Why Self-Harm Haunts Youth with ADHD: Causes, Signs, and Treatment

Editor’s Note: Self-harm impacts an estimated 17% of teens worldwide.¹ Among youth with ADHD, especially girls, the prevalence of self-injury is significantly increased, in part, because hallmark characteristics of ADHD such as impulsivity and emotional dysregulation can compel self-injurious behavior.

Dramatically higher rates of self-harm among youth with ADHD are reflected in many studies, including the Berkeley Girls ADHD Longitudinal Study (BGALS), which found that girls with combined-type ADHD are 2.5 times more likely than their neurotypical peers to engage in non-suicidal self-injury, and 3 to 4 times more likely to attempt suicide. A recent study found that, among self-harming teens, the incidence of hyperactivity and emotional dysregulation were so much higher than in the control group that the researchers concluded that self-harm may serve as a first presentation of ADHD, especially among girls who might otherwise go undiagnosed.² They further suggested that all teens who present with self-harm should be screened for ADHD.

The newest research has revealed that rates of self-harm among youth with ADHD may be even higher than past studies suggested. A 2024 study published in Psychiatry Research³ that involved 5,100 youth in Australia found that subjects with ADHD were 25 times more likely to self-harm than were their neurotypical peers.

Why Do Kids and Teens Self-Harm?

For some people, self-injury is an effective way to regulate unwanted emotions like anxiety and sadness, which they feel very, very strongly in their bodies. For some individuals, self-harm may bring them back into their body if they feel disassociated or emotionally numb.

Sometimes, the function of the self-injury is to communicate needs, or for kids to feel in control of their bodies and minds. There’s something about the behavior, symbolically, that allows kids and teens to take something amorphous — a bundle of abstract feelings — and put it somewhere on their body. They claim the power of defining the look of it, of expressing, “this is what these emotions look like,” and then the body heals it.

[Read: We Demand Attention on Self-Harm, Intimate Partner Violence, and Substance Abuse Among Women with ADHD]

Typically, the self-injury results from a trigger, causing a cascade of intense emotion that the person then wants to be rid of. Common categories of triggers include:

• Interpersonal stressors: a sense of rejection or relationship stress
• Performance anxieties

Self-Harm Patterns and Red Flags

While self-injuring behaviors vary by individual, studies have provided us with data about general patterns of self-harm among children and teens: ^{4 5}

• Average age of onset: 11-15 years old
• 25% of youth who self-injure do so only once
• 75% of youth report multiple episodes of self-injury
• Most youth who repeatedly self-injure stop within 5 years
• Self-injury can be cyclical and occur again after periods of stopping

[Read: Teen Girls Are Not Alright. ADHD Magnifies the Crisis.]

Self-Harm Red Flags:

Non-physical signs:

• Persistent changes in mood or character

Physical signs:

• Scars or wounds, especially multiple injuries clustered together
• Wrist coverings or inappropriate dress for the season (i.e. long sleeves in summer)
• Confusing paraphernalia in unexpected places (i.e. sharp object in bed)

What to Do If Your Child is Self-Harming?

If you find out your child is self-injuring, it’s important to form your response thoughtfully. Parents’ reactions to self-harm matter: Conversations that go well can really open doors for healing, but conversations that go poorly can do the opposite.

1. Remain neutral. Don’t display shock, pity, or judgment.

Discovering your child has been self-injuring can trigger many emotions including fear, shock, guilt, confusion, and anger, but it’s very important that you don’t attempt to talk to your child until you’ve worked through and subdued these feelings. Broach the topic only when you feel you can be dispassionate and centered.

It’s common to feel anger, which often results from worry, and there may be an urge to ask, “What are you doing? Why would you do this? Stop it!” Be sure to refrain from any condemnation, shame or criticism, as this may exacerbate the behavior.

2. Communicate three sentiments:

“I love you.”

“I’m sorry you’re hurting.”

“I’m here to help.”

Verbalize these messages to your child. It’s what they need to hear.

3. Don’t fixate on the wounds:

While it’s normal to be concerned about self-inflicted wounds, you should steer clear of placing too much emphasis on the physical injuries themselves. Instead, focus on the underlying reasons for the injurious behavior. Research shows that is what kids want to talk about, and understanding what’s causing the behavior is the first step toward meaningfully and effectively addressing it.

If kids don’t want to talk: That’s okay. Evasiveness is common at first. The most important thing isn’t getting the information you want, it’s establishing a connection, and keeping that connection open.

If you blow it: Don’t spend too much time worrying about it. Just go back to your child later and say, “That didn’t go the way I wanted it to go. Let’s try again.”

Distinguishing Non-suicidal Self Injury from Suicidal Ideation

Self-injury, most often, is not a suicidal gesture. The behavior typically originates from kids and teens wanting to feel better, not wanting to end their life.

That said, self-injury is a sign of distress and, in some cases, children and teens who engage in this behavior may be considering suicide. It’s important to differentiate between non-suicidal self-injury, and self-injury associated with suicidality.

The best way for parents to find out if the child is having suicidal ideation? Ask them.

Ask your child: “Can you tell me if you feel or have felt like you want to end your life?” If they say yes, you should determine how immediate the threat is by asking, “Are you feeling that now?” If the answer is “yes,” you need to reach out to a professional right away.

If your child responds, “no,” but you suspect they’re not being totally honest, tell them, “I love you. I’m here for you,” then continue to observe them and broach the topic again at a later time. The most important thing for parents to do is to keep the door of connection open.

Is Self-Harm Addictive?

Early detection is important because self-harm can become habit-forming. One quarter of youth who have self-injured report that they only did it once, but for three quarters of youth, there were multiple episodes. Individuals report having to do more over time to get the same response and they report feeling the desire to self-injure outside of a triggering situation.

It isn’t uncommon for people to acquire more contexts and reasons to self-injure as time goes on and this makes it harder to stop. As it becomes a more central part of how a person manages their emotions, it becomes a bigger lift to replace it with something else over time.

Is Self-Harm Contagious?

Self-injury can be contagious, especially within institutions, such as schools.

If your child is self-injuring and you believe it’s also something their peers are doing, it can help to find the person who is likely the epicenter of the behavioral trend. Often, this is a high-status peer, who may be signaling that this is cool, even if that is not their intent.

Try to engage this student as an ally and explain that there’s some contagion happening, and they have the ability to help in many ways, from minimizing the attention they give to self-injury to getting help themselves. Don’t assume that this child is your enemy: often, they’re not aware of what’s happening, and they don’t want their friends to be hurting.

Self-Harm Treatment

If a child is self-injuring, especially if they have other underlying issues including anxiety, depression, and/or ADHD, it’s important to find a good therapist. Look for providers who have experience working with young people and with dialectical behavioral therapy (DBT), which is the most commonly used modality to treat self-harm. DBT’s focus on understanding and accepting emotions and distress tolerance as well as learning healthy coping skills can be effective for addressing self-harm.

It’s important to note that self-injury can be tough to treat because it works very effectively for some people to down-regulate. We all have preferred ways of coping, and this becomes some people’s deeply preferred way. It’s not as easy as just replacing the behavior with other techniques.

Because of this, therapists often won’t start by addressing the self-injury directly. Instead, they might start by addressing an underlying issue that’s driving it, the psychological architecture that gave rise to it in the first place.

Kids and teens who self-injure have to learn to lean on something else that feels as effective, which just takes time, practice, and guidance. 

Self-Harm and ADHD: Next Steps

• Read: Straight Talk on Suicide and ADHD
• Free Download: Get a Grip on Tough Emotions
• Read: DBT Skills – The Go-To Treatment for ADD?

Janis Whitlock, MPH, Ph.D., is director of the Cornell Research Program of Self-Injury and Recovery.

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