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Sleep problems are among the most frequent co-occurring disorders in people with ADHD. Research has shown that many people with ADHD even suffer from more than one sleep disorder, often of different etiology. Science has not yet solved the questions arising from these findings, but we do know that sleep loss impairs concentration, memory, mood stability, and the immune system’s functioning, increasing risk for infections and allergies. Not surprisingly, ADHD is associated with many allergies and infections. The importance of good sleep and its association with overall health cannot be overstated.

The good news is that most sleep disorders can be treated effectively, and doing so can reduce ADHD symptoms and lead to improved health and wellness.

In this webinar, you will learn:

• Why people with ADHD commonly suffer with sleep problems and disorders
• About the different kinds of sleep disorders, including the circadian sleep-wake disorder, delayed sleep phase type, insomnia, restless legs, periodic limb movement disorder and sleep apnea
• How researchers are working to better understand the close relationship between ADHD and sleep disorders
• About treatment study findings that show low-dose melatonin, bright light therapy and other interventions may help reduce ADHD symptoms and lead to better overall health.

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

Meet the Expert Speaker

J.J. Sandra Kooij is a psychiatrist at PsyQ, psycho-medical programs, and Head of the Expertise Center Adult ADHD, in the Netherlands. She is a professor of adult ADHD studies at the Department of Psychiatry, VU University Medical Center, Amsterdam. She has published more than 100 peer-reviewed international papers and more than 20 books or book chapters on ADHD in adults.

Since 2002, Dr. Kooij has been the head of the Dutch Expertise Center Adult ADHD, leading research, treating patients, educating professionals, informing the public, and publishing books, scientific papers, websites, webinars and podcasts. She recently launched a new ADHD app, Super Brains. Read more about Dr. Kooij here.

Join an ADHD and Women’s Health Survey!  PsyQ Expertise Center Adult ADHD, in collaboration with ADHD Europe, developed an international survey on the experiences and health of women with ADHD. Are you a woman and do you have ADHD symptoms? You are invited to participate in this survey!

ADHD and Sleep: More Resources

• Download: Sleep Disorders Linked to ADHD
• Self-Test: Could You Have Delayed Sleep Phase Disorder?
• Read: What Comes First: ADHD or Sleep Problems?
• Read: How to Fall Asleep with a Rowdy, Racing ADHD Brain
• Free eBook: How to Sleep Better with ADHD

Webinar Sponsor

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ADHD and disordered sleep can disrupt daily life, but you can take back control. Play Attention, inspired by NASA technology and backed by Tufts University research, helps you strengthen executive function and gain cognitive control. By combining mindfulness training with cognitive exercises, our program empowers you to manage focus, emotions, and routines—building the foundation for better sleep and overall well-being.

Start our online ADHD assessment now or schedule your 1:1 consultation. www.playattention.com 828-243-9291

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

Certificate of Attendance: For information on how to purchase the certificate of attendance option (cost $10), register for the webinar, then look for instructions in the email you’ll receive one hour after it ends. The certificate of attendance link will also be available here, on the webinar replay page, several hours after the live webinar. ADDitude does not offer CEU credits.

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

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

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

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

Elevated Emotional Dysregulation, Anxiety, ADHD

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

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

They also studied patterns associated with specific sensory subtypes:

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

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

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

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

Sources

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

Leaded gasoline and exposure to its exhaust may help explain an estimated 151 million U.S. cases of psychiatric disorders, including ADHD, depression, and anxiety, according to a new cross-sectional study spanning the last 75 years published in the Journal of Child Psychology and Psychiatry.¹

Exposure to leaded gasoline from car exhaust was tied to population-wide cases of mental health disorders from 1940 to 2015 by researchers from Duke University, Florida State University, and the Medical University of South Carolina. They estimated that more than half of the current U.S. population was exposed to harmful levels of lead in childhood, resulting in profound effects on their mental health, personality traits, and overall well-being. People born between 1966 and 1986 (referred to as Generation X) experienced the highest rate of lead exposure and are at the greatest risk for anxiety, depression, ADHD, and personality changes.

“Research on lead as a developmental neurotoxicant is robust,” says Joel Nigg, Ph.D., a clinical psychologist and a professor in the departments of psychiatry and behavioral sciences at Oregon Health & Science University. “Its correlation with ADHD is also well established. Even low levels of exposure have an effect on ADHD.”², ³

Nigg was the principal investigator on several studies suggesting that lead exposure has a causal role in ADHD. One study published in Psychological Science found that children with ADHD who had the HFE C282Y gene mutation exhibited significantly more symptoms of hyperactivity and impulsivity than did children with ADHD who lacked the mutation.⁴

“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,” he says.

Leaded Gasoline Exposure Is a Public Health Crisis

Nigg’s study and others have linked lead exposure to life-long mental, physical, and behavioral issues; lowered IQ points; and personality changes.⁵, ⁶, ⁷, ⁸ However, the findings from the Journal of Child Psychology and Psychiatry’s study highlight the historic and pervasive effects of lead exposure on the cognitive and psychological health of a staggering slice of the U.S. population.

“Lead’s potential contribution to psychiatry, medicine, and children’s health may be larger than previously assumed,” the researchers wrote.

The study analyzed lead levels in children’s blood collected for the CDC’s National Health and Nutrition Examination Surveys (NHANES) and correlated that with historic leaded-gasoline data. The researchers calculated “mental illness points” based on the fraction of changes in the mental health of Americans born in different years and the population elevations of mental health symptoms associated with lead exposure.

The researchers identified a cumulative increase of 602 million general psychopathology points across the population, corresponding to an estimated 151 million additional mental disorders. They found that lead exposure heightened the risks for anxiety, depression, and ADHD; increased neuroticism, associated with negative emotionality; and decreased conscientiousness, reflecting less self-control and goal-oriented behavior.

While the study’s results do not prove causation, the researchers say that their findings will provide doctors with insights about their patients’ symptoms and underscore the need for expanded lead testing in patients and the recognition of lead poisoning as a neurodevelopmental disorder within a psychiatric diagnostic framework.

Leaded Gasoline Exposure: Next Steps

Lead was added to gasoline in the 1920s to improve engine performance. During the early childhood years of Generation X, leaded gasoline became the predominant fuel type in the U.S. In the mid-1970s, the U.S. Environmental Protection Agency (EPA) began phasing out leaded gasoline, but a U.S. ban did not go in effect for on-road vehicles until 1996. Lead is still found in some paints, children’s toys, and deteriorating water pipes.

According to The CDC, high levels of lead exposure can lead to seizures, vomiting, memory loss, and even death. Exposure to even small amounts of lead can be harmful. Children 6 years or younger are most vulnerable to lead poisoning, which can cause development and growth delays, hearing and speech problems, difficulty learning and paying attention, and serious illness and death.

Symptoms of lead poisoning can be hard to recognize in children. The CDC recommends discussing possible lead exposure with a child’s healthcare provider and testing children ages 1 to 5 for lead if they:

• Live in a home built before 1978
• Receive Medicaid services
• Are an immigrant, refugee, or adopted from another country
• Live near a known source of lead, such as a lead smelter or mine

Sources

¹McFarland, M.J., Reuben, A. and Hauer, M. (2024). Contribution of Childhood Lead Exposure to Psychopathology in the US Population Over the Past 75 Years. J Child Psychol Psychiatr.https://doi.org/10.1111/jcpp.14072

²Sanders, T., Liu, Y., Buchner, V., Tchounwou, P.B. (2009). Neurotoxic Effects and Biomarkers of Lead Exposure: A Review. Rev Environ Health. https://doi.org/10.1515/reveh.2009.24.1.15

³Nigg, J. T., Knottnerus, G. M., Martel, M. M., Nikolas, M., Cavanagh, K., Karmaus, W., & Rappley, M. D. (2008). Low Blood Lead Levels Associated with Clinically Diagnosed Attention-Deficit/Hyperactivity Disorder and Mediated by Weak Cognitive Control. Biological Psychiatry. 63(3), 325–331. https://doi.org/10.1016/j.biopsych.2007.07.013

⁴Nigg, J. T., Elmore, A. L., Natarajan, N., Friderici, K. H., & Nikolas, M. A. (2016). Variation in an Iron Metabolism Gene Moderates the Association Between Blood Lead Levels and Attention-Deficit/Hyperactivity Disorder in Children. Psychological Science.https://doi.org/10.1177/0956797615618365

⁵Reuben, A., Schaefer, J.D., Moffitt, T.E., Broadbent, J., Harrington, H., Houts, R.M., Ramrakha, S., Poulton, R., Caspi, A. (2019). Association of Childhood Lead Exposure With Adult Personality Traits and Lifelong Mental Health. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2018.4192

⁶Heidari, S., Mostafaei, S., Razazian, N. et al. (2022). The Effect of Lead Exposure on IQ Test Scores in Children Under 12 Years: A Systematic Review and Meta-Analysis of Case-Control Studies. Syst Rev. https://doi.org/10.1186/s13643-022-01963-y

⁷Roy, A., Bellinger, D., Hu, H., Schwartz, J., Ettinger, A.S., Wright, R.O., Bouchard, M., Palaniappan, K., Balakrishnan, K. (2009). Lead Exposure and Behavior Among Young Children in Chennai, India. Environ Health Perspect. https://doi.org/10.1289/ehp.0900625

⁸Schwaba, T., Bleidorn, W., Hopwood, C.J., Gebauer, J.E., Rentfrow, P.J., Potter, J., Gosling, S.D. (2021). The Impact of Childhood Lead Exposure on Adult Personality: Evidence from the United States, Europe, and A Large-Scale Natural Experiment. Proc Natl Acad Sci USA. https://doi.org/10.1073/pnas.2020104118

Schizophrenia and ADHD share some similarities and may co-exist. For example, trouble with focus and emotional dysregulation are symptoms of both conditions.

However, schizophrenia is defined as a severe, chronic mental disorder characterized by disturbances in cognition, perception, emotions, and behaviors. ADHD is a developmental disorder characterized by symptoms of inattention and/or hyperactivity and impulsivity.

Find out more about the similarities and differences between schizophrenia and ADHD in this ADDitude Patient Resource.

In this download, you will learn about:

• featured characteristics of schizophrenia
• overlapping symptoms of schizophrenia and ADHD
• age of onset for schizophrenia and ADHD
• prevalence rates of comorbid ADHD and schizophrenia
• treatment options for both conditions
• and more!

Additional Resources

For more information about schizophrenia, support groups, and resources, visit:

• CureSZ Foundation
• Hope for Schizophrenia 
• National Alliance on Mental Illness (NAMI)
• Schizophrenia & Psychosis Action Alliance 

Family life brings smiles and struggles, but when persistent tantrums, resistance, or negativity dominate, they can strain relationships and household harmony. In this transformative webinar, psychologist Jeffrey Bernstein, Ph.D., shares a proven program to help caregivers reduce conflict and eliminate disruptive behaviors in children, teens, and even struggling adult children.

This webinar explores the underlying causes of oppositional defiance, offering practical tools to restore peace and connection. Moving from battles to bonding will empower you to put those fruitless power struggles behind you by turning emotional reactivity into opportunities for connection and cooperation.

Critical handouts will be included for registrants in this webinar to help caregivers learn the strategies that prevent emotionally dysregulated children from becoming defiant.

In this webinar, you will learn:

• How to foster empathy by building stronger connections with children through understanding and compassion
• How to regulate your emotions and model calm responses for your child
• About the power of emotion regulation coaching to transform resistance into collaboration
• How to navigate parenting in an era of heightened anxieties and societal challenges
• About cooperative, connection-building games to foster trust, communication, and teamwork

Watch the Video Replay

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

Defusing Defiance in Children with ADHD: More Resources

• Download: 10 Rules for Parents of Defiant Kids with ADHD
• Sign Up: The ADHD Parenting Class
• Read: The Facts About ADHD vs. ODD
• Read: Two Families’ Stories of Oppositional Defiant Disorder
• eBook: The ADHD Positive Parenting Guide

Obtain a Certificate of Attendance

If you attended the live webinar on January 16, 2025, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Dr. Jeffrey Bernstein is a psychologist with more than 34 years of experience specializing in child, adolescent, couples, and family therapy. He completed his post-doctoral internship at the University of Pennsylvania Counseling Center and holds a Ph.D. in Counseling Psychology from the State University of New York at Albany. He has appeared on the Today Show, Court TV as an expert advisor, and CBS Eyewitness News Philadelphia, 10! Philadelphia — NBC and public radio.

Dr. Bernstein has authored several books, including The Anxiety, Depression, & Anger Toolbox for Teens, The Stress Survival Guide for Teens, Mindfulness for Teen Worry, 10 Days to a Less Defiant Child, 10 Days to Less Distracted Child, Liking the Child You Love, and Why Can’t You Read My Mind? He has also published the Letting Go of Anger Therapeutic Card Deck.

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

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Autism in Girls: Key Takeaways

• Autism in girls is overlooked because symptoms manifest differently across genders, and because of persistent gender bias in clinical and research settings.
• Compared to boys, autistic girls are more socially motivated, which may make their social challenges less apparent and thus more likely to be missed by clinicians.
• Autistic girls seldom demonstrate repetitive movements, and their special interests are more likely to be seen as typical.
• In-depth evaluations are often necessary to identify or rule out autism in girls. Other supports — from therapy to emotional regulation skill-building — can significantly help.

Autism in Girls Looks Different

About one in 36 children in the U.S. is autistic, a diagnosis that is four times more common in boys than in girls.¹ What explains this gender gap?

Science is working to determine factors that may explain autism’s diagnostic prevalence in males, but many clinicians who specialize in autism in girls and individuals assigned female at birth clearly see that gender bias — in referrals, diagnostic criteria, and tests — plays a role in diagnostic outcomes.

Autism is more readily identified in boys than in girls because, historically, the clinical and research focus has been on boys almost exclusively. Many clinicians who are trained in diagnosing autism are unaware how its traits can uniquely manifest in girls. Failing to realize that girls and women don’t always demonstrate the more stereotypical signs of autism, many clinicians end up overlooking behaviors that are indicative of autism. This is part of why girls and women are often diagnosed as autistic later in life than boys.

Signs of Autism in Girls

Social Motivation

Autism is characterized, in part, by difficulties and differences with social communication and interaction. Some autistic children may have trouble initiating or engaging in social interactions, which can result in them feeling left out or different. Some children, meanwhile, may prefer solitary activities.

Some children may struggle to understand when and how to join a conversation. An autistic child may follow up to a peer’s question with a brief response or with nothing at all, bringing the interaction to an end. Sometimes, conversations and interactions can become one-sided; an autistic child, for example, may not realize that others want to play differently and will continue to insist that everyone play a game according to very fixed rules. Autistic children may also show differences in use of eye contact, gestures, and facial expressions or misinterpret these cues from others.

[Take This Free Screening Test: Autism in Girls]

Autistic girls may experience all of the above. However, many demonstrate more social motivation — the drive to understand, connect, and enter relationships with others — than do autistic boys, which may make their social challenges less apparent and thus more likely to be overlooked.

• Autistic girls are more likely to want to fit in. As such, they are more likely to mask (i.e., hide or compensate for autistic traits) and mimic neurotypical behaviors.
• Autistic girls are more socially observant, which helps them pick up on details that allow them to better fit in and mask. It’s common for autistic girls to painstakingly study patterns in how people interact to reverse engineer “normal” behavior.
• Autistic girls are often perfectionists. The urge to fit in and flawlessly mask drives
  perfectionistic tendencies. Sensitivity to rejection is also common; when autistic girls stumble and experience social exclusion — despite their best efforts and desires to make and maintain
  friendships — the pain of rejection is profound.

Autism in Girls: The Consequences of Masking

We can’t talk about autism in girls without talking about masking. While masking often emerges as a coping strategy for socializing, especially for autistic girls without intellectual development disorder or who may not have observable behavioral or academic needs, it can create lots of issues, too.

• Masking is mentally taxing. Constantly trying to figure out others, understand unspoken
  social rules, and fit in with changing circumstances is highly exhausting.
• Masking interferes with self-understanding. Autistic girls often have trouble tuning into their own needs and emotions because masking has long forced them to suppress their authentic selves. Identity and self-esteem issues are common; some girls don’t even realize when they are masking. Masking can also interfere with friendships, as girls are unable to bring their full selves to these relationships or know what they want in a friend.
• Masking can impact clinical evaluations. Autistic girls who have become accustomed to hiding their traits may struggle to express and make sense of their behaviors and experiences, which can interfere with autism evaluations and lead to underdiagnosis or misdiagnosis. (This compounds the gender bias that causes girls’ autistic behaviors to be downplayed.)
• Masking can cause health issues. Constantly worrying about blending in with societal norms can turn into anxiety and other internalizing and physical issues. Many autistic girls tend to suppress their feelings, which causes more mental health challenges.

[Read: What Does Autism Spectrum Disorder Look Like in Children?]

Differences in Restricted and Repetitive Behaviors

Autism is characterized by restrictive, repetitive patterns of behavior, interests, or activities as demonstrated by the following signs:

• hand flapping, finger flicking, rocking, and other stereotyped behaviors (or “stims”)
• lining up, stacking, spinning, sorting and/or categorizing toys and objects
• echolalia and other forms of repetitive speech
• a strong preference for routine; resistance to change
• rigid, perseverative thinking; insistence on adherence to rules
• highly restricted, fixated interests (i.e., special interests)
• hyper- or hyporeactivity to sensory input

While autistic girls can show the above signs, these behaviors may manifest differently.

• Autistic girls are less likely to demonstrate repetitive movements. When they do, they are more likely to demonstrate different types of repetitive movements than boys, like tapping their fingers or twirling their hair, which can be easily overlooked.
• Autistic girls’ special interests are more likely to center on animals, celebrities, or fictional characters, which can seem more socially acceptable and thus less likely to be flagged as a sign of autism.

Autism in Girls: How to Support Neurodivergent Youth

Know the Signs — and Myths

Early detection is key for autistic girls to receive the support they need so they can develop self-
understanding without shame. Parents, educators, and clinicians should be aware of the above signs of
autism in girls and these common autism myths:

Clinicians: Peel Back the Layers

Clinicians overlook autism in girls, especially in those without intellectual or language disorders, because these girls can be adept at camouflaging. Their symptoms tend to be more internalizing, and they may have trouble verbalizing their experiences and what they need. Even when girls do show signs of autism, to the untrained eye, these girls can appear “not autistic enough.”

• Dig deep. Ask about relationships when evaluating girls for autism. How does your patient experience friendships and connecting with others? How does your patient feel about their ability to make friends and maintain them? How does this experience connect to her self-esteem? What is the toll of social interactions on your patient? Watch for cues that your patient finds social interactions exhausting and effortful. You may need to carry out longer assessments and observe your female patients over time so you can dive deep into their experiences. If they do not show signs of or report impairment across settings, watch for signs of subjective distress.
• Screen for comorbid conditions. Autism and ADHD co-occur at high rates, and the symptom overlap cannot be overstated. Anxiety and specific learning disorders are also common.
• Actively educate yourself on autism in girls. Seek out training and review the latest literature. Listen and learn from patients with lived experience.

More Ways to Support Autistic Girls

• Seek interventions and supports. From speech, physical, and occupational therapy to IEPs or 504 plans, secure the services that support your child’s individual needs. Medications are available to help support mood and reactivity. Talk to an autism specialist about the best interventions for your child and seek a second opinion if your provider makes you feel disrespected or unheard.
• Provide structure and routine. Stability and predictability reduce anxiety, stress, and overwhelm in autistic children, who often struggle with rigidity, inflexibility, and stress during transitions.
• Support executive functions. The cognitive skills that allow us to plan, prioritize, organize, manage time, start tasks, and self-regulate are often impaired in autistic individuals and can significantly impact daily functioning. Scaffolding in the classroom and at home can help.
• Teach healthy coping skills. Emotional dysregulation is very much a part of autism. What’s more, girls are socialized to suppress their emotions, which can accumulate and lead to intense emotional outbursts. Autistic girls must be taught emotional awareness, including how to monitor, label, and understand their emotions. Breathing exercises, mindfulness, muscle relaxation techniques, and other strategies can help improve emotional regulation.
• Talk about autism from a neurodiversity-affirming standpoint. Viewing autism from a strengths-based perspective can help young girls accept themselves, refrain from masking, and gain the confidence to advocate for themselves throughout their lives.

Autism in Girls: Next Steps

• Get This Free Download: The ADHD-Autism Link in Children
• Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus
• Read: 4 Autism Myths — Dispelled
  

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “AuDHD Guidance: Why Autism is So Difficult to Diagnose in Women and Girls with ADHD” [Video Replay & Podcast #511] with Karen Saporito, Ph.D., which was broadcast on June 27, 2024.

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Sources

¹ Maenner, M. J., Warren, Z., Williams, A. R., Amoakohene, E., Bakian, A. V., Bilder, D. A., Durkin, M. S., Fitzgerald, R. T., Furnier, S. M., Hughes, M. M., Ladd-Acosta, C. M., McArthur, D., Pas, E. T., Salinas, A., Vehorn, A., Williams, S., Esler, A., Grzybowski, A., Hall-Lande, J., Nguyen, R. H. N., … Shaw, K. A. (2023). Prevalence and characteristics of autism spectrum disorder among children aged 8 years – autism and developmental disabilities monitoring network, 11 sites, United States, 2020. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C. : 2002), 72(2), 1–14. https://doi.org/10.15585/mmwr.ss7202a1

Children with ADHD are more likely to be obese, despite lower-than-average birth weights, according to a new study that found a correlation between elevated ADHD symptoms and higher body mass index (BMI) scores for both females and males. ¹The study, published in the Journal of the American Academy of Child & Adolescent Psychiatry, complements additional research tying ADHD impulsivity to unhealthy food consumption and overeating.

In analyzing data from the Millennium Cohort Study (MCS) of more than 19,000 families with children born between 2000 and 2002, researchers found that children with ADHD had significantly lower birth weights than did children in the control group. Both groups maintained similar obesity rates until age 5, when the ADHD group experienced a rise in obesity that continued throughout adolescence.

“As children with ADHD are typically lighter in weight at birth than children without ADHD, the results suggest there may be a sensitive time period between the ages of 3 and 5 years during which this association reverses, and higher ADHD symptoms become associated with obesity,” the researchers wrote.

Researchers collected data when the 442 ADHD cohort members reached 9 months and 3, 5, 7, 11, 14, and 17 years. (The study excluded cohort members taking ADHD medications.) They found that weight gain began earlier for girls with ADHD (age 7) compared to boys with ADHD (age 11). “The weight changes in girls additionally seemed to be more long-lasting, whereas the observed changes in boys seemed to be transitory,” the researchers wrote. It is unclear whether these associations continue into adulthood.

Further analysis revealed that elevated ADHD symptoms in females at ages 7, 11, and 14 predicted higher body mass index (BMI) scores at ages 11, 14, and 17, respectively. The same association occurred in males at ages 11 and 14. These results suggest that ADHD symptoms are not entirely responsible for the uptick in weight children experience between the ages of 3 and 5 years.

Genetics, Prenatal Factors Impact BMI

Hormones and puberty contribute to weight gain. “Sometimes pre-teens can gain weight as the body prepares for a growth spurt in height,” says Roberto Olivardia, Ph.D., clinical psychologist at Harvard Medical School. “Therefore, BMI normalizes as they gain height.”

Prenatal factors, including the mother’s pre-pregnancy BMI, prenatal blood pressure, smoking during pregnancy, and poor nutrition, predicted a higher BMI at 5 years. Genetics may also increase the risk of obesity.

“It is possible that there is a common genetic background to both ADHD and [being] overweight or, as parents with ADHD are more likely to have children with ADHD, this may have an impact on executive function skills involved in parenting, such as planning healthy meals, which in turn may influence weight status,” the researchers wrote. “Parents with an increased genetic risk may be influencing their child’s home environment in ways that compound inherited risk.” ², ³

Impulsivity Linked to Poor Dietary Decisions

Another recent observational study found a strong link between impulsivity, a common ADHD trait, and unhealthy food consumption and overeating, specifically in the form of snacking. ⁴

The study, published in the Journal of Attention Disorders, analyzed data from the KOALA Birth Cohort Study of 810 adolescents aged 16 to 20 years. The researchers identified five dietary patterns

• Snack — high intakes of regular (non-diet) soft drinks, fruit juice/drinks, fried snacks, chips, nuts or snacks, and energy drinks
• Healthy — high intakes of lettuce, raw vegetables, fruit, eggs, and tea
• Animal-based — high intakes of animal dairy products, meat and chicken, and fish
• Sweet — high intakes of pastry, chocolate bars, candy bars, cake or biscuits, and sweets
• Beverage — high intakes of diet soft drinks, light fruit juice/drinks, sports drinks, and energy drinks

Among the five dietary patterns, adolescents with an ADHD diagnosis scored higher on the Snacking dietary pattern than did those without ADHD. Higher Snack scores were associated with difficulties with cognition, inattention, and impulsiveness. Impulsivity was inversely related to Sweet dietary patterns and positively related to Beverage dietary patterns.

Interestingly, adolescents with ADHD appeared no less likely than their neurotypical peers to engage in Healthy dietary patterns. “The lack of a reverse association between ADHD symptoms, especially impulsivity, and the healthy pattern is unexpected and raises questions,” the researchers wrote.

Though the study does not prove causality, the findings suggest that eating habits may differ based on the specific ADHD symptoms each individual experiences.

“When studying how ADHD impacts an adolescent’s diet, looking beyond a simple diagnosis and considering the specific dimensions of their ADHD symptoms, like inattention, hyperactivity, and impulsivity, provides a more nuanced understanding of their dietary behaviors, as these individual dimensions can differentially influence food choices and eating patterns, even among individuals with the same ADHD diagnosis,” the researchers wrote.

Both ADHD and high BMI are associated with poor health outcomes, including asthma, diabetes, and cardiovascular disorders, so it’s vital that children understand the potential consequences of their dietary decisions. ⁵,⁶

Adolescents have more independent access to food, which can also result in unhealthy choices when impulsivity collides with puberty. “Parents have less control over what teenagers eat since they are not always with them,” Olivardia says, “and this most likely plays a bigger role in weight gain.”

Preventing Childhood Obesity

Educating children about their food choices can help curb unhealthy food cravings. For example, instead of banishing carbs from your kitchen, Olivardia says, explain them in a way children can understand. “Say, ‘Simple carbs, like potato chips, taste good, but basically break down in the body as sugar. There is no nutritional value in simple carbs, and they get in the way of healthy weight, high energy, and other things that matter, like your complexion.’”

Caregivers can help children and adolescents make better dietary decisions by incorporating the following strategies:

• Set up a “food environment” that promotes healthy eating. Children with ADHD may not notice they’re hungry until they’re starving. To fend off unhealthy pantry raids, stock up on nutritious, easy-to-grab meals and snacks that require little preparation, such as peanut butter crackers, yogurt, or string cheese. Display healthy snacks and fruits in plain view in the refrigerator or pantry.
• Practice good sleep hygiene. In addition to regulating hormone levels, a good night’s sleep makes it less likely that children will turn to food for comfort in fragile moments.
• Set healthy eating rules. Create family eating rules that encourage children to eat attentively — for example, no eating while watching T.V. or eating straight out of the bag. Consider requiring children to eat only in the kitchen or dining area.
• Teach children mindful eating skills. Children are less likely to overeat when they practice mindful eating. Teach children to put down their fork in between bites. Or ask them to describe what they’re eating as though the person listening has never tasted that food.
• Set a good example. Children learn by watching others, especially their parents. Set a good example by making smart food choices, dishing appropriate portions, and not distractedly eating while engaging in another activity (like using your phone).
• Treat ADHD. Make sure children adhere to their ADHD treatment plan. ADHD stimulant medications help children better observe and regulate their behaviors and avoid impulsive eating. They also make it easier to follow through with healthy eating and exercise plans.

Sources

¹ Reed, C., Cortese, S., Golm, D., Brandt, V., et al. (2024). Longitudinal Associations Between Physical Health Conditions in Childhood and Attention-Deficit/Hyperactivity Disorder Symptoms at Age 17 Years. Journal of the American Academy of Child & Adolescent Psychiatry https://doi.org/10.1016/j.jaac.2024.09.009
² Barker, E.D., Ing, A., Biondo, F., Jia, T., et al. (2021). Do ADHD-Impulsivity and BMI Have Shared Polygenic and Neural Correlates? Mol Psychiatry;26(3):1019-1028. https://doi.org/10.1038/s41380-019-0444-y
³ Faraone, S.V., Larsson, H. (2019). Genetics of Attention Deficit Hyperactivity Disorder. Mol Psychiatry; 24(4):562-575. https://doi.org/10.1038/s41380-018-0070-0
⁴ Dalnoki, L., Hurks, P. P. M., Gubbels, J. S., Eussen, S. J. P. M., Mommers, M., & Thijs, C. (2024). Exploring the Relationship of Dietary Intake With Inattention, Hyperactivity, and Impulsivity, Beyond ADHD. Journal of Attention Disorders https://doi.org/10.1177/10870547241293946/a>
⁵ Arrondo, G., Solmi, M., Dragioti, E., et al. (2022).Associations Between Mental and Physical Conditions in Children and Adolescents: An Umbrella Review. Neurosci Biobehav Rev. https://doi.org/10.1016/j.neubiorev.2022.104662
⁶ Horesh, A., Tsur, A.M., Bardugo, A., et al. (2021). Adolescent and Childhood Obesity and Excess Morbidity and Mortality in Young Adulthood—a Systematic Review. Curr Obes Rep; 10, 301–310. https://doi.org/10.1007/s13679-021-00439-9

Q: Do people with ADHD experience winter depression more often and more severely than do neurotypical individuals? Also, why is my quality of sleep affected in winter?

Winter depression is marked by two or more weeks of low mood, usually starting in the Northern Hemisphere’s fall or winter when there is less daylight, that resolves in the spring or summer when there is more light. There is an association between winter depression, also known as seasonal affective disorder, or SAD, and ADHD.

In the Netherlands, where I live, researchers asked 259 patients with ADHD about seasonal mood swings; 27% reported winter depression compared with 3% in neurotypical people.¹ Other researchers have confirmed this increased rate among people with ADHD.² What’s more, females are four times more likely than males to have winter depression.¹

Sleep problems are also common among people with ADHD: About 80% are late sleepers³ , which means they have a short sleep duration — they fall asleep at a later time and sleep less because they must wake up for work or school.

Q : How does winter depression relate to screen addiction in children with ADHD?

Children with ADHD who are late sleepers and who experience winter depression may turn to video games and the Internet. Screens emit blue light, and they’re often held close to the eye, so the effects are similar to light therapy if you’re staring at them for a while.

[Get This Free Download: How to Sleep Better with ADHD]

Screen use at night can induce delayed circadian rhythms, disrupting your sleep-wake cycle.⁴ Many children with ADHD are already late sleepers, so using screens after 9:30 pm will delay their rhythm even more; this is not recommended. Keep in mind that when sleep gets delayed, mood is affected.

The good news is that winter depression and sleep problems can be easily and quickly treated with artificial light therapy. A 10,000-lux light therapy lamp can be used for 30 minutes a day for 5 to 20 consecutive days. The lamp, or light box, should be used at a close distance to your eyes; the distance is very important for the intensity of the treatment. It’s best to do this every day at the same time, preferably between 7 and 8 am, to reset your biological clock and alter the sleep-wake cycle.

You may also consider using light therapy glasses, which work in the same way as lamps. You can wear these for 30 minutes a day while you’re dressing or eating breakfast; in other words, without disrupting your routine.

Light therapy is a serious antidepressant that often unlocks better mood, improved sleep, and more energy.

[Read: How to Fall Asleep with a Rowdy, Racing ADHD Brain]

Q:  Is vitamin D recommended for people with winter depression?

If your vitamin D is too low, then taking vitamin D is recommended. Vitamin D is generally low in people with ADHD, though we don’t know why.⁵ You get vitamin D from sunlight; in winter, when there is less light, you may need to take a supplement. Another way we can get vitamin D is by eating fatty fish, though many people don’t eat enough to affect levels.

Winter Depression: Next Steps

• Self-Test: Could You Have Delayed Sleep Phase Disorder?
• Read: 9 Sleep Deprivation Solutions for Adults with ADHD
• Read: 6 Tips to Overcoming Winter Depression
  

J.J. Sandra Kooij, M.D., Ph.D., is a psychiatrist and head of the Expertise Center Adult ADHD at PsyQ in the Netherlands.

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Sources

¹Amons, P. J., Kooij, J. J., Haffmans, P. M., Hoffman, T. O., & Hoencamp, E. (2006). Seasonality of mood disorders in adults with lifetime attention-deficit/hyperactivity disorder (ADHD). Journal of affective disorders, 91(2-3), 251–255. https://doi.org/10.1016/j.jad.2005.11.017

²Wynchank, D. S., Bijlenga, D., Lamers, F., Bron, T. I., Winthorst, W. H., Vogel, S. W., Penninx, B. W., Beekman, A. T., & Kooij, J. S. (2016). ADHD, circadian rhythms and seasonality. Journal of psychiatric research, 81, 87–94. https://doi.org/10.1016/j.jpsychires.2016.06.018

³Van Veen, M. M., Kooij, J. J., Boonstra, A. M., Gordijn, M. C., & Van Someren, E. J. (2010). Delayed circadian rhythm in adults with attention-deficit/hyperactivity disorder and chronic sleep-onset insomnia. Biological psychiatry, 67(11), 1091–1096. https://doi.org/10.1016/j.biopsych.2009.12.032

⁴Hartstein, L. E., Mathew, G. M., Reichenberger, D. A., Rodriguez, I., Allen, N., Chang, A. M., Chaput, J. P., Christakis, D. A., Garrison, M., Gooley, J. J., Koos, J. A., Van Den Bulck, J., Woods, H., Zeitzer, J. M., Dzierzewski, J. M., & Hale, L. (2024). The impact of screen use on sleep health across the lifespan: A National Sleep Foundation consensus statement. Sleep health, 10(4), 373–384. https://doi.org/10.1016/j.sleh.2024.05.001

⁵Khoshbakht, Y., Bidaki, R., & Salehi-abargouei, A. (2018). Vitamin D Status and Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Observational Studies.. Advances in nutrition, 9 1, 9-20 . https://doi.org/10.1093/advances/nmx002.

Brain volume, and the genetic variants that influence it, is tied to ADHD and Parkinson’s disease risks, suggests one of the most extensive international studies to date on DNA and brain structure.¹

The new study, published in Nature Genetics, examined how brain size and genetic differences influence key subcortical or ‘deep brain’ regions crucial for memory, emotional regulation, proprioception, sensory processing, and responses to rewards and punishments.

A team of 189 researchers from 45 countries analyzed data from genome-wide association studies (GWAS) and magnetic resonance imaging (MRI) brain scans of 74,898 participants across 19 countries. They identified 254 genetic variants that impact brain volume and the likelihood of developing ADHD and Parkinson’s disease.

“Genetic variants associated with larger brain volumes in key brain regions also increase the risk of Parkinson’s disease, while variants linked to smaller brain volumes in key regions are associated with an increased risk of ADHD,” said Miguel Rentería, Ph.D., study principal and associate professor at the Queensland Institute of Medical Research (QIMR Berghofer) in Australia, in a statement. “These findings suggest that genetic influences that underpin individual differences in brain structure may be fundamental to understanding the underlying causes of brain-related disorders.”

However, more studies are needed on the causal relationship between genes and brain-based diseases. “It’s worth noting that these are correlations, not causal relationships, and so interpretation must be approached with caution,” Rentería said.

“My theory is that the underlying mechanisms involve genes crucial to brain development, growth, and aging processes,” Rentería told Medical News Today. “We plan to further investigate to identify the exact biological pathways involved. Understanding these mechanisms could illuminate how brain structure impacts susceptibility to both neurodegenerative and psychiatric conditions, potentially guiding future therapeutic strategies.”

The researchers used data from the Enhancing Neuro Imaging Genetics through Meta-Analysis (ENIGMA) consortium, an international effort led by Keck School of Medicine of USC; the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) at Baylor College of Medicine; the UK Biobank; and the Adolescent Brain Cognitive Development (ABCD) study.

ADHD and Parkinson’s Disease

According to the World Health Organization and the Centers for Disease Control and Prevention, rates of Parkinson’s disease and ADHD continue to rise.

In 2018, researchers from the University of Utah Health found that the risk of early-onset Parkinson’s disease and similar disorders is 2.4 times greater among patients with ADHD than it is among individuals of the same gender and age without ADHD. The study, published in Neuropsychopharmacology, examined medical records from the Utah Population Database (UPDB) of 31,769 patients with ADHD and 158,790 individuals without the condition.²

Sources

¹ García-Marín, L. M., Campos, A. I., Diaz-Torres, S., Rabinowitz, J. A., Ceja, Z., Mitchell, B. L., Grasby, K. L., Thorp, J. G., Agartz, I., Alhusaini, S., Ames, D., Amouyel, P., Andreassen, O. A., Arfanakis, K., Arias-Vasquez, A., Armstrong, N. J., Athanasiu, L., Bastin, M. E., Beiser, A. S., … Rentería, M. E. (2024). Genomic Analysis of Intracranial and Subcortical Brain Volumes Yields Polygenic Scores Accounting for Variation Across Ancestries. Nature Genetics. https://doi.org/10.1038/s41588-024-01951-z

² Curtin, K., Fleckenstein, A.E., Keeshin, B.R., et al. (2018). Increased Risk of Diseases of the Basal Ganglia and Cerebellum in Patients with a History of Attention-Deficit/Hyperactivity Disorder. Neuropsychopharmacology. https://doi.org/10.1038/s41386-018-0207-5

Can someone have both ADHD and schizophrenia? At first glance, the two conditions might seem distinct and unrelated. But they do share some similarities and risk factors, and symptoms of each can dramatically affect a person’s life.

Many adults diagnosed with schizophrenia were previously diagnosed with ADHD or another behavioral disorder in childhood. Some researchers have suggested that, in rare cases, treating childhood ADHD with stimulants — especially amphetamines — may increase the risk of developing schizophrenia later in life.¹

In this discussion, we’ll explore how early cognitive issues in children with ADHD might sometimes lead to misdiagnosis, as these issues can look similar to symptoms of other conditions. We’ll also discuss how the effects of ADHD — along with environmental factors, developmental challenges, and trauma — can sometimes lead a treatable childhood condition to give way to a severe mental illness later in life.

In this webinar, you will learn:

• About the similarities and differences between ADHD and schizophrenia
• How developmental issues can begin with ADHD and lead to schizophrenia
• About the environmental factors that could lead a child to develop schizophrenia
• About the interventions to treat the diagnosis of ADHD and schizophrenia

Watch the Video Replay

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

ADHD & Mental Health Conditions: More Resources

• Sign Up: How ADHD and Schizophrenia Overlap
• Read: “They All Feed Off Each Other:” Stories of Life with ADHD and Comorbidities
• Research: Disparate Psychiatric Disorders Share Widespread Genetic Overlap
• eBook: 9 Conditions Often Diagnosed with ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on December 11, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Napoleon Higgins, M.D., is a child, adolescent, and adult psychiatrist in Houston, Texas. He is the owner of Bay Pointe Behavioral Health Services and Kaleidoscope Clinical Research.

Dr. Higgins is the Executive Director of the Black Psychiatrists of America, CEO of Global Health Psychiatry, President of the Black Psychiatrists of Greater Houston, Psychiatry Section Chair of the National Medical Association, and Past President of the Caucus of Black Psychiatrists of the American Psychiatric Association.

Dr. Higgins is co-author of Bree’s Journey to Joy: A Story about Childhood Grief and Depression, How Amari Learned to Love School Again: A Story about ADHD, Mind Matters: A Resource Guide to Psychiatry for Black Communities and author of Transition 2 Practice: 21 Things Every Doctor Must Know In Contract Negotiations and the Job Search. (#CommissionsEarned)

Dr. Higgins has worked with and founded programs that help to direct inner-city young men and women to aspire to go to college and finish their educational goals. He has worked with countless community mentoring programs and has special interest in trauma, racism, and inner-city issues and how they affect minority and disadvantaged children and communities.

#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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Dyslexia, a genetically rooted reading disability, affects the ability to decode (sound out) and spell words. Students with dyslexia are typically inaccurate in reading and spelling. They do not understand how to manipulate the sounds that form words. Their oral reading is often slow. They may focus so much on decoding individual words, not content and meaning, that their comprehension is compromised.

When teaching students with dyslexia, it is important to use evidence-based practices that have a significantly higher success rate than other approaches. Structured literacy is one such approach. It provides daily instruction in phonics through a carefully sequenced program offered to small groups of students with similar skill levels. This type of teacher-supervised instruction, also referred to as multisensory or Orton-Gillingham based, integrates the teaching of reading, spelling, and handwriting.

How to Help Students with Dyslexia

• Provide an appropriate, evidence-based reading program that requires implementation as designed, not piecemeal, until a student shows that they are ready to move on.
• Assign homework that reflects the student’s current reading level so they can complete work independently.
• Utilize oral exams that allow them to show what they know until reading skills are remediated.
• Give untimed tests.

A side note: Some students benefit from audiobooks reflecting what is being taught, though this does nothing to improve reading.

[Take This Self-Test: Does My Child Have Dyslexia?]

How ADHD Affects Reading

Roughly half of children with ADHD have learning disorders that affect academic achievement. This is in addition to the impact of inattention and related ADHD symptoms. Executive function challenges also impact reading and writing. Students with ADHD may decode well, but still not read accurately. Executive function includes the ability to stay focused on the correct place on the page, as well as to process and organize information.

Students with ADHD may also skip around the page, read impulsively or too quickly, or miss word endings, modifiers, and smaller words. They may lose track of content details and struggle to sort new information. They may not be able to maintain attention or retain information through longer passages. Comprehension becomes undermined by these inaccuracies.

Students with ADHD would benefit from:

• Use of prescribed stimulant medication, which has been shown to improve reading abilities.
• Placement in less distracting classrooms (such as having desks facing forward and less clutter) and with well-organized teachers.
• Strategies that help students stay focused on the page, like using a straight edge or their finger to stay on a line.
• Textbooks in which students have permission to underline and annotate pages, which aids focus.
• Direct instruction in higher level reading strategies, such as notetaking, previewing, and summarizing text.

Students with dyslexia are entitled to an Individualized Education Program (IEP) or 504 Plan that includes comprehensive direct instruction using an evidence-based reading program. For students with ADHD, an expansive plan should support all areas of executive function.

If this seems like a lot to ask, rest assured that supports for students with dyslexia and ADHD benefit all students’ growth.

Dyslexia and ADHD: Next Steps

• Read: The Defining Signs of Dyslexia Too Often Ignored
• Get This Free Download: Signs of Dyslexia at Every Age
• Read: Reading Strategies That Grow with Your Child
• Read: When Your Child Has ADHD and Dyslexia  — Treatment for Complex Symptoms

Mark Bertin, M.D., is a developmental pediatrician and author of How Children Thrive.

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Sleep problems are highly prevalent among adults with ADHD. Individuals who have ADHD and one or more psychiatric comorbidities face an increased risk for disordered sleep, according to a study published in the Journal of Attention Disorders.¹

The study followed a large sample of adults with ADHD in the Netherlands after they were referred to an outpatient mental health clinic. Nearly two-thirds of these patients screened positive for a sleep problem. Most screened positive for delayed sleep phase syndrome (35.8%), followed by insomnia (30.6%) and restless leg syndrome (28.8%).

Women with ADHD were more likely to report more types of sleep problems compared to men with ADHD. Women more often reported insomnia, hypersomnia, and parasomnia, while men more often reported sleep-related breathing disorders (SBD).

Adults with ADHD and mental health conditions faced a higher likelihood of having any type of sleep problem and of having more than one sleep problem than did those with ADHD alone. The risk of sleep problems was highest in adults with PTSD (OR=3.21), followed by:

• Substance use disorder (OR=1.76)
• Depression (OR=1.73)
• Anxiety (OR=1.51)
• Personality disorders (OR=1.54)

Why Do Adults with ADHD Struggle with Sleep?

Sleep disorders impact around 50 million Americans or 15% of the U.S. population.² This percentage is significantly higher in ADHD populations, as shown in the current study. According to data cited by the authors, disordered sleep affects an estimated 40% to 80% of adults with ADHD.^{3, 4} The most common sleep disorders are similar for both groups and include insomnia, restless legs syndrome (RLS), narcolepsy, and sleep apnea.^{5, 6}

ADHD and sleep go hand in hand, and the impact of one disorder can worsen the symptoms of the other. For example, the American Academy of Neurology found that people with ADHD and RLS experience more severe RLS symptoms than do those without ADHD.⁷

Many sleep problems are biological, but they can also be behaviorally motivated. A study cited by the authors shows that cognitive behavioral symptoms such as bedtime procrastination can delay sleep onset and potentially disrupt melatonin production.⁸

“Symptoms of ADHD exacerbate the things that make sleep hard for all of us,” said Joel Nigg, Ph.D., in his 2018 webinar with ADDitude, “Sleep and the ADHD Brain: Why It’s Critical and How to Get More.”

“Your body reacts more strongly to stimulation,” Nigg said. “You’re more hyper-aroused by things that happen during the day. It’s harder to turn your brain off. It’s a natural side effect of what ADHD is. Sleep requires the opposite of the energy that ADHD provokes, [making sleep] naturally difficult. That’s why it takes the kind of deliberate attention, behavioral strategy, or kind of tackling of this so often for those with ADHD.”

What Are the Consequences of Untreated Sleep Problems?

The impact of misdiagnosing symptoms of disordered sleep can have long-term consequences, leading to “poor treatment, and persistence and aggravation of symptoms,” the authors wrote.

Symptoms of poor sleep can look like ADHD and vice versa, making them somewhat difficult to differentiate. Left untreated, disordered sleep can worsen with age and cause a ripple effect from caregivers to their children.⁹

“Sung did a study [in 2008], which found that moderate or severe sleep problems in children with ADHD were strongly associated with the mental health of their primary caregivers and with those caregivers’ work attendance and overall family functioning,” said Roberto Olivardia, Ph.D., during his 2019 webinar with ADDitude, “Time for Bed! Sleep Solutions for the ADHD Brain.”

The good news is that “treatments for specific sleep problems are available, relatively accessible to implement in ADHD patients, and can improve ADHD treatment results substantially,” the authors wrote. Cognitive behavioral therapy (CBT) and lifestyle changes are first-line treatments for many sleep disorders and can be more effective than sleep medicine.¹⁰

Limitations, Strengths, and Future Research

The study followed 3,691 adults diagnosed with ADHD from 2018 to 2020. Data was assessed via electronic patient files and included an even male-to-female ratio. Adults with ADHD were referred to one of 46 specialized outpatient clinics in the Netherlands by their general practitioner or mental health counselor. The Holland Sleep Disorder Questionnaire (HSDQ) was used to assess sleep disorders, though it was used as a screening tool and not to diagnose. The DIVA-5 was used to test for ADHD, and the M.I.N.I was used to screen for psychiatric comorbidities.

Limitations of the study include a lack of control group. And although some patients had been diagnosed with a sleep disorder before being referred to an outpatient clinic, the HSDQ was only able to screen for sleep problems. Some data, such as BMI and treatment status, was not accounted for as it was not systematically recorded in patient files. Given each patient received a clinical referral, the severity of symptoms experienced by patients should be considered when interpreting results.

Future studies would benefit by measuring causal factors contributing to sleep problems in adults with ADHD. These studies should also include subjective sleep parameters, such as actigraphy and polysomnography, which were not included here. Insomnia has been widely studied in sleep research; more research is needed on other sleep disorders, including periodic limb movement disorder (PLMD), RLS, DSPS, and SBD.

Sources

¹ van der Ham, M., Bijlenga, D., Böhmer, M., Beekman, A.T.F., & Kooij, S. (2024). Sleep problems in adults With ADHD: prevalences and their relationship with psychiatric comorbidity. Journal of Attention Disorders, 28(13), 1642-1652. https://doi.org/10.1177/10870547241284477

² American Psychiatric Association. (2024). What are Sleep Disorders? https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders

³Wynchank, D., Bijlenga, D., Beekman, A.T. et al. (2017). Adult attention-deficit/hyperactivity disorder (ADHD) and insomnia: an update of the literature. Curr Psychiatry Rep 19, 98. https://doi.org/10.1007/s11920-017-0860-0

⁴Batten, L. (2022, August 17). How ADHD Impacts Your Sleep And What You Can Do About It. Frida. https://www.talkwithfrida.com/learn/how-adhd-impacts-your-sleep/

⁵ U.S. Centers for Disease Control & Prevention. (2024, May 15). About Sleep. https://www.cdc.gov/sleep/about/index.html

⁶ Cleveland Clinic. (2023, June 19). Sleep Disorders. https://my.clevelandclinic.org/health/diseases/11429-sleep-disorders

⁷ American Academy Of Neurology. (2001, May 8). Adults With Restless Legs Syndrome More Likely To Have ADHD. ScienceDaily. www.sciencedaily.com/releases/2001/05/010508082849.htm

⁸ Li, X., Buxton, O. M., Kim, Y., Haneuse, S., & Kawachi, I. (2020). Do procrastinators get worse sleep? Cross-sectional study of U.S. adolescents and young adults. SSM – Population Health, 10, 100518. https://doi.org/10.1016/j.ssmph.2019.100518

⁹ Sung, V., Hiscock, H., Sciberras, E., Efron, D. (2008). Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Arch Pediatr Adolesc Med, 162(4):336–342. https://doi.org/10.1001/archpedi.162.4.336

¹⁰ Mitchell, M.D., Gehrman, P., Perlis, M. et al. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Pract, 13, 40. https://doi.org/10.1186/1471-2296-13-40

Nonverbal learning disability (NVLD or NLD) is a little-understood condition characterized by deficits in visual-spatial reasoning.

Due to its confusing name and frequent co-occurrence and symptom overlap with ADHD and other conditions, NVLD is widely misunderstood, overlooked, and misdiagnosed. The name “nonverbal learning disorder” falsely suggests that those with NVLD  do not speak. Many children and adults with NVLD have strong verbal skills, vocabularies, and memory and auditory retention; their struggles are, instead, with interpreting nonverbal cues and communication.

Children with NVLD often hide or compensate for their challenges by charming adults with precocious conversation skills. Once puberty hits, NVLD can cause teenagers to develop anxiety over their inability to connect with their peers. Trouble setting priorities or picking up on social cues may jeopardize relationships or jobs in adults with the condition.

In this download, you will learn:

• Differences between NVLD and ADHD
• Signs of NVLD in Children
• Signs of NVLD in Adults
• How to treat NVLD
• Who can diagnose NVLD
• And more!

Sleep problems in children are associated with restless behavior and iron deficiency, two problems more common in patients with ADHD, according to a small study published in the journal Nutrients.¹

The study followed 199 patients referred to a Sleep/Wake Behavior Clinic between 2021 and 2023. It found that patients with ADHD were nearly twice as likely as their neurotypical counterparts to have restless leg syndrome (RLS). The most common psychiatric comorbidities among patients with sleep disorders included ADHD (46%), autism (45%), and anxiety disorder (41%).

Most patients in the study had an iron deficiency (94%), and 41% knew someone in their family who did. When comparing ADHD patients only, a family history of iron deficiency increased the patient’s risk of having RLS and insomnia.

“Recently, iron has received increasing attention due to its role in sleep disorders, as well as wake behaviors associated with mental health and/or neurodevelopmental disorders such as ADHD, autism spectrum disorder, and prenatal alcohol exposure/fetal alcohol spectrum disorder,” the research authors wrote.

RLS was the most common sleep disorder (74%) in the study, followed by:

• Chronic insomnia: 61%
• Signs of sleep-disordered breathing: 50%
• Restless sleep or PLMS: 30%
• Circadian rhythm sleep disorder (CRSD): 16%
• Probable painful RLS: 11%

Sleep and ADHD

Nearly three-quarters of children with ADHD experience a sleep problem or disorder.² For many children, sleep problems last into adolescence and can aggravate ADHD symptoms during the day.

“By the time they get into adolescence, we know that teens with ADHD are more likely than their peers without ADHD to get insufficient sleep on school nights,” said Stephen Becker, Ph.D., in his 2021 webinar with ADDitude, “Why Am I Always So Tired? The Latest Science on Improving Sleep in Children and Teens with ADHD.”

“We’ve also shown that poor sleep impacts academics, including academic performance, organization, and lower grades based on report cards that we’ve acquired from schools and college institutions,” Becker said. “In some of our work with young teens, even after we account for a teen’s initial levels of depressive symptoms or oppositional behaviors, those teens who had sleep problems went on to experience an increase in depressive symptoms and oppositional behaviors over time.”

Restlessness, defined as the “urge to move,” was a strong risk factor for sleep problems in children with and without ADHD in the present study. Hypermotor restlessness and hyper-arousal are central to ADHD and RLS but are often missed in pediatric patients, according to the authors. Symptoms of restlessness are based on adult criteria and do not account for physical differences that may be present in children.

“Characterizing hyper-motor restlessness during sleep as a new diagnostic entity supports our understanding that disorders presenting with hypermotor restlessness and/or hyper-arousability need an in-depth phenotyping approach from a pediatric sleep medicine perspective,” the authors wrote.

Limitations & Future Research

Standard diagnostic evaluations for sleep disorders typically do not assess for iron levels, according to the authors. Testing iron levels using blood tests could help improve treatment outcomes, as many patients in the present study were shown to be deficient. The authors noted that iron supplementation is often an effective treatment approach.

Evening activities, screen time, stimulant medication, homework stress, and inconsistent sleep/wake times may also make it difficult for children with ADHD to wind down at night.

Patients ages 3 months to 23 years and/or their family members answered questions upon intake about bedtime habits, excessive daytime sleepiness, nighttime awakenings, routines, sleep-disordered breathing, quality of sleep, and other non-specific concerns. The Sleep Disturbance Scale for Children (SDSC) and ADHD Rating Scale-IV were also administered.

The study has several limitations, including the absence of a control group and a small sample size. Additionally, medication use was not controlled, and there was no distinction made between anemic and non-anemic individuals with iron deficiency, nor between maternal and paternal family histories. Future research should explore the causes of iron deficiency. Inadequate nutrition, inflammation, and malabsorption were listed as potential contributors to iron deficiency.

Findings associated with other psychiatric disorders, including autism, were also shared in the study and can be found here.

Sources

¹ Ipsiroglu, O.S., Pandher, P.K., Hill, O., McWilliams, S., Braschel, M., Edwards, K., Friedlander, R., Keys, E., Kuo, C., Lewis, M.S., et al. (2024). Iron deficiency and restless sleep/wake behaviors in neurodevelopmental disorders and mental health conditions. Nutrients, 16(18):3064. https://doi.org/10.3390/nu16183064

² Sung, V., Hiscock, H., Sciberras, E., Efron, D. (2008). Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Arch Pediatr Adolesc Med, 162(4):336–342. https://doi.org/10.1001/archpedi.162.4.336