September 18, 2026

Rates of obstructive sleep apnea (OSA) are significantly higher among kids with ADHD, according to a systematic review published in the Journal of Attention Disorders.¹ that found 44% of children with ADHD also had OSA.

Three research databases were searched, resulting in an analysis of 11 longitudinal studies involving 903 children formally diagnosed with OSA or ADHD. Using a random-effects meta-analysis, researchers found that the pooled prevalence of OSA in children with ADHD was 44%. They also found that adenoidectomy, a surgical procedure to remove the adenoid glands, consistently led to significant improvements in OSA and ADHD symptoms.

OSA is a sleep-related breathing disorder in which the muscles that keep the upper airway open relax too much during sleep, causing the airway to narrow or collapse. This, in turn, leads to a drop in oxygen and night wakings, which fragment sleep.

The disturbed sleep caused by OSA can result in symptoms that heavily overlap with those of ADHD, including decreased concentration, issues with memory and other executive functioning such as problem solving and planning. Previous research has demonstrated that co-occurring OSA can exacerbate these symptoms in patients with ADHD.

“Not only does ADHD cause sleep problems, but sleep problems aggravate ADHD symptoms,” explained J.J. Sandra Kooij, M.D., Ph.D., in the ADDitude article “The Disorder That Never Sleeps.”

Wes Crenshaw, Ph.D., echoed this observation in the ADDitude article, “What Comes First: ADHD or Sleep Problems?” “Few things impact mental health more than sleep,” he wrote. “Poor or insufficient sleep makes almost every psychological problem worse. With ADHD, that link is obvious and complicated, because there are several ways sleep and ADHD affect each other.”

How Poor Sleep Amplifies ADHD Symptoms

According to ADDitude readers, sleep issues are ubiquitous — and among the most challenging parts of living with ADHD. A recent ADDitude sleep survey of 2,156 readers revealed the scope and depths of sleep problems, with up to half of kids and adults with ADHD reporting symptoms similar to those associated with OSA.

• 36% reported difficulty waking up each morning
• 49% reported waking at least once every night

Diagnosed OSA rates were significantly lower:

• 25% of adults with ADHD reported an OSA diagnosis
• 9% of children and teens with ADHD also had an OSA diagnosis

Proper diagnosis of OSA and other sleep disorders is critical for both physical and mental wellbeing, as treatment via continuous positive airway pressure (CPAP) machine or adenoidectomy has been shown to improve symptoms of ADHD as well.

“Physicians should be cognizant of this association,” wrote the study’s authors. ”And consider concurrent evaluation for OSA in children with ADHD symptoms, which can effectively guide treatment strategies.”

Sources

¹Leow, B. H. W., Tan, C. J.-W., Yeo, B. S. Y., Ng, N. N. E., Low, S. C. Y., Ng, A. C. W., Teoh, O. H., Toh, S. T., & Tay, E. G. H. (2026). Association between Attention Deficit Hyperactivity Disorder and Obstructive Sleep Apnea in Children: A Systematic Review and Meta-Analysis. Journal of Attention Disorders, 30(6), 822-832. https://doi.org/10.1177/10870547261426094

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.

It’s weird looking at my childhood photos. I seem so happy, so full of life. But I don’t remember feeling happy. Mostly, I remember feeling ashamed that I could never meet my teachers’ and my parents’ expectations.

Why Am I So Angry?

I tried to be the good kid, the good student, the good friend. Nothing ever went according to plan. Report cards pointed out the many ways in which I failed as a student. I was too late, too messy, too much. I was also not enough. I didn’t apply enough effort. I didn’t have enough willpower.

“Jesse is too emotional,” teachers said, and it was hard to argue with this. I felt emotions intensely and expressed them with the same ferocity. My classmates were quick to notice. No child wants to be labeled a crybaby, so I learned to hide inside the one emotion that seemed acceptable for boys: anger.

[Read: Crashing Out? How to Calm Down When You’re Angry]

Anger wasn’t weak, right? Anger felt strong. I could ball up my fists and fight in anger. When I got angry, no one called me a crybaby.

How Blame Becomes Shame

My frequent angry outbursts got me into trouble. It was clear that something was wrong. But instead of investigating the root of my behavior, teachers and administrators made me out to be the troublemaker. That blame became shame. And I carried it around with me like a heavy backpack. Each time I did or said the wrong thing, or forgot about another important task, or didn’t meet expectations, the backpack grew heavier. It weighed me down.

That shame didn’t diminish with age. Any time my actions didn’t line up with expectations, more shame was shoveled into the backpack. My bosses would tell me, “You’re the only person I’ve ever had trouble with. I just don’t know what to do with you.”

[Read: ADHD and the Epidemic of Shame]

I didn’t know what to do with me either. I tried to cover my faults by working harder, working longer, working later. I continued to fall short and burn out.

A Clarifying Diagnosis

When I was finally diagnosed with ADHD as an adult, it all made sense. I finally understood why my actions and intentions rarely synced up. But I couldn’t shrug off the heavy shame. The backpack was still there, weighing me down.

Yet trying to remove and unpack it didn’t feel like an option. After so many years, it felt like a part of me.
Then I realized the truth: The shame in my backpack never should have been mine. It was created by people who just didn’t understand ADHD.

Toxic Shame and ADHD: Next Steps

• Read: Life Is Too Short for Shame
• Download: Rein In Intense ADHD Emotions
• Read: Neutralize Chronic Shame by Understanding Its Source

Jesse J. Anderson is the author of Extra Focus: The Quick Start Guide to Adult ADHD. He is the host of the podcast ADHD Nerds.

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May 19, 2026

Artificial intelligence tools can accurately estimate a child’s risk of having ADHD years before a typical evaluation and diagnosis, finds a new study published in Nature Mental Health.¹ The potential consequences of this analysis were highlighted by another new study, which found that children with ADHD who were diagnosed at earlier ages had higher GPAs and were far less likely to drop out of high school, compared with kids who were diagnosed in adolescence.

The first study was conducted by a team of researchers at Duke Health who pre-trained an AI model to analyze patients’ medical history using the electronic health records (EHRs) of 720,000 individuals. They further refined the model, training it with the records of 140,000 children with and without ADHD such that the model was able to identify developmental, behavioral, and clinical patterns associated with a diagnosis of ADHD.

Using data available at age 5, the AI model predicted which children would be diagnosed with ADHD between ages 5 and 9 with 92% accuracy. The model’s accuracy remained consistent over various demographics, with subjects of differing sex, race, ethnicity, and insurance status.

“Early diagnosis is critical, yet demographic and clinical disparities can delay detection,” write the study’s authors. “EHR-based predictive models could help providers reliably identify children with ADHD in a timely manner.”

“We have this incredibly rich source of information sitting in electronic health records,” said the study’s lead author, Elliot Hill, Ph.D., M.D., in a press release. “The idea was to see whether patterns hidden in that data could help us predict which children might later be diagnosed with ADHD, well before that diagnosis usually happens.”

Early Diagnosis Linked to Higher GPAs Later

“Connecting families with timely, evidence-based interventions is essential for helping [students] achieve their goals and laying a foundation for future success,” wrote Naomi Davis, Ph.D., co-author of the Nature Mental Health study regarding the potential impact of predictive diagnostic models in ADHD.

This assertion was validated by the findings of another new study, published in JAMA Psychiatry.² Using Finland’s national registry data for individuals born throughout the 1990s, researchers found that receiving an ADHD diagnosis at an earlier age was associated with higher GPAs and lower high school dropout rates, compared with receiving diagnoses at older ages.

After adjusting for sociodemographic variables, the researchers found that, compared with those who received a diagnosis in mid-adolescence (ages 14-16), children who received an early diagnosis (ages 4-6):

• Had significantly higher GPAs (by .6 to .7 points on a 10-point scale)
• Were three times less likely to drop out of high school
• Were four times more likely to complete an academic track in high school (2.5 times more likely for girls)

The Long-Term Benefits of Early Treatment

Early and consistent ADHD treatment helps children with more than academic performance, explained Adelaide S. Robb, M.D., in the ADDitude webinar, “Beyond the Core Symptoms of ADHD.” “One 10-year follow-up study also found that stimulants, especially when taken in early childhood, have protective effects on the rates of developing comorbidities like depression, anxiety, and ODD,” she wrote. “It has real, long-term impacts on areas like higher education and employment, involvement with the law, risky behavior, and overall quality of life.”

In an April 2026 ADDitude webinar titled, “The Brain Chemistry of ADHD,” Greg Mattingly, M.D., echoed this sentiment, explaining that treating ADHD early can have long-lasting benefits: “There is now data out there… that treatment isn’t just about the symptoms now; it’s about preventing damage in the brain so you don’t develop secondary issues like anxiety, depression, emotional dysregulation, and insomnia.”

Sources

¹Hill, E.D., Loh, D.R., Davis, N.O. et al. Early attention deficit hyperactivity disorder prediction from longitudinal electronic health records. Nat. Mental Health (2026). https://doi.org/10.1038/s44220-026-00628-2

²Volotinen L, Remes H, Martikainen P, Metsä-Simola N. Age at First Attention-Deficit/Hyperactivity Disorder Diagnosis and Educational Outcomes. JAMA Psychiatry. Published online April 08, 2026. doi:10.1001/jamapsychiatry.2026.0181

May 18, 2026

Symptoms of inattention appear in both ADHD and anxiety, but new research suggests that distinct brain mechanisms are associated with this behavior in each condition. A study published in the Journal of Attention Disorders found that children with ADHD and those with anxiety notice or focus on information at the very beginning of a task in similar ways; however, they behave differently after realizing they have made a mistake.¹

Determining whether a symptom of inattention is explained by underlying ADHD or anxiety can be challenging for clinicians. Distractibility, poor concentration, and forgetfulness are core traits of inattentive ADHD. Though inattention is not a clinical symptom of an anxiety disorder, children with anxiety may appear distracted and forgetful.

“ADHD and anxiety disorder symptoms overlap,” says William Dodson, M.D. “Both cause restlessness. An anxious child can be highly distracted because they are thinking about their anxiety or their obsessions. Both can lead to excessive worry and trouble settling down enough to fall asleep. It takes time to do a comprehensive history to determine whether a patient is struggling with one or both conditions.” About half of children with ADHD also meet the diagnostic criteria for a co-existing anxiety disorder.¹, ¹

For the study, researchers examined distinct stages of the attentional process — from initial focus to error correction — to chart differing behaviors among 111 children, ages 7 to 11. The participants were divided into four groups: ADHD-only, anxiety-only, ADHD-and-anxiety, and typically developing (TD). Electroencephalography (EEG) recorded the participants’ brain activity as they completed three computerized attention tasks of various difficulty.

The study found that children with ADHD, anxiety, or both conditions exhibited similar early attention and arousal regulation difficulties when they began a task. More specifically, the groups showed weaker neural responses to important cues, in deciding what to pay attention to, and in adjusting alertness levels based on task demands, compared with the TD group. The TD group’s brains shifted into a more activated, “ready” state before starting difficult tasks, while the other groups’ brains did not.

Distinct patterns emerged between the ADHD-only, anxiety-only, and ADHD-and-anxiety groups at the attentional engagement, performance monitoring, and performance evaluation phases of the study.

Children with Anxiety and Inattention

Children with anxiety showed signs of heightened error monitoring. Their brains reacted more harshly when mistakes occurred, indicating that they were hypersensitive to errors and potential failure. At the same time, they showed reduced conscious processing of those mistakes afterward. In other words, anxious children appeared to overreact automatically to errors without learning from them.

The researchers suggest that this anxiety-related inattention may stem partly from excessive self-monitoring and worry. The anxious brain may become so focused on avoiding mistakes and rumination that it remains mentally “stuck” on the error and is unable to redirect. This cycle of heightened error sensitivity combined with inefficient conscious evaluation could contribute to the distractibility and difficulty with sustaining attention seen in children with anxiety.

Children with Inattentive ADHD

In contrast, the ADHD-only group was less likely to recognize mistakes or practice post-error slowing (immediately slowing down after making an error to improve performance on the next attempt). This finding suggests that attention issues in children with ADHD are caused by a reduced ability to monitor performances and use feedback from the environment to adjust behaviors.

Children with ADHD and Anxiety

Findings from the study showed evidence of two types of attention issues working in tandem among the ADHD-and-anxiety group. Anxious behaviors, such as hypervigilance or worrying about making a mistake, appeared to act as a compensatory mechanism that offset typical ADHD symptoms. The anxious behaviors paradoxically reduced ADHD symptoms, such as impulsivity, and improved focus, but in doing so created a different attention issue (getting stuck, careless mistakes). In this case, when children are inattentive, it is not only because of their ADHD but because their anxiety prevents them from moving on and focusing on the task at hand.

Understanding the different neural mechanisms underlying inattentive symptoms could help clinicians more accurately distinguish between ADHD-related and anxiety-related inattention.

“Inaccurate or incomplete diagnoses can delay appropriate treatment, potentially leading to greater functional impairment and worsening symptoms,” the researchers wrote. “The attentional processes identified in the present study as differing between ADHD and anxiety symptom profiles may represent promising candidate targets for objective assessment to support clinical characterization.”

Source

¹ Pranjić, M., Peisch, V., Li, Y., Troxel, M., Lee, K., & Arnett, A.B. (2026). Inattention in pediatric attention-deficit/hyperactivity disorder and anxiety: Neurophysiological evidence for distinct and overlapping cognitive Mechanisms. Journal of Attention Disorders. https://doi.org/10.1177/10870547261445680

¹Bowen R., Chavira D.A., Bailey K., Stein M.T., Stein M.B. (2008). Nature of anxiety comorbid with attention deficit hyperactivity disorder in children from a pediatric primary care setting. Psychiatry Research. https://doi.org/10.1016/j.psychres.2004.12.015

¹Reimherr F.W., Marchant B.K., Gift T. E., Steans T. A. (2017). ADHD and anxiety: clinical significance and treatment implications. Current Psychiatry Reports. https://doi.org/10.1007/s11920-017-0859-6

April 29, 2026

The distinct symptom profiles of ADHD — namely, inattention and hyperactivity-impulsivity — follow their own unique behavioral and developmental pathways, and they may benefit from targeted interventions and treatment, suggests a new study published in Frontiers in Psychology.¹

Findings from the study show that ADHD symptoms arise not from a single deficit, but from different underlying brain systems involved in attention, behavioral control, emotional regulation, and sleep.

The research team found that symptoms of hyperactivity and impulsivity typically decrease as children age and are more commonly observed in boys, whereas inattention remains stable throughout development and affects boys and girls at similar rates. Overall, symptoms of inattention were found to be more severe than symptoms of hyperactivity and/or impulsivity.

Learning challenges appeared to be the strongest predictor of inattention, according to the study. Children with more severe inattentive symptoms showed greater difficulty sustaining focus, filtering out distractions, and managing mental effort. “These deficits directly impact classroom learning and explain the strong association [of inattention] with academic difficulties,” the researchers wrote.

The researchers also found strong associations between symptoms of hyperactivity-impulsivity and oppositional or conduct-related behaviors, emotional dysregulation, as well as specific sleep disruptions, such as restless sleep, nightmares, or unusual nighttime movements.

Sleep emerged as an important factor across both symptom clusters, but in different ways. While general sleep difficulties were loosely connected to inattention, disturbances in sleep–wake transitions, specifically restless sleep, nightmares, or sleep talking were a significant predictor of hyperactivity-impulsivity.

“Poor sleep may impair brain regulation systems, especially those tied to impulse control and emotional reactivity,” the researchers wrote.

“Sleep problems in youth with ADHD are associated with several negative outcomes,” said Stephen P. Becker, Ph.D., in the ADDitude webinar “Why Am I Always So Tired? The Latest Science on Improving Sleep in Children and Teens with ADHD.” “They impact functioning during the day, be it at school or at home, and they are associated with mental health problems over time. Sleep problems in adolescents with ADHD are tied to poorer quality of life, as well as poor academic performance and lower grades.”

Low-Anxiety, High-Impulsivity Subtype

Interestingly, children with lower levels of anxiety tended to show higher levels of hyperactivity and impulsivity, leading researchers to infer that anxious behaviors may suppress overt hyperactive behaviors. Children with anxiety may be more cautious, self-aware, or responsive to consequences, while children with low anxiety may be more prone to risk-taking and impulsive actions and less responsive to threat cues.

This finding points to a possible “low-anxiety, high-impulsivity” subtype of ADHD.

The recognition that different ADHD symptom profiles are driven by different neurological mechanisms could reshape how clinicians diagnose and treat the condition and its many subtypes.

For example, children with primarily inattentive symptoms may benefit most from academic support, cognitive interventions, and strategies that strengthen attention and information processing. Children with more pronounced hyperactivity and impulsivity may respond best to behavioral therapy, emotional regulation support, and interventions that address sleep quality.

This cross-sectional study was conducted at the outpatient Cognitive Center of Guangxi Zhuang Autonomous Region People’s Hospital, between December 2020 and December 2022. It included a sample of 331 children aged 6 to 12 years with ADHD.

Source

¹Fu Y, Qin Z, Qin L, Zhang H, Liu H, Huang S and Li D (2025) Multidimensional factors associated with ADHD core symptoms in children: cognition, sleep, behavior, and demographics. Front. Psychiatry. https://doi.org/10.3389/fpsyt.2025.1658202