Energy drink consumption is associated with an elevated risk for physical and mental health conditions such as ADHD, depression, anxiety, and suicidal ideation among children and adolescents, according to a new study published in the journal Public Health.¹

The study’s U.K. research team linked energy drink consumption with a higher-than-average risk of poor academic performance, sleep problems, unhealthy dietary habits, and risky behaviors. Children and teens who consumed energy drinks were more likely than non-drinkers to engage in unsafe sex and vehicle use, binge drinking, vaping, violent behaviors, and alcohol and substance use.

Energy drink consumption was also tied to increased ADHD inattention, conduct disorder, and depressive and panic symptoms. The rates of suicidal ideation and attempts increased among those who drank more than one energy drink a day compared to non-drinkers.¹

The systematic review examined 57 studies about the effects of energy drinks on children and young people up to age 21 from January 2016 to July 2022. The data came from more than 20 countries and involved more than 1.2 million children and young adults. (The review did not include the brands of energy drinks consumed.) The report confirmed findings from a similar review in 2016 conducted by the same research team.²

What Are Energy Drinks?

The Centers for Disease Control and Prevention (CDC) defines an energy drink as “a beverage that typically contains large amounts of caffeine, added sugars, other additives, and legal stimulants such as guarana, taurine, and L-carnitine. Energy drinks are marketed as providing mental and physical stimulation; they contain no nutritional value.

The amount of caffeine in energy drinks typically exceeds adults’ daily recommended doses. Data from the Center for Science in the Public Interest shows that energy drinks may contain as little as 75mg of caffeine — slightly less than one average cup of coffee — or up to 316mg per 8 ounces, the equivalent of more than three cups.

Energy drinks have exploded in popularity in recent years, particularly among teens. A 2013 study of 37,500 children and adolescents in 16 European countries found that 18% of children (3–10 years) and 68% of adolescents (10–18 years) consumed energy drinks in the previous year.8 Between 12% and 35% of children and young adults consume them at least once per week.³

The U.K. study found that male teens consume more energy drinks than do females. Taste and energy-seeking were the main drivers of energy drink use. The study also reported that children and teens may turn to energy drinks as a coping mechanism, out of social acceptance, or to enhance performance on tests and in sports.

Energy Drink Consumption Among Kids with ADHD

Nearly 5% of ADDitude Reader Panel members say their children consume energy drinks every day or regularly, according to a recent survey.

“My children like to drink Prime because they think it’s cool, and they like the taste,” one reader said.

“My daughter tries out the latest fads with energy drinks,” said another reader. “I worry about her caffeine consumption. I keep teaching her to watch the caffeine content and to be careful about how much she drinks. I don’t see her drink them — I just see empty containers in her car — so I can’t say what the effect is on her ADHD symptoms.”

Another reader shared that her daughter (now 21) “has used Red Bull daily since high school. She is currently unmedicated (Her choice, not mine.) I believe it helps her focus a little.”

An additional 12% of ADDitude Reader Panelists said their children occasionally consume energy drinks.

“My teen kids will have an energy drink (Yerba Mate or Celsius) now and then for sports or athletic activities like between soccer games on tournament weekends or when skiing,” a reader said. “It adds to their energy, which is fine when engaging in physically demanding activities. I would not allow it before school as it likely would create jitteriness if they had to sit for hours.”

“My child occasionally swipes a sip of his dad’s Red Bull,” said another reader. “Other than that, he doesn’t drink them. We mostly avoid energy drinks because of the additional additives in them.”

Less than half (44%) of reader panelists said their children are prohibited from consuming energy drinks.

“I am fearful of the jittery anxiety it seems to produce,” one reader said. “The [energy drink] crash has caused my son to melt down and become horribly embarrassed when in public.”

“I do not want myself or my children to have energy drinks because they are high in sugar and caffeine,” another reader said. “We have diabetes and heart disease in our family, and we do not need to add on to that.”

Other readers offer energy drink alternatives. “We don’t allow our kids to have energy drinks as they contain harmful ingredients,” the reader said. “We have allowed our kids to try coffee. They don’t care for the taste, but it did help my son to be less crabby in the morning.”

“There’s too much empty sugar and caffeine in them,” another reader said. “As a special treat, my teens with ADHD buy themselves sweet drinks at Starbucks. I encourage caffeine-free drinks. The body is hard enough to understand and regulate without all the added effects of sugar and caffeine.”

Energy Drinks: Next Steps

The observational study could not prove causality between energy drink consumption and poor health outcomes; the drinks could, for example, be more popular among adolescents with naturally low levels of dopamine and/or those facing higher risks of mental and physical health issues. However, the researchers said their findings were strong enough to suggest policymakers consider banning the sales of these products to children.

“We have raised concerns about the health impacts of these drinks for the best part of a decade after finding that they were sold to children as young as 10 years old [for less] than bottled water,” lead author Amelia Lake, Ph.D., a professor of public health nutrition from Fuse, the Centre for Translational Research in Public Health at Teesside University in England, said in a press release. “The evidence is clear that energy drinks are harmful to the mental and physical health of children and young people as well as their behavior and education. We need to act now to protect them from these risks.”

The American Academy of Pediatrics states that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents.⁴

Keeping Energy Drinks Out of Children’s Hands — and Mouths

The Centers for Disease Control and Prevention (CDC) offered the following tips for caregivers and educators:

• Teachers and other school staff can educate students about the danger of consuming too much caffeine, including energy drinks.
• Coaches can educate athletes about the difference between energy and sports drinks and the potential dangers of consuming highly caffeinated beverages.
• School nutrition staff can provide only healthy beverages such as fat-free/low-fat milk, water, and 100% juice in the cafeteria.
• Parents, school staff, and community members can join the school or district wellness committee that sets the policies for health and wellness and establish or revise nutrition standards to address the sale and marketing of energy drinks in school settings.
• Adults can model good behavior by not consuming energy drinks in front of kids.

Sources

¹Ajibo, C., Van Griethuysen, A., Visram, S., Lake, A. A. (2024). Consumption of Energy Drinks by Children and Young People: A Systematic Review Examining Evidence of Physical Effects and Consumer Attitudes. Public Health doi: 10.1016/j.puhe.2023.08.024
²Visram, S., Cheetham, M., Riby, D.M., Crossley, S.J., Lake, A.A. (2016). Consumption of Energy Drinks by Children and Young People: A Rapid Review Examining Evidence of Physical Effects and Consumer Attitudes. BMJ Open. doi: 10.1136/bmjopen-2015-010380
³Zucconi, S., Volpato, C., Adinolfi, F., Gandini, E., Gentile, E., Loi, A., and Fioriti, L. (2013) Gathering Consumption Data on Specific Consumer Groups of Energy Drinks. The European Food Safety Authority Supporting Publications. doi: 10.2903/sp.efsa.2013.EN-394
⁴Heckman, M.A., Weil, J., Gonzalez De Mejia, E. (2010). Caffeine (1, 3, 7-Trimethylxanthine) in Foods: A Comprehensive Review on Consumption, Functionality, Safety, and Regulatory Matters. Journal of Food Science. 75(3):R77–87. doi: 10.1111/j.1750-3841.2010.01561

If you answered yes to any of the above, then you share a lot in common with our ADDitude readers, many of whom experience strong sensory reactions to food based on taste, texture, smell, and/or temperature. Sensory sensitivities, after all, commonly occur with ADHD, autism, and other forms of neurodivergence.

Aversions to certain foods can create minor inconveniences around eating, but in extreme cases — as is the case for some of our readers — food aversions and selective eating are due to avoidant/restrictive food intake disorder (ARFID), a condition wherein food avoidance or restriction is based on sensory characteristics and qualities of food, concern about aversive consequences of eating, and/or a lack of interest in food. ARFID, especially if untreated, is often accompanied by nutritional deficiencies and quality-of-life problems.

ARFID, Food Aversions, and Picky Eating: Your Stories

“I suspect that I have ARFID — troublesome but not severe. If I do eat meat, it will be a small serving, and it has to be extra, extra well done, almost burnt. I don’t like mushy, runny, moist textures like flan, tapioca, and runny eggs. Hot foods have to be hot, because cold food makes me gag. Foods can’t touch on my plate. As a child, dinner time was sometimes unpleasant because I was made to eat foods I didn’t like, including foods that had been mixed all on one plate. ” — Sara, Texas

“I had never heard of ARFID before reading about it in ADDitude. My daughter, who is in her 30s, definitely has this and has had it since she was a toddler! Life would have been so much easier for us if a diagnosis had been made. The problem we have now is finding someone who knows about this and can treat it. My daughter thinks she’s a ‘freak.’ My heart breaks for her. She NEVER eats anything except for pizza late at night. I fear for her mental and physical health.” —  Wendy, Canada

[Take This Self-Test: Signs of ARFID in Adults]

“I don’t eat any fruits or vegetables. I don’t like the smell of any dark-green vegetables. I eat lots of pasta and pizza, but the tomato sauce must be smooth. I drink juice only without pulp. I eat grape jelly only, no other kinds. I eat meat without fat or it has to be cooked medium-well or fried hard. Fish must be white and dry. I do take supplements and vitamins. I am 54 years old, and I didn’t know this was a thing with a name (ARFID) until very recently. I grew up in a clean-your-plate household, so it taught me to be sneaky about getting rid of vegetables and other things I didn’t want to eat. As a child, my uncle taught me how to order food in restaurants (ask for plain pasta, rice, or potatoes, and request meat or chicken to be grilled or sautéed). He was sick of my parents making such a big deal about my eating when he just wanted to go out to dinner.” — Julie, Georgia

“My son has been extremely picky since he was a baby. His diet is restricted to hamburgers with ketchup only, chicken nuggets with ranch, PB&J, macaroni and cheese, some fruit, and carrots (which are a new thing for him, but they need ranch). Every time I give him a new food that I think he will love, he gags and runs to the bathroom to throw it up.” — Angela

“I cannot stand anything that is gelatinous or wiggly (jelly, Jell-O, custard, boba, etc.). I am also disgusted by any meat/fish/poultry that contains visible fat, gristle, tendons, skin, bones, and/or is processed into a gelatinous cube. One bite of gristle and I’ll gag and toss out the rest of the meal. When I was younger, I had issues with hypoglycemia because of my imbalanced diet. Now, I eat meat/fish/poultry that is lean, boneless, and skinless, and I make sure each meal contains adequate protein. But you’ll never catch me at a steakhouse or BBQ joint — yuck!” — Jennifer, California

“At 43, I still cannot eat a majority of green vegetables. My diet is very limited, which limits where we can go to dinner as a family. It affects social gatherings, where I may have to bring my own food. I react to a combination of taste, smell, texture, and sight of different foods. My sense of smell is very strong — once I don’t like the smell of something, I refuse to try it. It has affected my health, as I have to take vitamins every day to make up for the lack of nutrition.” — Kelly, New York

[Get This Free Download: The Eating Disorders Associated with ADHD]

“My husband has a texture reaction to onions and other vegetables in food; he eats like an 8-year-old. This does affect his health, and I no longer cook healthy things I like because he complains of the smell. My health has plummeted since I now eat mostly what he eats; fried food, potatoes, red meats. I have considered buying prepared meals to get my missing veggies but have not found the right ones.” — An ADDitude Reader

“Mint and cilantro are absolute no-gos for me. I avoid any foods, even at restaurants, that may have hidden cilantro. I use unflavored toothpaste (literal godsend for me!) and I water down my mouthwash. Going to the dentist is traumatic only because of the intense mint flavors seemingly in everything they use. I have to ask them to water everything down or use polish with limited flavor (or a kids flavor) to avoid throwing up.” — An ADDitude Reader

“I cannot STAND foods that are solid but turn mushy while chewing, like bananas, beans, and avocado. I gag after the first bite. I love foods that are homogeneous in texture all the way through, like pudding and yogurt, or foods with varied textures all the way through, like mashed beans with tortilla chips and guacamole.” — Etti

“My favorite foods are typically plain or salty comfort foods that I liked eating as a kid and that have little to no nutritional value. I avoid fruit unless it’s cold, most vegetables unless they’re cooked, water unless it’s cold and filled with ice, and so many other things. I struggle to eat a balanced diet, if I remember to eat at all.” — An ADDitude Reader

“I have aversions to certain smells and textures, and executive dysfunction creates challenges around preparing and eating food. Take chicken: I don’t like the texture or taste of chicken on its own. But shred it and mix it with quinoa or into a stew, and it’s no problem! I also like fruits, but I’m much better at eating them if they’re cut up, or else they’ll remain on my desk, untouched. Pre-peeling, cutting, and packing fruits transforms them from an EF stumbling block to a healthy snack. If you have a food aversion, I highly recommend digging around to pinpoint the exact problem, because a solution may be easier than you think. Sometimes it requires letting go of expectations or shame. I only eat crustless sandwiches, which is something I get teased for, but I don’t care!” — Natalia, Pennsylvania

Food Aversions, ARFID, and Picky Eating: Next Steps

• Read: Got a Picky Eater on Your Hands? Here’s How to Cope
• Take This Self-Test: ARFID in Children
• Read: ADHD and Eating Disorders
• Read: More Than Picky Eating — Feeding Difficulties in Children

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.

One trademark of ADHD is low levels of dopamine, a neurotransmitter released by the brain that makes kids feel good and helps them focus. Increasing dopamine in the brain through medication is an effective treatment for ADHD. However, more than a year into a nationwide stimulant shortage, parents still struggle to fill prescriptions for their kids.

As the shortage stretches on, many caregivers are working to implement ADHD treatment tactics without medication. Here are some gut health strategies to consider.

Don’t Skip Meals

The way your child’s brain works is influenced by what they eat, and good nutrition is essential. Eating unhealthy, non-nutritious foods may contribute to inattention and problematic behaviors, while a diet with a variety of healthy foods nourishes the brain to pay attention and function optimally.

[Free Download: 5 Rules for an ADHD-Friendly Diet]

A study in Cell Metabolism found that dopamine release in the brain can occur at two different times: when food is swallowed and once the food reaches the stomach.¹ Skipping a meal robs the body of two potential releases of dopamine. If your child is not hungry, try to keep them on a regular meal schedule to help regulate opportunities for dopamine release. Healthy snacks help, too. A protein-rich diet, including fish, poultry, eggs, and legumes (e.g., beans, lentils, peas, etc.), can help increase dopamine levels.

Introduce Variety

Many kids with ADHD want to eat the same things every day, but doing so may mean they miss out on producing more of that feel-good hormone. Research has also found a strong connection between gut health and mental health. ² A healthy gut is best described as having a diverse microbiome, consisting of different types of microorganisms (bacteria, fungi, viruses, etc.) that coexist harmoniously in the digestive tract. Increasing the diversity of your child’s gut microbiome with a protein-rich diet, including fish, poultry, eggs, and legumes (e.g., beans, lentils, peas, etc.), ensures that dopamine can be adequately synthesized.

Introduce new foods slowly and in a variety of ways. For example, pick a vegetable your child usually eats and connect it to another vegetable or legume. So if your child eats raw carrots, pair them with a dip made of puréed red peppers or smooth refried beans. If your child prefers crunchy foods, make crunchy cooked veggies in the oven or air fryer. Experiment with spices, too. Offering your child small tastes (repeatedly) will build their acceptance of new foods. Kids are more likely to expand their taste and preference for new foods when given multiple chances to learn about and experience new food.

[Free Download: Meal-Planning Guide for ADHD Families]

Mindful Eating

Young children, especially those with ADHD, may be easily distracted during mealtimes. Make it a point to give your child a heads-up on what’s for dinner and when it will be served. Kids with ADHD do best when they know what to expect and follow a schedule. Then, turn off all electronic devices, including the TV, while eating to limit distractions. If possible, sit and eat together at the table. This lets your child know that during meals, it’s time to pause (even for a minute) and focus on eating. This is also a great time to share a moment with your child.

Gut Health Strategies for Treating ADHD: Next Steps

• Read: The ADHD Diet Plan: Healthy Foods and Supplements for Kids & Adults 
• Read: Food Therapy: The Right Nutrition for ADHD Symptoms
• Download: ADHD Brain Food: What to Eat, What to Avoid
• Watch: “What to Eat, What to Avoid: The ADHD Guide to Food and Nutrition for Children”

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

The opinions expressed in ADDitude Guest Blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of ADDitude. Blogs are not reviewed by an ADDitude physician or any member of the ADDitude editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. ADDitude does not endorse any specific product, service or treatment.

Do not consider ADDitude Blogs as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on ADDitude. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. ADDitude understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately.

Sources

¹Thanarajah, S.E., Backes, H., DiFeliceantonio, A.G., Albus, K., Cremer, A.L., Hanssen, R., Lippert, R.N., Cornely, O.A., Small, D.M., Brüning, J.C., Tittgemeyer, M. (2018) Food Intake Recruits Orosensory and Post-ingestive Dopaminergic Circuits to Affect Eating Desire in Humans. Cell Metabolism. https://doi.org/10.1016/j.cmet.2018.12.006

²Chen, Y., Xu, J., Chen, Y. (2021). Regulation of Neurotransmitters by the Gut Microbiota and Effects on Cognition in Neurological Disorders. Nutrients. https://doi.org/10.3390/nu13062099

Red Dye No. 3 is one of four food additives now banned by the landmark California Food Safety Act, the first law of its kind in the United States. The ban, which was signed on October 7 by Governor Gavin Newsom, cites research linking the additives to serious health risks but has drawn ire from some trade associations that accuse it of sidestepping the Food and Drug Administration (FDA).¹ , ² According to Food Safety magazine, the targeted chemicals are already banned in the European Union, in part, because studies have linked them to cancer, reproductive issues, and childhood behavioral and developmental problems.³

Known as the “Skittles ban,” the California law will take effect in 2027 and prohibit the manufacturing, selling, or distributing of food products containing potassium bromate, brominated vegetable oil, propylparaben, and Red Dye No. 3, a synthetic dye made from petroleum that is found in foods, drinks, and medications.⁴

Joel Nigg, Ph.D., director of the ADHD Research Program at Oregon Health and Science University, called food dyes a “public health concern” that affects children with and without ADHD.

“There is enough evidence that food dyes affect behavior in some sensitive children with ADHD (and other children without the condition) to justify warning labels on foods containing synthetic dyes,” Nigg told ADDitude.

Concerns about increasing rates of ADHD and other behavioral disorders prompted the California Legislature to ask the Office of Environmental Health Hazard Assessment (OEHHA) to conduct a food dye assessment in 2021. Its report, titled Health Effects Assessment: Potential Neurobehavioral Effects of Synthetic Food Dyes in Children, found links between several dyes and hyperactivity in children. The report argues that current federal levels for safe intake of synthetic food dyes may not sufficiently protect children’s behavioral health.

According to the OEHHA report, the FDA’s Acceptable Daily Intake levels (ADIs) for synthetic food dyes are based on 35- to 70-year-old studies that were not designed to detect the types of behavioral effects observed in children today. Comparisons with newer studies indicate that the current ADIs may not adequately protect children from the behavioral effects of some dyes, and suggest they should be lowered.²

Is Red Dye No. 3 a Health Risk?

Red Dye No. 3 was approved for use in food in 1907 but was banned in cosmetics in 1990 after studies found it caused cancer in lab animals. Food safety advocates, scientists, and doctors have urged the FDA to issue a nationwide ban on synthetic food dyes for years. (Red No. 3 is already banned in The European Union, Canada, Australia, New Zealand, China, and Japan.)

“The FDA considered the issue in 2011 and again briefly in 2019 but opted not to take action,” Nigg said. “Since 2011, several new literature reviews have converged supporting the conclusion that food dyes increase the risk of ADHD symptoms.”

The California law may exert new pressure on the FDA to act.

“The primary purpose of this bill was to protect kids and families and consumers in the state of California,” State Assemblyman Jesse Gabriel told The New York Times. “But a secondary purpose here was to send a message to Washington that the FDA process is broken, and hopefully to spur momentum in Washington D.C., for real, significant change.”

“We’re stuck in this regulatory quandary where you’re not allowed to apply it [Red No. 3] to your skin, but you can ingest it in food — so it’s completely illogical,” Brian Ronholm, director of food policy for Consumer Reports said in the same article.

In October 2022, the Center for Science in the Public Interest (CSPI), a consumer advocacy group, and 23 other organizations, filed a petition formally asking the FDA to ban Red No. 3 in foods.

An FDA spokesperson told NPR the agency is “actively reviewing” the petition and will assess whether there’s “sufficient data” to revoke its use. The FDA spokesperson added that the agency “evaluates and regulates ingredients added to food to ensure that the authorized use of these ingredients is safe. This includes the four ingredients included in the California bill.”

How to Avoid Red Dye No. 3

In the meantime, Nigg advises children with ADHD to avoid foods containing food dyes — an admittedly difficult task. According to the Environmental Working Group’s Eat Well Guide, Red Dye No. 3 is used in nearly 3,000 products, including sodas, juices, yogurts, snacks, candy, frostings, instant rice and potato products, cereals, and boxed cake mixes. It is also used in medications including Vyvanse. ⁵

“Parents are well-advised to remove food dyes from their child’s diet if they can,” Nigg said. “It is on the list of things to try to do — along with other health actions like a healthy diet, exercise, and lower stress. I encourage parents to do what they can knowing it’s hard to do it all. Every bit can help.”

To start, Nigg suggests steering clear of most processed and packaged foods.

“Eat whole foods found on the perimeter of the grocery store — eggs, milk, cottage cheese, meat and poultry, nuts and seeds, fresh fruits, vegetables, and legumes,” he said. “Families should also be cautious when buying seemingly ‘healthy’ foods, some of which contain synthetic dyes: pickles, flavored oatmeal, salad dressing, peanut butter, and microwave popcorn, for example. Synthetic dyes are also in toothpaste, medication, and cosmetics. Parents should read all product labels closely.”

To check for the presence of Red Dye No. 3, look at a product’s ingredient lists for “FD&C Red #3” and look for dyes in the “inactive ingredients” section for medications.

The American Academy of Pediatrics has also advised parents to limit foods that often contain synthetic dyes, such as sugary drinks, juices, and candy, that may affect children’s behavior and attention.

Sources

¹ McCann, D., Barrett, A., Cooper, A., Crumpler, D., Dalen, L., Grimshaw, K., Kitchin, E., Lok, K., Porteous, L., Prince, E., Sonuga-Barke, E., Warner, J.O., Stevenson, J. (2007) Food Additives and Hyperactive Behaviour in 3-Year-Old and 8/9-Year-Old Children in the Community: A Randomised, Double-Blinded, Placebo-Controlled Trial. Lancet. doi: 10.1016/S0140-6736(07)61306-3.

² California Office of Environmental Health Hazard Assessment. (2021) Health Effects Assessment: Potential Neurobehavioral Effects of Synthetic Food Dyes in Children. https://oehha.ca.gov/media/downloads/risk-assessment/report/healthefftsassess041621.pdf

³ Henderson, Bailee. (2023, October 9) California Food Safety Act Signed Into Law, Officially Banning Four Toxic Additives by 2027. Food Safety. https://www.food-safety.com/articles/8939-california-food-safety-act-signed-into-law-officially-banning-four-toxic-additives-by-2027

⁴  Osborne, Margaret. (2023, October 17). What to Know About California’s New Law Banning Food Additives, Including Red Dye No. 3. Smithsonian. https://www.smithsonianmag.com/smart-news/california-bans-food-additives-including-red-dye-no-3-180983082/

⁵ FD&C Red No. 3. drugs.com. https://www.drugs.com/inactive/fd-c-red-no-3-247.html

The appeal of subscription boxes — for meals, pet supplies, household essentials, toys, and beyond — is obvious. For ADHD households, these services are a game changer. Most notably, they reduce the executive-function stress of planning meals, remembering every ingredient or detail, and running errands endlessly.

Subscriptions Boxes for ADHD Families

ADDitude readers told us that subscriptions boxes help them manage time, reduce impulsivity, smooth family dynamics, and simplify shopping. Nearly half of respondents from an ADDitude survey said they had tried or currently receive a subscription box service. Here are the ones they recommended most, plus tips to stay in charge of your spending.

Meal Planning

“HelloFresh meal kits helped our son, who has sensory challenges around food, become more open to trying new things. Cooking from scratch allowed him to see and smell the ingredients before being asked to try them. Once he had a few meals that he really enjoyed, he was more willing to try new ones, and has learned what ingredients he likes.” — Sue, Michigan

[Download: Free Meal-Planning Guide for ADHD Families]

“My current favorite is Home Chef, which has a nice variety of options. I usually go for the Oven Ready meals that require very little prep, but they also provide more advanced cooking options should I desire. The best part is the meals are well-sized, tasty, and nutritionally balanced without me having to expend mental energy on deciding what to eat or shop for. And the generally quick and easy cleanup keeps me from dreading cooking at home.” — Dawn, Illinois

“My teen likes to cook and follow directions for new recipes that she selects. She looks forward to it arriving in the mail.” — An ADDitude reader

“It helps with decision fatigue and having to plan every single meal.” — An ADDitude reader

Grocery Delivery

“Hungry Harvest produce boxes helped us save produce from being tossed, so I feel like I’m doing something good while also being catered to. Affordable and customized, it helps me get fresh food to my doorstep. It was especially useful during the more stringent periods of the pandemic.” — Paulette

“I have used Blue Apron meal kits in the past, but I’ve developed systems with meal prep since then that make it a lot easier. The Monday to Friday Cookbook taught me how to regularly keep things on hand in a pantry, and how to throw something together easily. I used Fresh Direct in NYC a lot for groceries and would keep certain things in standing order.” — An ADDitude reader

“Imperfect Foods allowed me to try new foods and divert waste, but I found it overwhelming to stay on top of cooking after a few weeks (even with the smallest possible box option) and canceled by the end of month three.” — Hannah, Pennsylvania

“When I get home after a long day where I barely ever sit down, the planning and advanced thinking part is already done. Otherwise, I would have to generate motivation, which would sap my remaining executive function skills and leave me cranky.” — An ADDitude reader

Fashion & Beauty

“I like to try new products with IPSY even when I like the products I am currently using. The trial sizes ensure I don’t get bored with my skincare and makeup routine.” — An ADDitude reader

“I subscribe to FabFitFun. It’s a reliable way to ensure I am receiving things that I enjoy and not only focusing on others.” — An ADDitude reader

“It’s a reliable way to ensure I am receiving things that I enjoy and not only focusing on others.” — An ADDitude reader

“If I had to remember to order it, it would happen far less often.” — An ADDitude reader

Best for Home Essentials

“With Who Gives A Crap, I don’t run out of toilet paper. I don’t have to remember to buy it at the store, figure out the cost per square inch, or determine what the best kind is. It just magically shows up at my house.” — Tamara, Idaho

“I subscribe to Amazon for products such as bathroom essentials, personal care products, and vitamins. This also reduces the need to store extra supplies in my small living space.” — Daphne, Minnesota

“Subscribing to eco-friendly cleaning products saves me from trying to find them in store.” — An ADDitude reader

Pet Supplies

“Chewy sends me dog and cat food, treats, and toys so I don’t run out or have to carry heavy bulky bags home. I never have to go and get an emergency bag of dog food anymore. I hate that. Loading kids in the car, dragging them through the pet shop, having to buy them another toy that I’ll accidentally step on and break just makes me angry.” — Tamara, Idaho

“We sure do get excited on BarkBox day! Our pets are a huge part of our family.” — An ADDitude reader

Art & Reading

“Of past subscriptions, the one I miss the most is Once Upon A Book Club. It’s perfect for people with ADHD because they package the book with three to five gifts that you open as you read. It’s a great incentive to keep going. I was introduced to books I love but that I never would have picked for myself. Currently, I have Paletteful Packs, which is an art subscription. I also use Amazon auto ship for some essentials, such as iron pills and Frontline flea treatment.” — Sherry, Texas

“Let’s Make Art is a good, constructive activity box that develops skills. However, it does have a screen component and sometimes my child will get frustrated and walk away mid-project.” — An ADDitude reader

“It gives me that little dopamine boost getting stickers in the mail… I’ve never been able to keep a calendar or planner until now. I find putting the stickers on to be a form of active meditation.” — An ADDitude reader

STEM Projects & Games

“My son gets Little Passports science kits every month. Science is a strength for him, so it feeds something positive. ADHD kids — and especially those with learning difficulties — can really get caught in negative thinking. This is something positive for him.” — Deidra, Florida

“My children were quite interested in KiwiCo and learned some neat things. But… we have found better experiences with renting library kits because they get the same experience without the cost. We also tried Epic Family reading subscription and ABCmouse. Those were interesting at times, and we see the kids reusing them… [but] we’ve had a better experience with book rentals from library apps.” — Amy, Michigan

[Read: 10 Captivating Audiobooks for Middle Grade Readers]

“Tinker Crates are engaging, non-electronic, and [help my son] learn something new. However, he is not quite at the age to be independent, so it’s a hands-on activity for both of us.” — AJ, Ohio

Sneaky Spending

Recurring subscriptions for everything from multivitamins and movies are convenient, but recurring costs automatically deducted from your bank account are easy to forget — and quick to add up.

To avoid paying for products and services you no longer need or use, use a subscription tracker like Rocket Money or Hiatus to conduct periodic reviews of your spending. Then ask yourself these questions to determine whether you should cancel a current subscription:

1. Are you continuing to watch, listen to, and/or read podcasts, cable, music, and other streaming media services?
2. Does it actually save any money to continue your recurring subscriptions to multivitamins, pet food, shampoo, and other products through delivery memberships like Amazon Prime?
3. Are you using your gym membership enough to justify the cost, or would switching to a subscription for online classes be more affordable and convenient?
4. Are you delighted by the quality of new clothes, cosmetics, craft beverages, or other products to which you subscribe?

Note renewal dates in your calendar and set a cancellation reminder before they automatically renew. Or better yet, uncheck the auto-renewal button when you sign up.

#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.

Subscription Boxes for ADHD: Next Steps

• Download: Activity Ideas for ADHD Families
• Read: Follow These 9 Healthy Food Rules
• Read: Learn How to Sharpen Executive Functions

Sources

¹Davidkhanian, S. (2021, July 30). More US consumers likely to continue shopping via ecommerce subscription models. eMarketer. https://www.insiderintelligence.com/content/more-us-consumers-ecommerce-subscription-models

Dietary Disguises

“My 6-year-old is a super smeller and taster with texture issues. I put 1/2 teaspoon of orange sherbet-flavored fish oil in orange juice. I mix a capsule of supplements in a peanut butter and honey sandwich. I sprinkle a probiotic in a sports drink.”

“Eating a popsicle before taking any medicine or supplement freezes the taste buds so the taste isn’t as strong.”

“Thick chocolate milkshakes work for us. In a blender, pour in milk, the powder or liquid supplement, and chocolate ice cream. Blend until no longer chunky.”

“Homemade waffle and pancake mix can hide protein powder and flax seeds.”

[Download: Free Guide to ADHD Brain Food]

“There are vegan alternatives to fish oil that provide omega-3 nutrients, like chia seeds and hemp. I use these in smoothies, yogurt, and oatmeal.”

“I drip the liquid from a fish oil capsule into a shot of fruit juice, then have my kids eat dinner to overshadow any lingering tastes.”

“My son loves the protein café latte shakes and they’re loaded with vitamins and minerals. They also have caffeine, which I think helps him.”

“Protein powders, spinach, and hemp, flax, and chia seeds go in smoothies with frozen fruit and non-dairy almond or coconut milk.”

[Read: ADHD and Fish Oil Supplements — What’s a Safe Dosage?]

“My child is autistic and has gut issues. He needs to take a laxative daily. I mix the powder in flavored water to make it taste better.”

“I put fish oil in smoothies and make popsicles out of the smoothies.”

“I always put powdered supplements in applesauce. For the ones that taste bad, I give a juice chaser afterward.”

“I have my own challenges with supplements and find that using yogurt with a drizzle of honey helps.”

“I sprinkle my son’s capsules into a small spoonful of pre-made cake frosting. A spoonful of sugar makes the medicine go down!”

“I put powder or liquid supplements in banana smoothies, chocolate milk, and pudding.”

“I give my kids gummies.”

“I mix liquid fish oil into tea with lemon and sugar.”

Picky Eaters with ADHD: Next Steps

• Download: Everyday Foods Filled with Omega-3s
• Read: The Parent’s Guide to Mealtime with Picky Eaters
• Read: ARFID, SPD, & Other Conditions Linked to Feeding Difficulties in Kids

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.

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

Thus, it seems increasingly clear that genes and environments work together to shape development of the brain and behavior throughout life, but especially —and most dramatically — in very early life. ADHD, like other complex conditions, doesn’t have a single cause. Both nature and nurture influence its development.

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

ADHD Risk Factors: What We Know

Prenatal Risk Factors

Teratogens: Alcohol, Smoking, and Other Substances

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

[Read: Is ADHD Genetic? Yes and No]

Alcohol

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

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

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

Tobacco Use

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

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

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

Drugs and Other Substances

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

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

Maternal Health Issues

Maternal Metabolic Syndrome

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

Emotional Stress and/or Trauma

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

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

Birth Trauma and Delivery Complications

Oxygen Deprivation

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

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

C-Section Delivery

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

Prematurity and Low Birth Weight

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

ADHD Risk Factors: Events and Exposures in Early Life

Lead and Other Pollutants

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

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

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

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

Breastfeeding and ADHD

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

Head Injuries

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

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

Childhood Trauma

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

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

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

ADHD Risk Factors: The Bottom Line

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

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

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

2. Not all ADHD risk factors have equal influence.

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

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

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

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

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

ADHD Risk Factors: What Parents Can Do

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

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

1. Engage in Behavioral Parent Training

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

2. Focus on Nutrition

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

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

3. Encourage Good Sleep Habits

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

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

4. Get Your Child Moving

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

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

5. Reduce Exposure to Lead and Other Pollutants

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

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

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

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

6. Limit Screen Time and Watch for Quality

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

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

7. Practice Self-Care

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

What Causes ADHD? Next Steps

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

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

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

Sources

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

February 21, 2023

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

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

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

[The ADHD Symptom Test for Teen Girls]

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

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

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

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

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

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

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

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

Sexual Violence at an All-Time High

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

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

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

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

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

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

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

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

Cyberbullying Twice as Likely for Girls

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

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

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

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

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

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

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

Substance Use Higher in Girls

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

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

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

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

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

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

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

How Can Parents Protect Their Kids?

Keep lines of communication open

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

• Prioritize a positive relationship

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

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

• Make communication routine

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

• Actively listen, rather than offer unsolicited advice

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

Help your daughter find treatment

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

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

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

Get Help

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

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

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

Stop Bullying

Mental Health in Teens: Next Steps

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

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

Source

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

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

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

NOTE: This resource is for personal use only.

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

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

Topics of discussion will include:

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

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

Listen to the Replay

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

Download or Stream the Podcast Audio

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

Resources and Organizations

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

More on Eating Disorders and Mental Health

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

Meet the Expert Speakers

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

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

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

Listener Testimonials

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

“Very skillfully done!”

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

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

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

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

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

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

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

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

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

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

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

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

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

Sources

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

October 7, 2022

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

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

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

[ADDitude Special Project: Mental Health Out Loud]

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

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

The Social Media Effect

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

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

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

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

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

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

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

How to Protect Your Teen’s Mental Health

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

1. Model emotional regulation at home.

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

2. Try to minimize exposure to negative news.

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

3. Encourage healthy social media use.

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

4. Encourage healthy habits.

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

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

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

ADHD & the Mental Health Crisis: Next Steps

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

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

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

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

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

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

Physical Activity, ADHD, and School: Next Steps

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

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

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Sources

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

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

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

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

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

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

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

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

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

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

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

Sources

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

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

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

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

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

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

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