From lead exposure and maternal stress during pregnancy to low birth weight, the list of prenatal and perinatal risk factors associated with ADHD seems to grow longer and longer with ongoing research. But there is much left to learn. The causal role of many exposures linked to ADHD is unclear; some appear to be artifacts of ADHD’s genetic element, while others are truly causal contributors. The other critical factor is that none of the risk factors cause ADHD every time; most children exposed to these risk factors do not develop ADHD.

Thus, it seems increasingly clear that 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.

Some prenatal and perinatal risk factors for ADHD are unavoidable and inevitable. Mothers grappling with their child’s ADHD diagnosis especially may place undue blame on themselves as they fixate on past events that could have contributed to their child’s ADHD. But science provides comforting truths: Exposure to risk factors does not guarantee ADHD, and early and effective treatment approaches can often mitigate the effects of previous complications and improve outcomes.

ADHD Risk Factors: What We Know

Prenatal Risk Factors

Teratogens: Alcohol, Smoking, and Other Substances

Teratogens are substances and agents that could harm a developing fetus during pregnancy. Some teratogens have been linked to ADHD, though association should not be mistaken for causality.

[Read: Is ADHD Genetic? Yes and No]

Alcohol

Children whose mothers consumed alcohol during pregnancy were at 1.55 times the risk for developing ADHD compared to children whose mothers did not consume alcohol while pregnant, according to a 2015 study of roughly 20,000 parents.¹ Other studies have found mixed evidence on prenatal alcohol exposure and ADHD risk.^{2 3}

Drinking alcohol during pregnancy can cause a group of conditions called fetal alcohol spectrum disorders (FASD), which are associated with some symptoms and features linked to ADHD, including behavioral challenges, inattention, learning disabilities, poor memory, hyperactivity, and impulsivity. ⁴

In many cases, FASD is overlooked altogether and even misdiagnosed as ADHD. ^{5 6}

Tobacco Use

Maternal prenatal smoking increases risk for ADHD in children by more than one and a half times, according to a 2020 review of 12 large studies.⁷ Other studies have found that paternal smoking before and during pregnancy increases risk for ADHD in offspring.^{1 8 9}

However, while smoking in pregnancy is a major correlate of ADHD, it’s probably not a causal factor. Studies that controlled for genetic effects found that the maternal smoking association to ADHD largely disappeared.

[Read: What Causes ADHD? Culture Vs. Biology]

Drugs and Other Substances

• Opioids: Children whose mothers used opioids during pregnancy had more than double the risk for ADHD compared to those whose mothers did not use the drug, according to a 2022 study of about 3,000 children.² The same study found that risk for ADHD increases with exposure to multiple substances, including tobacco and cannabis.
• Acetaminophen exposure in the womb may increase a child’s risk for ADHD.¹⁰ It’s unclear whether there are time periods when the developing brain may be most sensitive to acetaminophen exposure. The FDA urges pregnant parents to consult with a doctor before taking pain medication.

But, as with smoking, we do not yet know if these effects are causal independent of genetic effects.

Maternal Health Issues

Maternal Metabolic Syndrome

Maternal obesity, hypertension, diabetes, and related conditions before and during pregnancy are associated with increased risk for ADHD, autism, and other neurodevelopmental disorders in offspring.^{12 13} While researchers are still investigating the connection, the risk for these effects in isolation appears small, especially considering the prevalence of these conditions at large. Still, they are effects that helps us learn about mechanisms that are possibly tied to ADHD.

Emotional Stress and/or Trauma

Maternal exposure to stress or trauma, if it’s high, can influence offspring behavior and temperament. What’s more, chronic prenatal stress increases the likelihood that a child will have ADHD or other conditions.

One 2018 study found that mothers who experienced high levels of stress during their pregnancy were more than twice as likely as less-stressed mothers to have a child diagnosed with ADHD or conduct disorder.¹⁴

Birth Trauma and Delivery Complications

Oxygen Deprivation

Insufficient oxygen supply and blood flow in utero and during birth is associated with increased risk for ADHD in later life.

Birth asphyxia is associated with a 26% greater risk of developing ADHD, while neonatal respiratory distress syndrome is associated with a 47% greater risk for ADHD, according to a 2012 study of more than 13,500 children with ADHD.¹⁵

C-Section Delivery

Compared to babies born via vaginal delivery, babies born via cesarean delivery (whether elective or emergency) are at greater risk for ADHD, according to a 2019 review of 61 studies comprising more than 20 million deliveries.¹⁶ The link between the two – including whether C-section delivery plays a causal role in the development of ADHD – remains unknown.

Prematurity and Low Birth Weight

Low birth weight and prematurity do appear to have a significant causal influence on the development of ADHD. Extremely preterm babies and those with very low birth weight are about three times likelier than healthy babies to develop ADHD, according to a 2018 meta-analysis of 12 studies involving 1,787 participants.¹⁷ Studies that controlled for genetics found the association still held.

ADHD Risk Factors: Events and Exposures in Early Life

Lead and Other Pollutants

Research on lead as a developmental neurotoxicant is robust. Its correlation with ADHD is also well established.¹⁸ Even low levels of exposure have an effect on ADHD.

Recent evidence suggests that lead has a causal role in ADHD. In our 2016 study, we looked at the effect of a common gene mutation – HFE C282Y – on the relationship between blood lead levels and ADHD symptoms in children, and found that children with ADHD who had the gene mutation exhibited greater symptoms of hyperactivity and impulsivity than did children with ADHD without the mutation.¹⁹

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

As far as other pollutants, early exposure to nitrous dioxide and persistent organic pollutants has also been linked to ADHD, among others.^{20 21}

Breastfeeding and ADHD

Breastfeeding is linked to decreased risk for ADHD in children.²² Mothers of children with ADHD are more likely than mothers of neurotypical children to report shorter breastfeeding duration.²³ What underlies the ADHD-breastfeeding link is unclear, like whether breastfeeding protects the developing brain from ADHD, or if infants who are going to develop ADHD are more difficult to breastfeed and are thus breastfed for a shorter period of time. We used advanced statistical methods to test this in one study, and found that the causality was reversed: child ADHD caused reduced breastfeeding duration.

Head Injuries

Head injuries, especially severe traumatic brain injuries, increase risk for ADHD, according to a 2021 review of 24 studies that included 12,374 children.²⁴

Head injuries and ADHD share a complicated chicken-and-egg relationship, as ADHD itself increases risk for head trauma.²⁵ Children with ADHD are twice or three times as likely to obtain serious head injuries and accidental head injuries through their impulsivity.

Childhood Trauma

Children who experience trauma and who are exposed to adverse childhood experiences (ACES) are at increased risk for ADHD. The inverse is also true: ADHD increases the risk of exposure to trauma.^{26 27}

Trauma is also known to exacerbate symptoms of ADHD. Compared to children without ADHD, children with ADHD who experience trauma are more reactive and sensitive to it, and need additional support.

Beyond a bi-directional relationship, trauma and ADHD share similar symptoms. It takes an experienced clinician to distinguish the conditions and understand if a child is experiencing a trauma effect or showing true signs of ADHD or both.

ADHD Risk Factors: The Bottom Line

Though research links a host of prenatal and early life risk factors to ADHD, it’s crucial to understand the following:

1. Few of these risk factors are yet known to be causal.

In most instances, we don’t yet know if risk factors have a causal effect or if it’s just artificial due to unmeasured correlates (in particular, genetic confounding). A key principle seems to be that the accumulation of multiple risk factors matters most in a child’s health. Genetic risk can be seen as one of the risk factors. But even a family history of ADHD doesn’t guarantee that a child will develop the condition.

2. Not all ADHD risk factors have equal influence.

Evidence for risk factors vary from “very strong” to “maybe.” Risk factors also tend to add up and occur in clusters, which ultimately makes it difficult to assess a factor’s relationship to ADHD. Some populations, including disadvantaged groups, may also be more vulnerable and sensitive to these risk factors or experience more of them.

3. To date, research has focused almost entirely on ADHD risk factors related to maternal health and pregnancy – but a dramatic shift is underway.

The history of psychiatry has unfortunately seen misguided blaming of mothers. It is important to realize that many of the risks are unavoidable, and that fathers are not off the hook. Paternal support, for one, can be a protective factor in maternal prenatal health and thus fetal health. But we are also learning more about how paternal exposures pre-pregnancy can affect sperm health and thus fetal health.

4. Exposure to a risk factor – even to a causal contributor of ADHD – does not guarantee an ADHD diagnosis down the line.

Most children who are exposed to these risk factors do not develop ADHD. There still has to be some other vulnerability or some other factors combined with these things in order for ADHD to emerge. In all, exposure to risk factors are rarely by themselves the entire explanation.

ADHD Risk Factors: What Parents Can Do

Exposure to ADHD risk factors may become a source of regret and second-guessing for parents. What I say to caregivers in this: Move forward; don’t belabor the past. Ultimately, at today’s level of knowledge, the cause of your child’s ADHD is not entirely known. More practical is to recognize that there is still a lot you can do to move forward positively.

If you are an expectant parent and/or the parent of a child with ADHD, follow these strategies below to minimize exposures, manage (and even reduce) your child’s ADHD symptoms, and protect your family’s health and wellbeing.

1. Engage in Behavioral Parent Training

ADHD can cause challenging behaviors that may overwhelm parents and lead to a negative parent-child dynamic — in itself a factor that can impact a child’s health and wellbeing. That’s why behavioral parent training (BPT) is an essential component of any child’s ADHD treatment. BPT teaches you how to respond to your child’s behaviors without inadvertently making those behaviors worse. Another benefit of BPT? It increases the chances that ADHD medication will work, and can lead to medication working at a lower dose.

2. Focus on Nutrition

Research has uncovered various links between nutrition and ADHD – some of which translate to actionable steps for your family.

• Eat healthy foods during pregnancy. A 2018 study of about 1,240 mother-child pairs found that children whose mothers had a healthy prenatal diet were less likely to exhibit symptoms of hyperactivity over time than were children whose mothers had an unhealthy prenatal diet.²⁸ Limit heavily processed foods and opt for whole, nutrient-dense foods.
• Consider omega-3 supplements (1000 mg EHA/DPA a day). Children with ADHD tend to have lower omega-3 levels compared to children without ADHD, and supplementation modestly improves ADHD symptoms.²⁹ Furthermore, prenatal omega-3 supplementation improved attention development in infants and toddlers in at least one controlled experiment.³⁰
• Try an elimination diet. Five percent to twenty-five percent of children with ADHD may see symptom improvement in response to a diet that eliminates common food allergens (cow-milk protein, soy, wheat, eggs, peanuts, seafood/shellfish) and additives (artificial food dyes and flavors).³¹ An elimination diet may be worthwhile if you suspect a dietary factor at play. But note that dietary changes are often difficult to implement. Your child may object, or the entire family may need to be involved. Adequate nutritional replacement also must be identified. Thus, only attempt this elimination plan in consultation with a behavioral counselor and nutritionist and/or your child’s pediatrician.
• Opt for whole, unprocessed foods. Shop the perimeter of the supermarket for fresh, nutrient-dense foods. Avoid added sugars and caffeine, and try to keep your kitchen stocked with only healthy food choices.
• Test for nutritional deficiencies. Children with ADHD are more likely than other children to have low levels of iron, zinc, and vitamin D.^{32 33 34} Supplementation can sometimes help with ADHD if nutrient levels are low. Recent evidence also suggests that specialized multi-nutrient supplements benefit important aspects of ADHD.³⁵

3. Encourage Good Sleep Habits

Behaviorally-related sleep problems — from going to bed to falling and staying asleep — are common among children with ADHD. (True endogenous sleep disorders also occur at above chance levels in ADHD, but still are present only in a minority.³⁶ ) Insufficient sleep, of course, worsens ADHD symptoms and functioning.

Create a bedtime routine, turn off or take away electronic devices before bed, and aim for your child to get 10 hours of sleep per night (depending on age). Talk to your child’s doctor to screen for potential co-occurring sleep disorders, or to get help with your child’s sleep problems.

4. Get Your Child Moving

Exercise improves health, mood, and ADHD symptoms.³⁷ Exercise may even reverse some of the biological effects of past traumatic events on the body, as shown in animal studies.³⁸ Children need at least one hour of moderate to vigorous exercise — be it sports, free play, or anything in between — on most days of the week.³⁹

Nutrition, sleep, and exercise are healthy lifestyle factors with the clearest effect on ADHD symptoms. While they usually will not substitute for professional treatment, they may well reduce the stimulant or psychotherapeutic dosage your child needs.

5. Reduce Exposure to Lead and Other Pollutants

A lead test —for your child and for yourself, especially if you are pregnant or planning for it — is worth doing if you live in an area of high lead exposure. However, note that common medical lead tests do not detect the low exposure levels that have now been associated with ADHD in scientific studies. Thus, even if your child does not have detectable exposure, it is prudent to minimize lead exposure.

A healthy diet and sufficient levels of iron and vitamin D can help minimize the effects of lead (because of the way lead is metabolized).

Consider the following steps to address potential pollutant exposures at home and school:

• Purchase a lead-removing water filter certified by an ANSI-accredited body.
• Install HEPA-quality air filters.
• If you live in home built before 1980, prevent and repair loose or chipped paint and do not let your child play in the soil right next to the house if possible.
• Learn about various sources of lead exposure and how to protect your family.

6. Limit Screen Time and Watch for Quality

Though still a new area of research, findings from screen time research are cautionary. In a 2018 study, teens who spent excessive time on social media were more likely to exhibit ADHD symptoms after a two-year follow-up compared to teens who did not use social media as frequently.⁴⁰

“Gaming addiction,” while still controversial, is receiving increased scrutiny. While more work is forthcoming, it remains possible that children with ADHD may be more susceptible to problematic video game play due to self-regulation challenges and the high-reward nature of gaming itself. Studies also link exposure to violent content with increased aggression in vulnerable children.⁴¹

7. Practice Self-Care

• Manage stress and reduce stressors in your life. The more stressed out you are, the more stressed out your child will be, and the more you’ll get into a negative cycle. Social support and self-compassion are among the key elements for managing stress.
• Recognize your own history of stress and trauma if present, and seek counseling and treatment if needed. Tell your doctor (and your child’s doctor) about your family’s experience with trauma, if any.
• Eat a healthy diet, practice good sleep hygiene, and get exercise daily.
• If you have ADHD, depression, or other mental health challenge yourself, stick to your treatment plan or talk to your doctor to see if an adjustment is necessary.

What Causes ADHD? Next Steps

• Read: Epigenetics and ADHD — How Environment and Lifestyle Impact ADHD
• Read: Beyond Genes  — Leveraging Sleep, Exercise, and Nutrition to Improve ADHD
• Free Download: Natural ADHD Treatment Options
• Resource Hub: What Causes ADHD?

The Clinicians’ Guide to Differential Diagnosis of ADHD from Medscape and ADDitude

• How can I better understand ADHD, its causes, and its manifestations?
• What is attention deficit hyperactivity disorder (ADHD)?
• What is the prevalence of ADHD?
• Which regions of the brain are involved in ADHD?
• What causes ADHD?
• What characterizes the inattentive ADHD subtype?
• Can ADHD be diagnosed before age 6?
• Free Webinar: How Our Understanding Has Evolved
• Free Webinar: Why Inattentive ADHD is Misdiagnosed
• Free Webinar: How Genes and the Environment Contribute to ADHD in Children
• What do I need to understand about ADHD that is not fully represented in the DSM?
• How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
• How can I best consider psychiatric comorbidities when evaluating a patient for ADHD?
• How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
• How can I best consider trauma and personality disorders through the lens of ADHD?
• What diagnostic criteria and tests are recommended for performing a differential diagnosis of ADHD?

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “Genes and the Environment: How Biology and Exposures Contribute to ADHD in Children” [Video Replay & Podcast #433] with Joel Nigg, Ph.D., which was broadcast on November 30, 2022.

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Sources

¹ Han, J. Y., Kwon, H. J., Ha, M., Paik, K. C., Lim, M. H., Gyu Lee, S., Yoo, S. J., & Kim, E. J. (2015). The effects of prenatal exposure to alcohol and environmental tobacco smoke on risk for ADHD: a large population-based study. Psychiatry Research, 225(1-2), 164–168. https://doi.org/10.1016/j.psychres.2014.11.009

² Garrison-Desany, H. M., Hong, X., Maher, B. S., Beaty, T. H., Wang, G., Pearson, C., Liang, L., Wang, X., & Ladd-Acosta, C. (2022). Individual and combined association between prenatal polysubstance exposure and childhood risk of attention-deficit/hyperactivity disorder. JAMA Network Open, 5(3), e221957. https://doi.org/10.1001/jamanetworkopen.2022.1957

³ Eilertsen, E. M., Gjerde, L. C., Reichborn-Kjennerud, T., Ørstavik, R. E., Knudsen, G. P., Stoltenberg, C., Czajkowski, N., Røysamb, E., Kendler, K. S., & Ystrom, E. (2017). Maternal alcohol use during pregnancy and offspring attention-deficit hyperactivity disorder (ADHD): a prospective sibling control study. International Journal of Epidemiology, 46(5), 1633–1640. https://doi.org/10.1093/ije/dyx067

⁴ Centers for Disease Control and Prevention. Fetal Alcohol Spectrum Disorders (FASDs) – Basics. https://www.cdc.gov/ncbddd/fasd/facts.html

⁵ Chasnoff, I. J., Wells, A. M., & King, L. (2015). Misdiagnosis and missed diagnoses in foster and adopted children with prenatal alcohol exposure. Pediatrics, 135(2), 264–270. https://doi.org/10.1542/peds.2014-2171

⁶ Luderer, M., Ramos Quiroga, J. A., Faraone, S. V., Zhang James, Y., & Reif, A. (2021). Alcohol use disorders and ADHD. Neuroscience and biobehavioral reviews, 128, 648–660. https://doi.org/10.1016/j.neubiorev.2021.07.010

⁷ He, Y., Chen, J., Zhu, L. H., Hua, L. L., & Ke, F. F. (2020). Maternal Smoking During Pregnancy and ADHD: Results From a Systematic Review and Meta-Analysis of Prospective Cohort Studies. Journal of Attention Disorders, 24(12), 1637–1647. https://doi.org/10.1177/1087054717696766

⁸ Zhu, J. L., Olsen, J., Liew, Z., Li, J., Niclasen, J., & Obel, C. (2014). Parental smoking during pregnancy and ADHD in children: the Danish national birth cohort. Pediatrics, 134(2), e382–e388. https://doi.org/10.1542/peds.2014-0213

⁹ Biederman, J., Fitzgerald, M., Spencer, T. J., Bhide, P. G., McCarthy, D. M., Woodworth, K. Y., Saunders, A., & Faraone, S. V. (2020). Is Paternal Smoking at Conception a Risk for ADHD? A Controlled Study in Youth With and Without ADHD. Journal of attention disorders, 24(11), 1493–1496. https://doi.org/10.1177/1087054717690809

¹⁰ Ji, Y., Azuine, R. E., Zhang, Y., Hou, W., Hong, X., Wang, G., Riley, A., Pearson, C., Zuckerman, B., & Wang, X. (2020). Association of cord plasma biomarkers of in utero acetaminophen exposure with risk of attention-deficit/hyperactivity disorder and autism spectrum disorder in childhood. JAMA Psychiatry, 77(2), 180–189. https://doi.org/10.1001/jamapsychiatry.2019.3259

¹¹ U.S. Food and Drug Administration. FDA drug safety communication: FDA has reviewed possible risks of pain medicine use during pregnancy. Retrieved from https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-has-reviewed-possible-risks-pain-medicine-use-during-pregnancy

¹² Edlow AG. Maternal Metabolic Disease and Offspring Neurodevelopment—An Evolving Public Health Crisis. JAMA Netw Open. 2021;4(10):e2129674. doi:10.1001/jamanetworkopen.2021.29674

¹³ Perea, V., Simó-Servat, A., Quirós, C., Alonso-Carril, N., Valverde, M., Urquizu, X., Amor, A. J., López, E., & Barahona, M. J. (2022). Role of Excessive Weight Gain During Gestation in the Risk of ADHD in Offspring of Women With Gestational Diabetes. The Journal of Clinical Endocrinology and Metabolism, 107(10), e4203–e4211. https://doi.org/10.1210/clinem/dgac483

¹⁴ MacKinnon, N., Kingsbury, M., Mahedy, L., Evans, J., & Colman, I. (2018). The Association Between Prenatal Stress and Externalizing Symptoms in Childhood: Evidence From the Avon Longitudinal Study of Parents and Children. Biological psychiatry, 83(2), 100–108. https://doi.org/10.1016/j.biopsych.2017.07.010

¹⁵ Getahun, D., Rhoads, G. G., Demissie, K., Lu, S. E., Quinn, V. P., Fassett, M. J., Wing, D. A., & Jacobsen, S. J. (2013). In utero exposure to ischemic-hypoxic conditions and attention-deficit/hyperactivity disorder. Pediatrics, 131(1), e53–e61. https://doi.org/10.1542/peds.2012-1298

¹⁶ Zhang, T., Sidorchuk, A., Sevilla-Cermeño, L., Vilaplana-Pérez, A., Chang, Z., Larsson, H., Mataix-Cols, D., & Fernández de la Cruz, L. (2019). Association of cesarean delivery with risk of neurodevelopmental and psychiatric disorders in the offspring: A systematic review and meta-analysis. JAMA Network Open, 2(8), e1910236. https://doi.org/10.1001/jamanetworkopen.2019.10236

¹⁷ Franz, A. P., Bolat, G. U., Bolat, H., Matijasevich, A., Santos, I. S., Silveira, R. C., Procianoy, R. S., Rohde, L. A., & Moreira-Maia, C. R. (2018). Attention-Deficit/Hyperactivity Disorder and Very Preterm/Very Low Birth Weight: A Meta-analysis. Pediatrics, 141(1), e20171645. https://doi.org/10.1542/peds.2017-1645

¹⁸ Nigg, J. T., Knottnerus, G. M., Martel, M. M., Nikolas, M., Cavanagh, K., Karmaus, W., & Rappley, M. D. (2008). Low blood lead levels associated with clinically diagnosed attention-deficit/hyperactivity disorder and mediated by weak cognitive control. Biological psychiatry, 63(3), 325–331. https://doi.org/10.1016/j.biopsych.2007.07.013

¹⁹ Nigg, J. T., Elmore, A. L., Natarajan, N., Friderici, K. H., & Nikolas, M. A. (2016). Variation in an Iron Metabolism Gene Moderates the Association Between Blood Lead Levels and Attention-Deficit/Hyperactivity Disorder in Children. Psychological science, 27(2), 257–269. https://doi.org/10.1177/0956797615618365

²⁰ Thygesen, M., Holst, G. J., Hansen, B., Geels, C., Kalkbrenner, A., Schendel, D., Brandt, J., Pedersen, C. B., & Dalsgaard, S. (2020). Exposure to air pollution in early childhood and the association with Attention-Deficit Hyperactivity Disorder. Environmental Research, 183, 108930. https://doi.org/10.1016/j.envres.2019.108930

²¹ Lenters, V., Iszatt, N., Forns, J., Čechová, E., Kočan, A., Legler, J., Leonards, P., Stigum, H., & Eggesbø, M. (2019). Early-life exposure to persistent organic pollutants (OCPs, PBDEs, PCBs, PFASs) and attention-deficit/hyperactivity disorder: A multi-pollutant analysis of a Norwegian birth cohort. Environment international, 125, 33–42. https://doi.org/10.1016/j.envint.2019.01.020

²² Soled, D., Keim, S. A., Rapoport, E., Rosen, L., & Adesman, A. (2021). Breastfeeding Is Associated with a Reduced Risk of Attention-Deficit/Hyperactivity Disorder Among Preschool Children. Journal of developmental and behavioral pediatrics : JDBP, 42(1), 9–15. https://doi.org/10.1097/DBP.0000000000000854

²³ Stadler, D. D., Musser, E. D., Holton, K. F., Shannon, J., & Nigg, J. T. (2016). Recalled Initiation and Duration of Maternal Breastfeeding Among Children with and Without ADHD in a Well Characterized Case-Control Sample. Journal of abnormal child psychology, 44(2), 347–355. https://doi.org/10.1007/s10802-015-9987-9

²⁴ Asarnow, R. F., Newman, N., Weiss, R. E., & Su, E. (2021). Association of Attention-Deficit/Hyperactivity Disorder Diagnoses With Pediatric Traumatic Brain Injury: A Meta-analysis. JAMA Pediatrics, 175(10), 1009–1016. https://doi.org/10.1001/jamapediatrics.2021.2033

²⁵ Liou, Y. J., Wei, H. T., Chen, M. H., Hsu, J. W., Huang, K. L., Bai, Y. M., Su, T. P., Li, C. T., Yang, A. C., Tsai, S. J., Lin, W. C., & Chen, T. J. (2018). Risk of Traumatic Brain Injury Among Children, Adolescents, and Young Adults With Attention-Deficit Hyperactivity Disorder in Taiwan. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 63(2), 233–238. https://doi.org/10.1016/j.jadohealth.2018.02.012

²⁶ Brown, N. M., Brown, S. N., Briggs, R. D., Germán, M., Belamarich, P. F., & Oyeku, S. O. (2017). Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity. Academic pediatrics, 17(4), 349–355. https://doi.org/10.1016/j.acap.2016.08.013

²⁷ Lugo-Candelas, C., Corbeil, T., Wall, M., Posner, J., Bird, H., Canino, G., Fisher, P. W., Suglia, S. F., & Duarte, C. S. (2021). ADHD and risk for subsequent adverse childhood experiences: understanding the cycle of adversity. Journal of child psychology and psychiatry, and allied disciplines, 62(8), 971–978. https://doi.org/10.1111/jcpp.13352

²⁸ Galera, C., Heude, B., Forhan, A., Bernard, J. Y., Peyre, H., Van der Waerden, J., Pryor, L., Bouvard, M. P., Melchior, M., Lioret, S., de Lauzon-Guillain, B., & EDEN Mother-Child Cohort Study Group (2018). Prenatal diet and children’s trajectories of hyperactivity-inattention and conduct problems from 3 to 8 years: the EDEN mother-child cohort. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 59(9), 1003–1011. https://doi.org/10.1111/jcpp.12898

²⁹ Hawkey, E., & Nigg, J. T. (2014). Omega-3 fatty acid and ADHD: blood level analysis and meta-analytic extension of supplementation trials. Clinical psychology review, 34(6), 496–505. https://doi.org/10.1016/j.cpr.2014.05.005

³⁰ Colombo, J., Kannass, K. N., Shaddy, D. J., Kundurthi, S., Maikranz, J. M., Anderson, C. J., Blaga, O. M., & Carlson, S. E. (2004). Maternal DHA and the development of attention in infancy and toddlerhood. Child development, 75(4), 1254–1267. https://doi.org/10.1111/j.1467-8624.2004.00737.x

³¹ Nigg, J. T., & Holton, K. (2014). Restriction and elimination diets in ADHD treatment. Child and adolescent psychiatric clinics of North America, 23(4), 937–953. https://doi.org/10.1016/j.chc.2014.05.010

³² Tseng, P. T., Cheng, Y. S., Yen, C. F., Chen, Y. W., Stubbs, B., Whiteley, P., Carvalho, A. F., Li, D. J., Chen, T. Y., Yang, W. C., Tang, C. H., Chu, C. S., Yang, W. C., Liang, H. Y., Wu, C. K., & Lin, P. Y. (2018). Peripheral iron levels in children with attention-deficit hyperactivity disorder: a systematic review and meta-analysis. Scientific reports, 8(1), 788. https://doi.org/10.1038/s41598-017-19096-x

³² Arnold, L. E., & DiSilvestro, R. A. (2005). Zinc in attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 15(4), 619–627. https://doi.org/10.1089/cap.2005.15.619

³⁴ Li, H. H., Yue, X. J., Wang, C. X., Feng, J. Y., Wang, B., & Jia, F. Y. (2020). Serum Levels of Vitamin A and Vitamin D and Their Association With Symptoms in Children With Attention Deficit Hyperactivity Disorder. Frontiers in psychiatry, 11, 599958. https://doi.org/10.3389/fpsyt.2020.599958

³⁵ Johnstone, J. M., Hatsu, I., Tost, G., Srikanth, P., Eiterman, L. P., Bruton, A. M., Ast, H. K., Robinette, L. M., Stern, M. M., Millington, E. G., Gracious, B. L., Hughes, A. J., Leung, B. M. Y., & Arnold, L. E. (2022). Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths: A Placebo-Controlled Randomized Clinical Trial. Journal of the American Academy of Child and Adolescent Psychiatry, 61(5), 647–661. https://doi.org/10.1016/j.jaac.2021.07.005

³⁶ Hvolby A. (2015). Associations of sleep disturbance with ADHD: implications for treatment. Attention deficit and hyperactivity disorders, 7(1), 1–18. https://doi.org/10.1007/s12402-014-0151-0

³⁷ Seiffer, B., Hautzinger, M., Ulrich, R., & Wolf, S. (2022). The Efficacy of Physical Activity for Children with Attention Deficit Hyperactivity Disorder: A Meta-Analysis of Randomized Controlled Trials. Journal of attention disorders, 26(5), 656–673. https://doi.org/10.1177/10870547211017982

³⁸ Kashimoto, R. K., Toffoli, L. V., Manfredo, M. H. F., Volpini, V. L., Martins-Pinge, M. C., Pelosi, G. G., & Gomes, M. V. (2016). Physical exercise affects the epigenetic programming of rat brain and modulates the adaptive response evoked by repeated restraint stress. Behavioural brain research, 296, 286–289. https://doi.org/10.1016/j.bbr.2015.08.038

³⁹ Lobelo, F., Muth, N. D., Hanson, S., Nemeth, B. A., COUNCIL ON SPORTS MEDICINE AND FITNESS, & SECTION ON OBESITY (2020). Physical Activity Assessment and Counseling in Pediatric Clinical Settings. Pediatrics, 145(3), e20193992. https://doi.org/10.1542/peds.2019-3992

⁴⁰ Ra, C. K., Cho, J., Stone, M. D., De La Cerda, J., Goldenson, N. I., Moroney, E., Tung, I., Lee, S. S., & Leventhal, A. M. (2018). Association of Digital Media Use With Subsequent Symptoms of Attention-Deficit/Hyperactivity Disorder Among Adolescents. JAMA, 320(3), 255–263. https://doi.org/10.1001/jama.2018.8931

⁴¹ Anderson, C. A., Bushman, B. J., Bartholow, B. D., Cantor, J., Christakis, D., Coyne, S. M., Donnerstein, E., Brockmyer, J. F., Gentile, D. A., Green, C. S., Huesmann, R., Hummer, T., Krahé, B., Strasburger, V. C., Warburton, W., Wilson, B. J., & Ybarra, M. (2017). Screen Violence and Youth Behavior. Pediatrics, 140(Suppl 2), S142–S147. https://doi.org/10.1542/peds.2016-1758T

February 21, 2023

Teen girls in the U.S. are “engulfed in a growing wave of sadness, violence and trauma,” according to a report released last week by the Centers for Disease Control and Prevention (CDC) that found alarming increases in rates of rape, depression, suicidality, and cyberbullying among adolescents.¹ “The numbers are unprecedented,” said Kathleen Ethier, director of the CDC’s Division of Adolescent and School Health. “Our young people are in crisis.”

The CDC report echoes findings from a 2022 ADDitude survey of 1,187 caregivers, which found that an astounding 75% of adolescent girls with ADHD also have anxiety, 54% suffer from depression, more than 14% have a sleep disorder, and nearly 12% report an eating disorder — more than three times the national average for neurotypical women.

“The kids are not alright. Not at all,” wrote one ADDitude reader who works as a youth therapist.

[The ADHD Symptom Test for Teen Girls]

The CDC report, based on the most recent Youth Risk Behavior Survey, included a nationally representative sample of students in public and private high schools, and it found that adolescent health risks have ballooned to levels never seen before—especially for girls. Its findings include the following:

• Nearly 60% of teen girls reported persistent feelings of sadness and hopelessness during the past year, double the rate reported 10 years ago, and twice the rate in boys. For LGBTQ+ teens, this number jumped to a startling 70%.
• 1 in 3 of girls seriously considered attempting suicide during the past year, up nearly 60% from a decade ago.
• At least 1 in 10 girls attempted suicide in the past year. Among LGBTQ+ youth, the number was more than 1 in 5.

Girls with combined type ADHD are 3 to 4 times more likely to attempt suicide than are their neurotypical peers, and they are 2.5 times more likely to engage in non-suicidal self-injuring behavior, said Stephen Hinshaw, Ph.D., in an ADDitude webinar titled, “Girls and Women with ADHD.” The 2022 ADDitude survey found that 18% of girls with ADHD had engaged in self-harm in the past two or three years, as opposed to 9% of boys; it did not specifically ask about suicidality, however anecdotal reports from caregivers are both frequent and frightening.

“A few years ago, I would have been shocked by these numbers,” said one mom of a teen daughter recently diagnosed with ADHD. “But in 2021 my girl was admitted to a clinic for suicidal ideation. She is still here and working on her mental health daily.”

Only 6% of caregivers rated their adolescents’ mental health as “very good” in the ADDitude mental health survey. Contributing to elevated rates of depression, self-harm, and suicidality among teen girls with ADHD are poor response inhibition and peer victimization, as well as a history of maltreatment, such as physical abuse, sexual abuse, or neglect, Hinshaw said.

“I can’t tell you how many mums are holding their girls tight as they self-harm their way through adolescence,” wrote one ADDitude reader in Canada.

[ADHD and Self-Harm: How to Help the Girls Who Suffer Most]

“We are gaslighted, misdiagnosed, or expected to suck it up,” wrote an ADDitude reader on Instagram. “The wait times for help are not OK, and once you finally do get ‘help,’ they barely listen or dismiss your concerns.”

Sexual Violence at an All-Time High

Among the CDC report’s more distressing findings was a stark increase in sexual violence among teen girls. It found the following:

• 1 in 5 girls recently experienced sexual violence
• 14% have been forced to have sex, an increase of 27% over the past 2 years
• For American Indian or Alaska Native girls, that number jumped to 18%, and for LGBTQ+ teens, it was 20%

“For every 10 teenage girls you know, at least one of them, and probably more, has been raped,” Ethier said during a press briefing.

The prevalence of sexual violence causes significant and understandable anxiety. According to the ADDitude survey, 20% of girls expressed anxiety about physical or sexual assault, as opposed to 7% of boys.

The CDC’s study reflects this anxiety, reporting that:

• 10% of girls did not go to school in the past 30 days because of safety concerns, nearly double the rate from 10 years ago; the same was true for 7% of boys.
• School avoidance rates were higher among LGBTQ+ students, at 14%; American Indian and Alaska students, at 13%; and Black students at 12%.

The prefrontal cortex in a developing brain is especially sensitive to the effects of stress and “children with ADHD may be even more sensitive to the effects of traumatic stress,” said Cheryl Chase, Ph.D., in her ADDitude webinar, “How Stress and Trauma Affect Brain Development.” In other words, the trauma of sexual violence leaves lasting scars.

The mother of a girl with ADHD explained the long-term implications of a sexual assault on her daughter’s health and well-being four year after the attack: “When she was a freshman in college this past year, she was re-triggered while in public talking to a boy who touched her inappropriately without her consent.”

Cyberbullying Twice as Likely for Girls

Whether in school or online, girls are more likely to be victims of bullying, according to the CDC report.

• 1 in 5 girls said they were bullied through texting and social media, almost double the percentage of boys who were cyberbullied
• In school, 17% of girls and 13% of boys reported experiencing bullying in school over the past year

Among teens with ADHD, the rates of bullying are much higher. According to ADDitude survey respondents, 60% of girls with ADHD have been bullied at school, 58% on social media and 44% in text messages.

“We know that kids who are neurodiverse are often seen as peculiar and different,” explained Sharon Saline, Ph.D. “You miss social clues, you blurt things out, and chances are you’re more likely to experience bullying and be socially excluded.”

This was the case for the daughter of an ADDitude reader in Wisconsin: “Bullying has been around my daughter’s lack of age-appropriate social insight and her emotional reactivity. Girls exclude her from group texts. Friends screenshot the negative posts others create about her, and she then ruminates until her mood totally plunges.”

Bullying is a widespread problem, and so is the response (or lack thereof) from most schools;  72% of ADDitude survey respondents who reported that their kids were the victims of bullying also said they were dissatisfied with the school’s response.

“The lack of help in the public school system is so disappointing,” wrote an ADDitude reader on Instagram. “They claim to not be tolerant of bullying, yet anytime you seek help you’re met with nothing but rotating doors and promises of help that go undone.”

Substance Use Higher in Girls

Teen girls are more likely to use alcohol, marijuana, vaping, and illicit drugs, according to the CDC.

• Alcohol: 27% of teen girls reported drinking in the last month vs 19% of boys
• Vaping: 21% of girls reported vaping in the last month vs 15% of boys
• Illicit drugs: 15% of girls reported ever using illicit drugs vs 12% of boys
• Misuse of prescription opioids: 15% of girls reporting ever misusing opioids vs 10% of boys

“ADHD affects substance abuse in both children and adults,” explained Walt Karniski, M.D., in a recent ADDitude webinar on ADHD medication. “Children with ADHD are more likely to smoke and to begin smoking at younger ages. They’re more likely to use alcohol at younger ages and more likely to abuse alcohol as adults.”

“A Level of Distress that Calls on Us to Act”

In the introduction to its 89-page report, the CDC authors clearly state its takeaway: “Young people in the U.S. are collectively experiencing a level of distress that calls on us to act.”  The CDC urges schools to act swiftly and thoughtfully for maximum impact.

“Schools play an integral role in promoting wellness and connectedness, and facilitating protective factors among students,” said Anna King, president of the National PTA. Specifically, the report highlights the importance of implementing quality health education, connecting young people to needed services, and making school environments safer and more supportive.

“It’s about time someone noticed, besides all the struggling parents and kids,” wrote one ADDitude reader in New York.

How Can Parents Protect Their Kids?

Keep lines of communication open

“As girls reach the teen years, they naturally want to emancipate from adult control,” Chase says. “But teens’ brains have more ‘accelerators’ than ‘brakes,’ so they need a loving, interested adult to guide them.” This is doubly true for teens with ADHD, whose executive function weaknesses may exacerbate impulse control. So, how do you stay connected with a teen who seems intent on pushing you away?

• Prioritize a positive relationship

Sources for conflict between adolescents and parents abound, but Saline advises that parents pick their battles. “Your Number One agenda item as the parent of a teen is maintaining a positive connection,” Saline says. “So that they will come and talk to you if they need help.”

To build that connection, Chase emphasizes the importance of unstructured time together. “Going for walks, grabbing a smoothie together, playing a game,” she suggests. “Time just to ‘be’ and if they want to talk, they can.” Don’t wait for your teen to reach out to you. Be proactive, and invite them to do something low-key and stress-free every week or two.

• Make communication routine

When teens push back against their parents, seeking autonomy and space, anxious parents often ask a lot of questions, which can make teens feel hounded, Saline says. Keep communication open without putting teens in the hot seat by making conversations routine. Saline suggests instituting a family-wide practice of sharing one “happy” and one “crappy” thing that happened during the day — at dinner or in the car ride home. If it’s a daily practice in which everyone participates, your daughter won’t feel singled out.

• Actively listen, rather than offer unsolicited advice

When your child share experiences with you, practice active listening to ensure the communication continues. Allow your child tell their story, uninterrupted, and follow up with reflective statements, like “I think I’m hearing you say…”  Avoid swooping in with unsolicited advice — that’s the fastest way to get a teen to shut down, according to Chase and Saline.

Help your daughter find treatment

Depression, anxiety, trauma, and self-harm are all treatable, and a mental health professional can help you figure out what avenue of treatment to pursue. If you sense something’s persistently troubling your teen, Chase urges you not to wait to find them a therapist. “It’s like going to the dentist with a toothache,” she explains. “It doesn’t mean they are broken.”

Cognitive behavioral therapy, dialectical behavior therapy, and medication are among the most common interventions. If trauma is involved, consider somatic therapy, which increases awareness of the sensations in the body as a form of healing.

If your child has ADHD, consider that ADHD treatment may decrease their risk for other challenges. Hinshaw says that treating ADHD can decrease rates of suicidality in teens. “Treatment is a huge antidote to internalization, self-stigma, and the belief that there’s something wrong with you,” he explains. In addition, multiple research studies have indicated that children and adults with ADHD who are taking stimulant medication are less likely to engage in substance use than are their untreated peers.

Get Help

Suicide &Crisis Lifeline: Call or Text 988
988lifeline.org

National Sexual Assault Helpline: 1-800-656-HOPE

National Substance Abuse Helpline: 1-800-662-HELP

Stop Bullying

Mental Health in Teens: Next Steps

• Read: Special 2022 Mental Health Report from ADDitude
• Read: Compare & Despair: Social Media & Mental Health Concerns in Teens with ADHD
• Self-Test: Signs of Depression in Teens
• Learn: Nearly One in Four Women with ADHD Has Attempted Suicide

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.

Source

¹Centers for Disease Control and Prevention (2023). U.S. Teen Girls Experiencing Increased Sadness and Violence. Youth Risk Behavior Survey cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf

If the inherently ADHD-unfriendly task of meal planning falls on your shoulders, try using this ADHD-friendly system. These meal-planning tips will help you sail through the supermarket aisles and put dinner on the table in no time. In this download, you will learn the following:

• How to sort meals into time-saving sequences
• How to create a Top 10 Dinner list
• How to get every family member engaged in meal planning
• How to share responsibilities for dinner preparations
• How to give yourself a night off from cooking
• How to grocery shop efficiently and resist impulse buys
• And more!

NOTE: This resource is for personal use only.

• Improved diet, exercise, or sleep: 11.9%
• Education services (e.g., tutoring, accommodations): 10.13%
• Behavioral therapy: 7.34%
• Limited screen time: 4.56%
• Supplements (e.g., omega-3s, magnesium, zinc): 2.53%
• Speech, occupational, or physical therapy: 2.53%
• Mindfulness exercises: 1.77%

Comments and questions submitted during the webinar, titled “Genes and the Environment: How Biology and Exposures Contribute to ADHD in Children,” centered on the lifestyle and environmental factors with the biggest impact on ADHD symptoms.

The Importance of Diet, Exercise, and Sleep in Managing ADHD

Diet, exercise, and sleep are the Big Three — the lifestyle changes with the most significant, most scientifically proven effect on ADHD. When these lifestyle factors are optimized, your child may require a lower dose of stimulant medication or may find their ADHD medication works better, according to Joel Nigg, Ph.D., a clinical psychologist and a professor in the departments of psychiatry and behavioral sciences at Oregon Health & Science University.

Next Steps to Optimize Diet, Exercise, and Sleep:

• Read: Exercise and Sleep – the Better Brain Therapies Your Child Needs
• Read: 5 Big Natural Remedies for ADHD
• Read: Leveraging Sleep, Exercise, and Nutrition to Improve ADHD

Q: “Are there specific foods or nutrients that we should increase to better manage ADHD symptoms?”

Omega-3 supplements have been shown to improve ADHD symptoms. Learn more about the benefits of omega-3s in these resources:

• Read: Omega 3s – the Ultimate (ADHD) Brain Food
• Free Download: 12 Surprising Sources of Omega-3 Fatty Acids
• Read: “How Do I Get My Sensory-Sensitive Child to Take Fish Oil Supplements?”

Q: “What, if anything, should we eliminate from our child’s diet?”

A portion of children with ADHD will respond positively to a diet that eliminates allergens, additives, and dyes. Consult with your child’s doctor and/or a nutritionist to safely follow an elimination diet.

Next Steps:

• Read: The Truth About Food Dyes and ADHD – What Science Tells Us
• Read: Eggs, Dairy, Nuts, and Soy – Testing for Food Sensitivities with an ADHD Elimination Diet
• Free Download: What to Eat — And Avoid — to Improve ADHD Symptoms

Q: “What about caffeine?”

The active ingredients in caffeine are clearly beneficial for attention, Nigg says, but it’s unknown what caffeine doses are safe for children. Too much caffeine can actually be harmful for development. It’s best to avoid caffeine (e.g., watch sports drinks and other sources of caffeine) until the late teenage years.

Next Steps:

• Read: The Truth About Caffeine and ADHD

Screen Time and Video Games

Q: “Do violent video games impact my child’s behavior?”

“There is quite a bit of evidence linking violent content with increased aggression in vulnerable children,” Nigg says. Monitor your child’s gaming activities and redirect if you notice signs of aggression, depression, and irritability.

Next Steps:

• Read: ADHD and Video Games – Is Your Child Hooked?
• Read: Do Video Games Exacerbate ADHD?
• Free Download: An “Ethics Manual” for Your Child’s Electronics

Stress and Family Conflict

Q: “My child’s ADHD has worsened since the pandemic. Do I need to adjust their treatment plan?”

“Scientific evidence supports your feeling that kids’ problems have gotten a lot worse in the last two and a half, three years,” Nigg says. In a chronically stressful situation, it’s normal for children to be (and act) stressed. As the stressful situation reduces, your child’s behaviors should go back to baseline. In the meantime, continue to support and coach your child and model appropriate coping behaviors. Talk to your child’s doctor if you notice concerning behaviors. There could be more than ADHD in the picture, which will influence your child’s course of treatment.

Next Steps:

• Read: How Do You Reassure Your Anxious Child When You’re Scared, Too?
• Read: How Trauma and Chronic Stress Affect Developing Brains
• Read: Does Trauma Cause ADHD? And Vice Versa?
• Read: Building Resilience Begins Here –  6 Motivation Strategies for ADHD Families

Remember, ADHD is Not Caused by “Bad Parenting”

Parents of children with ADHD can easily get caught in negative loops that may inadvertently reinforce challenging behaviors. (Parental ADHD can also complicate the dynamic.) Behavioral therapy is proven to help reduce difficult behaviors in children and create a positive family dynamic. Parental self-care is also important.

Next Steps:

• Read: Behavioral Therapy for ADHD – A Pragmatic Parent’s Guide
• Read: “None of Us Were Trained How to Be Good Parents” – An ADHD Guide to Behavior Therapy
• Read: A Survival Guide for Parents with ADHD – Strategies from Preschool to High School
• Read: Hey, ADHD Parents – Shoot for Progress, not Perfection
  

To learn more about how lifestyle and environmental factors impact ADHD symptoms in children, listen to the ADDitude ADHD Experts webinar, “Genes and the Environment: How Biology and Exposures Contribute to ADHD in Children” by Joel Nigg, Ph.D., which was broadcast live on November 30, 2022.

How to Treat ADHD in Children: Next Questions

1. What ADHD medications are used to treat children?
2. Is ADHD medication right for my child?
3. What are common side effects associated with ADHD medication?
4. What natural treatments help kids with ADHD?
   • What are the most effective natural ADHD treatments for kids?
   • What foods can help control ADHD symptoms?
   • What vitamins and supplements should my child take?
   • Does brain training help with ADHD?
   • How much and what type of exercise helps kids with ADHD?
   • What types of therapy help patients with ADHD?
5. What if the medication stops working?
6. How can I find an ADHD specialist near me?

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

In Part I of our conversation on eating disorders among teens and tweens, we talked about what defines an eating disorder, why girls with ADHD are at highest risk, and how caregivers and teachers can identify and address eating disorders in students.

In Part II of our conversation, clinical psychologist Dena Cabrera and registered dietician Megan Kniskern will answer your questions about building healthy nutrition habits for teens with eating disorders.

Topics of discussion will include:

• Strategies to encourage healthy eating in tweens and teens with eating disorders
• How to talk with your teen about nutrition and its impact on the body and development
• Approaches to address binge eating and the weak self-regulation skills that contribute to this disorder
• How to outwit comfort food cravings brought on by emotional dysregulation
• How to help teens with anorexia have a healthier relationship with food
• How to know when a teen needs professional help

The Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 is a confidential, free, 24-hour-a-day, 365-days-a-year information and referral service. For anyone experiencing a crisis, immediate help is also available by calling the National Suicide Prevention Lifeline at 1-800-273-TALK.

Listen to the Replay

Enter your email address in the box above labeled “Video Replay” to listen to the Q&A recording and access related resources.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; Amazon Music; iHeartRADIO.

Resources and Organizations

• Alliance for Eating Disorders
• National Eating Disorders Association
• Eating Disorder Hope
• Fairplay for Kids
• Eating Disorder Coalition

More on Eating Disorders and Mental Health

• Download: Is It More Than Just ADHD?
• Read: The ADHD-Eating Disorders Link
• Read: Healthy Foods and Supplements for Kids & Adults

Meet the Expert Speakers

Dena Cabrera, Psy.D., CEDS, is a Clinical Psychologist and Certified Eating Disorder Specialist with over 24 years of experience treating psychological and psychiatric disorders. Before opening her own private practice in Anthem, Arizona, she served as the Vice President of Clinical Services for Rosewood Centers for Eating Disorders. Dr. Cabrera is a nationally recognized expert in her field, having authored numerous articles and publications including co-author of the book Mom in the Mirror: Body Image, Beauty and Life After Pregnancy (#CommissionsEarned). She’s also a sought-after speaker and has been featured on numerous news outlets, talk shows, and prominent national and local publications. She previously served as president of the International Association of Eating Disorders Professionals (IAEDP). Learn more by visiting her online at denacabrera.com.

Megan Kniskern, R.D., is the owner of MAK Nutrition Services. She is a senior lecturer at Arizona State University teaching management, leadership, professional preparation, and nutrition undergraduate courses, as well as a graduate eating disorders and substance use disorder course which she developed. In 2021 Megan launched her online training program, Deepen Your Perspectives: Nutrition Therapy for Mental Health, to registered dietitians. Megan works with complex eating disorder clients, and supervises other registered dietitians, in the areas of eating disorders, substance use and mental health nutrition support; educating through a non-diet, weight inclusive, client-centered, trauma and experience informed lens; helping clients and professionals to improve food dynamics and body connection understanding. She co-authored the Revised 2020 Eating Disorder Standards of Practice and Standards of Professional Practice (published) and has served in past leadership roles with the Behavioral Health Nutrition (BHN) DPG and continues to volunteer the International Federation of Eating Disorder Dietitians (IFEDD).

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

Listener Testimonials

“Two great contributors. I tuned in because I have an adult child with ADD with an eating disorder. This was a fabulous presentation. I wish I had it had been available 10 years ago. Thanks for producing it now.”

“Very skillfully done!”

“Thank you for covering this topic. It’s the only time I’ve seen it covered in such depth and it was extremely useful. I’m going to share it with my college student and high schooler with ADHD as well as with my husband.”

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
Apple Podcasts | Google Podcasts | Spotify | Google Play | Amazon Music | RadioPublic | Pocket Casts | iHeartRADIO | Stitcher

Docosahexaenoic acid (DHA) and alpha-linolenic acid (ALA) — both omega-3 polyunsaturated fatty acids — may improve attention performance and impulsivity in healthy adolescents, according to a recent study published in European Child & Adolescent Psychiatry. ¹ DHA consumption was associated with selective and sustained attention and executive conflict response.

Researchers examined the associations between DHA, ALA, and attention function in 332 healthy Spanish adolescents aged 11 to 16 with equal gender distribution. Using the Attention Network Test (ANT), the study found that dietary DHA played a positive role in attention performance. Levels of DHA in red blood cells (RBC) were significantly higher in participants who consumed four or more weekly servings of fatty fish compared to lower consumption.

Adolescents with higher levels of RBC DHA exhibited lower hit reaction time (HRT), lower hit reaction time-standard error (HRT-SE), and lower stimuli conflict in attention tasks compared to the lowest DHA tertile. Lower attention scores indicated greater selective, sustained, and executive attention.

“Polyunsaturated fatty acids are critical for brain development and function, and their deficiency may have long-term functional consequences, such as memory impairment, attention deficit hyperactivity disorder, depression, or anxiety disorders,” researchers said. ¹

Blood tests measured the proportion of DHA and ALA in red blood cells; computerized tests measured for attention scores; and questionnaires measured sociodemographic, clinical, and lifestyle data including consumption of fatty fish and nuts. Participants were grouped into three tertiles based on red blood cell proportions for both DHA and ALA.

“Our results concur with those from another observational study using a similar approach, adding evidence on the brain benefits of fatty fish consumption (the main source of DHA) in this population segment, to date mostly related to cognitive performance.”

Researchers did not observe an association between ALA and self-reported consumption of nuts, which are known to be a source of this omega-3. Consumption of nuts, therefore, did not contribute to attention scores. Participants with higher levels of ALA exhibited longer reaction times, but a positive relationship was found with impulsivity. Increasing levels of ALA across tertiles resulted in lower impulsivity response.

“This result might be of great clinical relevance, since impulsivity is known to be a key feature of several psychiatric disorders (i.e. ADHD, personality and substance abuse disorders, etc.).”

The current cross-sectional study relied on baseline data from the Walnuts Smart Snack Dietary Intervention Trial conducted in Barcelona, Spain, between 2015 and 2016. Most of the research available on DHA and attention is focused on adolescents with ADHD or children age 10 and younger. Limited data exists on ALA, which is recognized for its marginal conversion to DHA.

“This research is warranted to help better shape basic dietary recommendations for the adolescent population to ensure an optimal dietary omega-3 polyunsaturated fatty acid intake for a healthy brain development.”

“Future intervention studies are needed to determine the causality of these associations and to better shape dietary recommendations for brain health during the adolescence period.”

Sources

¹Pinar-Martí, A., Fernández-Barrés, S., Gignac, F. et al. Red blood cell omega-3 fatty acids and attention scores in healthy adolescents. Eur Child Adolesc Psychiatry (2022). https://doi.org/10.1007/s00787-022-02064-w

Mood swings. Sleep disturbances. Deteriorating relationships. Worsening grades. Total lack of interest in recreational activities. These are among the troubling behaviors observed by more than half of caregivers since the start of the pandemic, according to a new ADDitude survey on the mental health of youth with ADHD.

Our 1,187 survey responses mirror reports by the U.S. Surgeon General with one important caveat: The mental health crisis plaguing today’s youth appears even more severe for adolescents with ADHD.

The mother of a 14-year-old in Michigan put it this way: “My daughter has developed social anxiety and sometimes has difficulty going to school or to stores where other teens might be present. She is overly obsessed with her looks, so much so that she covers our mirrors. She went from an honor roll student to Ds and Es.”

[ADDitude Special Project: Mental Health Out Loud]

Many high school students, as we now know, weren’t doing well before the pandemic: One in three reported a persistent feeling of sadness or hopelessness between 2009 and 2019, according to U.S. Surgeon General Vivek Murthy. And one in five children aged 3 to 17 reportedly had a mental, emotional, developmental, or behavior disorder during that time period.

But in the last two to three years, mental health challenges grew even more troublesome for high school students with ADHD, according to the caregivers who responded to the ADDitude survey: An astounding 67% of teens have now been diagnosed with anxiety and 46% with depression. Among children ages 3 to 17 with ADHD, the survey also revealed above-average levels of oppositional defiant disorder (11%), sleep disorders (6.75%), and eating disorders (5.32%), not to mention the learning differences that impact more than one in five students with ADHD.

The Social Media Effect

Less than 6% of parents surveyed said their adolescents with ADHD have “very good” mental health today. On a 4-point scale, this group’s average mental health rating was 2.27.

The most alarming signs of a mental health crisis revealed by the survey data involved adolescent girls with ADHD who use social media. The rate of anxiety among this group is a startling 75%, and the rate of depression is 54%, according to the survey. More than 14% have a sleep disorder, and nearly 12% report an eating disorder—more than three times the national average for neurotypical women. Though the survey cannot demonstrate causality with social media use, it does reveal that this demographic has the most severe mental health challenges.

The most “pervasive and troubling” emotions impacting all adolescents with ADHD today include anxiousness (66%), irritability (60%), apathy (59%), withdrawal (47%), and anger or aggression (45%).

[Free Resource: Too Much Screen Time? How to Regulate Your Teen’s Devices]

Among adolescent girls with ADHD, the most common sources of anxiety were school (76%); COVID-19 (54%); finances (31%); gun violence in schools and social media use (28% each). Among teens with ADHD who are not cisgender, 38% report feeling anxiety over political violence.

“Sometimes my son goes through acute depression,” said a caregiver of a transgender adolescent with ADHD, anxiety, and depression. “When this happens, the entire world goes dark for him, and we just do what we can to get him through.”

If your child is experiencing troubling symptoms of anxiety, depression, or self-harm, call or text 9-8-8 to access mental health services in the United States.

How to Protect Your Teen’s Mental Health

Talk to your child’s pediatrician if you are concerned about your child’s mental health. Learn about the signs of anxiety and depression (and other signs of distress) and ask your child’s doctor if screenings for these conditions are warranted. If your child has been diagnosed with anxiety, depression, and/or other conditions, ensure that they are adhering to treatment plans.

1. Model emotional regulation at home.

Practice self-care and prioritize your well being. Even if it doesn’t seem like it, your behaviors serve as a guide for your teen.  Keeping calm will help your teen do the same – or at least prevent emotions from escalating. Make sure you aren’t enabling your child’s anxiety.

2. Try to minimize exposure to negative news.

Avoiding discussing potentially stressful subjects – finances, marital problems, etc. – around your child, as these topics could undermine your child’s sense of safety and stability. Limit your family’s exposure to distressing news events. Learn more about navigating conversations around gun violence and school shootings here.

3. Encourage healthy social media use.

Have ongoing conversations about online experiences, and watch for warning signs of problematic Internet use. Listen to our conversation with Linda Charmaraman, Ph.D., on social media and youth mental health for more strategies. If unhealthy social comparison over social media is a problem for your teen, read this article.

4. Encourage healthy habits.

Consistency and routine ground us, as do sufficient sleep, nutritious meals, and physical activity. Social connection is also vital for teens. Take steps to ensure that your child’s life has all these elements.

5. Prioritize a good relationship with your child above all else.

A stable, supportive environment does wonders for fostering resiliency and confidence. Bond with your child over things they enjoy (don’t come in with an agenda), and really listen to your child’s concerns without judgment. (Check your immediate reactions and unsolicited advice at the door.)

ADHD & the Mental Health Crisis: Next Steps

• Join Us! Mental Health Out Loud Event on Eating Disorders in Teens
• Read: Special 2022 Mental Health Report from ADDitude
• Read: Compare & Despair: Social Media & Mental Health Concerns in Teens with ADHD
• Listen: “Mental Health Out Loud – The Mental Health Fall Out from Social Media Use”
• Free Resource: Social Anxiety Facts & Falsehoods
• Read: A Clinicians’ Guide to Serving and Protecting LGBTQIA+ Youth  

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This is a fantastic idea, though it may not be commonly implemented by families of children with attention deficit hyperactivity disorder (ADHD). Multiple studies show that exercise, especially aerobic exercise, helps children with ADHD.^{1 2} There is also research on the benefits of certain exercise programs in reducing ADHD symptoms³, which supports the idea of extending such programs to schools for all students. For all children, the American Academy of Pediatrics (AAP) also recommends 60 minutes of physical activity most days of the week.⁴

Federal law requires states, districts, and schools to provide students with and without disabilities equal opportunity to participate in physical education and physical activity.⁵ That said, if you know your child benefits greatly from movement, it is definitely worth a conversation with the IEP team to determine how to incorporate more of it into his learning without disrupting other students. Your child’s physical education teacher should form part of those conversations.

[Get This Free Download: Sports & Activities for Kids with ADHD]

Keep in mind your child’s quality of exercise in those conversations. What qualifies as P.E. in some schools is sometimes questionable. It’s important that your child (and all children, really) participate in exercise that elevates the heart rate and works up a sweat.

Movement before and after school might help your child as well. Your child might enjoy playing in a sports team, or, like many children with ADHD, they might prefer an individual sport, like swimming, tennis, cycling, running, and/or martial arts.

Physical Activity, ADHD, and School: Next Steps

• Free Download: Natural ADHD Treatment Options
• Read: Why Recess Is Non-Negotiable for ADHD Kids
• Research: Physical Exercise Is the Most Effective Natural Treatment for ADHD — and Severely Underutilized

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “Lifestyle Changes with the Biggest Impact on Kids with ADHD” [Video Replay & Podcast #414],” with Sanford C. Newmark, M.D., which was broadcast on August 4, 2022.

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Sources

¹ Centers for Disease Control and Prevention (CDC). Inclusive School Physical Education and Physical Activity. Retrieved from https://www.cdc.gov/healthyschools/physicalactivity/inclusion_pepa.htm

²Berwid, O. G., & Halperin, J. M. (2012). Emerging support for a role of exercise in attention-deficit/hyperactivity disorder intervention planning. Current psychiatry reports, 14(5), 543–551. https://doi.org/10.1007/s11920-012-0297-4

³Christiansen, L., Beck, M. M., Bilenberg, N., Wienecke, J., Astrup, A., & Lundbye-Jensen, J. (2019). Effects of Exercise on Cognitive Performance in Children and Adolescents with ADHD: Potential Mechanisms and Evidence-based Recommendations. Journal of clinical medicine, 8(6), 841. https://doi.org/10.3390/jcm8060841

⁴Taylor, A., Novo, D., & Foreman, D. (2019). An Exercise Program Designed for Children with Attention Deficit/Hyperactivity Disorder for Use in School Physical Education: Feasibility and Utility. Healthcare (Basel, Switzerland), 7(3), 102. https://doi.org/10.3390/healthcare7030102

⁵Lobelo, F., Muth, N. D., Hanson, S., Nemeth, B. A., COUNCIL ON SPORTS MEDICINE AND FITNESS, & SECTION ON OBESITY (2020). Physical Activity Assessment and Counseling in Pediatric Clinical Settings. Pediatrics, 145(3), e20193992. https://doi.org/10.1542/peds.2019-3992

Celiac disease ⁠— an autoimmune disorder that causes intolerance to gluten ⁠— may be linked to attention deficit hyperactivity disorder (ADHD), according to a systematic review recently published in Children.¹

The review, which comprises 23 studies that reference ADHD and celiac disease published in the last two decades, found that more than half of those studies established a positive association between the conditions. Most of the studies that show a positive association were published in the last five years.

A 2021 study of 112,340 participants, for example, found that patients with celiac disease faced an increased risk for ADHD (OR: 1.75) compared to patients without celiac disease.² A small study published the year prior of 73 pediatric patients with celiac disease found that 16% of the group also had ADHD, higher than the 9.4% prevalence of ADHD found in the general population.^{3 4}

The review included a few small studies on the association between gluten-free foods, celiac disease, and ADHD. In one study, 15% of participants with ADHD who tested positive for celiac disease and subsequently avoided gluten for six months saw a reduction in ADHD symptoms.⁵

The review builds on emerging research linking celiac disease to other conditions, including autism, anxiety, and mood disorders.⁶ A 2017 study (included in the systematic review) found that children with celiac disease had a 1.4-fold increased risk for psychiatric disorders later in life.⁷

The author of the review cautions that the referenced studies on celiac disease and ADHD differ considerably in methodology, diagnostic criteria, study design, number of participants, and other parameters that may impact reporting. More research is needed to understand celiac disease and its connection to ADHD.

Sources

¹ Clappison, E., Hadjivassiliou, M., & Zis, P. (2020). Psychiatric Manifestations of Coeliac Disease, a Systematic Review and Meta-Analysis. Nutrients, 12(1), 142. https://doi.org/10.3390/nu12010142

² Butwicka, A., Lichtenstein, P., Frisén, L., Almqvist, C., Larsson, H., & Ludvigsson, J. F. (2017). Celiac Disease Is Associated with Childhood Psychiatric Disorders: A Population-Based Study. The Journal of pediatrics, 184, 87–93.e1. https://doi.org/10.1016/j.jpeds.2017.01.043

³ Niederhofer H. (2011). Association of attention-deficit/hyperactivity disorder and celiac disease: a brief report. The primary care companion for CNS disorders, 13(3), PCC.10br01104. https://doi.org/10.4088/PCC.10br01104

⁴ Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 47(2), 199–212. https://doi.org/10.1080/15374416.2017.1417860

⁵ Alkhayyat, M., Qapaja, T., Aggarwal, M., Almomani, A., Abureesh, M., Al-Otoom, O., Zmaili, M., Mansoor, E., & Abou Saleh, M. (2021). Epidemiology and risk of psychiatric disorders among patients with celiac disease: A population-based national study. Journal of gastroenterology and hepatology, 36(8), 2165–2170. https://doi.org/10.1111/jgh.15437

⁶ Coburn, S., Rose, M., Sady, M., Parker, M., Suslovic, W., Weisbrod, V., Kerzner, B., Streisand, R., & Kahn, I. (2020). Mental Health Disorders and Psychosocial Distress in Pediatric Celiac Disease. Journal of pediatric gastroenterology and nutrition, 70(5), 608–614. https://doi.org/10.1097/MPG.0000000000002605

⁷Gaur S. (2022). The Association between ADHD and Celiac Disease in Children. Children (Basel, Switzerland), 9(6), 781. https://doi.org/10.3390/children9060781

Here, eight ADDitude readers tell us how they manage their kids’ sensory sensitivities — and avoid tears and sensory meltdowns when the world gets loud and bright. Does your child have sensory difficulties? Share your sensory-safe strategies in the comments below.

“We knew from a very young age that our son was sensitive to bright lights and loud sounds, not to mention large crowds of people. We’ve never gone to the main area in town to see fireworks — we go to a quieter spot a good ways away.” — Alison, Maryland

“We have a family member who’s a race car driver. My daughter wears headphones or earplugs at the track. We watch the sound levels all the time, but we don’t avoid the fun!” — An ADDitude Reader

“My daughter has always been extremely sensitive to loud noises. She would cry when people sang happy birthday, clapped, or even laughed! She is 11 now and has improved greatly. She doesn’t like these things, but she’s learned to tolerate them with the help of noise-canceling headphones.” — Caron, Canada

[Self-Test: Sensory Processing Disorder in Children]

“It’s been a little disappointing for me as a parent because I love fireworks, and I miss them. But I want my daughter to feel comfortable and safe more than I want to see fireworks shows. It’s a small sacrifice. I think every family needs to balance their collective needs against the needs of their neurodivergent kid.” — Lauren, Virginia

“I couldn’t even take my daughter into stores as a baby; they were too bright and noisy. She would cry and scream as soon as we got inside. We tried fireworks when she was about 3 and she started crying as soon as they started. We have only watched them on TV since then.” — An ADDitude Reader

“We no longer go to fireworks. Up until age 10, my son hated them and screamed and we had to leave. It was torture. We finally realized it’s just not a match. We tried noise-canceling headphones, and sunglasses, and it just did not work for him. We have awesome fireflies in our area, so we watch those together instead. It’s a great fit for us.” — An ADDitude Reader

“My little one does not like the noise of fireworks, but his sister and father adore them. So he and I stay inside and watch through the door or window, or he covers his ears outside if it’s a smaller cracker, and he can enjoy the sights without the impact of the sounds.” — An ADDitude Reader

[Download: Could It Be Sensory Processing Disorder?]

“We are currently going through testing with our 7-year-old, who has had sound sensitivities since he was 2. We’ve avoided firework displays until last year, when he asked to go and we gave him ear defenders.” — Louis H.

Sensory Sensitivity in Kids: Next Steps

• Read: How to Help a Child With Sensory Processing Disorder and ADHD 
• Watch: Sensory-Smart Strategies for Children with Sensory Processing Disorder
• Read: How to Treat Sensory Processing Disorder

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Lifestyle changes — improving nutrition and exercise, taking select supplements, and reliably using prescribed medication — may help to effectively manage ADHD symptoms in children, according to research. The impact of these changes is often underestimated and undervalued, but evidence shows that they can have a positive effect on a child’s academic performance, behavior, and sleep. In this webinar, caregivers will learn about the outcomes they might expect when they build the following lifestyle changes into a child’s day:

• Time in nature
• Unstructured play
• Healthy exercise and nutrition
• Stress management
• Behavioral management
• Adequate Sleep
• Screen time management

Watch the Video Replay

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

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; Amazon Music; iHeartRADIO.

More on Lifestyle Changes and ADHD:

• Download: Your Guide to Natural ADHD Treatment Options
• Read: Healthy Foods and Supplements for Kids & Adults
• Read: Bedtime Aids for Kids with ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on August 4, 2022, 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:

Sanford Newmark, M.D., is the director of clinical programs at Osher Center for Integrative Health at the University of California, San Francisco. Prior to joining the Osher Center, Dr. Newmark founded the Center for Pediatric Integrative Medicine, an integrative medicine consulting practice treating a wide array of pediatric problems. He specializes in the integrative and holistic treatment of children with autism and ADHD, combining conventional medicine with nutrition, behavior management, and various complementary modalities.

Dr. Newmark lectures widely on autism and ADHD and has authored three chapters in integrative medicine textbooks. He is the author of the book ADHD Without Drugs, a Guide to the Natural Care of Children with ADHD. (#CommissionsEarned)

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

Listener Testimonials

“Loved this webinar. It utilized evidence-based research to support the information provided. Dr. Newmark is an expert in his field and highly knowledgeable!”

“A lot of helpful information in a short period of time!”

“My kids and I really enjoyed this webinar. Thank you so much!”

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The sponsor of this ADDitude webinar is….

Accentrate® is a dietary supplement formulated to address nutritional deficiencies known to be associated with ADHD. It contains omega-3 fatty acids in phospholipid form (the form already in the brain). This Brain Ready Nutrition helps manage inattention, lack of focus, emotional dysregulation, and hyperactivity without drug-like side effects. | fenixhealthscience.com

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Unhealthy eating habits are more prevalent among children with inattentive symptoms of attention deficit hyperactivity disorder (ADHD) than they are among those without the condition. This finding came from a new study published in Nutrients that compared the food consumption and dietary habits of children with and without ADHD in relation to their age and ADHD presentation. ¹

The study sample included 734 children in Spain, including 259 preschoolers aged 3 to 6 years (57 with ADHD and 202 controls) and 475 elementary-school-age children aged 10 to 12 years (213 with ADHD and 262 controls).

Researchers measured three types of eating patterns:

• Western-like (including eggs, processed meat, potatoes, legumes, sodas, and cooked vegetables)
• sweet (dairy desserts, sweet cereals, preserved fruit, and sweets)
• healthy (nuts, fish, raw vegetables, and fresh fruit)

Findings revealed only 12% of children with inattentive ADHD adhered to a healthy pattern compared to 40% of children in the control group. Children with inattentive ADHD were most likely to follow the Western-like pattern.

Both groups demonstrated unhealthy eating habits, specifically consuming more than the recommended amount of sweets (fruit juice, dairy desserts, red meat, sweet cereals, and sweet sodas). Almost all preschool children (95% of the children with ADHD and 96% of children in the control group) practiced poor eating habits. In the elementary-school-age group, researchers found that 92% of children across both groups should improve the quality of their diets. ¹

“The study population generally has a poor-quality diet that it needs to improve to prevent future health issues,” the authors said. “This indicates the need to improve children’s diets in general. These results paint a picture of a current problem in many developed countries: nutritional deficiencies and excesses that can lead to childhood obesity.”

Researchers did not find any remarkable differences between age groups either in food intake (by grams or servings) or between children with ADHD and their control peers. Both groups ate adequate amounts of protein products, dairy products, and oily fish. They ate inadequate amounts of starches, vegetables, fruits, legumes, nuts, white meat, white fish, and eggs.

This study supports previous reports that “inattentive symptoms of ADHD were directly related to bingeing or disinhibited eating behavior and indirectly to internal appetite signals by pathways of association via negative mood.” ²,³

“This emotional dysregulation may lead to emotional eating, which in turn may significantly influence the individual’s food choices (usually for unhealthy and comfort food),” the authors said.

Sources

¹Rojo-Marticella, M., Arija, V., Alda, J. Á., Morales-Hidalgo, P., Esteban-Figuerola, P., & Canals, J. (2022). Do children with attention-deficit/hyperactivity disorder follow a different dietary pattern than that of their control peers? Nutrients. 14(6), 1131. //doi.org/10.3390/nu14061131

²O’Neill S., Rudenstine S.(2019).Inattention, emotion dysregulation and impairment among urban, diverse adults seeking psychological treatment. Psychiatry Research. 282,112631.//doi.org/10.1016/j.psychres.2019.112631

³Kaisari P., Dourish C.T., Rotshtein P., Higgs S. (2018). Associations between core symptoms of attention deficit hyperactivity disorder and both binge and restrictive eating. Frontiers in Psychiatry. 9,103. //doi.org/10.3389/fpsyt.2018.00103

Lack of sleep. Increased stress. Medication side effects. Depression and anxiety. Fear of falling behind. You might not realize it, but if you or your children are living with ADHD, these issues could bring on or worsen headaches — and they might even worsen your ADHD. For some people, headaches might stem from undiagnosed ADHD. When headaches are frequent and debilitating, students miss school days and adults lose time at work, adding to stress.

Wait, you might say. There’s actually a connection between headaches and ADHD? Research says yes, and it might be worse for women. Help may be elusive, as physicians who treat migraine headaches might not be familiar with ADHD and the factors that can lead to or aggravate this condition. But this webinar with Dr. Sarah Cheyette is designed to expose those connections to improve your quality of care.

In this webinar, you will learn:

• The connection between migraine headaches and ADHD
• The factors that may lead to or worsen headaches in people with and without ADHD, and in women in particular
• Strategies to reduce or stop migraines
• Resources to help you overcome the problems that lead to headaches

Watch the Video Replay

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

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; Amazon Music; iHeartRADIO.

More on ADHD and Migraine Headaches

• Download: Choosing the Right Professional to Treat ADHD
• Read: Study Reveals Significant Comorbid Link Between ADHD and Migraines
• Read: ADHD Medications and Headaches

Obtain a Certificate of Attendance

If you attended the live webinar on May 24, 2022, 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:

Sarah Cheyette, MD, is a pediatric neurologist. She graduated from Princeton University and UCLA Medical School. She is a co-author of the books, Winning with ADHD: A Playbook for Teens and Young Adults with Attention Deficit/Hyperactivity Disorder (#CommissionsEarned) and ADHD & The Focused Mind: A Guide to Giving Your ADHD Child Focus, Discipline & Self-Confidence. (#CommissionsEarned)

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

Listener Testimonials

“The presenter was great. I wish she was in my area to be my neurologist!”

“This webinar shed a lot of light on so many issues my family has struggled with.”

“Dr. Cheyette’s lecture was very insightful and well presented.”

Webinar Sponsor

The sponsor of this ADDitude webinar is….

Inflow is the #1 app to help you manage your ADHD. Developed by leading clinicians, Inflow is a science-based self-help program based on the principles of cognitive behavioral therapy. Download now on the App Store and Google Play Store.

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

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Congress must work to improve access to and increase funding for child and adolescent mental health care across the nation, especially in the wake of the pandemic, according to testimony delivered by the American Psychological Association (APA) during a House hearing last week.¹

Federal response efforts should focus on mitigating the real and damaging effects of the pandemic on child and adolescent mental health in the short and long term, said Arthur C. Evans, Jr., APA’s CEO, in a Congressional hearing on the topic.

“Social isolation, financial uncertainty, and disrupted routines place considerable stress on children and their families, significantly affecting their mental health and well-being,” Evans said before members of the House Energy and Commerce Subcommittee on Oversight and Investigations.

He added that failing to meet a child’s mental health needs could impact their trajectory in life. “This can include a greater likelihood of difficulties with learning, addiction to substances, lower employment prospects, and involvement with the criminal justice system,” he said.

To better serve children and adolescents, Congress must address shortages of mental health providers and increase access to school-based behavioral and physical health care through legislation, as well as remove other barriers to appropriate care, he said.

The country’s approach to child mental health care, Evans noted, necessitated improvement well before the pandemic. The current behavioral health system, he said, requires a patient’s needs to escalate to a crisis point before initiating treatment, which “does not work for children.” A multi-tiered approach that addresses at-risk individuals and emphasizes early intervention would be most effective, he said.

Evans also called on Congress to increase Medicaid funding to schools and to permanently extend the Children’s Health Insurance Program, which provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid.

While the country has already made significant investments in mental health during the pandemic, Evans noted that funding must not be temporary, as it traditionally tends to be in moments of crisis. “New investments must be made with the understanding that a long-term commitment is needed.”

Sources

¹ American Psychological Association. (2021, September 22.) Congress should increase child and adolescent mental health care, says APA [Press release].https://www.apa.org/news/press/releases/2021/09/increase-child-mental-health

Pornography is much more prevalent and accessible than it used to be. It’s easy for kids to find porn online — or accidentally stumble across it thanks to a poorly worded Google search.

That said, pornography is not cause for panic, regardless of how your child found it.

How to Talk to Your ADHD Teen About Porn

1. Consider Your Options – and Approach

Since you’re unsure whether your teen is viewing porn, you can address this issue in several ways. You could take steps to confirm your suspicions by, for example, checking his browser history. Just be aware that doing so may feel like an invasion of privacy to your teen if you haven’t already established that part of your job as a parent is to periodically monitor his Internet use.

If you decide to look into his browser history, be ready for what you might find. If you’re upset about what you discover while you talk to him, it will undermine the effectiveness of your conversation.

[Get This Free Download: An “Ethics Manual” for Your Teen’s Electronics]

You could also address his exposure to porn as a general thought by saying something like, “You’re getting older now, so we should probably have a conversation about pornography. I know it’s all over the Internet, and I want to get ahead of it.” This option allows you to have the conversation while maintaining more dignity for your child.

Punishing him by taking away his computer or phone would be a mistake. That sends the message that curiosity and interest in sex is bad, and, potentially, that sexual feelings are wrong. Instead, it is better to talk patiently and calmly with your son about what occurred.

2. Keep the Conversation Brief and Direct

Bringing up porn won’t be comfortable for you or your teen. But it should be brought up. Just keep things direct and brief. A protracted conversation may close the door for future questions, which will do more harm than good. Your son may look for answers in less reliable places.

3. Remember That Interest in Sex Is Appropriate

Interest in sex is developmentally appropriate for teenagers. Looking at porn doesn’t mean your son is going to grow up to become a deviant; it just means he’s curious.

[Read: How to Talk About Sex with Your Teen]

Views on porn vary widely, with some people thinking it’s no big deal, while others are strongly opposed to it on moral grounds, ranging from religious views to concerns about the exploitation of women. Regardless of how you answer the “is porn bad?” question, making your child feel guilty about his natural curiosity will likely do more harm than good, in terms of your relationship with him, and with regard to his self-image. But do talk to him about your values and how looking at porn relates to them.

4. Factor in ADHD

ADHD is almost certainly playing a role in this. The ADHD brain produces less dopamine than does a neurotypical brain, and it uses the dopamine less efficiently. As a result, it craves sources that increase levels of the neurotransmitter. And porn is an excellent source. This could be a reason why he seeks out pornography now and may be a reason for him to seek it out again in the future. Don’t take it as disrespect if he does.

It is also important to recognize the role that pandemic social isolation may be playing here. Your son may be turning to the Internet for a lot of things right now. This may just be another on the list. During this boring time with minimal connection, the stimulation pornography provides can be very attractive. If you catch him looking at porn again, chalk it up to impulsivity and boredom. Then revisit your previous conversation regarding curiosity, porn use, and your values.

5. Be Sure He Knows Porn Isn’t Sex

When talking to your son, distinguish porn from sex. In the same way that an action scene in a movie isn’t a real fight, porn isn’t real sex. It’s acting. It’s fantasy. It should not set expectations of actual sex and intimacy. This is not how real sex works. It’s important that your son understands this, so that he has reasonable expectations for what sexual relationships are like in real life.

Sex education in schools in the United States is sorely lacking, and this may be an excellent chance to help guide your son toward becoming a healthy adult.

Porn Addiction: Signs That Your Teen May Have a Problem

• You notice changes in mood or behavior.
• There’s been a significant increase in the amount of time they spend online.
• They suddenly need much more privacy.
• They are isolating themselves.
• You’ve spoken with them about their use of porn, but they have continued anyway despite attempts to stop.
• Their sexual knowledge or behavior is not developmentally appropriate.
• They engage in risky behaviors — viewing porn on school computers, say.

Porn Addiction Help: What to Do

If your teen exhibits these behaviors, it’s important to find an experienced and compassionate mental health professional who is skilled in this area. The professional should also screen your child for other mental health challenges, since ADHD and mood disorders are often associated with porn addiction.

Porn Addiction: Next Steps

• Free Download: How Well Does Your Teen Regulate Emotions?
• Read: Hormones, High School, and ADHD: A Parent’s Guide
• Read: Safe Sex Tips for Teens

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.