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Our understanding of and diagnostic criteria for autism, a lifelong condition, have evolved considerably over the last 50 to 60 years. One fall-on effect of this awareness: Many autistic adults overlooked or misdiagnosed in childhood are finally pursuing an evaluation. This population is sometimes called “the lost generation.”

Today, there remains a significant lack of information and understanding about the unique needs, supports, and challenges of autistic people in midlife and at older ages. This webinar will highlight autism and aging as a rapidly advancing and important area of research, and it will provide approaches to help autistic adults live full and happy lives.

In this webinar, you will learn:

• About the historic changes to diagnostic criteria that resulted in some 90 percent of autistic people receiving diagnoses at and after age 50 worldwide
• How complementary conceptual approaches can be used to examine aging in autism (i.e., dimensional trait-based approaches and categorical diagnosis-based approaches)
• What recent empirical research findings tell us about aging as an autistic person, covering a range of studies related to cognition, health, wellbeing, and life experiences
• How the information gained from these studies can be pieced together to create a broad picture of where support can be provided to improve the quality of life and outcomes of older autistic adults to ensure they live long and happy lives

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

Autism in Adults: Resources

• • • Free Download: The Truth About Autism in Adults
    • Read: AuDHD: ADHD and Adult Autism Symptoms, Diagnosis & Interventions for Both
    • Read: Q: How Can I Get Evaluated for Autism as an Adult?
    • Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus

Meet the Expert Speaker

Gavin Stewart, Ph.D., is a senior postdoctoral research fellow at King’s College in London. He is an expert in autism and aging, and his research takes a multifaceted approach to explore the life experiences of autistic people across adulthood and as they age.

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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I used to think autism meant headbanging or stimming in obvious ways. I didn’t see myself in the stereotypes, and I definitely didn’t think it explained my chaos. But then came TikTok.

It started innocently enough. Like many people, I downloaded the app during the pandemic to see what the fuss was about. The algorithm didn’t take long. Almost instantly, my For You page was filled with chaotic, rainbow-haired women my age talking about ADHD and autism. Women who looked like me. Women who were me.

I didn’t even have to search. They just appeared — video after video of people with the same explosive personality traits, the same sensory issues, the same thought patterns. The same trauma responses. The same jokes. The same blue hair.

At first, it was comforting. “That’s me!” I’d laugh. “Oh my God — that’s so me!” But then the laughter started to sting.

[Read: “I’m ‘The ADHD Doctor’ on TikTok. Here’s How the App Has Changed Me.”]

One video hit particularly hard. A woman — split-dyed blue and black hair, like mine — left her house to grab blueberries. The timestamp showed it had been over an hour when she came back through the door with five full shopping bags, arms overflowing. Her husband called out, “Did you get the blueberries?” And her face froze in horror. She hadn’t. She’d forgotten the one thing she went out for. I laughed out loud… then felt punched in the gut. Because I had done that exact thing — only with orange juice.

Once the algorithm clocked my reaction, it doubled down. Every time I opened the app, I saw someone like me: brushing their teeth and suddenly realizing the toilet roll needed changed… which led to changing the bin… which led to discovering their toothbrush in the kitchen beside the bin they forgot to empty. These bizarre, tangled thought spirals I thought were unique to me were suddenly just… everywhere.

As my friends discovered the app, my inbox started to fill with more versions of myself — daily scenarios acted out by strangers who looked like me, always with the same message: “This is so you.” People even said it in person: “You know that girl — the one who’s basically you on the Internet,” when they were talking about an AuDHD video.

And that’s when it hit me. I wasn’t special. I was one of thousands. Millions, even.

Weirdness as Identity, Stolen by TikTok

All my life, I’d felt weird, different. I had clung to that as a form of identity. Even when it hurt, even when I felt alone, I had accepted my quirks as mine. But TikTok held up a mirror I hadn’t requested — and in that mirror, I saw not one reflection, but hundreds. Thousands. My traits, once mine alone, were playing out on screens all over the world. It felt like I’d been cloned and scattered across the Internet.

That realization spiraled into a strange grief. I was relieved to have answers for my lifelong struggles, yes. But at the same time, I was grieving the person I thought I was. I had worn my difference like armor — if I couldn’t blend in, I’d be the loudest, weirdest one in the room. I didn’t realize how much of my identity hinged on feeling like the only one.

Seeing “me” reflected back so often, in so many strangers, made me feel exposed. Invisible, even. Was I just ADHD sprinkled with some autism — another neurodivergent stereotype of blue hair and mandalas? Had anything about me ever been unique?

I Don’t Need to Be One-of-a-Kind

For weeks, I found myself torn. I kept scrolling through these videos that made me laugh, cry, and feel understood. But they also made me feel hollow. Like my sense of self had dissolved. I started snapping the app shut, unable to face the steady stream of doppelgängers.

And then one night, I looked at my son — this messy, brilliant little boy who shares many of my quirks — and something shifted.

If I can see myself everywhere… maybe that means I was never alone.

Maybe there’s comfort in that.

Maybe I’m not a diluted version of a stereotype, but a real, whole person who happens to be neurodivergent — like so many others. And maybe that’s not a bad thing. Maybe it’s a blessing. Maybe I can see the humor in this — the light in myself by seeing it in others like me.

Because if I can find myself in all of these strangers, then maybe he will, too.

Maybe he’ll grow up seeing himself everywhere and never feel the kind of loneliness I felt as a child.

Maybe the weird won’t feel weird at all. That’s all I can hope for.

These days, I still fall into the TikTok rabbit holes. I still see my reflection in strangers. But now I feel a little more grounded. A little more grateful. I’m learning to let go of the need to be “one of a kind,” and embracing the strange, beautiful truth that we are never as alone as we think.

I may not be the only blue crayon in the box — but I’m still here, coloring outside the lines.

AuDHD in Women: Next Steps

• Read: TikTok Is My Therapist — The Dangers and Promise of Viral #MentalHealth Videos
• Read: ADHD, Autism, and Neurodivergence Are Coming Into Focus
• Read: “5 Unique Features of AuDHD in Women”

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

Some psychiatric disorders commonly co-exist because they share genes, according to a large study published in Nature that analyzed the genetic data of more than 6 million people worldwide.¹

International researchers examined and traced genetic connections among 14 conditions, including ADHD, anxiety disorders, autism spectrum disorder, bipolar disorder, major depression, schizophrenia, obsessive-compulsive disorder, Tourette syndrome, post-traumatic stress disorder (PTSD), and substance use disorders, such as opioid-use disorder, cannabis-use disorder, and nicotine dependence.

They identified 428 genetic variants linked to more than one disorder, along with 101 regions, or “hot spots,” on chromosomes with high concentrations of shared genetic variants.

Using statistical modeling, the researchers determined that the 14 studied conditions clustered into five groups of conditions that shared high genetic overlap:

1. compulsive disorders: obsessive-compulsive disorder, anorexia nervosa, and, to a lesser extent, Tourette disorder and anxiety disorders
2. internalizing disorders: major depressive disorder, anxiety disorders, and PTSD
3. neurodevelopmental disorders: ADHD, autism spectrum disorder, and, to a lesser extent, Tourette disorder
4. schizophrenia and bipolar disorder
5. substance use disorders: opioid use disorder, cannabis use disorder, alcohol use disorder, nicotine dependence, and, to a lesser extent, ADHD

The internalizing and substance use disorder groups demonstrated particularly high levels of shared genetic risk: Major depression, anxiety disorders, and PTSD shared about 90% of their genetic risk; schizophrenia and bipolar disorder shared roughly two-thirds of their genetic markers.

ADHD and autism spectrum disorder showed a strong genetic correlation, suggesting the two conditions share many of the same genetic risk factors. A separate study published in October 2025 found that later-diagnosed autism (after age 10) had a more significant genetic correlation to ADHD, as well as mental health conditions like depression and PTSD, compared to autism diagnosed at age 6 or younger. ²

The researchers also found that disorders with shared genetic risk often exhibit similar biological patterns in the specific genes active during development and the types of brain cells they affect. For example, genes active in oligodendrocytes (brain cells responsible for maintaining neuronal health in the central nervous system) were more strongly associated with internalizing disorders. In contrast, genes active in excitatory neurons, which stimulate other neurons, were more closely associated with schizophrenia and bipolar disorder.

About half of all people who meet the criteria for one psychiatric disorder will be diagnosed with a second or third condition in their lifetime.^{3, 4} According to a 2023 ADDitude survey of 1,500 readers, anxiety and depression are the two most common co-occurring conditions diagnosed alongside ADHD in adults, with co-diagnosis rates of 72% and 70%, respectively.

According to the researchers, this study represents the largest and most comprehensive analysis to date of genetic overlap among 14 psychiatric conditions. Findings from the study may help researchers and clinicians better understand the biological connections among psychiatric conditions and lead to more tailored treatments for patients.

Source

¹Grotzinger, A.D., Werme, J., Peyrot, W.J. et al. (2026). Mapping the genetic landscape across 14 psychiatric disorders. Nature. https://doi.org/10.1038/s41586-025-09820-3

²Zhang, X., Grove, J., Gu, Y., Buus, C. K., Nielsen, L. K., Neufeld, S. A., Koko, M., Malawsky, D. S., Wade, E. M., Verhoef, E., Gui, A., Hegemann, L., Geschwind, D. H., Wray, N. R., Havdahl, A., Ronald, A., St Pourcain, B., Robinson, E. B., Bourgeron, T., Warrier, V. (2025). Polygenic and developmental profiles of autism differ by age at diagnosis. Nature. https://doi.org/10.1038/s41586-025-09542-6

³ Kessler, R.C. et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch. Gen. Psychiatry. https://doi.org/10.1001/archpsyc.62.6.593

⁴Kessler, R.C., Chiu, W.T., Demler, O. & Walters, E.E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch. Gen. Psychiatry. https://doi.org/10.1001/archpsyc.62.6.617

To complement ADDitude magazine’s Spring 2026 cover story on autism, we invited readers to share artwork that captures the diversity and depth of life on the spectrum for them. Here, we spotlight seven artists whose artwork is as varied as the autistic community itself.

“My art is as detailed as my cluttered brain folds, and the detailed artworks that conceal things in the nooks and crannies are most representative of how this autistic person sees the world.”

Kimberly Gerry-Tucker
Connecticut

“I painted this piece to understand myself better, to feel free and renewed. This piece represents strength and humility talking with each other in my inner universe.”

Marcele Silvina Rodrigues White
Epsom, United Kingdom

“I originally painted this piece to explore colors and textures and to capture the magic I see in nature. As a neurodivergent person, this painting is me: bright, bold, beautiful, and sometimes, a little chaotic, just like Mother Nature.”

Casey-Lee Flood
Hai’kū, Hawaii

“I drew this image because, my whole life, I felt like an alien who didn’t belong. Today, this alien stands proud in a sea of other neurodivergent folks. I finally feel seen and accepted for who I am.”

Cat Contillo
Newburgh, New York

“Many people are under the false understanding that individuals with autism are restricted by their diagnosis and act according to their prescribed identity. The sky here is visible and asks for attention, just as autism is still characterizing and relevant but isn’t the most important thing on the canvas.”

Lilly Corradetti
Ontario, Canada

“There is beauty and vibrance in embracing neurodivergence. I have learned to move with the dance of darkness, light, and color, in the emergence of self, and integrating who I am.”

Angela Taylor
Winnipeg, Manitoba, Canada

“I wanted to portray the complexities of what it is like for neurodivergent people to mask, and how much of ourselves we lose in the process. It is my first piece of work, and, because of that, I found it cathartic to finally put my experiences of masking down on canvas. As chaotic as it looks, it’s very real.”

Lilya Taylor
Portsmouth, United Kingdom

Understanding Autism: Next Steps

• Free eBook: The Truth About Autism in Adults
• Read: “My Art Style is Expressive, Bold, and Moving — Like Me.”
• Read: “A Big Part of Unmasking Is Honoring Your Limits”

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

Today, Vittert is a NewsNation TV anchor and author of a book with Don Yaeger. Born Lucky: A Dedicated Father, A Grateful Son, and My Journey with Autism (#CommissionsEarned) illuminates the ferocity of parental love and support in the face of adversity. Here, he speaks with ADDitude.

Q: Why did you write this book with your dad, and why now?

LV: We wrote this to give parents the hope that my parents didn’t have when I was diagnosed. I had behavioral issues and sensory issues. My parents were told by an expert that it was difficult to know what was going on in my mind and that they couldn’t do much for me.

Born Lucky is a love letter to my dad, who encouraged me to reach my full potential. It follows the arc of my development from not being able to understand human interaction to being able to get along and function in the real world. We want parents to know that they have enormous agency and power to affect the outcomes of their kids’ lives.

Q: Can you talk more about the challenges of growing up autistic and how, as you say in the book, it led you to become resilient?

[Is My Child on the Autism Spectrum? Take This Test To Learn More]

LV: I was in and out of four schools by fifth grade. Two weeks into seventh grade, the principal told my parents, “Everyone in this school thinks Lucky is weird and, frankly, I do too.”

I had lots of meltdowns. If a kid touched me in line, I’d turn around and hit them because touch felt very threatening to me. If kids were being serious, I’d tell a joke. I didn’t understand how to interact, and the rejection was so persistent and stinging that I cried myself to sleep every night.

My dad was my best and only friend. He gave me an immense amount of love and care, and he always made me go to school the next day. My parents were very clear that I could not expect the world to change for me. This made me resilient. I always say the best training for the Washington newsroom was middle school!

In 2021, I had just been asked to leave by my employer, Fox News, had broken up with my longtime girlfriend, and was living in my parents’ guest bedroom. My dad and I were talking one night, and I was feeling sorry for myself. He said, “If you could get up and go to school day after day as you did in eighth grade, you can get through this.”

[Get This Free Download: What Are Your Teen’s Weakest Executive Functions?]

Q: How did you build the social skills you felt you needed to interact with people? 

LV: I still struggle every day with the things my dad and I worked on for 15 years: how to listen, how to understand where someone else is coming from emotionally, how to match that emotion.

My dad used to take me to lunch with his friends, and, when I was talking too much, rather than say, “Be quiet,” he’d tap his watch as a cue for me to stop. Later, we’d talk about it. He’d say, “When you interrupted Mary to talk about something else, why did you think that’s what she wanted to talk about?” I’d say, “Well, that’s what I wanted to talk about.” Then we’d role-play. He was teaching me how to interact with others. Social dynamics are innate for other people. For me, they’re a learned skill.

Q: What qualities do you credit for your success as a TV anchor and now author?

LV: I was taught that you can control just two things in life: your character and your hard work. I was taught to work like hell. When I started in journalism, my quest was to outwork everybody. It’s hard to beat a man who won’t quit.

Parental Love: Next Steps

• Free Download: Help Your Child Develop Positive Self-Talk
• Read: Your Positive Parenting Toolkit Has Arrived
• Read: Autism and ADHD: The Complete Playbook for Social Challenges
• Read: A Dad’s Role in Modeling Social Skills

Leland Vittert is the anchor of On Balance with Leland Vittert at NewsNation.

Carole Fleck is Editor-in-Chief at ADDitude magazine.

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

ADHD 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

Reserve your spot in this free webinar, and get the event replay link plus a 15% discount to ADDitude magazine

Not available April 2nd? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.

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.

Webinar Sponsor

Emotional dysregulation can make everyday triggers feel bigger and harder to manage. Play Attention, inspired by NASA technology and backed by Tufts University research, strengthens executive function and self regulation so adults can respond with greater calm and control. With a personalized plan and expert coaching, Play Attention supports lasting change. Take our ADHD assessment or schedule a consultation today.

www.playattention.com

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

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.

Closed captions available.

Chronic stress, high rates of co-occurring conditions, and unhelpful school and clinical interventions are common among individuals living with pathological demand avoidance (PDA), according to the first-ever comprehensive survey exploring the lived experience of PDA.¹ The survey found that failure to meet the needs of children and adults with PDA results in difficulties at school, at work, and in relationships, often leading to family breakdown and estrangement, school refusal, underemployment, and mental health struggles.

The 2,000 survey respondents comprised three groups: caregivers of children and teens with PDA; caregivers of adults with PDA; and adults with PDA themselves. Though the ripple effects of PDA on education, work, and family life varied across these groups, the core characteristic of PDA remained strikingly stable, with the “resistance to being told what to do” emerging as the most commonly reported trait across all groups.

For children, school was one of the realms most dramatically impacted by PDA; 88% of children with PDA experienced school avoidance or refusal at some point, and 40% struggled to attend school most days. While 70% of children with PDA had IEPs/ 504 Plans, only 17% of caregivers found these to be “very helpful.”

For adults with PDA, family life and mental health were major areas of struggle, with almost a quarter of adults with PDA, and/or their caregivers, reporting family estrangement. Nearly 60% of adults with PDA reported experiencing thoughts of suicide.

Understanding PDA

In a recent ADDitude webinar, “Don’t Tell Me What to Do: Pathological Demand Avoidance in Neurodivergent Kids,” Diane Gould, LCSW, founder and executive director of PDA North America, discussed the degree to which PDA is misunderstood. She explained that core features for children include:

• Resisting and avoiding ordinary demands of life
• Difficulty complying with the requests or rules of others
• Difficulty making themselves do the things they want to do
• A fundamental need for control

Because of this difficulty with compliance, Gould said: “PDA individuals are so often undiagnosed or misdiagnosed. Adults and teens are often misdiagnosed as having bipolar or borderline personality disorder. Children are misdiagnosed with oppositional defiant disorder or conduct disorder.”

As the report’s authors write: “PDA is not about ‘refusing to cooperate,’ but about the need for autonomy, safety and survival.”

A Dearth of Effective Interventions

This lack of awareness about PDA has resulted in a notable dearth of effective interventions.

“Across surveys, no single intervention was consistently rated as helpful, highlighting the need for better tailored approaches for PDA individuals,” write the report’s authors. Moreover, the report found that encounters with affirming, informed providers were rare, and that caregivers and adults with PDA infrequently received helpful, validating guidance. According to survey results:

• The most helpful interventions were medication management and occupational therapy
• The least helpful interventions were Applied Behavior Analysis (ABA) and emergency room visit
• 94% of caregivers reported that punishment can worsen behaviors

“Probably the hardest thing for parents to talk about was how hard they tried to follow all the advice that they were given from therapists, psychiatrists, pediatricians, teachers, and even parenting books,” Gould said. “But those strategies didn’t work, and often made things worse.”

The report’s authors explain that PDA-informed care involves “respecting autonomy at any age, reducing pressure and unnecessary demands, planning for sensory needs, and using relationship-based, responsive approaches.”

Common Co-Occurring Conditions

PDA commonly co-occurs with neuropsychiatric conditions, most frequently autism, ADHD, or both.

The Impact of PDA on Education

Chronic, severe difficulty attending school is the norm for children and teens with PDA. The survey revealed the following:

As Reported by Caregivers of Kids

• 88% of children with PDA experienced school avoidance or refusal at some point
• 4 in 10 children struggled to attend school most days
• 1 in 5 reported suspensions
• 1 in 10 was not currently accessing any education
• 70% had an IEP or 504 Plan
• Just 1 in 6 found their IEP/ 504 Plan to be “very or extremely helpful”

Despite these consistent difficulties, adults with PDA overwhelmingly report having received a high school diploma, with the majority also earning a four-year college degree.

As Reported by Adults

• 96% completed an education equivalent to a high school diploma
• 83% had a four-year college degree<

The Impact of PDA on Work

While adults with PDA struggle to attend work regularly, and experience episodes of under- or unemployment, the vast majority are employed. A high percentage of PDA adults are self-employed, which helps alleviate work-based challenges:

As Reported by Caregivers of Adults

• Two-thirds reported employment at some point
• More than half reported periods of unemployment or underemployment

As Reported by Adults

• 97% of adults reported employment at some point
• Among these, 55% had a history of self-employment
• 80% reported challenges with workplace attendance
• Two-thirds reported periods of unemployment or underemployment

The Impact of PDA on Family

Family life is strained for those with PDA, whether adults or children. This finding is vividly illustrated by Lisa McKay’s experience, as described in the ADDitude article, A Parent’s Guide to Navigating Pathological Demand Avoidance.

“During his early years, Max would frequently refuse to do what was asked of him and insist everything be done his way,” McKay writes. “He would inexplicably melt down or erupt in anger over seemingly minor issues.”

The survey measured the extent to which these areas of life are affected by PDA:

As families navigate these turbulent, murky waters, validation and accurate information about what works for PDA — and what doesn’t — is key.

“Commonly suggested behavioral strategies for neurodivergent children — from setting clear rules to using checklists, visual timers, and liberally doling out praise — didn’t help.” McKay says. “In fact, all they seemed to do was set up further power struggles where everyone lost.”

McKay’s experience is echoed over and over again by the findings of the survey. “This report makes clear that the challenges families face are not due to a lack of effort or care, but to systems that are not designed with PDA in mind,” said Ruth Hevelone, PDA North America’s director of Strategic Growth & Marketing. “When supports are aligned with how PDA is actually experienced, outcomes can change dramatically.”

Research Team Lead for the PDA report, Michele Kleinmann, added: “We hope this data helps shift conversations away from ‘fixing behavior’ and toward building environments where PDA individuals can feel safe, understood, and supported.”

Sources

¹McKenzie, M., Kleinmann, M., Hevelone, R., & Gould, D. (2026). The PDA Experience Report. PDA North America. https://learn.pdanorthamerica.org/products/digital_downloads/key-findingsPDA-Experience-Report

I felt out of control around certain foods and completely uninterested in others. I chased diets, lost and gained hundreds of pounds, and eventually landed in eating disorder treatment as an adult for atypical anorexia and binge-eating disorder. (I can’t be classically diagnosed with anorexia because I live in a large body, even when I am in a calorie deficit)

Convinced I was the problem, I blamed myself for what I now understand was my nervous system desperately trying to regulate itself.

Chasing Dopamine

One day in eating disorder treatment, a clinician noticed that I was adding chips to the inside of my sandwich, something I had been doing for as long as I could remember. When she asked me why I did that, my response was simple: “I like my food to crunch.”

But I didn’t just like the crunch. I needed it. Chips. Crackers. Extra crunchy bacon. Anything with resistance. Anything loud. Anything that gave my brain a sharp sensory hit.

[Read: The ADHD-Eating Disorders Link]

The truth is that crunchy things ground me. The crunch focuses me and cuts through the constant chitchat in my brain in a way soft foods never could.

That’s when it clicked. For the first time, I began to see that my eating behaviors weren’t just about taste or hunger. My “out-of-control eating” wasn’t an issue of willpower; it was partly sensory-seeking behavior, a well-documented ADHD trait.

My Eating Disorder Is About More Than Food

People with ADHD are significantly more likely to develop eating disorders, especially binge eating disorder and anorexia. Dopamine is thought to play a role in that connection. As ADHD brains like mine are chronically low in dopamine — which we all need for motivation, pleasure, and focus — we are wired to seek stimulation. And food just happens to be fast, legal, and always available.

ADHD symptoms explain much more than the sensory-seeking aspect of my eating behaviors. Hyperfocus means I can forget to eat for extended periods. Poor interoceptive awareness means I can’t reliably feel hunger or fullness. Emotional dysregulation means feelings hit hard and fast, and food becomes the farthest thing from my mind.

So it’s not that I lack self-control. I’m chasing dopamine. And I realized that recovery from disordered eating is going to be so much harder for me and my neurospicy brain.

In treatment, I also learned that my eating disorder had very little to do with food and everything to do with coping. Control, dopamine, sensory input, grief, trauma; my brain needed more support than it was ever given.

Traditional eating disorder advice assumes a neurotypical brain: Just eat regularly and plan ahead. Listen to your body. But for someone with ADHD, this advice feels impossible. I know, as I spent decades believing I was failing my body. Shame rushes in when we fail to follow through, which only adds fuel to the eating disorder.

Recovery That Honors My Brain

Recovery, for me, doesn’t come from rigid meal plans or white-knuckling urges. It comes from understanding my ADHD and working with it instead of against it. It comes from building structures without punishment, allowing sensory accommodations without shame, and learning that “healthy” does not always equal small.

If you have ADHD and struggle with food, you are not broken. You are not weak. You are not doing recovery wrong. You are neurodivergent in a world (and in a treatment system) that still doesn’t fully understand how our brains work.

Understanding the connection between ADHD and eating disorders didn’t erase my past, but it gave me language and a framework for my brain and body that finally allowed me to begin healing.

Eating Disorders and ADHD: Next Steps

• New Resource: From the Editors of ADDitude… Embody!
• Free Download: The Eating Disorders Associated with ADHD
• Read: How ADHD and Eating Disorders Overlap
• Read: Build a Better Relationship with Food to Benefit Your Brain

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Many autistic people hear this as they get to know their true selves better and intentionally begin to unmask. This observation is often followed by the equally unhelpful, “You used to be able to do it; why can’t you do it now?”

In the process of unmasking, some neurodivergent people experience “skill regression.” This is the term many clinicians use when a person with autism and/or ADHD suddenly has trouble with routine tasks like self-care, attending events they once seemed to enjoy, or managing executive functions like time management. The term skill regression, however, is quite pathologizing and a bit misleading.

[Take This Self-Test: Signs of Autism in Women]

Why ‘Skill Regression’ Is a Misleading Term

When I was in college, I went for a hike in the woods by myself and fell, rolling my ankle. It stung but held my weight, so I walked the rest of the way back. As soon as I got home and sat down, I couldn’t get up again. It’s not that the pain suddenly hit at home, but that I pushed myself past my limits, ignoring the pain until it was safe to acknowledge it.

When someone is high-masking, they exert a lot of energy presenting as neurotypical. Masking your authentic self involves disregarding your own needs, sensory sensitivities, and communication style to meet society’s expectations. A big part of unmasking is getting back in touch with these needs and recognizing the unhealthy or even unsafe ways you have overextended yourself.

In other words, it is misleading to call this a skill regression. I prefer to say that the individual has recognized their limits and begun to honor them. If you are in the process of unmasking, you may notice that some previously palatable situations and tasks now seem exhausting or even impossible. In my case, I realized how overwhelming I found my in-person office setting. Spending 40 hours in that setting was suddenly unsustainable. Learning what is sustainable has helped me discover hidden strengths and capabilities.

If someone you love seems to be experiencing skill regression, please be patient with them. Know that they are not trying to give you a hard time; rather, they are getting to know themselves better. If they trust you enough to show you how they are struggling, recognize that this is an honor. They feel safe telling you about their needs and newly identified limitations. Support them and encourage them to be honest and open about all of it.

Unmasking in Autism and ADHD: Next Steps

• Free Download: The Guide to Autism in Adults
  
• Read: 10 Steps to Unmasking Your ADHD
• Read: “I Thought I Sucked at Life. But I Was High-Masking Autism All Along.”
• Watch: “Understanding AuDHD Burnout: How Neurodivergent Masking Sparks Stress, Exhaustion”

Amy Marschall, Psy.D., is a licensed psychologist, author, and speaker.

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During this time, I was diagnosed with autism and ADHD. I wasn’t expected to show up to work or social gatherings due to the pandemic, and that left more space to focus on drawing — something I did for up to 10 hours a day. I made my own schedule, added physical therapy to reduce my chronic pain, adapted my clothing and home to better suit my needs, and engaged in my special interest full time, all of which deepened my relationship with myself.

[Read: ADHD & the Interest-Based Nervous System]

“The illustration I created for the cover of this issue was inspired by movement and repetitive movement, something that autistic people do as a form or regulation and communication. To me, the illustration shows a person spinning in their own world, and I wanted to illustrate the feeling of vestibular movement.”

I started to draw on the computer and eventually moved to an iPad, which allowed me to create works at the speed of my thoughts and impulses. As I began to truly understand my autism, I was able to find a path to the art of illustration.

A friend recommended that I try illustrating articles in magazines and newspapers, and that really sparked my interest. It felt like a perfect way to combine my love for drawing scenes and for creatively telling a story.

[Read: On the Awesomeness of ADHD Creativity]

I also began posting my works online. Viewers’ reactions to my work gave me the confidence to approach retail stores and pitch my designs for greeting cards and prints, and to create more art around storytelling. An art director saw my work at a bookstore and hired me for my first editorial assignment.

All the hours I spent on my special interest helped to develop my skills and allowed me to fully dedicate myself to illustration – and get paid for it. My style is expressive, bold, and moving – a lot like me.

Emcie Turineck, an artist in Montreal, Canada, created the artwork that appears on this issue’s cover.

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These results align with research that has found about 80% of people with ADHD have a delayed circadian clock.

Jamie M. Zeitzer, Ph.D., a circadian rhythm researcher at Stanford University, revealed how ADHD creates a cycle that weakens your body’s internal clock and worsens sleep problems over time, in his February 2026 ADDitude webinar. The event, titled “How Your Circadian Rhythm Shapes Energy, Focus, Productivity, and Cognitive Functioning,” offered these five insights that could transform your sleep.

1. Your Body Has Multiple Circadian Clocks

Every living organism on Earth has a 24-hour clock that predicts changes in the environment. While most of us think of circadian rhythm as a single internal clock, we actually have clocks throughout our bodies. Muscle clocks, for example, anticipate exercise timing. Gut clocks prepare for meals. The central circadian clock, located in the brain, also acts as a conductor that keeps all our peripheral clocks aligned.

But the circadian clock is most known for its role in regulating sleep-wake cycles. It determines when we sleep and how consolidated our sleep is. We’re naturally programmed to be awake for 16 hours and sleep the remaining 8, Zeitzer said, but ADHD can complicate this.

[Read: The Under-Recognized Impact of Delayed Sleep Phase Syndrome in ADHD]

2. The ADHD Doom Loop Weakens the Circadian Clock

Many people with ADHD fall into what Zeitzer calls a “doom loop.” It starts with erratic sleep schedules — going to bed at 11 p.m. one night, 2 a.m. the next, 4 a.m. another night. Insomnia, ADHD medication, co-occurring conditions, or ADHD itself may contribute to inconsistent schedules. Regardless, when you’re awake late, you’re also probably exposed to some sort of light (like that from a television or phone).

“Light is the main way the internal clock remains synchronized with the external world,” Zeitzer said. “When you’re exposed to light, you’re not only changing the time of the clock, but the amplitude of the clock or how strong the clock is as well. So, when you have erratic light schedules coupled with erratic sleep schedules, you get a weaker circadian clock.”

A weak circadian clock makes it harder to stay awake during the day, leading to daytime exhaustion and naps. These naps make it harder to sleep at night, which makes you more tired the next day, leading to more naps — and the doom loop continues. The consequences extend beyond fatigue. Long-term sleep deprivation is associated with increased emotional instability, greater susceptibility to infectious disease, and higher risk of depression.

While practicing regular sleep-wake times is the ideal way to regulate a circadian clock, incremental improvements can help, too. Aim for at least 7 hours of sleep per night a few nights a week. Sleep with your window shades open so sunlight hits your eyelids in the morning (even as you sleep).

3. Insomnia Doesn’t Just Mean Inadequate Sleep

About 44% of people with ADHD have insomnia. But contrary to popular belief, insomnia isn’t just about inadequate sleep. The clinical definition requires difficulty initiating, maintaining, or reinitiating sleep at least three times per week for three months, with adequate opportunity to sleep, and significant daytime distress or impairment.

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

“If it takes you 30 minutes to fall asleep and it doesn’t bother you, that’s not insomnia,” Zeitzer explained. “If it takes you five minutes to fall asleep but it bothers you, that’s insomnia.”

The first-line treatment is cognitive behavioral therapy for insomnia (CBT-I), which works not by changing sleep patterns but by changing your mindset about sleep. “Pay attention to your sleep, but not too much,” Zeitzer said. “The only thing worse than not getting a good night of sleep is not getting a good night of sleep and being anxious about it.”

4. Device Use at Night Invariably Impacts Sleep. But It’s Not About Blue Light.

You’ve probably heard that blue light from screens disrupts sleep. While technically true, the light from devices is not the only culprit.

When you watch a show on Netflix and you get addicted to it, you stay up late at night. “We’re competing with sleep,” Netflix CEO Reed Hastings admitted in a corporate earnings call. These platforms are engineered to keep your eyes on the screen, not closed in bed.

Ideally, devices should be kept out of bedrooms. If that’s not feasible, aim for bright light exposure in the afternoon, which changes how your brain responds to evening light exposure. If you use devices at night for relaxation, choose content that’s less engaging — boring enough to help you wind down. And try to be mindful of the fact that apps and platforms are designed to trigger an elevated emotional state, which impacts sleep.

5. Eating Too Close to Bedtime Affects Sleep

Eating during your “biological night” — when your circadian clock signals that it’s time to sleep — interferes with sleep. What’s more, your body doesn’t process food well at night. Being awake at night when you’re supposed to be sleeping also triggers the release of a thyroid-stimulating hormone, which signals your body to increase energy intake dramatically. It causes you to crave high-calorie foods and overestimate how much you actually need.

“Your body’s trying to help you out,” Zeitzer said. “It thinks something must be chasing you, so it gets you more glucose and fat right now.”

Circadian Rhythm, ADHD, and Sleep: Additional Resources

• Self-Test: Could You Have Delayed Sleep Phase Disorder?
• Free Download: How to Sleep Better with ADHD
• Read: ADHD Is the Disorder That Never Sleeps
• Read: Never-Never-Ever Land — Why ADHD Ruins Sleep

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Autistic and ADHD burnout can build gradually and vary in intensity. Signs include:

• persistent fatigue
• chronic pain
• headaches
• difficulty focusing, worsening executive dysfunction
• social withdrawal
• depression, anxiety, and other emotional shifts
• heightened sensory sensitivities

If ignored or unaddressed, these signs of stress can erode day-to-day functioning and weaken coping mechanisms. Some people are so paralyzed by burnout that they pause their careers and relationships, and may need a year or longer to reset.

If you recognize the signs of burnout, explore which situations might be causing you the most harm. Ask yourself:

• What drains or energizes me?
• When do I function best or worst?
• How do I judge productivity?
• Which environments support me?

💡Free Self-Test: Am I Burnt Out?

To halt the downward spiral into burnout, you will need to make changes that prioritize your health over others’ needs or wants. These can include:

• Establishing reasonable goals. Learn to ask for help. Drop non-essential tasks from daily life. If your job is overwhelming, consider pivoting to a less stressful job or career path if you can.
• Practice unmasking. It takes time and thoughtful practice to know your authentic self. Experiment with approaches that have helped others unmask — for example, stimming at home.
• Finding the right provider. A neurodivergent-affirming healthcare professional can help you unmask and stop the burnout cycle. Ask potential providers these questions:
  • Have you provided care to someone like me?
  • What does providing neurodiversity-affirming care mean to you? (Their answer should reflect that neurodivergence is not a problem to be solved nor something shameful.)
  • What is your experience assessing and helping someone who is high-masking?

Treatment can include:

• cognitive behavioral therapy for coping skills and improved self-awareness
• support groups that help neurodivergent individuals find validation by connecting with others who face similar situations
• self-care, such as eating healthy foods, getting adequate sleep, and exercising regularly

Amy Marschall, Psy.D., is an autistic psychologist diagnosed with ADHD. She is the author of Neurodiversity-Affirming Therapy.

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Chronic pain — twice as common in neurodivergent youth — is as real as it is invisible and misunderstood. (Veterinarians receive more education about the neurobiology of pain than do human doctors!) As awareness grows, so has our understanding of why autism and ADHD place children at higher risk for chronic pain, and of the supports that help their unique nervous systems feel safe and heal.

The Neurobiology of Pain

Chronic pain, which is defined as pain that lasts for more than three months, is often the result of a nervous system imbalance rather than ongoing tissue damage.

The brain and nervous system work to keep us safe by shifting between two branches: the sympathetic system, which activates the fight-or-flight response to mobilize the body during challenges, and the parasympathetic system, which calms and regulates us.

Chronic pain occurs when the fight-or-flight system stays activated, amplifying pain signals, intensifying danger perception, disrupting sleep and mood, and further dysregulating the body – creating a cycle of overactivation.

But what triggers overactivation?

The Chronic Pain-Neurodivergence Overlap

Pain is influenced by biological, psychological, and social factors, as described by the fear-avoidance model of pain.¹ This framework also illustrates how neurodivergence can make children more susceptible to sympathetic activation and chronic pain.

Neurodivergence and Pain

• Sensory sensitivity amplifies pain and discomfort in response to everyday sensory input.
• Differences in interoception heighten awareness of bodily sensations.
• Emotional dysregulation intensifies worry, distress, and overwhelm caused by pain.
• Hyperfocus, cognitive inflexibility, and perseveration lock attention on pain.
• Uncertainty intolerance undermines coping beliefs and fuels hypervigilance.
• Social challenges increase stress and trigger the fight-or-flight response.
• Co-occurring conditions — sleep disturbances, anxiety and depression, developmental conditions, migraines, autonomic dysregulation and more — predict and contribute to chronic pain.^{2 3 4 5 6}

About 16 percent of autistic children experience frequent or chronic pain — nearly twice the rate seen in neurotypical peers — and the rate rises to 20 percent among those with developmental conditions.⁵ In our study, we found:⁶

• About 30 percent of pediatric pain clinic patients are autistic.
• More than half report widespread rather than localized pain.
• About 60 percent are girls, reflecting the higher chronic pain rates found in women likely due to factors like hormones, co-occurring conditions, stress, and medical bias.

About one-quarter of youth with chronic pain have ADHD, while 65 percent of children with ADHD report chronic pain.⁷ Women diagnosed with ADHD in childhood show higher chronic pain rates in adulthood.

Signs of Chronic Pain

Expressions of pain may include:

• Guarding a body part or favoring one side
• Avoiding movement or reduced range of motion
• Tenderness to light touch
• Increased sensory sensitivity
• Sudden or increased irritability or meltdowns
• Sudden or increased anxiety, clinginess, or fear of being alone
• Needing help with tasks previously done independently
• Frequent nurse visits, requests to go home, or school refusal
• New or worsened sleep problems
• Fatigue, low stamina, need for frequent breaks
• Reduced engagement with special interests and enjoyable activities

Pain Management: Regulating the Nervous System

Managing chronic pain requires coordinated approaches that calm a dysregulated nervous system over time and restore function. Treatment must be tailored to each child’s needs, abilities, and context.

Pain Management Programs

Chronic pain programs include pediatric anesthesiologists, pain psychologists, occupational and physical therapists, and other specialists. Many programs are housed in pediatric hospitals with specialists who have experience with neurodevelopmental differences.

These programs focus on function beyond pain reduction, helping kids return to daily activities. Most are outpatient, but inpatient or day treatment options exist for severe cases.

For neurodivergent children, treatment plans should address:

• Sensory regulation
• Executive function challenges
• Activities of daily living (e.g., bathing, dressing, eating)
• School-based behavioral and social supports

School Advocacy

Educators will benefit from understanding chronic pain and how the school environment influences it. A pain psychologist can explain the chronic pain and school connection, provide documentation of your child’s needs, and advocate for accommodations supporting gradual school participation, including:

• Quiet space for short breaks
• Sensory-regulating tools (noise-reducing headphones, sunglasses)
• Reminders to use pain-management strategies (deep breathing, muscle relaxation)
• Alternative seating options
• Excused absences, tardies, and extra transition time between classes
• Note-taking accommodations (access to notes, speech-to-text, typing)
• Adapted physical education with low-impact options

What Caregivers Can Do

1. Validate your child’s pain.
Most of us equate pain with acute, nociceptive forms — broken bones, cuts, burns. But that is just one type of pain. Nociplastic pain, common with chronic pain, can occur without tissue or nerve damage. Believing your child helps to calm their nervous system. Remember that neurodivergence alters pain processing. Avoid viewing your child as noncompliant or attention-seeking, as this leads to power struggles that can increase stress and dysregulation.

2. Start low and go slow.
Begin with tiny steps to help your child heal and regain function. Increase demands only when manageable. If walking to the driveway is challenging, start with a few steps, gradually increasing. Use fitness trackers and rewards for motivation.

3. Redirect.
Shifting focus from pain can reduce its intensity. Say, “It makes sense that you’re experiencing pain and that hyperfocus makes it hard to think of anything else. Let’s try taking a smaller step this time.” Psychologists can also help shift your child’s thinking patterns related to pain and come up with replacement behaviors.

Other ways to redirect your child:

• Ask for help with a task (e.g., deliver a message to a family member, think of grocery list items, brush the family pet)
• Count objects by color
• Name things they can see, touch, hear, smell, and taste

4. Create a comfort toolbox with calming activities:

• Breathing exercises
• Music, coloring, puzzling
• Guided imagery and meditation
• Special interests

5. Provide visual cues to remind your child of preferred coping strategies.

6. Maintain routines to establish predictability and reduce anxiety.

7. Prioritize quality sleep.

Quality sleep reduces pain and supports self-regulation. Ensure your child is screened for sleep disorders and receives adequate treatment. Support healthy sleep habits, too:

• Dim lights and turn off screens one hour before bed
• Follow a short bedtime routine with a visual schedule
  (e.g., bath, brush teeth, put on pajamas, bedtime story or relaxation exercise)
• Use timers to indicate transitions
• Choose comfortable pajamas and bedding (remove scratchy tags)
• Keep the bedroom dark, cool, and quiet
• Maintain consistent sleep-wake times, even on weekends
• Reserve the bed for sleep only

8. Educate others.
Help family and friends understand how chronic pain is different. This explanation works well for children: My body is like a pot of water. Sometimes, the water boils and overflows, which hurts. I’m getting help to keep water from overflowing!

9. Keep calm.
Chronic pain is highly treatable. You did not cause your child’s pain — we all have different nervous systems and are shaped differently by life’s experiences. However, your calm presence can significantly influence how they respond to pain over time.

Gradual exposure to uncomfortable activities is part of healing — it’s how fear subsides and pain fades. A pain psychologist can help you understand how to best support and encourage your child in breaking the fear-avoidance cycle and regaining their life.

Gloria T. Han, Ph.D., is a pediatric pain psychologist at Vanderbilt Children’s Hospital in Tennessee and an assistant professor at Vanderbilt University Medical Center.

Anna C. Wilson, Ph.D., is a pediatric pain psychologist at Oregon Health & Science University Doernbecher Children’s Hospital and a professor at OHSU.

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

Sources

^{1 Asmundson, G. J., Noel, M., Petter, M., & Parkerson, H. A. (2012). Pediatric fear-avoidance model of chronic pain: foundation, application and future directions. Pain Research & Management, 17(6), 397–405. https://doi.org/10.1155/2012/908061}

^{2 Jain, S. V., Panjeton, G. D., & Martins, Y. C. (2024). Relationship between sleep disturbances and chronic pain: A Narrative Review. Clinics and Practice, 14(6), 2650–2660. https://doi.org/10.3390/clinpract14060209}

^{3 Velly, A. M., & Mohit, S. (2018). Epidemiology of pain and relation to psychiatric disorders. Progress in Neuro-psychopharmacology & Biological Psychiatry, 87(Pt B), 159–167. https://doi.org/10.1016/j.pnpbp.2017.05.012}

^{4 Groenewald, C. B., Murray, C. B., & Palermo, T. M. (2020). Adverse childhood experiences and chronic pain among children and adolescents in the United States. Pain Reports, 5(5), e839. https://doi.org/10.1097/PR9.0000000000000839}

^{5 Whitney, D. G., & Shapiro, D. N. (2019). National prevalence of pain among children and adolescents with autism spectrum disorders. JAMA Pediatrics, 173(12), 1203–1205. https://doi.org/10.1001/jamapediatrics.2019.3826}

^{6 Han, G. T., Heavner, H. S., Rains, T. R., Hoang, A. H., & Stone, A. L. (2024). Chronic Pain in Autistic Youth: Clinical Prevalence and Reflections on Tailoring Evidence-Based Interventions from an Interdisciplinary Treatment Team. Children (Basel, Switzerland), 11(3), 312. https://doi.org/10.3390/children11030312}

^{7 Battison, E. A. J., Brown, P. C. M., Holley, A. L., & Wilson, A. C. (2023). Associations between Chronic Pain and Attention-Deficit Hyperactivity Disorder (ADHD) in Youth: A Scoping Review. Children (Basel, Switzerland), 10(1), 142. https://doi.org/10.3390/children10010142}

New research has identified distinct genetic profiles linked to different behavioral and developmental patterns in autistic individuals, reinforcing the understanding that autism is highly complex and not driven by a single cause or influence.

In one study, researchers at the University of Cambridge discovered that individuals who were diagnosed with autism in early childhood, usually before age six, appeared to have a different genetic makeup and lower risk of developing co-occurring mental health conditions than did those who were diagnosed in late childhood and beyond.

Children with an early autism diagnosis were more likely to demonstrate challenges with social interactions from infancy to early childhood, the study showed. Children with a later diagnosis were more likely to experience social and behavioral struggles in adolescence, plus higher rates of comorbid ADHD, depression, PTSD, and self-harm. The study was published in October 2025 in the journal Nature.¹

“Understanding how the features of autism emerge not just in early childhood but later in childhood and adolescence could help us recognize, diagnose, and support autistic people of all ages,” senior study author Varun Warrier, Ph.D., assistant professor of neurodevelopmental research at Cambridge University’s Department of Psychiatry, said.

In a separate study from Princeton University and the Simons Foundation, researchers identified four clinically distinct subtypes of autism, setting the stage and establishing the potential for specialized care. They used data from more than 5,000 children to analyze combinations of traits, looking at social interactions, repetitive behaviors, and developmental milestones, rather than studying genetic links to single traits. The study was published in July 2025 in Nature Genetics.²

The four autism subtypes defined in the Princeton/Simons Foundation study included:

1. Social and Behavioral Challenges

Children in this group face more difficulties with social communication, attention, and repetitive and disruptive behaviors than do participants in other subtypes. This group also has the highest genetic predisposition for ADHD, anxiety, obsessive-compulsive disorder, and depression. Its members do not experience significant developmental delays.

2. Moderate Challenges

In this subtype, children exhibit traits that manifest as social challenges or stimming, but they usually reach developmental milestones at ages similar to their neurotypical peers. They generally do not experience co-occurring psychiatric conditions.

3. Mixed ASD and Developmental Delays

Gene variations identified in this subtype lead to early developmental challenges, as with walking and talking, in many, but not all, children. Members in this group tend to receive an autism diagnosis at an early age, and usually do not show signs of anxiety, depression, or disruptive behaviors.

4. Broadly Affected

Children in this subtype present with the most severe and wide-ranging difficulties, including ADHD, anxiety, depression, and mood dysregulation. The researchers observed impulsivity, hyperactivity, and aggressive behaviors only in this subtype.

Diagnosing Autism and Comorbid Conditions

In the University of Cambridge study, researchers analyzed genetic data from more than 45,000 autistic individuals in the U.S. and Europe, and behavioral data across childhood and adolescence from the U.K. and Australia. The team then linked the genetic data to the age at diagnosis, and found that the genetic profiles differed between those diagnosed with autism earlier vs. later in life, with only a modest overlap.

They also found that the average genetic profile of autism diagnosed later in life was closer to that of ADHD, and co-occurring disorders like depression and PTSD, than it was to autism diagnosed in early childhood. A lack of support in early childhood, however, may potentially increase the risk for mental health issues in the later-diagnosed group, the researchers pointed out.

“The presence of clear behavioral signs helps to facilitate diagnoses in younger children, but the umbrella of core features — social-communication differences and restricted interests and repetitive behaviors — can be more subtle and look different by age, sex, and sociocultural context,” says Gloria T. Han, Ph.D., assistant professor in the Department of Anesthesiology, Division of Pain Medicine, at Vanderbilt University Medical Center.

She says the Cambridge University study helps explain why some individuals, including females, children without language delays, and those who are highly verbal, are often identified later — sometimes after ADHD, anxiety, or other mood concerns are diagnosed. She says autism can be missed or overshadowed when differences in attention, executive functioning, or social difficulties are attributed only to ADHD or social anxiety.

Cambridge University’s Warrier summed up his research: “For the first time, we have found that earlier- and later-diagnosed autism have different underlying biological and developmental profiles. An important next step will be to understand the complex interaction between genetics and social factors that lead to poorer mental health outcomes among later-diagnosed autistic individuals.”

Carole Fleck is Editor-in-Chief at ADDitude magazine.

Sources

¹Zhang, X., Grove, J., Gu, Y., Buus, C. K., Nielsen, L. K., Neufeld, S. A., Koko, M., Malawsky, D. S., Wade, E. M., Verhoef, E., Gui, A., Hegemann, L., Geschwind, D. H., Wray, N. R., Havdahl, A., Ronald, A., St Pourcain, B., Robinson, E. B., Bourgeron, T., Warrier, V. (2025). Polygenic and developmental profiles of autism differ by age at diagnosis. Nature. https://doi.org/10.1038/s41586-025-09542-6

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