ADHD traits in childhood predict physical health problems in midlife, but early exercise interventions may offset this risk, suggest two new studies.

A cohort study of 10,930 participants published in JAMA found that adults with severe childhood ADHD traits had more physical health problems and greater physical health-related disability by age 46 compared to those with less severe ADHD symptoms by age 10.¹

The researchers reported that 42.1% of participants with higher ADHD traits in childhood developed multimorbidity (two or more co-occurring physical health conditions) by age 46. In comparison, just 37.5% of participants with fewer ADHD traits experienced the same health outcomes. Notably, the link between ADHD traits and physical health-related disability appeared much larger in women than it did in men.

Cumulative exposure to health risk factors, such as smoking, alcohol use, psychological distress, low educational attainment, and high body mass index, explains part of the association between ADHD, multimorbidity, and physical disability. However, the researchers emphasized that the direct association between ADHD and physical health outcomes remained significant.

“Clinicians should be aware of the increased rates of physical health problems and associated disability in people with ADHD and should proactively address potential contributing health risk factors,” they wrote. “Integrated interventions addressing mental health, physical health, and key health risk factors may help to reduce chronic conditions in this population.”

The JAMA study analyzed data from the population-based 1970 British Cohort Study, which included people born in England, Scotland, and Wales during the same week in 1970, with follow-up data collected over 46 years.

Increased Mortality Risk for People with ADHD

Untreated physical health problems and co-occurring conditions could reduce the life expectancy of people with ADHD at a higher rate than seen in the general population. A January 2025 study published in The British Journal of Psychiatry comparing the mortality rates of people diagnosed with ADHD to people without ADHD found that the life expectancy for women with ADHD is 8.6 years shorter than that of women without ADHD, while the life expectancy of men with ADHD is 6.8 years shorter. ²

“Adults with diagnosed ADHD are living shorter lives than they should,” the study’s authors wrote. “We believe that is likely caused by modifiable risk factors and unmet support and treatment needs in terms of both ADHD and co-occurring mental and physical health conditions.”

Exercise Interventions Improve Long-Term Mental Health

A 2023 treatment survey of 11,000 ADDitude readers reported positive benefits of exercise. About half of the respondents who exercise regularly rate this ADHD treatment as “extremely” or “very” effective. A staggering 94% of caregivers and 95% of adults recommend exercise to treat ADHD symptoms. However, only 13% said a doctor had recommended exercise to reduce symptoms, and just 37% said physical activity was part of their treatment plan.

“When I get into a good stride with routine exercise, it almost always goes hand-in-hand with better eating habits, better focus, energy levels, mental clarity, and stronger relationships and productivity,” said one adult with ADHD. “Exercise is undoubtedly a crucial piece of the (treatment) puzzle.”

“Depression can really take hold of my 10-year-old son,” one parent said. “We see great improvements after physical activity. He enjoys the elliptical, rower, spin bikes, automatic stepper, and treadmill.”

A new meta-analysis including 18 studies further explores the potential of exercise as an effective adjunctive approach for improving mental health in individuals with ADHD when it is integrated into a multimodal treatment plan that includes pharmacotherapy, behavioral therapy, or psychoeducation.
Exercise interventions produced small-to-moderate improvements in depressive symptoms, anxiety, and emotion regulation in individuals with ADHD, according to the study published in Frontiers in Psychology.

Mind-body integrated exercises, such as yoga and tai chi, significantly improved both depression and anxiety symptoms compared to physical exercises (e.g., structured fitness or sports without a mindfulness component), which did not show significant improvements across outcomes.

The researchers suggest that this advantage may stem from the “mind-body integration” of activities like yoga. By combining physical movement with breath awareness, focused attention, and present-moment acceptance, mind-body exercises directly target emotional dysregulation and attentional control, which are core components of ADHD.

Results from the meta-analysis found that adolescents with anxiety who practiced mind-body exercises experienced the greatest improvements. While children showed moderate improvement, the results were not statistically significant. These discrepancies could be due to developmental differences: Adolescents may be better able to engage with and benefit from the psychological components of exercise, while younger children may require more play-based or gamified approaches.

In addition, the most statistically significant reduction in depressive symptoms occurred from moderate-intensity exercise, whereas low-intensity and high-intensity exercises did not demonstrate measurable benefits for depression, anxiety, or emotion regulation.

While intervention length varied widely (from single sessions to 20-week programs), with no clear differences emerging across durations, single sessions demonstrated immediate short-term anxiety-reducing effects. However, to sustain benefits, longer-term participation may be necessary, the researchers suggest.

They emphasized that the study’s overall findings should be viewed as hypothesis-generating rather than definitive. “Because study designs and exercise protocols varied considerably, the results should be interpreted cautiously, and more rigorous research is needed before definitive clinical guidelines can be established,” they wrote.

Sources

¹Stott, J., O’Nions, E., Corrigan, L., Cotton, J., Donnellan, W.J., et al. (2026). Attention-Deficit/Hyperactivity Disorder Traits in Childhood and Physical Health in Midlife. JAMA Netw Open. https://doi.org/10.1001/jamanetworkopen.2025.54802

²O’Nions, E., El Baou, C., John, A., Lewer, D., Mandy, W., McKechnie, D.G.J. et al. (2025). Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study. The British Journal of Psychiatry. https://doi.org/10.1192/bjp.2024.199

³Shenning, Z., Yaoqi, H., Wenying, S., and Xiangqin, S. (2026). The effect of exercise interventions on mental health in children and adolescents with attention-deficit/hyperactivity disorder: a meta-analysis. Front. Psychol. https://doi.org/10.3389/fpsyg.2026.1748777

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Emotional distress includes feelings of anxiety, low mood, worry, rumination, and self-criticism. For people with ADHD, as well as those facing chronic stress, it can stem from changes in relationships, work, caregiving demands, health problems, or challenges to life satisfaction. When we feel prolonged uncertainty, our distress can become self-perpetuating. Heightened emotional reactions lead to overthinking and avoidance, which ultimately limit meaningful action and personal growth.

In this webinar, Doug Mennin, Ph.D., introduces ideas aligned with emotion regulation therapy, a research-based approach designed to help people better understand and respond to emotional distress. Rather than trying to erase difficult emotions, this approach focuses on changing how we relate to them so that we can move forward with greater clarity, flexibility, and purpose.

In this webinar, you will:

• Understand emotional distress through a motivation and emotion-regulation lens, including why anxiety and depression often feel so hard to shift
• Recognize common patterns like worry, rumination, and self-criticism that keep distress going
• Build mindful awareness of emotions, body sensations, and internal conflicts without becoming overwhelmed by them
• Develop practical skills to step back from intense thoughts and feelings and see them more clearly
• Use emotion-regulation strategies to support meaningful actions, even when emotions are uncomfortable

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

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Emotional Dysregulation in Adults: Resources

• • • Free Download: Emotional Regulation & Anger Management Scripts
    • Read: Everything You Never Knew About the ADHD Brain
    • Read: Does ADHD Emotional Dysregulation Ever Fade?
    • Read: After the Shame: How to Re-Center Your Bruised Emotions

Meet the Expert Speaker

Doug Mennin, Ph.D., is a Professor of Clinical Psychology and Director of Clinical Training of the Clinical Psychology Ph.D. Program at Teachers College, Columbia University. He earned his Ph.D. from Temple University in 2001 and has previously held positions in the Department of Psychology at New York University, Yale University, and CUNY Hunter College, where he was Co-Director of the Health Psychology and Clinical Science PhD training program. In his academic role, Professor Mennin has trained numerous graduate students and post-baccalaureate research assistants on diagnosis, assessment, and treatment of anxiety and mood disorders. He has published more than 150 articles, chapters, and books and is the developer of Emotion Regulation Therapy (ERT). He regularly leads workshops to help people better understand and respond to their struggles with anxiety, worry, and depression. He currently serves on the editorial board of six journals and has been on the executive boards of the APA Division of Clinical Psychology, the Society for a Science of Clinical Psychology, and is the former Chair of the Scientific Council of the Anxiety and Depression Association of America (ADAA).

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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Among autistic and ADHD children, the risk of developing comorbid depression or anxiety in adulthood is driven largely by emotional exposures in childhood and how intensely they are experienced, suggests a new study published in the Journal of Child Psychology and Psychiatry.¹ In other words, it’s not the ADHD and autistic traits alone that increase the risk for comorbidities, but the emotional load and regulation problems that often come with trauma.

The study found that emotional burden (EB) and emotional regulation difficulty (ERD) independently predicted higher rates of depression or anxiety in autistic youth with and without ADHD, as well as among teens with ADHD alone. Adolescents within these groups also experienced greater frequency and intensity of common upsetting events (CUEs) and substantially higher overall EB, especially during unstructured or socially complex situations at school, compared to their neurotypical peers. The frequency and intensity of CUEs, and higher EB, were uniquely associated with depression or anxiety.

The researchers identified distinctive sets of CUEs with discriminating burden among the ADHD, autistic, and ADHD-autistic groups.

ADHD-Autistic Group: Burdensome CUEs

• last-minute change of plans
• not allowed self-regulation strategies
• being rushed to move on from task to task

ADHD Group: Burdensome CUEs

• teachers don’t listen
• boring lessons or tasks
• stopped from doing something enjoyable
• losing and forgetting things
• being told to try harder
• being unfairly accused of something

Autistic Group: Burdensome CUEs

• peer gossip
• unexpected wait in a queue
• sensory discomfort
• being rushed to complete work
• not understanding others

Lowering stressors and emotional triggers, the researchers suggest, may be just as important as learning emotion regulation skills.

“The concept of induced EB has the potential to expand, or even to shift, the focus of emotion-related interventions from attempts to reduce ERD within an individual through emotion regulation training alone to ones that incorporate EB reduction — by decreasing CUEs and/or improving ways such provocations might be managed to ameliorate the intensity of emotional reactions they induce,” the researchers wrote.

How Autistic and ADHD Traits Relate to Emotional Burden

The study also revealed that autistic adolescents with ADHD appeared to experience only the same level of burden as those with ADHD or autism alone, rather than the conditions acting additively. “This was a surprising finding, which needs to be replicated in future studies,” the researchers wrote.

One possibility is that there exists a ‘ceiling’ in emotional burden experienced by neurodivergent individuals. “Another possibility,” the researchers wrote, “is that the co-occurrence of ADHD and autism leads to the former cancelling out the latter effect and vice-versa, leading to each contributing to a smaller proportion of emotional burden than each condition alone.”

More longitudinal studies are needed to explore how EB and ERD relate to depression and anxiety in ADHD and/or autistic individuals.

“EB could add significant power to explain the emergence of mental health problems in adolescents with ADHD and/or autism, over and above more traditional measures of emotion dysregulation,” the researchers wrote.

By adulthood, about half of autistic people and 30% of those with ADHD will have a clinical depression and/or anxiety diagnosis. ², ³

“Understanding — not undermining — the lived experiences of those who live with ADHD and/or autism is critical,” explained Karen Saporito, Ph.D., in the ADDitude webinar “AuDHD Guidance: Why Autism is So Difficult to Diagnose in Women and Girls with ADHD.” “The experiences, traits, symptoms, and challenges of our patients do not always align with textbook definitions and available research findings, and firsthand accounts can offer a more accurate and comprehensive understanding of these conditions… When patients feel heard and respected, they are more likely to engage in their care and advocate for themselves, leading to better outcomes.”

Sources

¹Lukito, S., Chandler, S., Kakoulidou, M., Griffiths, K., Wyatt, A., Funnell, E., Pavlopoulou, G., Baker, S., Stahl, D., & Sonuga-Barke, E. Emotional burden in school as a source of mental health problems associated with ADHD and/or autism: Development and validation of a new co-produced self-report measure. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.70003

²Dow, D., Morgan, L., Hooker, J.L., Michaels, M.S., Joiner, T.E., Woods, J., & Wetherby, A.M. (2021). Anxiety, depression, and the interpersonal theory of suicide in a community sample of adults with autism spectrum disorder. Archives of Suicide Research.

³Wilens, T., Nierenberg, A.A., Rostain, A., & Spencer, T.J. (2008). Adult attention-deficit hyperactivity disorder and the role of depression. CNS Spectrums.

Children with ADHD and behavioral disorders face an elevated risk for major depressive disorder (MDD) and depressive symptoms like high suicidality, whereas those with ADHD and autistic traits experience more irritability and poor sleep, according to recent research findings published in the Journal of Attention Disorders.¹

The study identified three distinct clusters of depressive symptoms in children with ADHD: ‘low symptoms,’ ‘irritable/poor sleep,’ and ‘high symptoms.’ Data from 696 children, aged 6 to 18, from the Study of ADHD Genes and Environment (SAGE) and latent profile analysis of 34 depression symptoms rated by caregivers in follow-up questionnaires formed the basis of the profiles.

‘Low Symptoms’ Profile

Nearly half (48.5%) of the children in the study were placed into the ‘low symptoms’ profile, meaning they presented relatively minor depressive symptoms in 26 of the 34 parent-rated questions. Members of this profile exhibited slightly elevated levels of restlessness, indecisiveness, unhappiness, poor sleep, and tiredness. They also showed the highest mean scores for irritability and difficulty concentrating, which was not surprising since those are also common signs of ADHD.

‘High Symptoms’ Profile

In contrast, the ‘high symptoms’ profile, representing 15.5% of the sample, presented very high mean scores of depression symptoms across all categories. Notably, these children were more likely to report loss of hope for the future, feeling that life is not worth living, thoughts of death and dying, and that their family would be better off without them. Suicidal thoughts and symptoms relating to low self-esteem ranged from ‘somewhat high’ to ‘high’ for this group.

The researchers also associated behavioral problems, such as oppositional defiant disorder (ODD) and conduct disorder (CD), ADHD-related impairment, low family income, and anxiety disorders with the ‘high symptoms’ profile.

‘Irritable/Poor Sleep’ Profile

More than one-third (36.1%) of the sample identified with the ‘irritable/poor sleep’ profile. The depression symptom mean scores of this group fell in the middle of the other two symptom clusters. However, irritability (being grumpy with parents), inattention, and poor sleep ranked much higher in mean scores than the other parent-rated symptoms. Traits of autism and ODD were also aligned closely with the ‘irritable/poor sleep’ cluster, which was more common in girls.

“This pattern of symptoms was unexpected and may be less easily explained than the other classes identified in our study,” the researchers wrote. “Although irritability is common in young people with ADHD, its high mean score within this class suggests heterogeneity within the sample, with a subset of individuals showing particularly high levels of irritability.”

The researchers stressed that irritability does not always occur alongside other depressive symptoms or indicate MDD in children with ADHD, as irritability is common in children with ADHD.

“High levels of irritability and poor sleep could be more general symptoms associated with neurodevelopmental phenotypes, rather than being specific symptoms of depression,” the researchers wrote.

“On the other hand, evidence from a longitudinal study suggests that children with ADHD who present with persistent irritability are at elevated risk of developing depression,” they continued.² “Evidence also suggests that poor sleep precipitates irritability, which might explain their co-occurrence in this class, although no causal mechanism was established.”

The researchers recommend more studies on depression symptom heterogeneity in children with ADHD, with a focus on the link between irritability, poor sleep, and MDD.

Why Studies on Depressive Symptoms in Youth with ADHD Matter

Depression is a common ADHD comorbidity — children with ADHD exhibit a five-fold or higher increased risk of developing depressive disorders compared to their neurotypical peers.^{3, 4}

“Evidence suggests that depression can be more severe when comorbid with ADHD, including an earlier onset and longer duration of depressive symptoms, along with a higher suicide rate compared to those without ADHD,” the researchers wrote.⁵

ADDitude caregivers know firsthand about the negative impacts of comorbid depression. Less than 6% of the 1,187 parent respondents to a 2022 ADDitude survey on mental health said that their adolescents with ADHD have “very good” mental health today. On a 4-point scale, this group’s average mental health rating was 2.27.

According to caregivers, 67% of teens with ADHD have now been diagnosed with anxiety, and 46% with depression. The percentages fared much worse for adolescent girls: An astounding 75% of teenage girls with ADHD experience anxiety, and 54% suffer from depression, according to the ADDitude survey.

“Girls and women with untreated ADHD are at double the risk for engaging in self-harm, and they are significantly more likely to attempt suicide,” said Julia Schechter, Ph.D., of the Duke Center for Girls and Women with ADHD.

Early recognition of depression and treatment in children with ADHD should be a priority for this high-risk population.

The American Academy of Pediatrics (AAP) recently issued new guidance that recommends mental and behavioral health screenings for children, beginning at 6 months old, and continuing those screenings at 12-, 24-, and 36-month well visits. After age 3, the screening, which includes questions to reveal autism spectrum disorder and developmental disorders, continues annually.

“Our findings may be useful for clinicians in understanding how depression symptoms might present in various subgroups and in identifying which young people with ADHD may be at higher risk of more severe presentations of depression symptoms, potentially reducing underdiagnosis and facilitating more tailored interventions,” the researchers wrote.

“Depression sets in slowly and stealthily, so it may be unclear when to seek treatment,” Roberto Olivardia, Ph.D., says. “It’s almost always best to do so sooner rather than later. Effective depression medications (most of which are safe to use with ADHD medication) may complement therapeutic models like cognitive behavioral therapy, which helps teens assess and address negative or distorted thought patterns. Dialectical behavior therapy focuses on distress tolerance, mindfulness, emotional regulation skills, and interpersonal effectiveness skills.”

Get Help

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

Sources

¹Williams, G., Powell, V., Eyre, O., Thapar, A., & Riglin, L. (2025). Investigating the symptom presentation of depression in children with ADHD. Journal of Attention Disorders. https://doi.org/10.1177/10870547251366783

²Eyre, O., Riglin, L., Leibenluft, E., Stringaris, A., Collishaw, S., Thapar, A. (2019). Irritability in ADHD: association with later depression symptoms. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-019-01303-x

³Angold, A., Costello, E.J., Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/1469-7610.00424

⁴Gundel, L.K., Pedersen, C.B., Munk-Olsen, T., Dalsgaard, S. (2018). Longitudinal association between mental disorders in childhood and subsequent depression: A nationwide prospective cohort study. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2017.10.023

⁵Biederman, J., Ball, S.W., Monuteaux, M.C., Mick, E., Spencer, T.J., McCreary, M., Cote, M., Faraone, S.V. (2008). New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. Journal of the American Academy of Child and Adolescent Psychiatry. https://doi.org/10.1097/CHI.0b013e31816429d3

What is it like to be a man living with ADHD in a culture shaped by long-established ideals and expectations of masculinity? Research and treatment have historically centered on boys with ADHD, but has the field adequately listened and responded to the voices of men? How they mask their symptoms due to fear of failure or not meeting expectations? How they long to express their emotions but fear being perceived as weak? How they feel shame when they lose emotional control, forget to pay the bills, or think that they’ve let down their family? How they question their intelligence, or harbor self-doubt, because they struggle with professional goals, planning, and time management? ADDitude has convened a special roundtable with men who have ADHD to discuss their lived experiences—and to increase understanding and support. You might recognize a few of these men; they have their own podcasts about navigating life with ADHD.

Watch the Video Replay

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ADHD Symptoms in Men : Resources

• Free Download: 3 Defining Features of ADHD That Everyone Overlooks
• Read: For Men With ADHD — and Those Who Love Them
• Read: We Demand Attention on Sex Differences in ADHD
• Read: Face It — People with ADHD Are Wired Differently
  
  

Obtain a Certificate of Attendance

If you attended the live webinar on October 7, 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 Our Panelists

Brendan Mahan, M.Ed, M.S.

Brendan is the producer and host of the ADHD Essentials Podcast, an internationally recognized ADHD/Executive Function expert, and an engaging, sought-after speaker. He helps individuals, families, schools, and businesses manage the challenges of Attention Deficit/Hyperactivity Disorder through an approach that blends education, collaborative problem-solving, and accountability with compassion, humor, and a focus on strengths and growth.

Shane Thrapp

Shane is a Certified ADHD and AuDHD Life Coach, founder of Creating Order from Chaos, and Operations Director for the nonprofit Men’s ADHD Support Group. Through his private practice and his work with ScienceWorks Behavioral Health, Shane provides executive function coaching and parent support to individuals and families navigating ADHD and AuDHD — at home, in school, at work, and in relationships. He leads several peer-driven communities on Facebook, including the Men’s ADHD Support Group, the ADHD Parent Support Group, and serves on the board of Dueling Minds, a nonprofit supporting the AuDHD community. As a speaker and advocate, Shane focuses on building systems that work for neurodivergent minds.

Jesse J. Anderson

Jesse J. Anderson is a creator, writer, speaker, and author of Extra Focus: The Quick Start Guide to Adult ADHD. (#CommissionsEarned) Through his weekly newsletter Extra Focus, he helps more than 70,000 readers navigate their ADHD journeys or better understand their loved ones. His ADHD Writers newsletter helps authors with ADHD find support and guidance. Jesse’s YouTube channel publishes educational content about ADHD, and he’s spoken about ADHD at events including SXSW, NeuroDiversion, The Executive Function Online Summit, The ADHD Growth Summit, and The Annual International Conference on ADHD. He also cofounded Wavepal, an app to help you keep in touch with the people who matter most.

Kyrus Keenan Westcott

Kyrus Keenan “Ky” Westcott is the creator and host of The Vibe With Ky, a digital platform reaching more than 1.8 million people across TikTok, Instagram, Facebook, and beyond. Diagnosed with ADHD at age 34, Ky blends humor, honesty, and personal storytelling to make conversations about ADHD, introversion, anxiety, and mental health approachable. He is the author of multiple ADHD digital guidebooks, and he is a sought-after speaker featured at events like the White House Creator Economy Summit and WHO’s Global Mental Health initiatives. Named one of Feedspot’s Top 10 ADHD Influencers in 2025, Ky’s mission is simple: help adults feel seen, validated, and empowered to live authentically, even on the messiest days.

Marc Almodóvar

Marc Almodóvar is the founder of the Men’s ADHD Support Group, a safe space where men could be vulnerable without judgment. It is the largest online community dedicated to men with ADHD and has since grown into a 501(c)(3) nonprofit, reshaping how the world views ADHD and men’s mental health. Diagnosed at 16, Marc turned his own challenges into advocacy, becoming a certified life coach at 23. He has been featured in Forbes and on top podcasts like I Have ADHD, and the ADHD Essentials Podcast.

#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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Building interpersonal connections is difficult — and essential – for people struggling with mood disorders. Specifically, reinforcing and repairing the parent-child relationship is critical work along the path to recovery for teens with depression. Here are six methods that can help caregivers.

#1. Open Up to Your Teen

Model what it looks and sounds like to talk openly about emotions. This shame-free dialog equips teens with a vocabulary to discuss their own moods, gives them an example of resilience, and de-stigmatizes mood issues. Talk about times when you felt sad, anxious, or irritable. Begin during the car ride home from school. Share that you had a tough day and give examples of ways you asked for help. This shows that seeking support is a sign of strength.

#2. Observe Behavior, Not Mood

When your teen seems down, you may be tempted to ask, “What’s the matter? Why are you upset?” However well-intentioned, this approach can trigger defensiveness or evasion. Instead, focus on observed behavior changes. “I noticed that you’ve been staying at home on weekends lately.” Concrete changes are more difficult to dismiss outright and more likely to trigger a conversation.

[Read: The Depression Treatment Gap for Teens and How to Close It]

#3. Challenge Black-and-White Thinking

Depression and anxiety can cause the brain to interpret people and situations as all good or all bad. Introduce a 1 to 10 rating scale to help your teen remember that most of life, including emotions, exists on a spectrum. Ask your child where they’re falling on an emotion or mood scale, and offer your own periodic self-ratings. You might say, “My social battery is at a three right now.” Such dialogue promotes awareness of subtle but key changes in mood – and possible causes. For example, you might offer: “Your mood was at a three, but, after your bike ride, it feels like a seven.”

Try replacing the typical “How was your day?” with: “Tell me two good things and one not-so-good thing about your day.” This sets up the idea that most days have both positive and negative moments. It helps teens who jump to the negative to search for the positive – or at least the neutral. It also invites more than a monosyllabic answer.

#4. Help Your Teen Deal with Negative Emotions

Despite our best efforts, we can’t snap our fingers and make our kids’ bad feelings vanish. That’s why we need to teach them resilience, which requires tolerating uncomfortable emotions.

[Free Resource: A Parent’s Guide to Depression in Teens]

When we suppress an emotion like sadness or anger, it can result in an uncontrollable expression of that feeling (rage). Teens need to feel their feelings. But when those feelings become overwhelming, they may need help tolerating them.

Demonstrate or suggest creative ways to engage with and discharge emotions. If your teen’s angry, listening to heavy metal and banging on drums might be helpful. Or maybe they need to lie in a hammock, petting their cat. The goal is to experience the emotion, rather than avoid it.

#5. Ask About Thoughts of Self Harm

To protect your teen from suicide, ask them about it directly. Don’t worry that asking, “Have you thought about hurting yourself?” will introduce a dangerous idea; research has clearly shown that this is not the case. In fact, many people who have survived suicide attempts say they wish somebody had asked them this question.

Asking about self-harm destigmatizes a taboo topic. It allows teens to feel more comfortable about sharing their thoughts, and gives parents the opportunity to secure effective help for them if needed. It also shows that parents can handle hearing about hard, even frightening, feelings.

#6. Seek Help When Needed

Depression sets in slowly and stealthily, so it may be unclear when to seek treatment. It’s almost always best to do so sooner rather than later. Effective depression medications (most of which are safe to use with ADHD medication) may complement therapeutic models like cognitive behavioral therapy, which helps teens assess and address negative or distorted thought patterns. Dialectical behavior therapy focuses on distress tolerance, mindfulness, emotional regulation skills, and interpersonal effectiveness skills. For teens with ADHD, effective depression treatment of ADHD, which impacts overall mood and self-esteem.

What are the Signs of Depression in Teens?

• Irritability or sadness
• Loss of interest in hobbies
• Sleeping too much or too little
• Withdrawing socially
• Changes in appetite
• Feelings of worthlessness or inappropriate guilt
• Suicidal thoughts or actions

Next Steps

• Read: Teen Girls Are Not Alright. ADHD Magnifies the Crisis.
• Download: Am I Depressed? Symptoms of Depression and ADHD, Untangled
• Watch: “Identifying Depression and Anxiety in Teens with ADHD“

Roberto Olivardia, PH.D., is a clinical psychologist and clinical instructor of psychology at Harvard Medical School.

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Chronic pain is more common in autistic children and teens with and without ADHD than it is in neurotypical youth. Conditions such as migraines, gastrointestinal pain, and musculoskeletal pain occur at significantly higher rates in neurodivergent populations, yet these symptoms are often overlooked or misunderstood by medical professionals and caregivers.

Emerging research suggests that autistic children and teens with and without ADHD may be more susceptible to developing chronic pain, perhaps because differences in sensory processing, emotional regulation, and communication shape how they experience and express pain. These unique factors can make it challenging for caregivers and health care professionals to recognize and address chronic pain in neurodivergent individuals.

If left unaddressed, chronic pain can profoundly impact a child’s daily life — affecting academic performance, physical function, social relationships, and emotional well-being.

In this webinar, experts in autism, ADHD, and chronic pain will provide insights into the science and lived experiences of children navigating these overlapping challenges. In this webinar, caregivers and professionals will learn:

• Why chronic pain is more common in autistic children with and without ADHD: How sensory differences, stress, and co-occurring conditions like anxiety may contribute to pain.
• How pain presents in unique ways: Why autistic children with and without ADHD may express or experience pain differently — and how this can make it harder to recognize.
• The impact on daily life: How chronic pain affects school, social interactions, and emotional health, and how pain-related distress may show up as irritability, withdrawal, or other behaviors.
• Strategies to reduce pain’s impact: Evidence-based approaches for caregivers, including medical interventions, coping tools, sensory supports, and environmental adjustments.
• How to communicate with doctors and teachers: Tips for navigating the healthcare and school systems and advocating for appropriate supports.

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 Chronic Pain, Autism, and ADHD: Resources

• Free Download: The ADHD-Autism Link in Children
• Read: Autism in Girls: Why Signs of Neurodivergence are Overlooked
• Read: How ADHD Can Intensify Physical Health Conditions
• Read: Comorbid ADHD Complicates Most Diagnoses and Treatment Plans
  

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Meet the Expert Speakers

Gloria T. Han, Ph.D., is an Assistant Professor in the Department of Anesthesiology, Division of Pain Medicine, at Vanderbilt University Medical Center. She also serves as a pediatric pain psychologist in the pediatric pain clinic at Monroe Carell Jr. Children’s Hospital at Vanderbilt, where she collaborates with physicians, physical therapists, and occupational therapists to support a high proportion of children and teens navigating autism, ADHD, and pain-related challenges. Dr. Han’s clinical and research efforts focus on the intersection of autism and chronic pain, particularly how features of autism — such as differences in sensory, emotional, and social information processing — may contribute to an increased vulnerability for chronic pain. By identifying these developmental pathways, she hopes to expand upon current evidence-based strategies for managing chronic pain and develop effective interventions tailored to the specific needs of neurodivergent youth facing these overlapping challenges.

Anna C. Wilson, Ph.D., is a Professor of Pediatrics at Oregon Health & Science University (OHSU). She is also a pediatric psychologist at the Pediatric Pain Management Clinic at OHSU/Doernbecher Children’s Hospital, which provides multidisciplinary care for children and teens with a variety of chronic pain conditions. Dr. Wilson’s research has focused on the prevention of chronic pain in children and adolescents, with a focus on studying how parents and parenting influence children’s pain experiences. She has also recently conducted work on how pain experiences in young people relate to ADHD symptoms. Her work has been supported by the National Institutes of Health, the Medical Research Foundation of Oregon, and the Friends of Doernbecher Children’s Hospital. Together with health journalist Rachel Rabkin Peachman, Dr. Wilson authored When Children Feel Pain: From Everyday Aches to Chronic Conditions (Harvard University Press, 2022). (#CommissionsEarned) This book tells the story of pain in childhood, why it has been poorly understood even by doctors and nurses, and how we can better support all children and reduce the negative impact of chronic pain.

#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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Children with ADHD endure frequent criticism or negative feedback from parents, teachers, other adults, and peers, and this steady stream of judgment often degrades their self-esteem. When emotional outbursts, poor social skills, and disorganization are misunderstood in school and at home, that may lead kids to internalize negative beliefs about themselves.

This webinar will offer age-appropriate practical tools to help adults build resilience and self-confidence in children with ADHD, from elementary school through high school. Participants will learn how to use supportive language, foster self-advocacy in their children, and apply strategies that make a lasting impact.

In this webinar, you will learn:

• • Why children with ADHD are prone to low self-esteem and how negative thinking patterns impact kids all the way through adulthood
  • About successful parenting strategies to build self-confidence across different age groups, including what to say and what is well-meaning but should be avoided
  • Practical scripts to teach kids how to advocate for themselves, manage criticism, and push back against stigma
  • Effective ways for parents to collaborate with schools and other professionals in supporting your child’s resilience and self-esteem
  • Subtle approaches to communicate with and educate others (e.g., coaches, other caregivers, extended family members) to incorporate more inclusive and compassionate language

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Play Attention is more than a tool – it’s a confidence-building program for children with ADHD. Shaped by over 3 decades of practice, proven outcomes, and research by Tufts University School of Medicine, Play Attention uses NASA-inspired neurotechnology to strengthen executive function. Your child can build self-control, improve focus, and develop the resilience to grow with confidence.

Take our online ADHD assessment or schedule a consultation to see how Play Attention can support lasting self-esteem and success. Home and professional programs available. www.playattention.com

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

Self-confidence and Resilience with ADHD: Resources

• • • Free Download: Evaluate Your Teen’s Emotional Control
    • Read: How to Invest In Your Child’s “Emotional Bank Account”
    • Read: Why We Feel So Much — and Ways to Overcome It
    • Read: 6 Behavioral Parent Training Programs for ADHD Families

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If you attended the live webinar on July 10, 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

Larisa Litvinov, Ph.D., is a senior psychologist in the ADHD and Behavior Disorders Center at the Child Mind Institute. Dr. Litvinov has more than 20 years of experience in the evaluation and treatment of behavioral, anxiety, and mood disorders in children, adolescents, and adults.

Dr. Litvinov has worked extensively with children who’ve been diagnosed with PTSD, depression, anxiety, and ADHD. She has expertise in dialectical behavior therapy (DBT), parent-child interaction therapy (PCIT), trauma-focused cognitive behavioral therapy (TF-CBT) and child-parent psychotherapy (CPP).

Dr. Litvinov has certifications in the Reflective Parenting Program and Adoption Specific Therapy (ADAPT), as well as PCIT. She also specializes in early childhood mental health and adoption-specific treatment. She has found that working with children who has experienced chronic trauma requires looking beyond the diagnoses and using the adoption, trauma, biological, and developmental lenses to understand and help children and their families.

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Listening to music while practicing mindfulness exercises may improve focus, mood, and emotional wellbeing in people with symptoms of ADHD, anxiety, and depression, according to two new studies.

A systematic review examining the relationship between music and ADHD found that music listening activates brain regions involved in sensory processing, motor control, and motivation — networks that are often dysregulated in individuals with attention deficit.¹

Traditional thinking suggests that quiet environments help sustain attention; however, the opposite may be true. The review, published in Behavioral Science, indicated that music, especially calm music with or without lyrics, can improve focus and performance in individuals with ADHD, especially when it is heard before or during tasks. Listening to music can also help filter out distractions, leading to improved learning and mood.

“People with ADHD benefit from ‘rhythmic entrainment,’ using strong, steady rhythms to imprint structure and consistency. This assists with regulation of attention and behavior,” said Roberto Olivardia, Ph.D., Clinical Instructor of Psychology at Harvard Medical School, during his presentation titled, “We Got the Beat: The Impact of Music on ADHD,” at the 2024 Annual International Conference on ADHD.

Listening to music could become counterproductive if it causes overstimulation or if the listener is doing a challenging task that requires significant cognitive resources, the researchers noted.

Music Therapy Boosts Emotional, Social Skills

Music listening may be self-directed or facilitated by a trained music therapist, as part of music therapy. Music therapy sessions often incorporate active music listening, playing instruments, songwriting, or singing, as well as passive music listening.

The review made a compelling case for using music therapy to complement ADHD medications and other recommended therapies, citing evidence for the efficacy of music therapy in reducing symptoms of ADHD. For example, active music-making can enhance working memory and social skills while decreasing aggression. Conversely, passive music listening may improve learning and reduce disruptive behaviors.

“These insights highlight the potential for music to contribute to more holistic, non-pharmacological approaches, offering individuals with ADHD new avenues for enhancing cognitive functioning and overall wellbeing,” the study’s authors wrote.

The systematic review included 20 studies published between 1981 and 2023, reflecting data from 1,170 participants aged 2 to 56 years. Several limitations exist: The studies primarily focused on children and adolescents, rather than adults. Variations in study methods and design also resulted in some inconsistent findings.

“Despite these limitations, this review provides a valuable foundation for future research on the interaction between ADHD and music,” the study’s authors wrote.

Mindfulness Paired with Music Reduces Stress, Improves Mood

Another recent, smaller study, published in Frontiers in Neuroscience, suggests that listening to music while performing mindfulness exercises activates areas of the brain and body related to stress and emotional regulation that could reduce moderate symptoms of anxiety and depression in adults.sup>2

The study, led by a team of researchers from the Yale School of Medicine, assessed the physiological impact of music mindfulness by recording heart rates and EEGs from 38 participants, aged 18 to 65, as they engaged in a bilingual, two-week mindfulness program centered on “focus” and “mindfulness.”

“Anxiety and depression reduce autonomic system activity, as measured by Heart Rate Variability (HRV), and exacerbate cardiac morbidity, while both music and mindfulness have been shown to increase HRV,” wrote the researchers.

They found that music mindfulness quickly improved HRV — a sign of better stress regulation — and changed brain wave patterns (measured by EEG) in areas of the brain linked to emotion, awareness, and decision-making.

Both virtual and in-person sessions incorporated similar guided mindfulness exercises, accompanied by live improvised music, music listening, or no music at all. In addition to wearing mobile heart rate and EEG monitors during each session, participants completed surveys regarding their stress levels, degree of mindfulness, state of consciousness, and level of social connection before and after each session.

The virtual group exhibited a significant decrease in stress and a significant increase in altered states of consciousness during the “focus” sessions, but not the “motivation” sessions. This contrasted with the in-person sessions, where stress decreased and mindfulness and altered state of consciousness increased during both Focus and Motivation sessions.

The researchers said that the differences in music composition features (tempo, key, mode) between “focus” and “motivation” sessions may explain the physiological differences observed in heart rate variability.

In-person sessions with music boosted feelings of social connection more than the virtual sessions did, underscoring the value of live, shared experiences in therapeutic settings.

“Our results imply that, while virtual sessions reduce stress, they do not have as extensive an effect on psychological states as in-person sessions do,” the researchers wrote. “Important aspects of live social interaction may drive feelings of social connection and serve as a key differentiator between live and virtual sessions.”

The researchers also observed gender-specific effects via HRV; women appeared to benefit more physiologically from music mindfulness than men.

While the findings from the Behavioral Science and Frontiers in Neuroscience studies contribute to a growing body of evidence supporting the use of music as a viable adjunct treatment for ADHD and mood disorders, both research teams emphasize the need for further investigation. Future studies would include randomized controlled trials, long-term outcome assessments, and greater representation of adult populations.

Sources

¹Saville, P., Kinney, C., Heiderscheit, A., Himmerich, H. (2025). Exploring the intersection of ADHD and music: A systematic review. Behav. Sci. https://doi.org/10.3390/bs15010065

²Ramirez, C., Alayine, G.A., Akafia, C., Selase, K., Adichie, K. et al. (2025). Music mindfulness acutely modulates autonomic activity and improves psychological state in anxiety and depression. Frontiers in Neuroscience. https://doi.org/10.3389/fnins.2025.1554156

Serotonin neurons signal to the brain the expected value of near-future rewards, a discovery that helps to clarify the neurotransmitter’s complex role in regulating mood, learning, and more, according to a new study in Nature. ¹ The research puts forth a unifying theory that makes sense of previously irreconcilable contradictions regarding the understanding of how serotonin functions, based on what its interdisciplinary team of scientists from the University of Ottawa calls a “prospective code for value.”

Serotonin, involved in the regulation of everything from mood and movement to appetite and sleep, has been historically deemed a “feel good” chemical. However, previous research revealed that serotonin is activated by pleasure, pain, and surprise, a finding that led scientists to suspect that its role in the central nervous system is more complex than was previously understood.

The Canadian researchers combined ideas from reinforcement learning theory (used to understand learning, behavior, and decision making) with insights into the properties of the dorsal raphe nucleus (the region of the brain containing neurons that release serotonin) to arrive at a nuanced understanding of the messages sent by the serotonin system.

The study found that serotonin tells the brain what reward to expect in the near future, information the brain needs to make decisions about what to do next. This function of serotonin may resemble that of dopamine, which is centrally involved in reward prediction. In fact, the authors were inspired by advances in the dopamine research field, which have paved the way for research of this kind.²

“Your brain needs to compute the expected value of the actions you contemplate and undertake as you interact with a changing world,” explains Jean-Claude Béïque, Ph.D., co-author of the study and professor in the Department of Cellular and Molecular Medicine. “What we think serotonin actually does in the brain is encode the expected value of a particular environment or course of actions in order to ultimately guide everyday decisions.”

This unifying theory explains why serotonin neurons are activated by both rewards and punishments, why they are more strongly activated by surprising rewards but not by surprising punishments and why negative uncertainty results in slow changes in neuron activity.

According to the study’s lead author, Emerson Harkin, Ph.D., the serotonin system is essentially updating the brain with the following message: “Here’s our best guess about how good your near future will be, and here’s how quickly that guess is improving.”

“Serotonin might promote patient waiting by increasing perceived reward availability,” the authors write regarding the brain’s response to the serotonin-fueled information it receives. “Whether serotonin sustains reward-seeking behavior in general, and how this relates to behavioral reinforcement, remains unclear.”

Implications for Understanding ADHD, Depression, and More

This new research may impact scientific thinking about ADHD, which impacts the brain’s reward system.

“Key aspects of the dopamine reward system are underactive in ADHD brains, making it difficult to derive reward from ordinary activities,” explains Ellen Littman, Ph.D., in the ADDitude article “Never Enough? Why ADHD Brains Crave Stimulation.” “Deficits in the reward pathway, including decreased availability of dopamine receptors, decrease motivation. Indeed, ADHD brains struggle to sustain motivation when rewards are mild or are linked to long-term gratification.”

The research may also inform the treatment of mood disorders like depression, in which serotonin is thought to play a central role. Selective serotonin reuptake inhibitors (SSRIs) that increase levels of serotonin in the brain are the first-line treatment for depression, which affects 21.9 million adults in the U.S (8.5% of all adults).³

Among individuals with ADHD, depression is the second most common comorbidity. The risk of developing depression is about 2.5 times higher for people with ADHD than it is for the general population. What’s more, for people with mood disorders, having comorbid ADHD is associated with an earlier onset of depression, more recurrent episodes, more frequent hospitalizations, and higher risk of suicide.⁴

It’s unclear whether the new research will impact interventions for depression or neurodevelopmental disorders, however a deeper understanding of what Harkin calls the brain’s “notoriously difficult to understand” neurons is noteworthy.

Sources

¹Harkin, E.F., Grossman, C.D., Cohen, J.Y. et al. A prospective code for value in the serotonin system. Nature (2025). https://doi.org/10.1038/s41586-025-08731-7

²Sousa, M., Bujalski, P., Cruz, B., et al. Dopamine neurons encode a multidimensional probabilistic map of future reward. bioRxiv (2023).11.12.566727; doi:https://doi.org/10.1101/2023.11.12.566727

³Substance Abuse and Mental Health Services Administration. (2023). Key Substance Use and Mental Health Indicators in the United States: Results from the 2023 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.

⁴McIntyre RS, Kennedy SH, Soczynska JK, Nguyen HT, Bilkey TS, Woldeyohannes HO, et al. Attention-deficit/hyperactivity disorder in adults with bipolar disorder or major depressive disorder: results from the international mood disorders collaborative project.

Children and adolescents with avoidant restrictive food intake disorder (ARFID) are more likely to have comorbid neurodevelopmental and psychiatric disorders like autism, ADHD, and anxiety, according to a new study¹ published in The Journal of Child Psychology and Psychiatry.

Among the 30,795 children included in the large-scale study, those with ARFID (n=616) were 14 times more likely to have autism and nine times more likely to have ADHD than were children without ARFID. They also demonstrated an increased risk for OCD, separation anxiety, generalized anxiety disorder (GAD), depression, learning disorders, conduct disorder, and more.

These results stand out amid the relatively scarce research data on ARFID, an eating disorder added to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) in 2013.

“This study is one of the few large-scale epidemiological investigations of ARFID comorbidities in a general population sample,” the researchers wrote. “The findings emphasize the importance of incorporating routine screening for neurodevelopmental disorders, anxiety, and depression into ARFID assessments.”

Individuals with ARFID avoid foods based on sensory characteristics, a lack of interest in eating, and/or fear-related concerns over adverse eating experiences — not due to the body image concerns that compel other eating disorders like anorexia nervosa. ARFID is characterized by a “failure to meet appropriate nutritional and/or energy needs.”

Despite affecting 1-2% of children and adolescents², ARFID is often excluded from eating disorder discourse and clinical examinations. ARFID’s high comorbidity can complicate symptom identification, according to researchers.

“It’s important to really think about those with ADHD being at risk for a variety of eating disorder thoughts and behaviors, not just binge eating,” said Christine Peat, Ph.D., in a 2024 ADDitude webinar, “Eating Disorders Comorbid with ADHD: What You Need to Know About ARFID, Anorexia, and Others.” “In clinical contexts, ARFID and atypical anorexia nervosa may be overlooked, even in very routine eating disorder screenings.”

The study’s results emphasize the importance of identifying ARFID, the diagnosis of which may shed light on comorbidities.

“Early identification of these comorbidities can facilitate timely, targeted interventions and improve treatment outcomes,” the researchers wrote.

One ADDitude reader, Tiffany Bird, suffered decades of poor health before being diagnosed with ARFID in her late 20s. “For the first time, a doctor fully examined me and determined that I’ve been severely malnourished my entire life, no matter what ‘the numbers’ might have said. It made complete sense,” wrote Bird in an ADDitude guest blog post, “I went Over 25 Years Without Consuming a Vegetable.”

ARFID and Neurodevelopment Disorders

The study examined parent reports for 30,795 children born between 1992 and 2008, at 9 or 12 years old (depending on their cohort), from the Child and Adolescent Twin Study in Sweden. The parents rated their child using three measures of neurodevelopmental and psychiatric disorders: the A-TAC inventory, the Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Short Mood and Feelings Questionnaire (SMFQ). The researchers examined the relationship between having ARFID and showing symptoms of other disorders using linear and logistic regressions.

The link between ADHD and ARFID found in the study reflects preliminary research in this area. According to Peat, one study found that 25% of adults with ARFID also had ADHD, and another reported that 10% of children and adolescents with ARFID had been diagnosed with ADHD at some point in their lives.

“We are so far from having causal explanations for this overlap,” Peat said. “But maybe kids and adults with ADHD are just sort of more biologically predisposed to have difficulty with sensory characteristics with food, so maybe that makes them more vulnerable to going on to develop something like ARFID.”

The study’s results regarding autism and ARFID also mirror prior research. One meta-analysis reported that autism was present in 16% of individuals with ARFID³.

People with ARFID are more likely to have autism than those without, and vice versa, possibly due to heightened sensory issues and inflexibility due to anxiety around change, both symptoms of autism, according to an article in ARFID Awareness UK.

ARFID and Psychiatric Disorders

According to the study, children with ARFID were four to six times more likely to have a psychiatric disorder, with OCD and anxiety presenting the greatest risks.

The most common type of anxiety found in the study was separation anxiety, which contrasts previous research that found GAD to be more common. This could be because of the younger age of onset characteristic of separation anxiety or younger age of the sample, the researchers wrote. However, they also hypothesize another reason their results differed.

“One hypothesis worth exploring is that separation anxiety is increased in ARFID because children fear separation from caregivers due to the potential for unanticipated exposure to feared foods or feeding-related situations,” the researchers wrote.

The study also found a higher rate of oppositional defiant disorder (ODD) (19.4%) than reported in previous studies, suggesting a possible overlap of symptoms between the two disorders.

“Our findings suggest that food-related conflicts may underlie the observed risk of ODD in ARFID, but further research is needed to confirm this association,” the researchers wrote.

Children with ARFID were found to face a higher risk for anxiety than depression. Depression is common among children with other eating disorders, according to the researchers. This discrepancy in comorbidities highlights the differences between ARFID and other eating disorders.

“The defining feature [of ARFID] is a persistent and pervasive eating or feeding disturbance in which someone is simply not meeting all of their nutritional needs,” Peat said. “In ARFID, these people don’t necessarily have that fear of fat or fear of weight gain.”

Gender and ARFID

Prior research may suggest that ARFID is more common in young males. However, this study found no gender-based differences in comorbidity rates associated with ARFID, meaning that the likelihood of having symptoms of another disorder in conjunction with ARFID did not significantly differ based on sex.

The results did indicate that, overall, boys had higher odds of developing a neurodevelopmental disorder, depression, and sleep problems; girls had higher rates of anxiety disorders (except for panic disorder).

“Unlike other eating disorders, the distribution of males and females with ARFID has been reported to be approximately equal,” the researchers wrote. “Given the sex differences observed in the prevalence of (neurodevelopmental disorders) and psychiatric conditions, it is important to investigate whether these sex differences are also present in individuals with ARFID.”

The study’s sample did not include transgender and nonbinary youth, a major limitation considering that transgender, nonbinary, and gender-expansive kids are at higher risk for eating disorders compared with their cisgender peers.

“There remains an urgent need to develop integrated treatment approaches that address both ARFID and its co-occurring conditions,” the researchers wrote.

Sources

¹ Nyholmer, M., Wronski, M.-L., Hog, L., Kuja-Halkola, R., Lichtenstein, P., Lundström, S., Larsson, H., Taylor, M.J., Bulik, C.M. and Dinkler, L. (2025), Neurodevelopmental and psychiatric conditions in 600 Swedish children with the avoidant/restrictive food intake disorder phenotype. J Child Psychol Psychiatr. https://doi.org/10.1111/jcpp.14134

² D’Adamo, L., Smolar, L., Balantekin, K.N., Taylor, C.B., Wilfley, D.E., & Fitzsimmons-Craft, E.E. (2023). Prevalence, characteristics, and correlates of probable avoidant/restrictive food intake disorder among adult respondents to the National Eating Disorders Association online screen: A cross-sectional study. Journal of Eating Disorders, 11, 214. https://doi.org/10.1186/s40337-023-00939-0

³ Sader M, Weston A, Buchan K, Kerr-Gaffney J, Gillespie-Smith K, Sharpe H, Duffy F. (2025) The Co-Occurrence of Autism and Avoidant/Restrictive Food Intake Disorder (ARFID): A Prevalence-Based Meta-Analysis. Int J Eat Disord. 58(3):473-488. https://doi.org/10.1002/eat.24369

Spravato, the esketamine nasal spray approved in 2019 for use alongside oral antidepressants for treatment-resistant depression, has been approved by the U.S. Food and Drug Administration (FDA) as a standalone monotherapy with no oral medication required.

Esketamine is a form of the dissociative agent ketamine, commonly used as an anesthetic; it works by targeting the neurotransmitter glutamate. According to a randomized, double-blind, placebo-controlled study, 22.5% of patients who took Spravato alone for four months achieved remission from depression (as measured by MADRS) compared with 7.6% of patients taking placebo.¹

Common side effects in clinical trials were disassociation, dizziness, nausea or vomiting, sedation, headache, decreased sensitivity, anxiety, increased blood pressure, and feeling of intoxication. Due to these potential risks, the treatment is available only through the Risk Evaluation and Mitigation Strategy Program and must be self-administered in certified health care settings. Spravato is approved for use in adults with major depressive disorder (MDD) who have had an inadequate response to two or more oral antidepressants.

Eight percent of Americans suffer from MDD, with far higher rates of prevalence found among people with ADHD. According to a decade-long study that looked at nearly 400,000 young adults with ADHD and an equal number of neurotypical young adults, approximately half of the ADHD group had a diagnosed depressive episode — more than twice the frequency seen in the non-ADHD group. The rate of attempted suicide was four times higher among the ADHD group than in the neurotypical control. ²

These findings echoed the results of an earlier study of people with mood disorders that found having comorbid ADHD was associated with a higher risk of suicide, more frequent hospitalizations, more recurrent episodes, and an earlier onset of depression.³

“MDD affects every aspect of a person’s life and makes it seem as though life is not worth living,” writes William Dodson, M.D., LF-APA, a psychiatrist specializing in adult ADHD, in his ADDitude article, “6 Unexpected Signs of Depression.” “The World Health Organization ranks depression as the single largest contributor to global disability.⁴ It’s a serious problem that needs to be addressed.”

Spravato may increase blood pressure and heart rate, a side effect also common with stimulant medications used to treat ADHD, like Adderall and Ritalin. Thus, taking both medications may increase risk of high blood pressure. This is one reason healthcare providers monitor patients’ heart rate and blood pressure in the two hours after medication is administered.

Treatment-Resistant Depression: Readers’ Experiences

About a third of individuals with depression find no relief from oral antidepressants.⁵ Consequently, millions of Americans who have tried multiple kinds of depression medication continue to struggle with symptoms like hopelessness and suicidality.

In recent years, a growing number of these individuals have sought relief through the monitored use of ketamine, a close relative of esketamine. FDA-approved as an anesthetic, ketamine must be used “off-label” to treat depression.

“I took ketamine for complex PTSD, depression, and suicidal ideation and it helped massively,” says Mia, an ADDitude reader in Texas.

Bob, a reader in Arizona explains that ketamine-assisted therapy helped him “immensely” with his depression: “My psychiatrist offered ketamine treatments for patients with treatment-resistant depression who likely would have checked themselves into a psychiatric hospital otherwise.”

Karlyn, in South Africa, credits ketamine treatments, recommended by her psychiatrist, with helping her through a period of acute suicidality when nothing else worked: “It was the best drug that I have ever used for the treatment of depression.”

Sources

¹Janik A, Qiu X, Lane R, et al. SPRAVATO (esketamine nasal spray) as a monotherapy for treatment-resistant depression (TRD). American Society of Psychopharmacology Annual Meeting.; May 28-31, 2024. Poster W80.

²Babinski DE, Neely KA, Ba DM, Liu GL (2020) Depression and suicidal behavior in young adult men and women with ADHD: Evidence from claims data. Journal of Clinical Psychiatry, 81 (6) 7-13.

³Zhang, Z., Zhang, L., Zhang, G., Jin, J., & Zheng, Z. (2018). The effect of CBT and its modifications for relapse prevention in major depressive disorder: a systematic review and meta-analysis. BMC Psychiatry, 18. https://doi.org/10.1186/s12888-018-1610-5.

⁴Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017, https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf

⁵Zhdanava M, Pilon D, Ghelerter I, Chow W, Joshi K, Lefebvre P, Sheehan JJ. The Prevalence and National Burden of Treatment-Resistant Depression and Major Depressive Disorder in the United States. J Clin Psychiatry. 2021 Mar 16;82(2):20m13699. doi: 10.4088/JCP.20m13699. PMID: 33989464.

Spravato (generic name: esketamine) is the first and only FDA-approved nasal spray used for adults with treatment-resistant depression. Depression is considered “treatment-resistant” when individuals have tried at least two different oral anti-depressant medications and symptoms persist. An estimated 30% of people with major depressive disorder have treatment-resistant depression¹.

In 2019, the U.S. Food & Drug Administration approved Spravato for use alongside an oral antidepressant; in early 2025, the spray was authorized as a standalone treatment. A recent Phase 4 clinical trial¹ found that, four weeks after starting Spravato, 22.5% of participants with major depressive disorder who took the nasal spray alongside an oral antidepressant achieved remission from depression symptoms, compared to 7.6% of participants achieving relief on an oral antidepressant and placebo spray.

It is not known whether SPRAVATO® is safe and effective in children.

How Does Spravato Work?

Spravato works by blocking a receptor in the brain activated by glutamate, a chemical messenger. This mechanism is similar to that found in other antidepressants, which target receptors for chemical messengers like seratonin and dopamine.

What Ingredients Are in Spravato?

The main active ingredient in Spravato is esketamine, which is conventionally used as an anesthetic similar to its parent compound, ketamine. Esketamine is more concentrated than ketamine, requiring a lower dose for efficacy.

Inactive ingredients include citric acid monohydrate, edetate disodium, sodium hydroxide, and water.

How Do You Use Spravato?

The medication is an intranasal spray that is self-administered under the supervision of a healthcare provider at a certified SPRAVATO® treatment center. Patients are required to remain for at least two hours after administration, so healthcare providers can monitor any side effects.

To prevent nausea, it is recommended that patients do not eat at least two hours before receiving the drug and not drink at least 30 minutes before.

What Is the Dosage for Spravato?

The optimal dosage of Spravato varies by patient. The typical dose is 28 mg (two sprays), administered biweekly.

For updated information about dosages, interactions, and precautions, see the Spravato (Esketamine) drug monograph on WebMD.

What Side Effects Are Associated with Spravato?

The most common side effects include:

• Disassociation (feeling disconnected from yourself, thoughts, feelings, and surroundings)
• Dizziness/spinning sensation
• Nausea/vomiting
• Sedation, sleepiness, lack of energy
• Decreased feeling of sensitivity
• Anxiousness
• Increased blood pressure
• Feeling intoxicated
• Headache
• Feeling very excited or happy

Side effects will typically occur 40 minutes after taking the drug and tend to go away within two hours.

Spravato also may have serious side effects, including:

• Allergic reactions: breathing problems, racing heart, fever, stomach cramps
• Memory or thinking problems: unusual changes in judgment/decision-making, trouble concentrating or paying attention, and remembering things
• Bladder problems
• Breathing problems: slow or shallow breathing
• May increase the risk of suicidal thoughts or actions

Consult your healthcare provider about these possible side effects before beginning Spravato.

Visit the Spravato website to see the full list of side effects.

What Precautions Are Associated with Spravato?

You should not take Spravato if you have a history of blood vessel disease or brain bleeding, an abnormal connection between your veins and arteries, or are allergic to esketamine, ketamine, or any other ingredients in Spravato.

Taking Spravato can lead to physical and psychological dependence. If you have a history of drug or alcohol abuse, make sure to discuss it with your doctor before taking Spravato.

This spray has not yet been proven safe and effective for children or for reducing and preventing suicidal thoughts.

Does Spravato Interact with ADHD Stimulants?

Spravato may increase blood pressure and heart rate, a side effect also common with stimulant medications used to treat ADHD, like Adderall and Ritalin. Thus, taking both medications may increase risk of high blood pressure. This is one reason healthcare providers monitor patients’ heart rate and blood pressure in the two hours after medication is administered.

Can You Take Spravato with Another Antidepressant?

According to the label, SPRAVATO® can be used:

• “with or without an antidepressant taken by mouth, to treat adults with treatment-resistant depression”
• “with an antidepressant taken by mouth, to treat depressive symptoms in adults with major depressive disorder (MDD) with suicidal thoughts or actions.”

What Else Does Spravato Interact With?

When taken with central nervous system depressants, like opioids and benzodiazepines, patients may experience excessive drowsiness and dizziness. The risk of experiencing dizziness and sleepiness may increase with alcohol consumption while taking Spravato.

There are no known interactions between Spravato and foods, herbs, and vitamins. Cannabis use may increase risk of side effects. Patients should discuss these and any other interactions with their healthcare providers.

Limitations of Use

SPRAVATO® is not for use as a medicine to prevent or relieve pain (anesthetic). It is not known if SPRAVATO® is safe or effective as an anesthetic medicine or if it is safe and effective for use in preventing suicide or in reducing suicidal thoughts or actions.

Spravato Nasal Spray and Other Depression Medications: Next Steps

• Read: Treatments for Depression and ADHD: New and Forthcoming Approaches
• Read: What to Expect When You Start Depression Medication
• Self-Test: Depression in Adults
• Free Download: Understanding Depression in Teens
• Read: How to Treat Depression

Sources

¹ Mayes, S.D., Becker, S.P. & Johnson & Johnson pivotal study of seltorexant shows statistically significant and clinically meaningful improvement in depressive symptoms and sleep disturbance outcomes. (2024, May 29). JNJ.com. https://www.jnj.com/media-center/press-releases/johnson-johnson-pivotal-study-of-seltorexant-shows-statistically-significant-and-clinically-meaningful-improvement-in-depressive-symptoms-and-sleep-disturbance-outcomes

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