September 15, 2026

Sex differences exert a significant and complex impact on ADHD symptoms, treatment, and risk of co-occurring conditions, according to the findings of several recent studies.

Most recently, researchers from Denmark found that individuals with ADHD faced relatively greater risk of developing 13 physical conditions, and that risk ratio was significantly affected by the sex of the patient.¹ Research on the impact of menstrual cycle hormones on ADHD symptoms further illuminated the notable influence of sex on ADHD symptomatology and impairment.² Finally, a study on the efficacy of cognitive behavioral therapy (CBT) for adolescents with ADHD also revealed differences across the sex divide.

Sex Impacts Risk of Physical Conditions

People with ADHD demonstrate a higher risk for 13 physical conditions, including endocrine, metabolic, and eye conditions, according to a study that used medical records of more than 800,000 Danish individuals. The study, published in the Journal of Attention Disorders, found that individuals diagnosed with ADHD showed a higher risk for all conditions, apart from malignant neoplasms, beginning in adolescence.

Having an ADHD diagnosis did not raise this risk equally for men and women, however.

In the general population, females were at a higher risk of most physical conditions beginning in adolescence. Specifically, females were nine times more likely to have an endocrine, nutritional, or metabolic disorder beginning in young adulthood. However, when researchers measured rates in females with an ADHD diagnosis, the relative prevalence fell by half.

In another case, males in the general population had a 15% higher risk than females of developing eye and adnexa diseases in childhood. Among those with an ADHD diagnosis, though, this trend was reversed; females had double the risk of males.

Sex and Hormonal Fluctuations Impact Symptoms

One notable difference in ADHD presentations between males and females stems from fluctuating symptoms over the menstrual cycle. The impact of estrogen on ADHD has been a primary research focus for Michelle Martel, Ph.D., chair of the psychology department at the University of Kentucky, who wrote this in the ADDitude article “Hormonal Changes in Women with ADHD: 4 Gaping Holes in Research:” “Each menstrual cycle brings hormonal peaks and valleys that significantly influence ADHD symptoms. Our recent research confirms that anxiety, mood, and attention all worsen as estrogen falls during the luteal phase.”

Prompted by the promising findings of a small study in 2018,⁴ Martel conducted a larger-scale study on ADHD symptoms and menstrual hormones. She recently presented her findings at the U.S. Psychiatric and Mental Health Congress.

Martel’s team collected daily measurements of hormone levels and ADHD symptoms from 97 female college students with an ADHD diagnosis and found ADHD symptoms, including impulsivity and inattention, increased in the days preceding and beginning their period.

“These studies have dramatic assessment and treatment implications,” Martel stated in a press release. “We should be paying attention to these things when we’re doing assessments, and then also we may want to change our treatments or personalize our treatments based on where women and girls are across their lifespan.”

Sex Impacts Efficacy of Treatment

A third study exploring yet another facet of sex differences focused on the varying impact of CBT on adolescent males and females with ADHD. Data from 200 teens who participated in randomized control trials in Norway or the Netherlands was analyzed.

According to parent reports, CBT significantly improved ADHD symptoms generally, however this improvement varied depending on the patient’s sex as well as accompanying symptoms of depression.

• CBT led to a significantly smaller reduction in ADHD symptoms for girls with higher levels of depression symptoms, compared to boys with these symptoms.
• For girls, receiving individual CBT (versus group CBT), led to double the improvement in ADHD symptoms.

Each of these studies sheds light on the highly complex and variable nature of ADHD symptoms, treatment, and co-occurring conditions and the still poorly understood ways in which sex differences may affect these realms.

Sources

¹Villumsen, M. D., Bilenberg, N., & Steinhausen, H.-C. (2026). Sex Differences in the Association Between Attention-Deficit Hyperactivity Disorder and Physical Diseases in Childhood and Adolescence Using Nationwide Birth Cohorts. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547261448260/

²Harper K. How menstrual periods can affect ADHD symptoms and treatment. Scientific American. May 2026. https://www.scientificamerican.com/article/adhd-symptoms-can-fluctuate-with-the-menstrual-cycle/

³Hanes, T. K., Andersen, A. C., Boyer, B. E., & Wagner, K. (2026). Gender Differences in Cognitive Behavioral Therapy Outcomes for Adolescents With ADHD: Examining the Impact of Internalizing Symptoms. Journal of Attention Disorders, 30(7), 945-954. https://doi.org/10.1177/10870547251415431

⁴Roberts B, Eisenlohr-Moul T, Martel MM. Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology. 2018;88:105-114. doi:10.1016/j.psyneuen.2017.11.015.

July 9, 2026

Adolescent boys with ADHD may exhibit lower self-esteem, more narcissistic traits, and greater aggression than do boys without ADHD. However, narcissistic tendencies and low self-esteem do not directly influence aggressive behaviors, according to a new study published in the International Journal of Developmental Neuroscience that examines the link between aggressive behavior and ADHD in children.¹

These findings refute earlier research suggesting that low self-esteem combined with narcissistic traits, such as perceived superiority and a heightened sensitivity to criticism, contribute to aggressiveness in children with ADHD.², ³

The study included 80 boys aged 9 to 14 years who had been diagnosed with ADHD and 41 age-matched boys without ADHD. Participants and their caregivers completed several rating scales and questionnaires on self-esteem, narcissistic traits, and aggressive behaviors, which revealed the following findings:

• On the Strengths and Difficulties Questionnaire (SDQ), boys with ADHD scored significantly higher than did the control group across all aggression scales and subscales, including verbal aggression, aggression toward objects and animals, provoked physical aggression, and unprovoked physical aggression.
• On the Rosenberg Self-Esteem Scale, the ADHD group exhibited significantly lower self-esteem scores than did the control group. The researchers also found that children with lower self-esteem scores tended to exhibit greater aggression toward objects and animals, though no causation was established.
• The researchers also observed a weak but statistically significant negative correlation between self-esteem and symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder based on diagnostic criteria in the Turgay DSM-5 Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S).

“While ODD has an estimated prevalence of 10%, it occurs in about half of children with ADHD, making it one of the most common disorders occurring with ADHD,” said William Dodson, M.D.-LF-APA, during the ADDitude webinar “How Oppositional Defiant Disorder Ruptures Families — and How You Can Learn to Manage It.”⁴

Narcissistic Traits in Children with ADHD

Study participants also completed The Childhood Narcissism Scale (CNS), which measures grandiose and entitled traits in children aged 8 to 14. The ADHD group scored significantly higher on the CNS than did the control group, a finding that aligns with previous studies on narcissistic traits.

Individuals diagnosed with ADHD in childhood have an increased risk of being diagnosed in late adolescence with a personality disorder, particularly narcissistic personality disorder (NPD), which occurs in 25% of adults with ADHD compared to 6% of adults without ADHD.⁵

Though mental health providers do not diagnose NPD before age 18, the researchers noted that younger children may show early signs of the personality disorder. “Narcissistic individuals may react to threats to their idealized self-image with intense emotions, such as shame, anger, or envy, often resorting to maladaptive strategies to regulate self-esteem,” they wrote.

Many symptoms of NPD and ODD overlap, such as a lack of empathy or accountability for actions, severe sensitivity to criticism, noncompliance, and manipulation of others. Though similar, these symptoms may manifest in different ways. For example, an individual with NPD often possesses an inflated sense of self-importance and entitlement that serves as justification for their actions.

“People with ODD typically do not regard themselves as oppositional or defiant,” Dodson said. “They often justify their behaviors as a response to unreasonable demands or provocation from the person in authority. As such, there is often no remorse or discomfort involved with these disruptive behaviors.”

Though symptoms of narcissism and ODD may mimic one another, the study found no correlation between high narcissistic trait scores and high scores of aggression.

This finding adds color to the picture painted by a 2025 study published in the Journal of Psychiatric Research that linked narcissistic traits in adults with ADHD with higher levels of anxiety and depression. Traits of vulnerable narcissism, specifically, were associated with more significant emotional dysregulation and a history of hospitalization, suicide attempts, and non-suicidal self-injury.⁶

How Emotional Dysregulation Influences Aggression

Missing from the study was a look at how emotional dysregulation influences aggressive or disruptive behaviors in children with ADHD. This omission may stem from the fact that emotional dysregulation is not included in the diagnostic criteria for ADHD, though many individuals describe it as the most impairing aspect of the condition.

“Emotional dysregulation is a defining characteristic of ADHD, which explains why so many children and teens with ADHD are easily swept away by intense emotions — resulting in explosive, aggressive, sometimes frightening reactions that disrupt the entire family,” said Dodson.

Joel Nigg, Ph.D., discussed the relationship between ADHD, emotional dysregulation, and anger in the ADDitude webinar titled, “You’re So Emotional: Why ADHD Brains Wrestle with Emotional Regulation.” “Individuals with ADHD experience disproportionate problems with anger, irritability, and managing other emotions,” he said.

“These problems walk in lock step with the general difficulties in self-regulation that characterize ADHD.”

Sources

¹Öcal, G.K., Önder, A., Adanır, A.S., Çoban, Ö.G. (2026). Narcissistic traits, self-esteem and aggression symptoms in children and adolescents with attention-deficit/hyperactivity disorder. Int J Dev Neurosci. https://doi.org/10.1002/jdn.70143

²Barry, C.T., Frick, P.J., and Killian, A.L. (2003). The relation of Narcissism and self-esteem to conduct problems in children: a preliminary investigation. Journal of Clinical Child & Adolescent Psychology. https://doi.org/10.1207/S15374424JCCP3201_13

³Hiemstra, W., Verhulp, E.E., Thomaes, S., and Orobio de Castro, B. (2020). Self-views and aggression in boys referred for disruptive behavior problems: self-esteem, narcissism, and their interaction. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-019-01347-z

⁴Eskander, N. (2020). The psychosocial outcome of conduct and oppositional defiant disorder in children with attention deficit hyperactivity disorder. Cureus. https://doi.org/10.7759/cureus.9521

⁵Stinson, F.S., Dawson, D.A., Goldstein, R.B., Chou, S.P., et al. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. https://doi.org/10.4088/jcp.v69n0701

⁶Duarte, M., Blay, M., Hasler, R., Pham, E., Nicastro, R. et al. (2024). Adult ADHD and pathological narcissism: A retrospective-analysis. J Psychiatr Res. https://doi.org/10.1016/j.jpsychires.2024.04.032

>>Part One: A Guide to Raising Teen Boys with ADHD

The toxic masculinity pipeline is active online, yet most boys and young men are not actively seeking it out. Entry into the manosphere often begins innocently — a desire for self-improvement. Social media algorithms funnel teenage boys who seek advice on fitness, social skills, mental health, discipline, dating, and similar topics to communities and influencers that promote extreme, hateful views.

Boys who struggle with social isolation, low self-esteem and self-efficacy, and mental health challenges are at greatest risk of getting sucked into these echo chambers. Such spaces often espouse misogynistic beliefs — for example, that the advancement of women’s rights and gender equality are to blame for the challenges facing men today. According to a report from Common Sense Media, more than two-thirds of teen boys regularly see masculinity content that reinforces gender stereotypes. Those who are exposed to higher levels of this content are more likely to experience low self-esteem and feelings of loneliness.

Beyond pressuring boys to be dominant, emotionless, and aggressive, these communities promote narrow views of masculinity, like a success-at-any-cost mentality. Prominent manosphere figures include Jordan Peterson and Andrew Tate, who faces charges of human trafficking and sexual assault in several countries.

Counter the Influence

Understand the landscape. Be aware of terms commonly shared in these spaces, from “redpill” to “alpha/beta” and more. UNwomen.org offers a helpful manosphere glossary.

Critically evaluate online content. Ask your child: Does the community or influencer make you feel…

• …angry — at yourself or a group of people?
• …like you’re being driven to an unrealistic standard?
• …inadequate — like you’re not doing enough?
• …hopeless, like the world is rigged against you for being male?

Spot red flags. Watch for irritability and anger, sweeping negative generalizations about women, deteriorating relationships with females (mom, sister, classmates, etc.), and talking as if from a script.

Promote positive masculinity. Spotlight diverse male role models and have ongoing conversations about what healthy masculinity looks like. A good start? Watch ADDitude’s ADHD men’s roundtable: additu.de/100725

ADHD in Boys: Next Steps

• Read: What Terrifies Men? Vulnerability.
• Read: On Finding a Healthier Way to Be a Man
• Read: “7 Ways to Parent in the Age of Brain Rot”

ADDITUDE IS HUMAN
Artificial intelligence does not create or edit any written content published by ADDitude. Our editorial team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

How do we ensure that our teen boys become healthy men? By leaning into trust. We’re inclined to offer excessive help to our sons because of their ADHD-related challenges. At the same time, their growth fundamentally depends on our trusting them and relinquishing control.

Learn to navigate this paradox of independence, and other hot spots for teen boys today, with the guidelines that follow.

Bonds and Friendships

Teen boys are more isolated today than ever before. Help your child make in-person connections at the gym, a hobby store, a skate park, card leagues, theater groups, or another place that builds on his interests.

Support connection. Remind your child that everyone feels awkward when meeting people. To reduce feelings of rejection sensitivity, tell your son that socializing is a skill that he and his peers are learning together.

Maintain family traditions. From movie and board game nights to monthly dinners at a favorite restaurant, these routines support and protect bonds. At the same time, give your kid permission to break one of the traditions if they have an opportunity to hang out with friends.

[Read: “My Son’s Only Social Interactions Are On Screens!”]

Anger and Vulnerability

Teen boys face intense pressure to suppress vulnerability just as they’re dealing with the emotional upheaval of puberty. Uncomfortable feelings – like rejection, inadequacy, embarrassment, or fear – are viewed as weaknesses and often disguised as anger.

Don’t avoid delicate topics. Your child needs to learn to deal with tough feelings. Pick a moment when your child is regulated and approach them calmly. If trying to talk provokes swearing or meltdowns, say, “When you start flying off the handle, I’m going to leave the room because I don’t deserve to be talked to like that. I’m going to give you time, and then we’re coming back to this.”

Talk side-by-side. Face-to-face conversations feel confrontational for many boys, so I like to talk to my sons in the car.

Model vulnerability. Share your own struggles. You can say something like, “When I was cut from the basketball team junior year, I cried because I was so disappointed.” Or you can say, “I screwed up with your mom and I need to apologize.”

[Read: 5 Ways to Build Bonds – a Guide for ADHD Dads]

Leave the door open. Respect your teen’s silence but remind them that you’re safe to go to. Say, “Okay, you don’t want to talk. That’s fine. Just know I’m around.”

Aid in self-awareness. Help your son take ownership of his emotional regulation. Talk about signs of dysregulation (defensiveness, reactiveness) and strategies to counter that, including exercise, low-stimulus activities, cold exposure, and box breathing. For example: “You seem to have a better day when you walk the dog in the morning. Why don’t you do that more often?”

Growing Pains

Punishments are ineffective power moves designed to hurt, not teach. Consequences are logical, natural results that effectively change behavior. Remember the difference when setting behavioral boundaries. For example:

Punishment: You didn’t do your homework, so no ice cream for dessert.

Consequence: You didn’t do your homework because you were playing video games. Moving forward, you can play video games only after homework is done.

Make the future tangible. For ADHD brains that live in the now, thinking about life after high school is nearly impossible. Tour colleges early and find opportunities for your son to shadow people in fields that interest him.

Going Solo

However unnatural it feels, the more you trust your child – even if ADHD has complicated that picture – the more trustworthy he will become.

“Practice independence” is the motto I turn to when I find myself overstepping with my own teen boys. As much as I’m driven to help, I want my children to have opportunities to build self-agency too.

Illuminate his trustworthiness. While your son may need to work on building trust in some areas (like doing his homework), lean into spaces where he can be trusted (like taking care of the family pet) to support your bond.

Digital Guardrails

Smartphones can do it all, but kids must learn to create limits around uses.

Set boundaries. Consider a household rule to stop using phones for entertainment after 7 p.m. They can still use the phone to research or text friends.

Decompression is essential after extensive screen time. Guide your child to rest his eyes and brain with a soothing activity, like a walk or a shower.

ADHD in Teen Boys: Next Steps

• Read: How Dysregulated Emotions Hijack the Teen ADHD Brain
• Read: Inside Your Teen’s ADHD Mind
• Read: “Should I Stop My ADHD Teen from Hanging Out with ‘Bad’ Friends?”

Brendan Mahan, M.Ed., M.S., is the producer and host of the ADHD Essentials podcast.

ADDITUDE IS HUMAN
Artificial intelligence does not create or edit any written content published by ADDitude. Our editorial team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.