic weight fluctuations
• refuse to eat certain foods or skip meals
• exercise excessively
• show signs of purging

Calorie restriction, or bingeing and purging, can have a particularly adverse effect on an older body, possibly leading to poor health outcomes. When eating disorders go untreated, they can lead to bone loss, heart problems, and, in people who force themselves to vomit, lung conditions. And research shows that 11% of women with ADHD, compared to 1% of women without it, have a history of bulimia nervosa, a common eating disorder that involves gorging followed by vomiting or laxative use.
Other eating disorders common in older adults include:

• anorexia nervosa (extreme food restriction)
• binge eating (consuming large amounts of food beyond the point of feeling full)

Eating Disorder Triggers

For some women, the battle with eating disorders began in childhood. For others, body image struggles may be triggered by later-in-life events. These include:

• Perimenopause and menopause. The transition to menopause is now recognized as a high-risk time for eating disorders to develop or redevelop, in part because women are seeking ways to “control” their changing bodies amid significant estrogen shifts.⁴
• Aging and unrealistic ideals. The anxiety and stress of aging in a society that values youthfulness provides fertile ground for increased symptoms of disordered eating and dysfunctional attitudes, beliefs, and behaviors around food and physical appearance.
• Transitions. Divorce, an empty nest, widowhood, and other life events may lead to or reactivate disordered eating.

[Watch: “Eating Disorders Comorbid with ADHD — ARFID, Anorexia, and Others”]

“Too Old” for an Eating Disorder

Eating disorders are considered diseases of the young, and, consequently, they often go unrecognized in older women. Many clinicians believe their mature patients are “too old” to have such conditions.

If you suspect that you or a loved one may have an eating disorder, talk with a doctor trained in this area. The National Alliance for Eating Disorders offers guidance, resources, and referrals for treatment and care. It provides free, therapist-led virtual support groups for women at midlife and older to connect with others who are experiencing or recovering from eating disorders.

Do I Have an Eating Disorder: Next Steps

• Free Download: Types of Eating Disorders Associated with ADHD
• Read: We Demand Attention! A Call for Greater Research on Women with ADHD
• Read: ADHD and Eating Disorders: Research, Diagnosis & Treatment Guidelines
• Watch: “Eating with ADHD: Improving Your Relationship with Food”

Johanna Kandel is the founder and CEO of the National Alliance for Eating Disorders and the author of Life Beyond Your Eating Disorder: Reclaim Yourself, Regain Your Health, Recover for Good. (#CommissionsEarned)

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

Sources

¹Kilpela, L.S., Hooper, S.C., Straud, C.L., Marshall, V.B., Verzijl, C.L., Stewart, T.M., Loera, T.T., Becker, C.B. (2023) The longitudinal associations of body dissatisfaction with health and wellness behaviors in midlife and older women. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph20247143

²Berrettini W. (2004). The genetics of eating disorders. Psychiatry (Edgmont), Nov;1(3):18–25. PMID: 21191522; PMCID: PMC3010958

³van Hoeken, D., & Hoek, H. W. (2020). Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. Current opinion in psychiatry. https://doi.org/10.1097/YCO.0000000000000641

⁴Khalil, J., Boutros, S., Kheir, N., Kassem, M., Salameh, P. et al. (2022). Eating disorders and their relationship with menopausal phases among a sample of middle-aged Lebanese women. BMC Women’s Health. https://doi.org/10.1186/s12905-022-01738-6

When Robert F. Kennedy, Jr. calls autism a “preventable disease” and floats the idea of an autism registry, he’s not only spouting fringe opinions. He’s echoing a long and harmful legacy of framing neurodivergent people — especially autistic people — as broken, burdensome, and in need of fixing.

As an autistic adult raising two autistic children, I know firsthand how this rhetoric shapes public perception, policy, and everyday life. I know how much damage it can do.

In casting autism as a public health crisis and something that “destroys families,” RFK, Jr. is stripping autistic people of their humanity. Our identities become problems to be solved, not lives to be understood or supported. The implication is that people like me and my children should not exist — or at the very least, should be feared, tracked, or corrected.

[Read: “Rising ADHD and Autism Rates Reflect Education — Not a Crisis”]

These comments from the secretary of Health and Human Services aren’t new. They echo decades of pathologizing narratives, including from some mainstream autism organizations that have historically centered some parents’ despair at raising neurodivergent children while ignoring autistic perspectives. But when the nation’s health secretary proposes a government registry of autistic people, it takes that fear-based framing out of the shadows and puts it on a national stage. It taps into old eugenic ideas and weaponizes public health rhetoric against a marginalized group.

Research shows just how dangerous this framing is. Autistic people already face higher rates of discrimination, mental health challenges, and suicidality — especially when we lack acceptance and community.¹ Portraying autism as a tragedy increases stigma, which in turn predicts worse well-being and reduced access to needed supports.² It also correlates with more negative parenting experiences: studies show that when caregivers view autism through a deficit lens, they report higher stress and lower family quality of life.³ In contrast, when autism is understood as a neurotype rather than a disease, outcomes improve — not just for autistic individuals, but for their families as well.

In raising two young children — both delightful, both autistic — my days are filled with sensory swings and deep chats and meltdown management and belly laughs. It’s not always easy, but parenting never is. The hard parts don’t necessarily come from my kids’ neurotypes. They often stem from systems and expectations that were never built for people like us.

When public figures portray autism as a tragedy, they reinforce those broken systems. Insurance becomes harder to access for affirming therapies. Schools and workplaces feel justified in denying accommodations. Families are instructed to control and conform instead of adapt. And autistic people — especially those who are also queer, BIPOC, or multiply disabled — internalize the message that their very being is a mistake.

[Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus]

But there is another story we can tell, one rooted in dignity, interdependence, and acceptance. It’s the story I live every day as I advocate for my kids and unlearn the shame I once felt about my own mind. It’s the story of thousands of autistic adults who are fighting not just for services, but for belonging. It’s the story the neurodiversity movement has been telling for years, and it deserves a louder megaphone than RFK, Jr.’s.

We don’t need a registry, and we don’t need a “cure.” We need a revolution in how we understand autism — not as something to be feared, but as a natural part of human diversity. Our job isn’t to eliminate autism. It’s to eliminate barriers and provide support so that all autistic people can live joyful, self-directed lives.

Autism and Neurodiversity: Next Steps

• Free eBook: The Truth About Autism in Adults
• Read: MAHA Commission Means Fear, Stigma, Health Threats for Two-Thirds of ADDitude Readers
• Read: “ADHD Is an Actual Condition. You Can’t Beat It Out of a Child.”

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 Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9(1), 42. https://doi.org/10.1186/s13229-018-0226-4

² Botha, M., & Frost, D. M. (2020). Extending the minority stress model to understand mental health problems experienced by autistic people. Society and Mental Health, 10(1), 20–34. https://doi.org/10.1177/2156869318804297

³ Botha, M., & Frost, D. M. (2020). Extending the minority stress model to understand mental health problems experienced by autistic people. Society and Mental Health, 10(1), 20–34. https://doi.org/10.1177/2156869318804297

Vitamin D insufficiency worsens sleep problems in children with ADHD, but it does not directly affect the condition’s symptoms or functional impairments, a recent study published in Frontiers in Psychology found.¹

Children with ADHD are more likely to experience vitamin D deficiencies than are children without ADHD, according to previous research.² However, this study found no causal relationship or direct link between ADHD symptoms and vitamin D insufficiency.

Scientists did find that low vitamin D levels (below 30 ng/mL) can worsen sleep difficulties, impairing sleep quality and worsening sleep disordered breathing, in children with ADHD.

The researchers wrote that sleep difficulties “increased daytime sleepiness, inattention, and oppositional defiant disorder symptoms in children.” Additionally, it was found that sleep disordered breathing can affect a child’s attention, focus, hyperactivity, memory, and executive functioning, essentially exacerbating ADHD symptoms.

Nearly three-quarters of children with ADHD experience a sleep problem or disorder.³ Additionally, up to half of children with ADHD have sleep problems, such as difficulty sleeping, insomnia, night waking, and hypersomnia.⁴, ⁵

This is the first study, to the researchers’ knowledge, that examines whether vitamin D insufficiency exacerbates sleep problems and symptoms in children with ADHD. Exploring the impact of vitamin D on sleep in children with ADHD is an important area of study since sleep problems in childhood may last into adolescence and adulthood.

“Poor sleep is a self-fulfilling prophecy,” says Joel Nigg, Ph.D., a clinical psychologist and a professor in the departments of psychiatry and behavioral sciences at Oregon Health & Science University. “Just one night of bad sleep can make a child’s inattention and opposition even worse the next day, in turn making it even more difficult to get ready and settled for sleep the next night. The pattern repeats indefinitely if not arrested.”

The case-control study examined data collected from 260 children with ADHD aged 6 to 14 years, 95 with vitamin D sufficiency and 165 with vitamin D insufficiency, from the Department of Child Health at Dalian Municipal Women and Children’s Medical Center in China.

The researchers noted several study limitations. Sleep information was obtained through subjective reports from the subjects’ parents, and researchers noted differences between these and objective sleep measures. Additionally, the study participants were limited to a group of children from Northeastern China. The sample size of 220 children is also too small to extrapolate the findings to other populations. Furthermore, since all participants had ADHD, there was no control group in this study.

The scientists hope to use the data collected from this study to further explore the relationship between ADHD symptom severity, sleep, and vitamin D levels in future studies with a more representative sample and a control group.

Vitamin D, which is mainly sourced from sunlight, can help with sleep difficulties commonly found in people with ADHD, like sleeping late, waking up throughout the night, or waking up very early. In the past few decades, researchers have found that locations with greater sunlight report lower-than-average ADHD prevalence, suggesting a possible connection between ADHD and vitamin D.⁶

Sources

¹ Zhang, P., Liu, Y., Yan, M. et al. (2025). Vitamin D insufficiency and sleep disturbances in children with ADHD: a case-control study. Frontiers in Psychology. https://doi.org/10.3389/fpsyt.2025.1546692

²Kotsi, E., Kotsi, E., Perrea, D.N. (2019). Vitamin D levels in children and adolescents with attention-deficit hyperactivity disorder (ADHD): a meta-analysis. <em>Attention deficit hyperactivity Disord. </em> https://doi.org/10.1007/s12402-018-0276-7

³ Sung, V., Hiscock, H., Sciberras, E., Efron, D. (2008). Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Arch Pediatr Adolesc Med. https://doi.org/10.1001/archpedi.162.4.336

⁴ Hvolby A. (2015). Associations of sleep disturbance with ADHD: implications for treatment. Atten Defic Hyperact Disord. doi: 10.1007/s12402-014-0151-0

⁵ Spruyt, K., Gozal, D. (2011). Sleep disturbances in children with attention-deficit/hyperactivity disorder. <em>Expert Rev Neurother.</em>.https://doi.org/10.1586/ern.11.7

⁶ Miller, M.C., Pan, X. Eugene Arnold, L. et al (2021). Vitamin D levels in children with attention deficit hyperactivity disorder: Association with seasonal and geographical variation, supplementation, inattention severity, and theta:beta ratio. Biological Psychology. https://doi.org/10.1016/j.biopsycho.2021.108099