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

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

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

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

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

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

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

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

#1: The Report Misrepresents the Causes of ADHD

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Threat to ADHD Care Access

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

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

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

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

Reactions from the ADHD Community

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

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

Russell Barkley, Ph.D.

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

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

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

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

Is Combination Therapy Safe?

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

Which Condition Do I Treat First?

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

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

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

Anxiety and ADHD

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

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

Autism and ADHD

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

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

[Read: Interventions for Adult Autism and ADHD]

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

OCD and ADHD

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

Depression and ADHD

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

Eating Disorders and ADHD

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

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

Executive Dysfunction and ADHD

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

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

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

Comorbid Conditions with ADHD: Next Steps

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

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

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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

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

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

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

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

Mental Health Stigma in ADHD Care: Next Steps

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

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

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

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

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

Moving from Reactivity to Proactivity

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

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

[Free Download: Your Guide to Parent Training Programs]

A good parent behavior training program can do the following:

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

6 Popular Training Programs

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

Parent-Child Interaction Therapy

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

Goals:

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

The Incredible Years

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

Goals:

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

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

Positive Parenting Program (Triple P)

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

Goals:

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

Helping the Noncompliant Child

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

Goals: To foster positive interaction by:

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

Parent Management Training

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

Goals:

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

GenerationPMTO

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

Goals:

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

Tips for Finding a Provider

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

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

Behavioral Parent Training (BPT): Next Steps

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

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

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

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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.

Use the examples below to help you explain ADHD to your child in easy-to-understand language that diminishes shame and accentuates strengths.

Executive Dysfunction: A Short-Staffed Airport Control Tower

Our brains are like busy airports with control towers that guide the airplanes of executive function — planning, prioritizing, organizing, managing time, and other skills that help us get through everyday life — to take off and land smoothly.

Except the ADHD brain’s control tower isn’t always well-staffed. It often feels like you’re the only one who showed up to work! You scurry around ensuring that airplanes take off and land without incident — a feat that requires enormous amounts of energy. Sometimes, airplanes become delayed in their take off, or fail to take off altogether.

This is called executive dysfunction. It’s why an ordinary day at school feels so exhausting for you, and why some things may seem harder for you than for your classmates.

How to Support Executive Function Skills: Next Steps

• Read: Your Child’s 7 Executive Functions — and How to Boost Them
• Read: How to Sharpen Executive Functions — Activities to Hone Brain Skills
• Free Download: Common Executive Function Challenges — and Solutions

Regulation: A Volume Button (Sometimes) Gone Haywire

Do you sometimes feel absolutely stuck, unable to get started on your homework even though everyone tells you to “just do it?” Does it ever feel difficult to wind down and get to sleep?

If you answered yes, your brain’s volume button may be stuck or off kilter. The volume buttons in our brains help us regulate and moderate energy, emotions, appetite, sleep, and activity levels. In ADHD brains, the volume button sometimes gets jammed, or it develops a mind of its own, tuning to sound levels that don’t match your commands.

You know your volume button is at zero when it feels impossible to get anything done. It looks like a lack of motivation and procrastination. Maybe you have no appetite, and you struggle to get out of bed.

Sometimes, for no reason in particular, your brain’s volume button will ramp up to 100. Big feelings will flood your brain, your appetite will surge, and it will feel impossible to stop scrolling through social media or to turn off your video game. Even falling asleep will be difficult with a mind that is going full blast.

Self-Regulation: Next Steps

• Read: How to Teach Emotional Regulation Skills
• Read: How to Motivate an Unmotivated Teenager
• Read: Why Task Switching is Difficult for ADHD Brains — and 7 Ways to Smooth Transitions

Sensory Sensitivity: Operating with No Filter

Every minute of every day, our brains filter through sensory input from inside and outside of our bodies. But the filters in ADHD brains are sometimes unreliable — allowing too much or too little information to break through. Often, every little input is received and processed in your brain, making you ultra-sensitive to things like how clothes feel on your body, the intensity of certain smells, the lighting in your classroom, and other sensations. Everything competes for your attention.

This is why hanging out with friends can feel so tiring sometimes. It’s not that you don’t like spending time with them, it’s just that your brain heightens the sensations of everything around you, draining you of your energy as you try to handle competing stimuli.

Sensory Sensitivities: Next Steps

• Read: What Is Your Child’s Sensory Profile?
• Read: Too Loud, Too Bright, Too Sticky!
• Free Download: Sensory Issues — Triggers, Symptoms & Types of SPD

Rumination: A Sticky Gearbox

We all have bad days. To move past challenges, you rely on your brain’s gearbox to shift out of negative thinking and cruise into a lighter perspective. If you find that you’re stuck in loops of negative, toxic thoughts, it’s because your gearbox is sticking — a common problem in ADHD due to emotional dysregulation. Once you notice what’s happening, strategies from cognitive behavioral therapy can be incredibly helpful in getting you unstuck.

How to Shift to Healthier Thoughts: Next Steps

• Read: How Do I Teach My Teen to Manage Emotions?
• Read: When Your Child Wants to Give Up
• Read: How Can I Help My Teen Adopt a Growth Mindset?

How to Explain ADHD to Kids and Teens: More Resources

• Free Download: 5 Ways to Build Self-Advocacy Skills
• Read: Your Brain Is a Ferrari
• Read: How Do You Talk to Your Child About ADHD? Advice from Fellow Parents
• Read: Your Brain Is Amazing! 5 Things All Neurodivergent Teens Need to Hear

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “The Emotional Lives of Girls with ADHD [Video Replay & Podcast #488]“ with Lotta Borg Skoglund, M.D., Ph.D., which was broadcast on January 23, 2024.

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.

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

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

ADHD and Hormones in Women: Research Priorities

Priority #1: Improved Assessments

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

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

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

Priority #2: Studies on Pivotal Developmental Periods

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

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

Priority #3: Formal Consideration of Comorbid Conditions

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

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

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

Priority #4: Testing Interventions in Women

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

Hormonal Changes in Women with ADHD: Next Steps

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

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

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

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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

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

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

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

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

In this webinar, Dr. Eccles will explain:

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

Watch the Video Replay

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

Joint Hypermobility, Pain, & Neurodivergence: Resources

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

Obtain a Certificate of Attendance

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

Meet the Expert Speaker

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

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

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

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

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

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

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

How Screeners Fail Women

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

[Get This Free Guide: ADHD Diagnosis for Women]

Here’s my analysis of the three problematic questions:

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

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

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

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

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

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

Better Training = Accurate Diagnoses

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

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

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

Diagnostic Criteria for ADHD: Next Steps

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

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

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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.

Since its publication last Sunday, The New York Times Magazine article “Have We Been Thinking About ADHD All Wrong?” has been called provocative and controversial. We would like to add a few adjectives: misrepresentative, biased, and dangerous.

In his 8,800-word article, writer Paul Tough used cherry-picked bits of decades-old data, very small studies, and interviews with three patients (all men) to exhume long-debunked ideas about ADHD and its treatment with prescription stimulant medication. Tough dismissed the lifelong work of esteemed ADHD researcher Russell Barkley, Ph.D., and suggested that the diagnosis of ADHD was unreliable or subjective because it relies not on a biomarkers or genetic tests, but on a trained clinician’s careful review of patients’ self-reported and observed symptoms in several settings.

To be clear, identifiable biomarkers do not yet exist for many psychiatric, neurodevelopmental, and neurodegenerative disorders. In the case of ADHD, medical experts use rating scales, neuroimaging studies, and/or criteria in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) to assess whether patients meet the threshold for a diagnosis.

“There’s no genetic marker for most psychiatric illness, but there is very clear heritability, as Dr. Russell Barkley has pointed out for years,” says Wes Crenshaw, Ph.D., a licensed psychologist and author. “I wonder if the Times author doubts depression? Or autism? Or anxiety? Or bipolar disorder?”

Though he was also quoted in the Times article, Crenshaw says he was never interviewed by the reporter, who pulled quotes out of context from his ADDitude articles.

ADHD Biases Divorced from Fact

Tough cited findings from the Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study to suggest that the benefits of stimulant medication wear off after 36 months. In arguing that Ritalin’s “advantage had completely faded,” Tough failed to report that long-term medication adherence among the MTA subjects was inconsistent — an important fact that undermines the author’s contradictory argument that stimulant medication is somehow both ineffective and “powerfully addictive,” as he claims in the article. (If it were addictive, wouldn’t the MTA subjects have taken it every day without fail? We know that half of teens and adults with ADHD stop taking stimulant medication within one year of starting it, suggesting that it is not addictive and shining a light on how woefully irresponsible it is to claim the ineffectiveness of a medication that is not taken consistently.)

Tough was guilty of biased reporting, or a deep misunderstanding of the subject he was covering, when he suggested that the increase in ADHD diagnosis rates — from 3 percent nearly 40 years ago to up to 11.4 percent of American children today, according to the CDC — represents a medical crisis or evidence of overdiagnosis. In truth, this uptick is is due, in large part, to a revised set of diagnostic criteria for ADHD in the DSM-5, a dramatic improvement in both clinician and patient understanding of ADHD, and critical research on its manifestations, especially in girls, women, and people of color — populations that have been historically overlooked and underserved, with serious consequences.

Perhaps the Times reporter was unaware of the basic fact that, 40 years ago, the scientific community screened almost exclusively only boys for symptoms of ADHD. It did not acknowledge the inattentive subtype of ADHD that many girls and women exhibit. And it insisted that symptoms only caused impairment in school settings. We now know much better.

Sloppy Reporting, Inaccurate Conclusions

Tough did Times readers a disservice by choosing not to interview more esteemed physicians, researchers, and clinical psychologists at the forefront of ADHD care. Instead, he plucked their quotes from the pages of ADDitude, stripped them of context, and did not pursue conversations with authors, like Crenshaw, or patients they suggested. [Crenshaw told ADDitude that, prior to the article’s publication, he offered “the author (through fact checker) a chance to interview an almost infinite number of ADHD people whose lives have been radically changed by integrative treatment.” No interviews were granted.]

For example, Tough quoted a feature from the Fall 2021 issue of ADDitude magazine in which Crenshaw addressed parents’ top concerns regarding ADHD medication. In the article, Crenshaw used established, evidence-based research to suggest that, if your child has ADHD, then stimulant medication paired with behavioral parent training and/or cognitive behavior therapy is shown to produce the greatest results in symptom management. Tough took Crenshaw’s words out of context to make it seem that he was arguing that ADHD exists as a binary, on-off diagnosis without any heterogeneity or symptom fluctuation. This is contrary to Crenshaw’s views and contradicts ADDitude‘s own recent reporting.

In its Spring 2025 issue, ADDitude magazine published a cover story titled “ADHD’s Vanishing (and Reappearing) Act,” in which author Maggie Sibley, Ph.D., explained her recent research into the sometimes unpredictable ebbs and flows of ADHD symptoms over a lifetime. Rather than acknowledge ADDitude‘s work to cover the scientific community’s evolving understanding of ADHD, Tough’s reporting painted ADDitude and its contributors as outdated. This is an unfair depiction.

He manipulated ADDitude content again in quoting an article published in 2020 and written by Roberto Olivardia, Ph.D., a clinical psychologist and Harvard Medical School lecturer. Tough did not interview Olivardia. Instead, he pulled a quote from Olivardia regarding the ways in which stimulant medication may quell a child’s social impulsivity. Tough deliberately omitted this vital precursor to the quoted statement in the ADDitude article: “Clinicians should assure parents that any medication that appears to mute the child’s positive aspects and core personality is indicative of an unsuccessful medical trial. Another medication should be tried.”

Olivardia didn’t mince words in his response to the Times article. “The suggestion that I and other ADHD clinicians would uniformly placate parental concerns with a canned response is insulting,” he says. “This is not the first time this has happened within the ADHD community, and it’s so frustrating. Some things in the article are accurate, but they are mixed in with very inaccurate, overly simplistic information.”

Unraveling a Dangerous Narrative About Medication

Of perhaps greatest concern is Tough’s inaccurate and harmful portrayal of stimulant medication as an ineffective Band-Aid that fails to improve students’ academic test scores and, therefore, must be unnecessary. He cited limited research casting doubt on ADHD medication’s ability to make kids score higher on timed tests, sort specific puzzles more efficiently, or excel in summer school. “If these studies are accurate, stimulant medications don’t do much to improve cognitive ability or academic performance,” Tough wrote. “And yet millions of young Americans (and their parents) feel that the pills are essential to their success in school. Why?”

Inexplicably, Tough did not report that ADHD medication has been shown to reduce impulsivity and, by extension, the risks of car accidents, substance abuse, unplanned pregnancy, comorbid depression and anxiety, incarceration, self-harm, and suicide. In fact, research has found that stimulant medication use among individuals with ADHD reduces the risk of premature death by a staggering 19%.

In a study published in The British Journal of Psychiatry in 2025, the life expectancy for adults with ADHD was found to be 7.5 years shorter than it was for those without the condition. Women with ADHD live 8.6 years fewer years than women without ADHD, while the life expectancy of men with ADHD was 6.8 years shorter than that of their peers. ADHD is a serious condition, and to willfully misrepresent its proven treatments is dangerous at best.

Research has documented the positive impact of ADHD treatment on life expectancy. A Swedish study, published in JAMA Network Open, followed nearly 150,000 adults and adolescents for two years after they received their ADHD diagnoses. The researchers shared the following insights about the use of stimulant medication — amphetamine or methylphenidate — which is effective for roughly 70% of patients with ADHD:

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

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

What’s more, researchers at the University of Michigan and Massachussets General Hospital studied 40,000 high school seniors, more than 4,000 of whom had ADHD. The research team compared the risk for marijuana abuse — the most common drug misused by this age group—among teens with ADHD to the overall population. They found that the students with the lowest incidence of substance abuse started ADHD treatment with stimulants before 9 years of age. When treatment began between ages 10 and 14, it was helpful, but the students still had a significantly higher likelihood of smoking marijuana. The highest risk of marijuana use was found among students with ADHD who started medication after age 15.

The late Joseph Biederman, M.D., the former Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at Massachusetts General Hospital, along with researchers at the hospital and at Massachusetts Institute of Technology, conducted a study in which teens with ADHD were separated into two groups, then tasked with driving through a virtual roadway featuring surprise events, including oncoming traffic. The teens in the first group received stimulant medication (lisdexamfetamine: brand name Vyvanse) while the teens in the second group did not. Compared with the group of non-medicated ADHD teens, the medicated group was 67% less likely to have a collision during these events.

“For families that stop ADHD treatment on weekends and during ‘downtime,’ I emphasize the importance of driving only while medication is active,” Dr. Biederman had said. “A short-acting medication taken about half an hour before hitting the road may just be lifesaving.”

Why Ignore Patients’ Real-World Experiences?

Indeed, ADHD treatment with medication is lifesaving for many children, adolescents, and adults with ADHD for many reasons beyond the decreased risks for car accidents, illegal drug use, unprotected sex, and the other dangers outlined above.

ADDitude readers write to us daily about the social, emotional, professional, and psychological benefits they experience while using prescription stimulant medication to treat their ADHD symptoms. By excluding these patient perspectives, Tough’s reporting could place lives at risk by telling a story that may scare caregivers and adult patients away from the ADHD treatments that are shown to safely, effectively improve and protect lives.

On that note, let us leave you with a few quotes from ADDitude readers explaining, in their own words, the benefits of stimulant medication and the threats they feel in 2025.

“Adderall is literally the difference between crippling depression due to executive function disorder and not. If my access to my much-needed medication goes away, the impact will be exponential.”

“If they mess with my stimulants or access to stimulants, I could lose my job and even my marriage. I rely on it to maintain focus as a design engineer. It also helps communication with my wife when I have my stimulants.”

“ADHD medication has huge benefits. It’s frustrating that the discourse is being steered from the top by someone so willfully ignorant, bringing out everyone who has totally misinformed ‘reckons’ about ADHD.”

Rebuttal from Russell Barkley, Ph.D.

More NYTimes Rebuttals

• 4-Part Video Response from Russell Barkley, Ph.D.
• The Child Mind Institute
• The ADHD Evidence Project

ADHD Article Corrections: Next Steps

• Free Download: The Ultimate Guide to ADHD Medication
• Reader Reactions: MAHA Commission Means Fear, Stigma, Health Threats for Two-Thirds of ADDitude Readers
• Read: Is ADHD Real? Yes — and Still Heavily Stigmatized

Corrections

This article was updated on April 25, 2025, to reflect the following:

• Wes Crenshaw, Ph.D., reported to ADDitude that he invited the author to interview several ADHD patients, not himself, and that invitation was not accepted
• The CDC’s 2022 estimate for the prevalence of ADHD in American children aged 3-17 years, which is 11.4 percent, not 5 to 7 percent
• Author Paul Tough did not directly describe the ADHD diagnosis process as “arbitrary,” but rather his quoted source, Edmund Sonuga-Barke, did. This quotation was removed.
• The full quote from Tough’s text was included: “If these studies are accurate, stimulant medications don’t do much to improve cognitive ability or academic performance. And yet millions of young Americans (and their parents) feel that the pills are essential to their success in school. Why?”
• This phrase was removed, “…and then questioned why American parents and students would accept the ‘risks inherent in taking prescription stimulants.'” The original article stated: “Researchers acknowledge that there are other risks inherent in taking prescription stimulants.”

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.

ADHD symptoms can manifest and be diagnosed in young children. In fact, research indicates that the earliest signs of ADHD can emerge in infancy. In preschoolers, certain behaviors and challenges — especially if they interfere with functioning as the child progresses through expected developmental milestones — offer early clues that ADHD is present.

Is it ADHD or Typical Preschool Behavior?

The preschool years are an exciting time of cognitive, physical, social, and emotional growth that bridges the gap between toddlerhood and the school-aged years. Common behaviors that mark the preschool years include the following:

• eagerness to participate in group activities
• curiosity and affection
• a budding sense of humor
• easily encouraged and discouraged
• intense feelings
• high energy
• showing off or demanding attention
• difficulty following adult-led activities for long periods of time
• emerging executive function skills

A wide range of behaviors is considered developmentally appropriate in preschool-age children. The following milestones, which focus on inhibition, a developing sense of danger, and awareness of social expectations, are particularly important:

• By age 3: avoids touching hot objects, like a stove, when warned
• By age 4: avoids danger (e.g., not jumping from tall heights at the playground); changes behavior based on the situation
• By age 5: follows rules and takes turns when playing games with other children; pays attention for 5 to 10 minutes during a screen-free activity

[Get This Free Download: Get the Caregiver’s Guide to Diagnosing ADHD]

The milestones above reflect the expected achievements of at least 75% of children in each age range. Similarly, common behavioral red flags that may indicate ADHD include the following:

• difficulty attending to a non-screen task for 5 to 10 minutes by age 5
• excessive climbing and jumping (like over furniture) when the behavior might not be expected or appropriate
• moving quickly from toy to toy or having difficulty playing with toys at all
• difficulty waiting; impatience
• frequently interrupting adults (during phone calls, in-person conversations)
• acting or moving in unsafe ways (e.g., bolting across the street despite being told to hold an adult’s hand, unbuckling their seat belt when the car is in motion, reaching for a piping hot dish)
• difficulty following instructions and adhering to routines
• excessive talking and noise making while doing activities (like homework)
• constantly on the go and “bouncing off the walls”; difficulty calming the body
• high reactivity
• social difficulties

It’s true that many preschool-age children will experience ADHD-like symptoms. Of these children, a small percentage will go on to develop ADHD that may impair day-to-day functioning if left untreated.

[Read: Is Preschool Too Early to Diagnose ADHD?]

How to Help Your Preschooler

By age 5, upwards of 90% of the brain is developed. Because of this, early childhood is a critical period of intervention, where new neural pathways can be built before patterns of behavior become entrenched. Here are some of the things you can do to help a child with ADHD develop positive patterns of behavior:

Offer Vigorous Praise

• Catch your preschooler being good. Celebrate your child when they engage in a behavior you want to see more of. Say, “Wow, thanks for coming to the table the first time I called you over!” or, “I love how you picked out your shirt without me even asking you to do it. Awesome work.” Do not immediately react when your child engages in behaviors you wish to see less of, like interrupting, so your child does not equate with non-preferred behaviors with instant attention.
• Praise by the numbers. You’ll be coaching and correcting your child in many ways, which makes frequent positive reinforcement essential. For every one time that you correct your child’s behavior, make sure to offer roughly four positive comments.

Model Structure & Consistency

• Use routines and visual schedules. These layer predictability into a unpredictable world, reducing stress and fostering stability. Illustrate the steps of your child’s morning, after-school, and evening routines on fun visuals to help with information processing. Have your child check off each step as they complete it.
• Offer advanced warnings. Because all good things must come to an end, let kids know when transitions are on the horizon. Give 3- and 1-minute alerts when playtime is about to end, for example. When time’s up, say, “Three, two, one, this is all done. Let me help you clean it up and move on to the next thing.” Visual timers are immensely helpful here, as they help your child know how much time is left, allowing them to better regulate their expectations and behavior.

Give Clear, Specific Instructions

• Clearly explain rules, expectations, and consequences. Your child must understand, in no uncertain terms, what is required of them and the consequences of not following the rules. You don’t want to surprise your child with an unexpected consequence for an expectation they didn’t fully understand.
  • Instead of: “Be a good boy!”
  • Try: “Please listen to your babysitter on your way home from school today.”
  • Instead of: “Play nicely with your toys!”
  • Try: “Toys are to play with. They’re not to throw. If you throw the toy, I will take it.”
  • Instead of: “Behave when you play with your brother!”
  • Try: “You cannot hit your brother. If you hit your brother, I will remove you.”
• Chunk it up — one step at a time. Directions like “get ready to go to school” or “get ready for bed” are complex and often difficult to process. Spell out all the involved micro-tasks to help your child follow through.
  • Instead of: “It’s time to go. Finish your breakfast, put your shoes on, and grab your backpack.”
  • Try: “Please finish your breakfast.” (Pause and wait to give the next step once this step is completed.)
• Avoid framing directions as questions or options that your child can say “no” to.
  • Instead of: “Can you put on your shoes?”
  • Try: “Please put on your shoes.”
  • Instead of: “Can you get ready for dinner?”
  • Try: “Please wash your hands for dinner.”

Never Penalize Your Child for Their Feelings

• Empathize but maintain expectations. Your child is allowed to feel sad or upset when, say, playtime is up. Show that you understand how they feel as you guide them to the next activity. Say:
  • “I know this is hard for you.”
  • “I hear you.”
  • “It’s OK to have big feelings.”
• Bond without correction. For 5 to 15 minutes a day, give your child your undivided attention as you engage in an activity together. Do not correct or discipline your child’s behavior during this special, positive time. If 15 minutes is too long to go without a correction, start with a shorter period of time. No matter the length, never make this bonding period with your child contingent on their behavior.

Involve the School

• Loop in your child’s school or nursery to their diagnosis and treatment program. Children with attention and regulation difficulties do better when they’re supported across environments. Without school-wide awareness, your child’s behaviors may be misunderstood and/or misattributed. Helpful school interventions include the following:
  • daily behavior report cards
  • visual schedules
  • movement breaks
  • clear directions
  • preferential seating
  • peer modeling

The Question of ADHD Medication

While the American Academy of Pediatrics (AAP) recommends behavioral interventions as the frontline treatment for ADHD in children ages 4 to 6, ADHD medication may be indicated for preschool-age children if behavioral interventions do not provide significant improvement and if moderate to severe disturbance in a child’s functioning persist. Talk to your pediatrician about whether medication may be an appropriate part of your preschooler’s treatment plan.

Signs of ADHD in Preschoolers: Next Steps

• Free Download: The Ages & Stages of ADHD: Key Solutions from Childhood to Adulthood
• Self-Test: Could Your Preschooler Have ADHD?
• Read: Starting with Preschool, Strive for Kids Who Thrive

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “ADHD in Preschool: Early Diagnosis & Intervention for Young Children” [Video Replay & Podcast #516] with Alexis Bancroft, Ph.D., and Cynthia Martin, Psy.D., which was broadcast on August 8, 2024.

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Men with ADHD experience higher rates of learning disabilities, tics, oppositional defiant disorder (ODD), and conduct disorder, while women with ADHD face an elevated relative risk for emotional and sleep disorders, according to a new cross-sectional study published in PLOS One¹. The research, which found a higher incidence of comorbid psychiatric conditions among adult men than any other demographic, notably did not examine eating disorders or migraines, two comorbid conditions known to be more common in women and girls with ADHD.

According to 3,152 ADDitude readers surveyed in 2022, 16% of women with ADHD reported having an eating disorder, compared to 7% of men. Similarly, a 2023 ADDitude survey of 7,095 adults found that 22% of women reported a migraine diagnosis, compared to only 8% of men. The same gender disparity is true for anxiety (74% in women vs. 63% in men) and depression (62% in women vs. 51% in men), according to ADDitude survey results.

These gender differences mirror those of prior scientific research that found higher rates of anxiety and depression in women compared with men before and after their ADHD diagnosis².

“Comorbidity is the rule rather than the exception,” said Lotta Skoglund, M.D., Ph.D., in her 2024 ADDitude webinar, “The Emotional Lives of Girls with ADHD.” “When you have a girl or woman with ADHD, you should be prepared for anxiety, depression, eating disorders, self-harm, even more serious than actually for the boys.”

The new cross-sectional study analyzed the age, sex, and psychiatric diagnoses of 112,225 individuals with ADHD, using data collected between January 2000 and December 2011 from the Taiwan National Health Insurance Research Database. (The researchers noted their use of a Taiwanese database may affect the results’ applicability across cultures.)

Among children ages 12 and younger, the prevalence of learning disabilities, ODD, and sleep disorders were evenly split between the genders. Boys of any age were twice as likely as girls to experience a tic disorder. In adolescence, depressive disorders became markedly more common among girls (29.41%) compared to boys (17.74%) in the Taiwanese study. The same is true for anxiety disorder (35.22% in girls vs. 30.8% in boys) and sleep disorder (24.89% in girls vs. 17.36% in boys).

Surprisingly, the Taiwanese study shows a reversal in adulthood, with depression, anxiety, and bipolar disorder becoming more common in men than women. These findings contradict other similar studies and the ADDitude survey data cited above.

Perhaps less surprisingly, the researchers found that adult male participants had higher rates of alcohol use disorder when compared with women. This discrepancy also reflects the 2023 ADDitude survey, in which 10.75% of men reported substance use disorder, compared to 6.83% of women.

“Alcohol use can mask genuine ADHD manifestations,” the researchers wrote. “The convergence of ADHD and substance use disorder complicates diagnosis, with affected individuals facing greater challenges, including elevated suicide risk and treatment complexities.”

Notably, two-thirds of the cross-sectional study participants were boys ages 12 and under; less than 3% of participants were women over the age of 18. This relative scarcity of data on adults may have skewed results. Despite these and other limitations, examining the relationship between comorbidity, age, and sex is important given the impact of overlapping conditions on treatment.

“From the perspective of me as a clinician and a researcher, I know that just by fulfilling the criteria for ADHD, you will live about 10 fewer years than a person of the same age, sex, and socioeconomic status,” Skoglund said. “Many of these years are lost due to the comorbidity in undetected and untreated ADHD.”

ADHD diagnoses are more common in males during childhood and adolescence, according to the study. However, this pattern appears to reverse in adulthood.

“Our data show a reversal in the male-to-female ADHD ratio from childhood to adulthood, possibly due to under-recognition of ADHD in young females and reduced help-seeking behavior among adult males,” the researchers wrote.

This lower rate of ADHD in young and adolescent girls reflects research demonstrating that ADHD often goes undiagnosed or misdiagnosed in women². At the same time, the impact of toxic masculinity and stigma on men and boys with ADHD has not been thoroughly examined.

“In my many years of ADHD coaching, I’ve encountered countless women who struggle with their husband’s or young adult son’s resistance to seek or accept an ADHD diagnosis because they fear the ‘stigma’ of the disorder,” wrote ADHD coach Alan P. Brown in the ADDitude article, “ADHD Symptoms in Men Manifest Differently.” “In their male minds, it’s admitting to ‘weakness.’”

Sources

¹ Kao PH, Ho CH, Huang CLC (2025) Sex differences in psychiatric comorbidities of attention-deficit/hyperactivity disorder among children, adolescents, and adults: A nationwide population-based cohort study. PLOS One, 20(1): e0315587. https://doi.org/10.1371/journal.pone.0315587

² 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

Emotional dysregulation is an invisible string linking sensory processing, anxiety, and ADHD in children, according to new research that explores the relationship between sensory processing subtypes and self-regulation in children with neurodevelopmental disorders. Researchers found that, while some sensory subtypes were associated with elevated anxiety and others with elevated ADHD symptomatology, all sensory processing subtypes were associated with higher emotional dysregulation compared with sensory-typical children.

The study, published in Nature, enrolled 117 participants from a community-based specialty clinic; all participants were children aged 8 to 12 years old with various neurodevelopmental diagnoses, including autism and ADHD.¹ The researchers uncovered five distinct sensory processing profiles in this group:

• Typical Sensory Processing (30% of the sample)
• Sensory Under-Responsive (20%): Child often does not respond to verbal information or what is around them
• Sensory Over-Responsive (19%): Child is bothered by wearing certain garments or by loud sounds
• Sensory Seeking (19%): Child has a persistent desire for fast movement and often cannot stop touching things or people
• Mixed Sensory Processing (11%): A combination of the above, depending on context or the stimuli

The study highlights the “wide range of heterogeneity in sensory experiences among populations with neurodevelopmental concerns,” say the study’s authors.

Elevated Emotional Dysregulation, Anxiety, ADHD

The researchers investigated the prevalence of behavioral and emotional regulation challenges in the group as a whole and in different sensory subtypes. They also considered the following comorbidities:

• 62% of the group exhibited ADHD symptoms
• 39% exhibited emotion dysregulation
• 19% exhibited anxiety

They also studied patterns associated with specific sensory subtypes:

• Children in the sensory over-responsive subtype reported significantly elevated anxiety levels.
• Children in the sensory seeking and sensory under-responsive subtypes reported the highest levels of ADHD behaviors.
• All subtypes, apart from typical sensory processing, reported elevated levels of emotion dysregulation.

These findings offer insights into the complicated relationship between sensory processing and self-regulation challenges, which researchers hope will help clinicians better serve neurodivergent children through targeted interventions that address overlapping symptomology.

“Not many people realize that the sensory systems are foundational to development, functioning and wellbeing. Differences in sensory processing may undermine the acquisition of skills of a higher order – from behavior to learning,” explains Candace Peterson MS, OTRL, in her ADDitude article. “What Is Your Child’s Sensory Profile?” “This is why sensory challenges in kids often manifest in school, show up as behavior problems, and make daily living difficult.”

An ADDitude reader who struggles with sensory over-responsiveness explains: “Sounds seem to overstimulate me the most frequently and easily. It feels like the sounds are physically pushing me into a corner and squishing me.” Another reader with sensory over-responsiveness says clothing tags and seams are her “mortal enemies.” “On good days, they’re a slight annoyance,” she says. “On bad days, it feels like they’ve come alive with tiny needles for fingers, incessantly poking at me, causing repeated stings.”

Sources

¹Brandes-Aitken, A., Powers, R., Wren, J. et al. Sensory processing subtypes relate to distinct emotional and behavioral phenotypes in a mixed neurodevelopmental cohort. Sci Rep 14, 29326 (2024). https://doi.org/10.1038/s41598-024-78573-2

ADHD is not a static condition with fixed symptoms, but rather a dynamic disorder with symptoms that wax and wane over the lifespan, sometimes disappearing for years at a time. This was the finding of a new study published in the Journal of Clinical Psychiatry ¹ that made another unexpected discovery: periods of higher environmental demands were associated with times of remission or reduced ADHD symptoms.

Led by Margaret Sibley, Ph.D., professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, the research used data from the longitudinal Multimodal Treatment of ADHD (MTA) study, which followed 483 participants, diagnosed with ADHD at 7-10 years of age, for 16 years.² Follow-up assessments, which were administered every two years, asked participants and parents about the severity and frequency of ADHD symptoms and impairments, as well as about environmental demands, including responsibilities in education, work, and finances.

The researchers found that longitudinal patterns revealed four groups:

• Fluctuating ADHD: 64%

Alternating periods of remission and recurrence

• Stable Partial Remission: 16%

A significant reduction in symptoms was experienced, typically beginning in late adolescence or early adulthood, that remained stable afterward

• Stable Persistence: 11%

High symptoms that met diagnostic thresholds with minimal or no improvement over time

• Recovery: 9%

Sustained full remission of symptoms

Among the group that experienced fluctuating ADHD, the following trends were uncovered:

• There were typically three to four transitions between remission and recurrence over the 16-year period.
• The first remission period often began in early adolescence, around age 12, with symptoms returning within a few years.
• Compared to other groups, symptom severity was moderate.

ADHD symptoms improved to a point of remission at some point over the 16 years for most study participants, Sibley explains in an article titled “ADHD’s Vanishing Act” that appears in ADDitude’s forthcoming spring 2025 issue. In most cases, faded symptoms returned three to four years later, Sibley says.

“In other words, most individuals with ADHD can expect to go through years when their symptoms do not cause meaningful problems,” Sibley writes. “The neurocognitive risks are always present, but the clinical problems may only emerge sometimes. This is comparable to a person who may struggle with weight gain biologically, but who may fluctuate in and out of the obesity range over the course of their lifetime.”

A Busy Schedule Linked to Reduced ADHD Symptoms

The MTA study gathered information about environmental demands, such as an increase in significant responsibilities at work, school, or home, in order to explore whether these demands impacted ADHD symptoms. It turns out they did — but not in the way researchers hypothesized.

“We speculated that increased stresses would be associated with higher levels of ADHD in participants,” Sibley explains. “We were surprised to find quite the opposite, [that] higher levels of demands were associated with remission of ADHD. In other words, people with ADHD were rising to the challenge when demands were high.”

Sibley notes that the nature of the relationship between higher demands and reduced symptoms remains unclear; the study revealed a link, but not how the link works.  “One explanation is that ADHD symptoms fade when consequences in the environment create an urgent need to stay on track,” she speculates. “It is also possible that, when people have lower ADHD symptom levels, they are able to take on greater responsibilities.” Likely, it’s a combination of the two, Sibley says.

Childhood Factors Predict Long-Term Outcomes

The study found that certain childhood factors served as predictors for long-term outcomes. Individuals in the stable persistent group tended to be at higher risk for mood disorders, substance use problems in adolescence, low medication utilization, and poorer response to treatment in childhood. Those in the partial remission group tended to have higher rates of comorbid anxiety. By contrast, individuals in the recovery group were less likely to have mood disorders and parents with psychopathology.

The study helps the scientific community more fully understand the complex landscape of ADHD, and Sibley sees great potential benefit if clinicians pass along this nuanced understanding to patients.

“For some people with ADHD, this may mean staying busy and keeping an active schedule,” Sibley ventures. “It may also mean working with practitioners to leverage a nuanced understanding of ADHD fluctuations when designing a treatment plan that boosts wellbeing.”

Sources

¹Sibley MH, Kennedy TM, Swanson JM, Arnold LE, Jensen PS, Hechtman LT, Molina BSG, Howard A, Greenhill L, Chronis-Tuscano A, Mitchell JT, Newcorn JH, Rohde LA, Hinshaw SP. Characteristics and Predictors of Fluctuating Attention-Deficit/Hyperactivity Disorder in the Multimodal Treatment of ADHD (MTA) Study. J Clin Psychiatry. 2024 Oct 16;85(4):24m15395. doi: 10.4088/JCP.24m15395. PMID: 39431909.

²The MTA Cooperative Group: A 14-Month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder (ADHD) . Arch Gen Psychiatry 1999;56:1073-1086.