The Clinicians’ Guide to Differential Diagnosis of ADHD is a clinical compendium from Medscape, MDEdge, and ADDitude designed to guide health care providers through the difficult, important decisions they face when evaluating pediatric and adult patients for ADHD and its comorbid conditions. This guided email course will cover the following topics:

• DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
• DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
• DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
• DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
• DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
• DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
• DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

NOTE: This resource is for personal use only.

CLINICAL REQUIREMENTS: What clinical requirements are required to confirm a diagnosis of attention deficit hyperactivity disorder (ADHD)?

A: All patients must have a full psychiatric evaluation and physical examination. Here is a cautionary note underscoring the need for a full assessment for late-onset ADHD in adolescents and young adults… | Keep reading on Medscape »

PEDIATRIC ADHD: Which diagnostic tests should I administer for the evaluation of pediatric ADHD?

A: Workup in attention deficit hyperactivity disorder (ADHD), previously termed attention deficit disorder (ADD), includes the following… | Keep reading on Medscape »

ADHD DIAGNOSIS: What steps comprise an authoritative ADHD diagnosis?

A: An accurate ADHD evaluation includes several standard diagnostic steps and nuanced considerations; other “tools” are unproven and worth neither your time nor your money… | Keep reading on ADDitude »

COMPLEX ADHD DIAGNOSIS: What tests, assessments, and questionnaires are used to evaluate patients for complex ADHD?

A: Many children and adults begin by taking an online test of common ADHD symptoms and then taking the results to an ADHD specialist for review and evaluation… | Keep reading on ADDitude »

Free Webinar: Expert Guidance for Securing an Accurate ADHD Evaluation

Expert Webinar with Thomas E. Brown, Ph.D. | Listen now on ADDitude »

Free Webinar: How Brain Imaging Helps Us Understand and Treat ADHD

Expert Webinar with Jonathan Posner, M.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
> DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

ADVERSE CHILDHOOD EXPERIENCES: How do adverse childhood experiences (ACEs) and trauma influence the development of ADHD in children?

A: Trauma and adversity can alter the brain’s architecture, especially in children, which may partly explain their link to the development of ADHD… | Keep reading on ADDitude »

ADHD AND TRAUMA: What are the symptoms shared by ADHD and PTSD?

A: Poor working memory is associated with ADHD, but also may be the hallmark of a mind avoiding thoughts of a traumatic experience. Practitioners must understand ADHD and trauma to treat a patient effectively…. | Keep reading on ADDitude »

ADHD AND PTSD: Is ADHD caused by PTSD? Is PTSD caused by ADHD?

A: Research increasingly reveals a strong relationship — and reciprocal risk factors — between ADHD and PTSD. What explains this mutual comorbidity? PTSD is associated with dysfunction in areas of the brain implicated in fear extinction learning… | Keep reading on ADDitude »

ADHD AND PERSONALITY DISORDERS: What is the link between ADHD and personality disorders?

A: Personality disorders are mental health conditions like borderline, histrionic, narcissistic, or antisocial personality disorder that cause unhealthy patterns of thought and behavior that persist over time and across situations, causing significant distress or impairment… | Keep reading on ADDitude »

ADHD AND SUBSTANCE ABUSE DISORDER: What is the link between ADHD and substance use disorder?

A: An estimated 15 and 25 percent of adults with a lifetime history of SUD also have ADHD. So how is SUD linked to ADHD? The short answer is we aren’t sure… | Keep reading on ADDitude »

ADHD AND OCPD: Why are individuals with ADHD at higher risk of developing OCPD?

A: Individuals with OCPD may be rigid and stubborn, insisting that others do things according to their strict standards. They may exhibit these behaviors at the expense of flexibility, openness, and efficiency… | Keep reading on ADDitude »

ADHD AND RISKS FOR EATING DISORDERS AND OBESITY: What is the symptom interplay between ADHD, eating disorders, and obesity?

A: Several factors – biological, cognitive, behavioral, and emotional – may explain why ADHD predisposes individuals to eating disorders and challenges… | Keep reading on ADDitude »

Free Webinar: How Stress and Trauma Affect Children with ADHD

Expert Webinar with Nicole M. Brown, M.D., MPH, MHS | Listen now on ADDitude »

Free Webinar: Borderline Personality Disorder and ADHD

Expert Webinar with Roberto Olivardia, Ph.D. | Listen now on ADDitude »

Free Webinar: How Stress and Trauma Impact Brain Development

Expert Webinar with Cheryl Chase, Ph.D.| Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
> DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

INATTENTIVE ADHD: What other conditions may cause symptoms of inattention typically associated with ADHD?

A: Several disorders can present with cognitive, attentional, and executive functioning deficits that resemble the presentation of ADHD. These include absence seizures and other types of seizures, Lyme disease, HIV infection, and encephalopathy…. | Keep reading on MDedge »

AUTISM AND ADHD DIAGNOSTIC CRITERIA: How are the diagnostic criteria for autism and ADHD in adults differentiated?

A: While research on adult autism and ADHD is scarce, clinicians largely agree on best practices in the evaluation and treatment of patients with both disorders… | Keep reading on ADDitude »

AUTISM VS ADHD:  What criteria must be present to merit an autism diagnosis vs. an ADHD diagnosis?

A: It’s critical for professionals to understand what constitutes a thorough ASD evaluation, and that a patient must demonstrate at least five of the seven criteria outlined in the DSM-5 in order to merit an autism diagnosis… | Keep reading on ADDitude »

TIC DISORDERS: What are the diagnostic criteria for the tic disorders that typically co-occur with ADHD, anxiety, and autism?

A: Tic disorders frequently co-occur with other conditions, like ADHD and anxiety, and can lead to problems in school and in social settings… | Keep reading on ADDitude »

ADHD VS LEARNING DISABILITIES: How is ADHD mistaken for comorbid learning disabilities like dyslexia, dyscalculia, and nonverbal learning disorder?

A: Learn how certain red flags, like an inability to communicate or difficulty remembering facts, might mean your child is struggling with a learning disability… | Keep reading on ADDitude »

HIGH IQ MASKING: How might a high IQ mask symptoms of ADHD and/or autism spectrum disorder?

A: Individuals with an above-average IQ and high-functioning autism, especially those with co-morbid ADHD, are less likely to be diagnosed and more likely to struggle in social spheres… | Keep reading on ADDitude »

Free Webinar: Diagnosing and Treating Comorbid Conditions in Children

Expert Webinar with Mark Bertin, M.D. | Listen now on ADDitude »

Free Webinar: How to Recognize and Address Dyscalculia

Expert Webinar with Daniel Ansari, Ph.D. | Listen now on ADDitude »

Free Webinar: Understanding Body-Focused Repetitive Behaviors with ADHD

Expert Webinar with Roberto Olivardia, Ph.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
> DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

COMORBIDITIES: What comorbidities are associated with ADHD?

A: The two most common comorbidities associated with ADHD are depression and an anxiety disorder, like OCD or generalized anxiety disorder… | Keep reading on Medscape »

COMORBIDITIES: How can diagnosticians differentiate symptoms of anxiety, depression, and ADHD?

A: Studies find that 80 percent of people with attention deficit disorder (ADHD or ADD) will have at least one other psychiatric disorder in their lifetime… | Keep reading on ADDitude »

ADHD AND DEPRESSION: What are the key distinctions between ADHD and depression?

A: Though ADHD and depression share similar symptoms, they are separate and distinct conditions with different treatment protocols. ADHD is a lifelong neurological disorder that impairs executive functions, attention, and self-control; depression is a mood disorder… | Keep reading on ADDitude »

ADHD, ODD, DMDD: How is ADHD distinct from oppositional defiant disorder and disruptive mood dysregulation disorder?

A: Moodiness is common with bipolar disorder, but it’s also common with ADHD, ODD, DMDD, and other neurobehavioral conditions. Differentiating one condition’s symptoms of moodiness from another is critical… | Keep reading on ADDitude »

ADHD AND BIPOLAR: How are the symptoms of ADHD and bipolar disorder often conflated?

A: The rates of misdiagnosis and delayed diagnosis are particularly high among patients with bipolar symptoms; they are astronomical for patients with bipolar disorder plus ADHD… | Keep reading on ADDitude »

ADHD and OCD: What are the shared and distinct characteristics of obsessive compulsive disorder (OCD) and ADHD?

A: To ensure an accurate diagnosis and effective treatment, clinicians must understand the unique interplay between OCD and ADHD, including how ADHD tends to present in patients with OCD… | Keep reading on ADDitude »

ADHD and RSD: How can diagnosing clinicians differentiate between rejection sensitive dysphoria (RSD) – the emotional highs and lows associated with ADHD – and the similar ups and downs of bipolar disorder?

A: Patients with ADHD — and, specifically, rejection sensitive dysphoria (RSD) — get triggered by a distinct event and then experience an intense but fleeting mood. People with bipolar disorder experience the random onset of a mood that lasts for weeks or months… | Keep reading on ADDitude »

RELATED RESOURCES

Treating Anxiety and Depression Alongside ADHD

Expert Webinar with Roberto Olivardia, Ph.D. | Listen now on ADDitude »

ADHD Irritability vs. DMDD vs. Bipolar Disorder

Expert Webinar with William French, M.D., DFAACAP| Listen now on ADDitude »

Why ADHD Is Mistaken for Bipolar Disorder in Women

Expert Webinar with Thomas Brown, Ph.D., and Ryan Kennedy | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
> DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

ADHD IN ADULTS: How does ADHD present in adults? Does current DSM diagnostic criteria adequately capture adult ADHD?

A: Understanding the weak points in standard diagnostic criteria — and how to factor for them in evaluation and treatment — requires a nuanced understanding of how ADHD manifests in adults… | Keep reading on ADDitude »

ADHD IN GIRLS: How does ADHD present in girls and women?

A: Research and clinical practices are built around male presentations of ADHD, and science has historically paid little attention to female manifestations and impairments… | Keep reading on ADDitude »

LATE DIAGNOSIS: How does ADHD present in older adults? How should clinicians change diagnostic and treatment approaches? (ADHD)?

A: Though the diagnostic manual was rewritten in 2013 to include descriptors for adult ADHD, it still does not adequately consider how the disorder manifests and evolves in patients past mid-life… | Keep reading on ADDitude »

CLINICIAN GUIDELINES: How can I, as a clinician, ensure more equitable and effective care for African American children with ADHD?

A: Great care requires clinicians to probe and consider each individual patient’s unique experiences, and the role that ADHD stigma plays in BIPOC communities… | Keep reading on ADDitude »

ADHD AND WOMEN: How should clinicians consider the impact of hormones, trauma, and mental health when evaluating girls for ADHD?

A: New research suggests that to effectively diagnose ADHD symptoms in women and girls, doctors should consider hormonal fluctuations, trauma, family dynamics, self-esteem, and eating habits… | Keep reading on ADDitude »

ADHD AND WOMEN: How does the presentation of ADHD change in perimenopause and menopause?

A: What we do know – about menopause in general, the role of estrogen, and the effects of hormonal fluctuations on ‘ADHD-like’ symptoms – may help us understand the menopausal transition for women with ADHD… | Keep reading on ADDitude »

CLINICIAN GUIDELINES: How can clinicians protect the mental health of LGBTQA+ youth with ADHD?

A: Health care providers must also do their part to provide inclusive care and reduce barriers to mental health care services for this group, as 60% of LGBTQ youth who wanted mental health care in the past year were not able to access it…. | Keep reading on ADDitude »

RELATED RESOURCES

Free Webinar: The Science Behind Diagnosing and Treating ADHD in Older Adults

Expert Webinar with David Goodman, M.D., FAPA | Listen now on ADDitude »

Free Webinar: Equity in ADHD Care

Expert Webinar with  Tumaini Rucker Coker, M.D., MBA | Listen now on ADDitude »

Free Webinar: Key Concerns in Diagnosing and Treating Adolescents with ADHD

Expert Webinar with Timothy Wilens, M.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x MDEdge x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
>DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

PATHOPHYSIOLOGY: How does ADHD impair the areas of the brain responsible for executive function? (ADHD)?

A: Findings from neuropsychological studies suggest that the frontal cortex and the circuits linking them to the basal ganglia are critical for executive function and, therefore, to attention and exercising inhibition… | Keep reading on Medscape »

DEFICIENT EMOTIONAL SELF-REGULATION: Is emotional dysregulation an ADHD trait? How does it affect diagnosis and treatment?

A: DESR, or deficient emotional self-regulation, is a core facet of ADHD that carries significant consequences. However, it is not included the disorder’s diagnostic criteria. As new research confirms…| Keep reading on ADDitude »

SLEEP: Why does ADHD impact a patient’s sleep?

A: Sleep disturbances caused by ADHD have been overlooked for a number of reasons, including the late age of onset. But recent studies confirm that ADD symptoms do not go away at night… | Keep reading on ADDitude »

COMPLEX ADHD: What is complex ADHD?

A: Most children and adults with ADHD have one or more co-occurring conditions, which almost always impact treatment and outcomes. “Complex ADHD” is a relatively new term that reflects this phenomenon… | Keep reading on ADDitude »

RSD AND ADHD: Is rejection sensitive dysphoria a symptom of ADHD?

A: Rejection sensitive dysphoria is not a formal ADHD symptom, but it is commonly experienced by patients with ADHD who experience extreme emotional sensitivity and emotional pain. It may imitate mood disorders with suicidal ideation and manifest as instantaneous rage at the person responsible… | Keep reading on ADDitude »

RESEARCH ON EMOTIONAL DYSREGULATION: What do I need to know about the latest research on ADHD and emotional dysregulation?

A:  Recent findings suggest that problems with emotional regulation, including anger and negative emotions, are genetically linked to ADHD… | Keep reading on ADDitude »

STIGMA: How can clinicians address the stigma around ADHD in Black communities to ensure better healthcare?

A: Battling stigma is nothing new in the ADHD community. The lack of understanding is surprising, even among professionals. But in Black and other marginalized communities, it abounds. | Keep reading on ADDitude »

RELATED RESOURCES

Deficient Emotional Self-Regulation: The Overlooked ADHD Symptom That Impacts Everything

Expert Webinar with Russell Barkley, Ph.D.| Listen now on ADDitude »

Complex ADHD: The New Approach to Understanding, Diagnosing, and Treating Comorbidities in Concert

Expert Webinar with Theresa Cerulli, M.D. | Listen now on ADDitude »

How ADHD Shapes Your Perceptions, Emotions & Motivation

Expert Webinar with William Dodson, M.D. | Listen now on ADDitude »

ADHD Then and Now: How Our Understanding Has Evolved

Expert Webinar with David Anderson, Ph.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x MDEdge x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
> DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

SYMPTOMS: What is attention deficit hyperactivity disorder (ADHD)?

A: ADHD is a developmental condition of inattention and distractibility, with or without accompanying hyperactivity. There are 3 basic forms… | Keep reading on Medscape »

FREQUENCY: What is the prevalence of ADHD?

A: In 2016, an estimated 6.1 million US children aged 2–17 years (9.4%) were diagnosed with ADHD. Of these children, 5.4 million… | Keep reading on Medscape »

PATHOPHYSIOLOGY: Which regions of the brain are involved in ADHD?

A: The underlying brain regions predominantly thought to be involved are frontal and prefrontal; the parietal lobe and cerebellum may also… | Keep reading on Medscape »

CAUSES: What causes ADHD?

A: Parents and siblings of children with ADHD are 2-8 times more likely to develop ADHD than the general population, suggesting that ADHD is highly familial… | Keep reading on Medscape »

INATTENTIVE: What characterizes the inattentive ADHD subtype?

A: Formerly called ADD, inattentive ADHD is characterized by symptoms of disorganization, poor time management, faulty working memory, and a lack of focus… | Keep reading on ADDitude »

RISK FACTORS: What do we know about prenatal and environmental risk factors linked to ADHD?

A: Biological, genetic, and environmental factors — including prenatal and early life exposures — may play a role (and to varying degrees) in the condition’s development… | Keep reading on ADDitude »

EARLY SIGNS: Can ADHD be diagnosed before age 6?

A: The AAP says children may be diagnosed with ADHD no younger than age 4, but that doesn’t mean that toddlers cannot have ADHD. There are real differences in the ADHD brain that are present at birth, and… | Keep reading on ADDitude »

RELATED RESOURCES

ADHD Then and Now: How Our Understanding Has Evolved

Expert Webinar with David Anderson, Ph.D. | Listen now on ADDitude »

What Is ADHD? Everything You Need to Know Before and After an ADHD Diagnosis

Expert Webinar with William Dodson, M.D., LF-APA | Listen now on ADDitude »

Focus on Inattentive ADHD: The Under-Diagnosed and Under-Treated Subtype

Expert Webinar with Mary V. Solanto, Ph.D. | Listen now on ADDitude »

7-Week Guide to Differential Diagnosis of ADHD, from Medscape x MDEdge x ADDitude:

> DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

Half of all women with ADHD receive a misdiagnosis or an incomplete diagnosis before finally identifying and treating their attention deficit disorder. This staggering statistic, revealed in a recent ADDitude survey of 2,760 women, confirms the anecdotal reports we hear often of medical gaslighting, distrust of self, unnecessary suffering, delayed treatment — and the grave consequences of each.

“I was misdiagnosed and received treatment that did not help me,” wrote one survey respondent misdiagnosed with depression and anxiety. “This led to me never getting better and ending up having a mental breakdown before I got my proper ADHD diagnosis 10 years later.”

“I believe if, instead of being diagnosed with bipolar 2 (cyclothymia), anxiety, and depression, I had been appropriately diagnosed with ADHD and given coping skills and treatment for that, my life would be completely different,” wrote another ADDitude reader.

“Antidepressants worked for a while, but my anger and frustration flare-ups were still an issue,” wrote a woman diagnosed with ADHD in her 50s. “Eventually, the antidepressants didn’t work anymore and I hit bottom… By the time I was diagnosed with ADHD, I was on long-term disability and felt I had no control over my life.”

The reasons for incomplete or inaccurate diagnosis range from outdated ADHD and gender stereotypes to low self-esteem and self-trust, seeded by years of criticism for unrecognized and untreated symptoms of ADHD, according to ADDitude‘s Women’s Health Month survey.

“Not being able to verbalize my emotions well continues to be a difficulty, likely due to not being able to trust my own emotions, whether they are valid or an under or over reaction,” wrote an ADDitude reader misdiagnosed with bipolar disorder. “In my opinion, this led to being misdiagnosed.”

This prevalent and debilitating roadblock to an ADHD diagnosis was a topic of discussion with Olympic marathon medalist Molly Seidel during her recent conversation with WebMD about barriers to mental health care for women.

“I wish that I had been more vocal about exactly how I was feeling earlier, because we might have gotten to the solution a lot earlier,” said Seidel, a world-class professional runner who was diagnosed with obsessive compulsive disorder and eating disorders before finally receiving an ADHD diagnosis a few years ago. “Especially as women, a lot of us are willing to almost gaslight ourselves by saying, ‘Oh it’s not really that bad.’ And then you look objectively at it, and you’re like, ‘No, this is objectively pretty bad and there has to be a better way to live than this.’”

For Seidel, an ADHD diagnosis was nothing short of life changing.

“My diagnosis came with such a sense of relief from knowing, Oh my God, there is a reason why I feel the way I feel. Maybe I’m not just thoroughly messed up and thoroughly a terrible person. My brain just works a little bit differently,” said Seidel, who earned the bronze medal in the Olympic marathon in Japan. “That diagnosis was the most freeing thing and the thing that has gotten me to the place that I am now.”

“What it took me years to figure out is that, if you are just trying to treat the symptoms and not addressing the underlying causes, it will just tend to jump from diagnosis to diagnosis to diagnosis,” said Seidel, who reported that she’s “in a much better and more stable place than I’ve been in a long time.”

Seidel’s ADHD treatment plan today includes mindful meditation, fine-tuned nutrition, miles upon miles of exercise, and therapy.

“Ultimately, the point of therapy is learning to have a better relationship with your own brain and understanding the mechanisms by which your brain works,”she said. “That has been the biggest thing in becoming more confident and trusting myself.”

ADHD Diagnosis in Women: Next Steps

• Self-Test: ADHD Symptoms in Women and Girls
• Read: Why ADHD in Girls Is Often Overlooked
• Read: Why Women with ADHD Feel Disempowered — And What We Can Do About It

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

ADHD’s abundance of research, treatment advances, and outspoken ambassadors should paint a clear picture for all to see. But that’s simply not the case. Outdated misconceptions continue to sabotage health outcomes for a diverse community of individuals with ADHD.

During ADDitude’s recent 25th anniversary webinar with Dave Anderson, Ph.D., we asked: “What ADHD myth — believed by others or by you — has had the biggest impact on your life?” Here are the most common responses we received from more than 100 listeners. (Bonus: We added ADDitude articles to counter each one.)

ADHD Myth #1: “ADHD doesn’t exist. Everyone feels like this…”

Read: Does Everyone Have ADHD? No.

ADHD Myth #2: “You’re just a busy working mom. That’s why you’re scattered and can’t get things done.”

Read: Why ADHD in Women is Routinely Dismissed, Misdiagnosed, and Treated Inadequately

ADHD Myth #3: “You choose to act this way.”

Read: How to Respond to Haters and Naysayers

ADHD Myth #4: “ADD is a behavior problem rather than a cognitive difference, and therefore something you can control if you just try hard enough.”

Read: ADHD Is Not a Behavioral Disorder — Executive Function Explained

ADHD Myth #5: “ADHD can be outgrown.”

Read: Do Children Outgrow ADHD? Not Often.

ADHD Myth #6: “Girls and women don’t get ADHD.”

Read: ADHD Looks Different in Women. Here’s How — and Why

ADHD Myth #7: “Female hormones do not affect ADHD symptoms.”

Read: ADHD Impairment Peaks in Menopause, According to ADDitude Reader Survey

ADHD Myth #8: “I wasn’t hyperactive enough so I could never have ADHD (big mistake).”

Read: How Inattentive ADHD Manifests

ADHD Myth #9: “You do not have ADHD if you can focus on some things.”

Read: Understanding Hyperfocus – the Intense Fixation with ADHD

ADHD Myth #10: “Wife about ADHD husband: ‘He’d remember if it was important to him!’”

Read: Why Working Memory Fails and How to Bolster It

ADHD Myth #11: “Kids are just exhibiting bad behavior [due to] poor parenting or poor classroom management skills.”

Read: Don’t Mistake Your Child’s ADHD Symptoms for Bad Behavior

ADHD Myth #12: “You will hurt your child if you give them medications, so try every possible non-medication option first.”

Read: ADHD Medications for Children — Safety, Side Effects, Dosage

ADHD Myth #13: “Using ADHD medications can lead to substance use disorder.”

Read: Treating a Child with ADHD Medication Diminishes His Future Risk of Substance Abuse

ADHD Myth #14: “Medicine is the only answer to helping with ADHD.”

Read: 5 Big Natural Remedies for ADHD: Nutrition, Exercise, Sleep & More

ADHD Myth #15: “You are stupid.”

Read: Children and Adults with ADHD Often Have High IQs

Addressing ADHD Myths: Next Steps

• Download: 3 Defining Features of ADHD That Everyone Overlooks
• Read: No, Gabor Maté Did Not Actually Diagnose Prince Harry with ADHD on Live TV
  
• ADDitude at 25: Giant Strides — and More to Go
  

The content for this article was based on poll responses submitted by live attendees during the ADDitude ADHD Experts webinar titled, “ADHD Then and Now: How Our Understanding Has Evolved” [Video Replay & Podcast #447] with Dave Anderson, Ph.D., which was broadcast live on March 21, 2023.

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.

The use of ADHD medication during pregnancy causes no impairment of a child’s neurodevelopment or physical growth, according to research published in Molecular Psychiatry.¹ A large population-based register study found in-utero exposure to medication for ADHD, including stimulants, did not impair a child’s neurodevelopment or growth compared to children whose mothers stopped taking ADHD medication prior to conception.

Research was conducted using data from Danish nationwide registers, including more than one million children born between 1998 and 2015. Of those, 898 children were delivered by mothers who started or continued taking ADHD medication during pregnancy; this became the study’s “exposed” group. The “unexposed” group included 1,270 children whose mothers discontinued — but had previously taken — ADHD medication before conception.

Prenatal & Postnatal Exposure to ADHD Medication

After adjusting for maternal demographic characteristics and psychiatric data, researchers found no difference in long-term neurodevelopmental or growth outcomes between the two groups. In other words, women could stop taking medication before conception or continue during pregnancy without putting their child at greater risk of neurodevelopmental psychiatric disorders (ADHD, ASD); neurodevelopmental impairments (vision, hearing, seizures, epilepsy); or growth impairments.

Though the percentage is small, the number of pregnant women taking ADHD medication has steadily increased over time.^{2, 3} In fact, ADHD medication is one of the most common medications prescribed during pregnancy.^{3, 4}

In a recent survey of ADDitude readers, 2.39% of 1,170 women who had been pregnant reported taking medication for their ADHD following conception. Many of those who did not take medication said they remained undiagnosed and untreated at the time of their pregnancies, and therefore had no prescribed medications. Just 2.58% took ADHD medication while breastfeeding.

If a woman decides to discontinue use while both pregnant and breastfeeding, she may go a year or longer without pharmacological treatment — a first-line treatment for ADHD.

“I stopped [taking] Adderall leading up until delivery, and had been told I couldn’t take it at all during breastfeeding,” wrote one 33-year-old woman in Texas. “I went back to work three months postpartum. I really struggled with symptoms and felt unable to do my job.

“I did some additional research… that suggested a low breastmilk transfer rate for Adderall, and an even lower rate with Ritalin. Five months postpartum, I brought that data to my GP, who agreed to prescribe 5mg of Ritalin twice daily. I continued exclusively breastfeeding for two more months, then did a combination of breastfeeding and formula until weaning completely when my daughter was nine months. At that time, my GP switched me back to Adderall. During this time, my daughter showed no adverse effects, remaining on her growth trajectory in the 90th percentile and sleeping like a champ!”

Impact on Children

The decision to cease or continue treatment for ADHD while pregnant is difficult, in large part because the effects of ADHD medication in utero are not well-documented. Due to the nature of the problem, research is limited to register studies like this most recent one — the second and largest long-term register study to examine the effects of ADHD medication during pregnancy.

In addition, the research is conflicting. A 2015 U.S. population-based study found that ADHD medication use in early pregnancy was associated with three specific, selected birth defects.⁵ Another U.S.-based study, published in 2017, suggested an increased risk of cardiovascular defects from prenatal exposure to methylphenidate — but not amphetamines.⁶

While exposed children faced no increased risks for common neurodevelopmental outcomes in the present study, researchers found that exposed children born to mothers who used other psychotropic medication during pregnancy were more likely to develop ADHD. This was also found when the mother had filled two or more prescriptions for ADHD medication during pregnancy.

Because the increased risk was limited to ADHD only, researchers speculate these results may be “driven by severity of maternal ADHD” through “higher disease liability for ADHD and through referral bias, that is, offspring of mothers with severe ADHD are assessed more carefully for ADHD.”

Impact on Women with ADHD

On average, women in the U.S. have their first child by age 27.⁷ According to the ADDitude survey, it’s around this time that women report a major impact caused by their ADHD symptoms. The majority — 64% to 70% of 2,010 respondents — said the overall impact of ADHD was major or life-altering in their 20s and 30s.

Half of survey respondents who had been pregnant said their ADHD symptoms remained stable during pregnancy. But following delivery, 56.7% of them said they experienced symptoms of postpartum depression. Around more than one-third told ADDitude these symptoms lasted for more than 6 months; for nearly 10%, postpartum depression lasted more than two years.

Similar findings were discovered in a 2020 survey conducted by the MGH Center for Women’s Mental Health. No significant changes in ADHD symptoms were reported by women during pregnancy, but those who chose to discontinue psychostimulant medication experienced a significant increase in postpartum depressive symptoms. Women who elected to adjust their ADHD medication use, or maintained the same prescription schedule, did not experience a significant change in depressive symptoms.

Limitations and Future Research

“Pregnant women who depend on stimulants for daily functioning must weigh the potential of exposing their fetus to unknown developmental risks against potential medical, financial, and other consequences to both mother and child that are associated with exacerbation of ADHD symptoms when stopping the medication, such as inability to maintain employment and unsafe driving,” the researchers stated.

ADHD medication in the present study included stimulants (methylphenidate, amphetamine, dexamphetamine, lisdexamphetamine) and other treatments (modafinil, atomoxetine, clonidine).

“The present study provides reassurance that several essential categories of child outcomes that could reasonably be suspected to be affected by stimulants, including body growth, neurodevelopment, and seizure risk, do not differ based on antenatal stimulant exposure.”

Compared to women without ADHD, the study’s sample population of women with ADHD tended to be younger at the time of childbirth, more likely to smoke during pregnancy, and more likely to have children born preterm or with low birth weight. This finding was consistent regardless of whether the mother took ADHD medication during pregnancy.

Finally, more research is needed to differentiate between the effects of ADHD medication types, dosage, and trimester. This study was limited to diagnoses formally entered into the Danish register. Future research should be expanded to include a larger sample population.

Sources

¹Madsen, K. B., Robakis, T. K., Liu, X., Momen, N., Larsson, H., Dreier, J. W., … Bergink, V. (2023). In utero exposure to ADHD medication and long-term offspring outcomes. Molecular Psychiatry, 1–8. doi: 10.1038/s41380-023-01992-6

²Lemelin, M., Boukhris, T., Zhao, J. P., Sheehy, O., & Bérard, A. (2021). Prevalence and determinants of attention deficit/hyperactivity disorder (ADHD) medication use during pregnancy: Results from the Quebec pregnancy/children cohort. Pharmacology research & perspectives, 9(3), e00781. https://doi.org/10.1002/prp2.781

³Haervig, K. B., Mortensen, L. H., Hansen, A. V., & Strandberg-Larsen, K. (2014). Use of ADHD medication during pregnancy from 1999 to 2010: A Danish register-based study. Pharmacoepidemiology and drug safety, 23(5), 526–533. https://doi.org/10.1002/pds.3600

⁴Louik, C., Kerr, S., Kelley, K. E., & Mitchell, A. A. (2015). Increasing use of ADHD medications in pregnancy. Pharmacoepidemiol Drug Saf, 24, 218– 220, doi: 10.1002/pds.3742.

⁵Anderson, K. N., Dutton, A. C., Broussard, C. S., Farr, S. L., Lind, J. N., Visser, S. N., Ailes, E. C., Shapira, S. K., Reefhuis, J., & Tinker, S. C. (2020). ADHD medication use during pregnancy and risk for selected birth defects: National birth defects prevention study, 1998-2011. Journal of Attention Disorders, 24(3), 479–489. https://doi.org/10.1177/1087054718759753

⁶Huybrechts, K. F., Bröms, G., Christensen, L. B., Einarsdóttir, K., Engeland, A., Furu, K., Gissler, M., Hernandez-Diaz, S., Karlsson, P., Karlstad, Ø., Kieler, H., Lahesmaa-Korpinen, A. M., Mogun, H., Nørgaard, M., Reutfors, J., Sørensen, H. T., Zoega, H., & Bateman, B. T. (2018). Association between methylphenidate and amphetamine use in pregnancy and risk of congenital malformations: A cohort study from the international pregnancy safety study consortium. JAMA psychiatry, 75(2), 167–175. https://doi.org/10.1001/jamapsychiatry.2017.3644

⁷Osterman, M.J.K., Hamilton, B.E., Martin, J.A., Driscoll, A.K., & Valenzuela, C.P. (2023). Births: Final data for 2021. National Vital Statistics Reports; 72(1). DOI: https://dx.doi. org/10.15620/cdc:122047.

As an ADHD coach with ADHD myself, I help people see how it is a whole-life, whole-body condition. I help them connect the dots between ADHD and other areas of life, with the goal of encouraging personal awareness and understanding.

Here, I present facts, observations, and questions to get you thinking about how ADHD is at the center of your life. As you gain insight into your person and condition, please remember that you have your own brand of ADHD — and you deserve to be treated with kindness above all.

How Does ADHD Affect Overall Health?

ADHD & Sleep

Why So Many Night Owls Have ADHD

Delayed sleep phase syndrome, defined by irregular sleep-wake patterns and thought of as a circadian rhythm disorder, is common in ADHD.¹ The ADHD brain takes longer — about an hour longer on average (remember, that’s just an average) — to fall asleep than does the non-ADHD brain.² That’s why it’s not uncommon for us to stay up late at night, and regret it in the morning.

Poor-Quality Sleep Worsens ADHD Symptoms

Suffering a sleep deficit with ADHD is like waking up to ADHD times two — or five. Lack of sleep slows a person’s response time, processing speed, and decision-making. We’re not as alert or as focused when we’re tired. We become crabby and inflexible. We imitate three of the Seven Dwarfs: Dopey, Sleepy, and Grumpy. Lack of sleep is a self-fulfilling prophecy; it only continues to throw our circadian rhythm off kilter and cause more dysregulated sleep.

[Get This Free Download: Lifestyle Changes for Adults with ADHD]

Is Your ADHD Medication Causing Sleep Problems?

Sleep problems are a common side effect of stimulant use. Then again, many people with ADHD find that stimulants help them to go to sleep. This is worth personal exploration.

ADHD & Nutrition and Eating Habits

Why ADHD Brains Chase Dopamine

The dopamine-deficient ADHD brain seeks this chemical in many places, from tobacco to junk food. Caffeine also boosts dopamine levels in the brain.³ And it’s always tempting to reach for simple carbs, since they rapidly break down into sugar and stimulate dopamine release.

ADHD Symptoms Influence Eating Behaviors

Symptoms like impulsivity and inattention easily invite dysregulated eating, which may lead to unintended weight gain.⁴ In fact, studies link ADHD to excess weight and obesity⁵ — which is linked to other conditions ranging from fatty liver, high blood pressure, and metabolic syndrome. Relatedly, research also links ADHD to Type 2 diabetes.⁶

Are Other Health Conditions Linked to ADHD?

From autoimmune diseases and skin conditions to hypermobility and pulmonary disease, a string of other health conditions have been linked to ADHD.^{7 8 9} Take a moment to think about how ADHD impacts your diet, health, and overall wellness.

[Free Guide: Health & Fitness Lifestyle Changes for Adults with ADHD]

How Does ADHD Affect Education and Careers?

Adverse School Experiences with ADHD Are Common

Our experiences in school often foreshadow our careers and other aspects of our lives. Did ADHD prevent you from graduating high school or from enrolling in or finishing college, as it did for so many of us?^{10 8} Or did ADHD help you excel in school? Did you have to navigate school with a learning difference like dyslexia or dysgraphia, as 45% of children with ADHD do?¹²

What Kind of Job Is Ideal for You?

Do you prefer to work in an office, or outside? Do you thrive in fast-paced, unpredictable environments? Or do you succeed with more structure and stability? Do you need complete silence to focus? Or do you work best with lots of stimuli? Are you self-employed? No matter your responses, know that ADHD guides your decisions across all these factors.

How Does ADHD Affect Relationships?

ADHD & Romantic Relationships

The Wonderful, Attractive Qualities of ADHD Partners

We’re spontaneous and lots of fun. We have a great sense of humor. (Because let’s face it: If we don’t laugh, we’ll cry.) We’re also really affectionate — and tend to pour it on when we’re in new relationships.

How Non-ADHD Partners Can Misunderstand Us

Our loved ones don’t always understand why we’re sometimes forgetful or disorganized. They don’t always know that we’re trying our absolute hardest. They don’t always know how to avoid taking our ADHD personally.

We Need Acceptance, Not Tolerance

Acceptance and compassion are key to a happy ADHD relationship and a true partnership.

ADHD and Family

Did ADHD Affect Your Decision to Have Children?

Some parents with ADHD have impulsivity to thank for their families. Other adults with ADHD choose not to have children, perhaps because of the very real challenges of managing symptoms while parenting a child who may also have ADHD. Are either of these true for you?

Are You a Parent with ADHD Raising Kids with ADHD?

If so, you’re in a unique place. Yes, it can be overwhelming, frustrating, and just plain hard a lot of the time. But it’s also worth it — especially when your own family can provide empathetic and constructive support because they understand your ADHD challenges.

Navigating the Opinions of Extended Family Members

They may doubt that you have ADHD, or they may mistakenly believe that only children can have ADHD. They may not think ADHD is real at all. They may only remember the version of you before you were diagnosed and informed. Either way, many of us are unfortunately forced to skirt the topic of ADHD with certain family members, or avoid some family altogether. But sympathetic family members do exist. They often have ADHD themselves, or they have children who are diagnosed with ADHD.

ADHD & Friendships

ADHD Sometimes Sabotages Relationships

Sometimes, we don’t know how to navigate social settings. Things like striking conversation or joining an ongoing conversation are tricky. In the company of friends, we sometimes blurt out whatever comes to mind, even if it’s brutally honest and not totally appropriate. Though we don’t mean to create divisions, these moments often cost us our friendships.

We Desperately Need Friends Who Get It

We need friends who understand us and will be there for us, either to cheer us on or offer their shoulder to cry on — without judgment or guilt.

[Read: How a Better Relationship with Food Can Benefit Your ADHD Brain]

Special Focus: ADHD in Girls and Women

ADHD is Often Unrecognized in Girls and Women

Women and girls with ADHD tend to be people-pleasers. We try really hard to mask our symptoms and perceived flaws. We blame ourselves entirely for our mistakes — often leading to a lifetime of shame, self-hate, and self-recrimination. That’s why early diagnosis and treatment are so important. Yet they are still so difficult to obtain.

Why? Because we don’t tend to fit the ADHD stereotype of a hyperactive little boy. The symptoms of inattentive ADHD, more common in women, are not as obvious and are harder to observe. Others tend to brush us off as dreamy and ditzy. If anything, we’re often misdiagnosed with depression or anxiety.

ADHD & Estrogen

Estrogen has an amazing and astonishing effect on the body.

• The menstrual cycle: Estrogen levels rise and fall during the monthly cycle. We focus best when estrogen levels are at their highest. When estrogen levels bottom out, all hell breaks loose. We’re unable to focus and our ADHD symptoms become more severe. Also, it’s important to note that premenstrual syndrome (PMS) and its more serious form, premenstrual dysmorphic disorder (PMDD), are more common and more severe in women with ADHD.¹⁴ Check with your doctor to see if you would benefit from an additional dose of stimulant medication or an antidepressant during the lowest point of your cycle.
• Pregnancy and postpartum: Estrogen shoots up during pregnancy, peaks in the third trimester, and drops considerably postpartum — changes that are bound to have considerable effects on the ADHD body and mind at the time women face the greatest risk for postpartum depression.
• Perimenopause and menopause: Brain fog, memory lapses, irritability, and other symptoms increase as estrogen levels decrease. It stands to reason that these changes worsen ADHD symptoms, too. These changes may also explain why so many women are finally diagnosed with ADHD in midlife. If you’re at this stage, talk to your doctor to see if estrogen supplementation is appropriate for you.

Wait, That’s ADHD, Too? Other Features and Strengths

• We are time blind: We often miscalculate how much time has elapsed, or how much time it takes to complete a task. This can have career implications, among others.
• We have sensory sensitivities: Can’t stand the feeling of certain textures and fabrics on your skin? Do bright lights and loud noises bother you? Sensory sensitivities are common in ADHD, causing us to react strongly to sights, smells, tastes, and more. This can impact nutrition and even anxiety.
• We experience rejection sensitive dysphoria (RSD): Are you sensitive to criticism, real or perceived? That’s RSD — a core part of the ADHD experience. Our sensitivity can cause us pain, but it also means that we’re intuitive and empathetic. It means we know how to take care of other people — because we know how we would like to be taken care of. RSD has an undeniably sizable impact on relationships touched by ADHD.
• We carry shame: Living with ADHD in a neurotypical world often means receiving negative feedback. It’s why so many of us feel like bad people. But ADHD is nothing to be ashamed about. Remember that you’re not alone.
• We love our pets: Whether it’s a turtle or a St. Bernard, many of us with ADHD have beloved pets. Could it be because they calm us? Because they’re not judgmental? Dog lovers often report that their daily walk schedule is an added benefit.
• We are good in a crisis: Whether it’s a true emergency or a manufactured one, we tend to perform well under serious pressure. (Is it any wonder that so many firefighters have ADHD?¹⁵)
• We are creative: We have a lot of great ideas, and we’re out-of-the-box thinkers. We like to hyperfocus for hours (a dopamine surge in itself) until we figure it out.
• We are absolutely resilient: We fall off a horse or two, but we get back on every single time.

Respect Your ADHD: Stop Trying to ‘Fix’ Yourself

Whether you’re newly diagnosed or have been diagnosed for years, chances are you keep throwing heaps of spaghetti at the wall to see what will stick and “fix” you, once and for all. My bet is that you’ve tried all the planners, time-management tips, and other productivity strategies and tricks available on the market.

But what if you tried giving yourself credit and praise instead of constantly focusing on the “wrongs” in your life?

• You already have strategies that work. You’ve been coping with ADHD your entire life. You’re the expert on you. You have wisdom in yourself, and you can trust that wisdom.
• 98% (or more) of your life is working. Focusing on the 2% makes your problems seem bigger than they are.

Today, I invite you to give your ADHD a little respect. Don’t fight it or treat it as the enemy. Think of it as your alter ego. No, you’re not defined by your ADHD, but you certainly live with it. So allow yourself to accept that every now and then and just be. (The truth is you probably really like that little part of you that’s kind of different. I mean, who wants to be boring?)

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “ADHD Is a Whole-Life, Whole-Body Experience” [Video Replay & Podcast #427] with Linda Roggli, PCC, which was broadcast on October 26, 2022.

How ADHD Affects All Areas of Life: Next Steps

• Free Download: The ADHD Healthy Habits Handbook
• Read: My 25 Rules for Life — A Practical Cure for ADHD Shame and Stagnation
• Read: Beyond Genes – Leveraging Sleep, Exercise, and Nutrition to Improve ADHD
  

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Sources

¹van Andel, E., Bijlenga, D., Vogel, S. W. N., Beekman, A. T. F., & Kooij, J. J. S. (2021). Effects of chronotherapy on circadian rhythm and ADHD symptoms in adults with attention-deficit/hyperactivity disorder and delayed sleep phase syndrome: a randomized clinical trial. Chronobiology international, 38(2), 260–269. https://doi.org/10.1080/07420528.2020.1835943

² Bijlenga, D., Van Someren, E. J., Gruber, R., Bron, T. I., Kruithof, I. F., Spanbroek, E. C., & Kooij, J. J. (2013). Body temperature, activity and melatonin profiles in adults with attention-deficit/hyperactivity disorder and delayed sleep: a case-control study. Journal of sleep research, 22(6), 607–616. https://doi.org/10.1111/jsr.12075

³ Volkow, N. D., Wang, G. J., Logan, J., Alexoff, D., Fowler, J. S., Thanos, P. K., Wong, C., Casado, V., Ferre, S., & Tomasi, D. (2015). Caffeine increases striatal dopamine D2/D3 receptor availability in the human brain. Translational psychiatry, 5(4), e549. https://doi.org/10.1038/tp.2015.46

⁴ Reinblatt S. P. (2015). Are Eating Disorders Related to Attention Deficit/Hyperactivity Disorder?. Current treatment options in psychiatry, 2(4), 402–412. https://doi.org/10.1007/s40501-015-0060-7

⁵ Cortese, S., Moreira-Maia, C. R., St Fleur, D., Morcillo-Peñalver, C., Rohde, L. A., & Faraone, S. V. (2016). Association Between ADHD and Obesity: A Systematic Review and Meta-Analysis. The American journal of psychiatry, 173(1), 34–43. https://doi.org/10.1176/appi.ajp.2015.15020266

⁶ Chen, Q., Hartman, C. A., Haavik, J., Harro, J., Klungsøyr, K., Hegvik, T. A., Wanders, R., Ottosen, C., Dalsgaard, S., Faraone, S. V., & Larsson, H. (2018). Common psychiatric and metabolic comorbidity of adult attention-deficit/hyperactivity disorder: A population-based cross-sectional study. PloS one, 13(9), e0204516. https://doi.org/10.1371/journal.pone.0204516

⁷ Csecs, J. L. L., Iodice, V., Rae, C. L., Brooke, A., Simmons, R., Quadt, L., Savage, G. K., Dowell, N. G., Prowse, F., Themelis, K., Mathias, C. J., Critchley, H. D., & Eccles, J. A. (2022). Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain. Frontiers in psychiatry, 12, 786916. https://doi.org/10.3389/fpsyt.2021.786916

⁸ Nielsen, P. R., Benros, M. E., & Dalsgaard, S. (2017). Associations Between Autoimmune Diseases and Attention-Deficit/Hyperactivity Disorder: A Nationwide Study. Journal of the American Academy of Child and Adolescent Psychiatry, 56(3), 234–240.e1. https://doi.org/10.1016/j.jaac.2016.12.010

⁹ Rietz, E., Brikell, I., Agnieszka, B., Leone, M. Chang, Z., Cortese, S. et.al. (July 6, 2021). Mapping phenotypic and aetiological associations between ADHD and physical conditions in adulthood in Sweden: a genetically informed register study. The Lancet Psychiatry.DOI:https://doi.org/10.1016/S2215-0366(21)00171-1

¹⁰ Kuriyan, A. B., Pelham, W. E., Jr, Molina, B. S., Waschbusch, D. A., Gnagy, E. M., Sibley, M. H., Babinski, D. E., Walther, C., Cheong, J., Yu, J., & Kent, K. M. (2013). Young adult educational and vocational outcomes of children diagnosed with ADHD. Journal of abnormal child psychology, 41(1), 27–41. https://doi.org/10.1007/s10802-012-9658-z

¹¹ Biederman, J., & Faraone, S. V. (2006). The effects of attention-deficit/hyperactivity disorder on employment and household income. MedGenMed : Medscape general medicine, 8(3), 12.

¹² DuPaul, G. J., Gormley, M. J., & Laracy, S. D. (2013). Comorbidity of LD and ADHD: implications of DSM-5 for assessment and treatment. Journal of learning disabilities, 46(1), 43–51. https://doi.org/10.1177/0022219412464351

¹³ Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. The primary care companion for CNS disorders, 16(3), PCC.13r01596. https://doi.org/10.4088/PCC.13r01596

¹⁴ Dorani F, Bijlenga D, Beekman ATF, van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. (2020) J Psychiatr Res. doi:10.1016/j.jpsychires.2020.12.005

¹⁵ Palmer, Charles G.; Gaskill, Steven; Domitrovich, Joe; McNamara, Marcy; Knutson, Brian; Spear, Alysha. 2011. Wildland firefighters and attention deficit hyperactivity disorder (ADHD). In: McCaffrey, Sarah M.; Fisher, Cherie LeBlanc, eds. 2011. Proceedings of the second conference on the human dimensions of wildland fire. Gen. Tech. Rep. NRS-P-84. Newtown Square, PA: U.S. Department of Agriculture, Forest Service, Northern Research Station: 9-13.

“Reading the book, I diagnose you with ADD,” Maté said, referring to the Duke of Sussex’s autobiography, Spare. “I see it as a normal response to normal stress, not a disease.”

Maté, author of Scattered Minds: The Origin and Healing of Attention Deficit Disorder and The Myth of Normal, also diagnosed the prince with anxiety, panic disorder, depression, post-traumatic stress disorder (PTSD), and substance abuse issues during the 90-minute, live-streamed event, which has been described as both unorthodox and reckless.

Maté made his diagnosis before meeting the prince and, admittedly, based his evaluation solely on stories of grief, trauma, and substance abuse from Spare. In his past work, Maté has called ADHD a “normal response to normal stress,” which he says may be healed without medication. In last week’s conversation, he suggested Prince Harry’s ADHD stemmed from his childhood, especially the death of his mother, Princess Diana, when he was just 12.

There is a lot to unpack here and so much ADHD misinformation to correct. Here, leading ADHD experts address Maté’s claims regarding ADHD and trauma, respond to his spontaneous diagnosis, and fact-check his treatment advice.

[Download This Free Guide to Debunking ADHD Myths]

Can Clinicians Diagnose ADHD Based on a Patient’s Life Story?

In short, no.

“An accurate and well-rounded ADHD diagnosis is a complex, multi-step process including a clinical interview, a medical history review, and the completion of normed rating scales by loved ones, educators, and/or colleagues,” says Thomas E. Brown, Ph.D., a clinical psychologist who served on the clinical faculty of the Yale School of Medicine for 21 years and has published six books on ADHD.

Only a medical professional, such as a pediatrician, a psychologist, a psychiatrist, or an advanced practice registered nurse (APRN), should diagnose ADHD. An in-depth, well-rounded ADHD evaluation comprises several components, explains Brown, the director of the Brown Clinic for Attention and Related Disorders in California.

First, Brown says, a clinician will determine whether the patient has the ADHD symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V). (A patient must have shown at least six of the nine symptoms of inattention and/or hyperactivity and impulsivity before age 12.) Next, the clinician will conduct an interview with the individual (and, if possible, with one or two people who know that person well) or refer the patient to a medical or mental health clinician who is familiar with ADHD and with the other medical or psychological disorders that produce similar symptoms, Brown explains.

“A good clinical interview may take two to three hours, including time explaining to the patient what we now understand about ADHD and what it means for them,” he said in the ADDitude article, “The Building Blocks of a Good ADHD Diagnosis.”

[Self-Test: Common ADHD Symptoms in Adults ]

The clinician should use normed ADHD rating scales, such as the Barkley, BASC, Brown, Conners, or BRIEF scales, to gather self-reported information from the patient and observer information from parents, teachers, partners, or others who have seen how this individual has functioned over recent months and previously in various aspects of daily life.

“A clinician should also conduct a complete physical exam to rule out medical problems, such as thyroid conditions or pinworms,” Brown says. A physical exam can also assess whether an individual can safely take ADHD medication.

A complete assessment may take several visits and/or visits with an ADHD specialist.

Does Trauma Cause ADHD?

Not exactly. Studies show that experiencing trauma increases a patient’s chances of being diagnosed with ADHD. However, research does not support the idea that trauma causes ADHD.¹

“Research does tell us that ADHD is a condition that’s largely genetic and inherited and that it causes specific areas of the brain to be underdeveloped or otherwise impacted,” says Nicole M. Brown, M.D., MPH, MHS, a general pediatrician and health services researcher and Chief Health Officer of Strong Children Wellness Medical Group in New York.

“Because trauma affects those same areas of the brain, it exacerbates ADHD symptoms,” she said in the ADDitude webinar titled How Stress and Trauma Affect ADHD in Children of All Colors — and How to Heal the Wounds. Her research on the topic was published in Academic Pediatrics, the official journal of the Academic Pediatric Association.

“ADHD is a brain-based disorder often diagnosed after a child struggles in school, or even later in life,” adds Kerry J Heckman, LICSW, a Seattle-based licensed therapist specializing in somatic therapy for the treatment of trauma. “Trauma is the result of exposure to stressful events or experiences that can occur anytime during a person’s life. Childhood trauma that occurs when the brain develops may lead to cognitive and emotional changes resembling ADHD.”

Epigenetics, which the Centers for Disease Control and Prevention (CDC) defines as “the study of how your behaviors and environment can cause changes that affect the way your genes work,” sheds some light on how environmental factors and experiences, such as trauma, may impact brain development. However, ADHD is not solely a result of trauma.

“It starts with genes,” says Joel Nigg, Ph.D., a clinical psychologist, and professor in the departments of psychiatry and behavioral sciences at Oregon Health & Science University. “But everyone is exposed to different environmental toxins and advantages beginning at conception — and after we’re born, psychological inputs like stress, adversity, and even trauma begin to factor in. Epigenetics uses this input to change how genes are expressed — meaning a gene’s output isn’t fully known until environmental and personal histories are factored in.” Nigg further explained how epigenetics affects ADHD in the ADDitude webinar titled Genes and the Environment: How Biology and Exposures Contribute to ADHD in Children.

Can ADHD Be “Healed?”

No silver-bullet solution or magic elixir exists for ADHD; it is a lifelong condition that persists well into adulthood for most people who have it.

The best treatment for managing the core symptoms of ADHD in children is a combination of behavioral parent training and medication. Stimulants (methylphenidate and/or amphetamine) are considered a first-line pharmacological treatment for adult ADHD.² Several types of non-stimulants (considered second-line treatments) can address ADHD symptoms as well.

Even medication can’t “cure” ADHD. “There is no ‘cure’ that we know of,” said Larry Silver, M.D., a psychiatrist, and former Clinical Professor of Psychiatry at Georgetown University Medical Center in Washington, D.C. “Think about a person with diabetes on insulin. Insulin corrects a chemical deficiency and allows a person to metabolize sugar. Once it wears off, however, the person can no longer do this. At this time, we can’t correct the problem, only compensate for it, and medication is an effective approach.” Silver was the former Acting Director and Deputy Director of the National Institute of Mental Health (NIMH).

Laurie Dupar, PMHNP, RN, PCC, a senior certified ADHD coach, trained psychiatric nurse, and founder of the International ADHD Coach Training Center, agrees with Silver. “We know from years of research that ADHD medications work — in fact, studies show they work up to 80% of the time,” she says.

Adults should expect to work closely with their physicians to adjust medication and dosage and to find the right ADHD treatment combination to alleviate symptoms.

For those individuals with ADHD who cannot or prefer not to take medication, cognitive behavioral therapy, nutrition, meditation, exercise, lifestyle changes, and/or brain training, among other natural treatments, may help alleviate or lesson some ADHD symptoms like poor focus and memory.

Can Individuals with ADHD Effectively Self-Medicate with Marijuana and Psychedelic Drugs?

The Duke of Sussex and Maté talked candidly about the benefits of drinking ayahuasca, a plant-based psychedelic from South America.

“I would say it [taking ayahuasca] is one of the fundamental parts of my life that changed me and helped me deal with the traumas and pains of the past,” Prince Harry said. He also described his experiences using cocaine, smoking marijuana, and trying magic mushrooms (Psilocybin).

While some individuals with ADHD seek alternatives to first-line treatments, research does not support the idea that illegal substances assuage ADHD symptoms. According to Roberto Olivardia, Ph.D., a Clinical Psychologist and Clinical Instructor of Psychology at Harvard Medical School, the risk of developing cannabis use disorder (CUD), a problematic pattern of cannabis use linked to clinically significant impairment, is twice as high in people with ADHD.³

“Contrary to popular belief, individuals can be mentally and chemically dependent on and addicted to cannabis. Contemporary marijuana has concentrations of THC higher than historically reported, exacerbating this. What’s more, the adverse effects of cannabis are especially amplified in people with ADHD,” he says.

Cannabis use may also exacerbate paranoia, panic, and mood disorders, explains Olivardia. Further, the increased risk of suicide associated with cannabis use further complicates marijuana among individuals with ADHD, who already face an elevated risk for suicide compared to neurotypical individuals.⁴

“The substance’s negative effects are most harmful to developing brains,” Olivardia says. “Many studies show that usage earlier in life, particularly before age 25, predicts worse outcomes. One study found that heavy marijuana use in adolescence was associated with a loss of 8 IQ points, on average, in adulthood.⁵ Another study found that people under 18 are four to seven times more at risk for CUD than adults.⁶  Olivardia discussed marijuana and the ADHD brain in the ADDitude webinars titled Marijuana and the ADHD Brain: How to Identify and Treat Cannabis Use Disorder in Teens and Young Adults and Marijuana and the ADHD Brain, Part 2.

The use of very low (micro) doses of psychedelics, such as LSD and psilocybin, appears promising for treating symptoms of obsessive-compulsive disorder, cluster headaches, and ADHD; however, additional research is required and these treatments are not without risks, cautions psychologist Ari Tuckman, Psy.D., and Stephanie Moulton Sarkis, Ph.D., NCC, LMHC, an AMHCA Diplomate and Clinical Specialist in Child and Adolescent Counseling. They stressed that psychedelics can potentially worsen symptoms of bipolar disorder or lead to psychosis and said that “these drugs are illegal unless they are administered in medical or research settings.”

Why Is a Public ADHD “Diagnosis” Like Prince Harry’s So Dangerous?

Doctor-patient confidentiality prohibits doctors from sharing patients’ medical information with others. It appears Maté disregarded this by diagnosing Prince Harry with ADHD in a public — and profit-generating — setting. Access to the interview required purchasing a $25 ticket (ticket holders received a hardcover copy of Spare.).

According to the American Academy of Family Physicians website, “a confidential relationship between physician and patient is essential for the free flow of information necessary for sound medical care. Only in a setting of trust can a patient share the private feelings and personal history that enable the physician to comprehend fully, to diagnose logically, and to treat properly.”

ADHD is not globally understood. Myths and misinformation abound, leading to systematic barriers to helping and supporting adults and children with ADHD. Some people falsely believe ADHD is a fake disorder, an excuse for bad behavior, or a pharmacological fairy tale. None of these things is true, but that doesn’t change the fact that enduring stigma impacts how and whether adults with ADHD choose to share their diagnosis.

The UK did not recognize ADHD until the publication of the NICE (National Institute of Clinical Excellence) Clinical guideline CG72 in 2008.⁷ According to a 2022 study published in BMC Psychiatry, before that time, there was an enormous amount of skepticism about ADHD and virtually no recognition of it in the UK.⁸

“While the last two decades have seen a stepped change and increase in the provision of adult ADHD clinical services in the UK and elsewhere, demand currently outstrips provision by a long way in many regions and countries,” the study’s authors wrote.

ADHD is treated as more of a “niche problem,” they wrote, “with diagnosis, treatment initiation and monitoring frequently constrained to scarce specialist services with limited capacity.”

By offhandedly diagnosing a public figure, Maté diminishes the experience of many people with ADHD in Europe who already struggle to access care.

The ADHD Foundation, UK’s leading neurodiversity charity, tweeted: “Gabor Maté — it is neither ethical nor appropriate to tell someone for the first time, — in a public interview, that they have ADHD. It is for the individual to decide whether to disclose their neurodiversity.”

Debunking Prince Harry’s ADHD “Diagnosis:” Next Steps

• Download: 31 ADHD Myths in 31 Days —Debunked
• Learn: The Brain Circuits that Link ADHD and PTSD
• Read: 21 Ignorant Comments (and Lies) About ADHD 
• Q: Who Can Diagnose ADHD? 
• eBook: Secrets of the ADHD Brain 

#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.

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

Sources

¹Brown, 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. Acad Pediatr.https://doi.org/10.1016/j.acap.2016.08.013

²Kolar, D., Keller, A., Golfinopoulos, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of Adults with Attention-Deficit/Hyperactivity Disorder. Neuropsychiatric Disease and Treatment. 4(2), 389–403.https://doi.org/10.2147/ndt.s6985

³Lee, S. et. al. (2011). Prospective Association of Childhood Attention-Deficit/Hyperactivity Disorder (ADHD) and Substance Use and Abuse/Dependence: A Meta-Analytic Review. Clinical Psychology Review. 31(3), 328–341. https://doi.org/10.1016/j.cpr.2011.01.006

⁴Balazs, J., & Kereszteny, A. (2017). Attention-Deficit/Hyperactivity Disorder and Suicide: A Systematic Review. World Journal of Psychiatry. 7(1), 44–59. https://doi.org/10.5498/wjp.v7.i1.44

⁵Meier, M, et. al. (2012). Persistent Cannabis Users Show Neuropsychological Decline from Childhood to Midlife. Proceedings of the National Academy of Sciences. 109 (40) E2657-E2664; https://doi.org/10.1073/pnas.1206820109

⁶Winters, K. C., & Lee, C. Y. (2008). Likelihood of Developing an Alcohol and Cannabis Use Disorder During Youth: Association with Recent Use and Age. Drug and Alcohol Dependence. 92(1-3), 239–247. https://doi.org/10.1016/j.drugalcdep.2007.08.005

⁷NICE. Attention Deficit Hyperactivity Disorder: The NICE Guideline on Diagnosis and Management of ADHD in Children, Young People and Adults: The British Psychological Society and The Royal College of Psychiatrists; 2008.

⁸Asherson, P., Leaver, L., Adamou, M., et al. (2022) Mainstreaming Adult ADHD into Primary Care in the UK: Guidance, Practice, and Best Practice Recommendations. BMC Psychiatry. 22, 640 https://doi.org/10.1186/s12888-022-04290-7</a?

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.

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

Sources

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