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.

August 25, 2026

A neurodivergent individual is 4.3 times more likely to have a structural connective tissue disorder, and 3.4 times more likely to have a hypermobility spectrum disorder than their neurotypical peers, according to a new analysis.¹ Analyzing information about 117 million U.S. adults and adolescents, the researchers built on previous data from small trials that found a link between ADHD, autism spectrum disorder (ASD), and connective tissue disorders.^{2, 3}

Researchers grouped patients into three categories according to neurodevelopmental diagnosis (patients with ASD alone, ADHD alone, and both ASD and ADHD) and matched each patient with a neurotypical control of similar age, sex, and health care visit frequency. Then they explored rates of the following connective tissue disorders:

• Heritable structural disorders, such as Ehlers-Danlos and Marfan syndrome
• Hypermobility spectrum disorders
• Autoimmune and inflammatory disorders, such as lupus

All connective tissue disorders were significantly more prevalent in all categories of neurodivergent patients than they were in comparison patients, with the highest associations found in patients who had ASD and ADHD. Specifically:

While the increase in relative risk was dramatic, the incidence of absolute risk for connective tissue disorders among neurotypical as well as neurodivergent groups remained low. Heritable structural disorders, for example, were found in 21 out of 1,000 patients with ADHD and ASD, compared with 4 out of 1,000 neurotypical patients.

Understanding Complex Connections Leads to Better Treatment, Readers Say

Joint hypermobility is central to understanding ADHD’s connections with asthma, allergies, autoimmune disorders, and gut issues, said James Kustow, Ph.D., in his ADDitude article “ADHD’s Curious Connections to Chronic Inflammation and Dysautonomia.”

“Strikingly, about half of people with ADHD are hypermobile,” Kustow wrote. “While many experience no issues, some develop hypermobile Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD), which are strongly linked to inflammation, in the form of mast cell activation syndrome, and dysautonomia.”

Leading researcher Jessica Eccles, Ph.D., echoed this observation in a recent ADDitude webinar, “How Joint Hypermobility Links Neurodivergence, Chronic Pain, Inflammatory Disorders, and Anxiety,” explaining that hypermobility may be the common thread binding neurodivergence to a range of physical health problems, including anxiety, chronic pain, and fatigue.

“Understanding the interconnectedness of these seemingly disparate symptoms and problems can be transformative, particularly for people seeking a diagnosis and treatment,” Eccles wrote in the ADDitude article “Bendy Bodies, ADHD Brains: Connecting the Dots.”

This understanding, however, is still nascent. Many healthcare providers are not yet familiar with these associations between connective tissue disorders and ADHD, making it difficult for patients to optimize their treatment.

“The traditional healthcare system can be frustrating to navigate with these types of issues, especially for aging women as hormones change, impacting joint health, gut health, and inflammation,” said Jennifer, an ADDitude reader in Utah with joint hypermobility and inflammatory symptoms. “It’s taken me years of frustration, persistence, and exploration to self-solve some of this.”

“It took more than 10 years to find doctors who believed me and helped me pursue a diagnosis of joint hypermobility,” said an ADDitude reader in Canada. “My doctor is an internal medicine specialist who tries to be helpful, even with limited experience, and encourages me to try treatments like compression wear and strength training.”

 Sources

¹Bartelt K, Keane G, Franklin B, Higgs E. Neurodivergence Linked to Higher Rates of Connective Tissue Disorders. Epic Research. https://epicresearch.org/articles/neurodivergence-linked-to-higher-rates-of-connective-tissue-disorders. Accessed on August 21, 2026.

²Csecs JLL, Iodice V, Rae CL, et al. Joint hypermobility links neurodivergence to dysautonomia and pain. Front Psychiatry. 2022;12:786916. doi:10.3389/fpsyt.2021.786916

³Cederlöf M, Larsson H, Lichtenstein P, Almqvist C, Serlachius E, Ludvigsson JF. Nationwide population-based cohort study of psychiatric disorders in individuals with Ehlers-Danlos syndrome or hypermobility syndrome and their siblings. BMC Psychiatry. 2016;16:207. doi:10.1186/s12888-016-0922-6

A growing body of research links ADHD to inflammatory and immune conditions ranging from asthma and rheumatoid arthritis to gut issues, allergies, and more. Several pathways and underlying mechanisms may explain the connections, but it’s unknown whether inflammation drives ADHD, ADHD drives inflammation, or shared factors are to blame. Regardless, the link begs a larger question, according to Beth Krone, Ph.D., a licensed clinical psychologist and research scientist at the Icahn School of Medicine at Mount Sinai in New York: “Does recognizing the role of immune inflammatory processes change the way we think about ADHD and having ADHD?”

This was the question underlying Krone’s August 2026 ADDitude webinar, “ADHD and Inflammatory and Immune System Disorders: Exploring Links and Risks.” Here are our takeaways from that event on ADHD, inflammation, and effective health protections.

Routes to Inflammation in ADHD

Researchers are investigating the following associations in an effort to understand the ADHD-inflammation link:

• Disrupted dopamine signaling. Differences in dopamine signaling are inherent in ADHD, but the role of the neurotransmitter dopamine goes far beyond the brain. Dopamine signaling, for example, directly regulates immune and inflammatory activity. It alters T cell activity, a type of blood cell that plays a big role in the way the body upregulates inflammation. One study found that a higher number of T cells was associated with ADHD symptoms, even without a diagnosis.
• Disrupted immunoglobulins (IgE). These antibodies drive allergic reactions by causing mast cells to release histamine. Some studies have found altered immunoglobulin patterns among people with ADHD. Read about mast cell activation syndrome and ADHD.
• Genetic vulnerabilities. Many genes that are tied to ADHD are also tied to immune system function.

[Take the ADDitude Survey! ADHD and Inflammation]

Chronic Stress and ADHD

ADHD is not a stress disorder, but its impairments add to allostatic load, or cumulative stress, a well-known trigger for inflammation. That is, living with ADHD itself may predispose individuals to inflammatory conditions.

“You’ve got the vulnerability genes, you’ve got the cumulative stress, and you have a worse stress outcome, which is possibly why ADHD is also associated with neurodegenerative disorders later in life,” Krone said.

What Can Be Done

There is no anti-inflammatory treatment protocol for ADHD, and it is currently unclear if ADHD medications help with inflammatory conditions. What is clear is that treating ADHD helps people live longer, healthier lives. Krone recommends taking the following steps to protect your health:

• Identify and treat any underlying allergies, autoimmune conditions, sleep disorders, or other health problems. Managing these conditions may indirectly improve ADHD symptoms.
• Track one to three cognitive and physical symptoms, noting sleep, illness, medication changes, pain, rashes, fever, digestive symptoms, and possible triggers. Bring your data to a provider to help them see patterns.
• Treat your ADHD. Symptom management can help you stay on top of your physical health conditions.
• Prioritize sleep and exercise. “Exercise has the highest yield for overall well-being,” said Krone.
• Only eat a specific diet if you have food allergies or intolerances. Otherwise, a nutritious diet and regular meals matter in leading the kind of healthy lifestyle that boosts resilience.

For more insights on ADHD, inflammation, and autoimmune conditions, watch the full webinar at additu.de/081826

Inflammation and ADHD: Next Steps

• Free Download: Healthy Lifestyle Changes for Adults with ADHD
• Read: ADHD’s Curious Connections to Chronic Inflammation and Dysautonomia
• Read: How ADHD Can Intensify Physical Health Conditions

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.

June 11, 2026

Adults with chronic pain are 2.4 times more likely to have ADHD traits than are members of the general population, according to a new cross-sectional screening study published in Scientific Reports.¹

Researchers found that ADHD symptoms were linked to higher pain intensity, and that almost a third of patients with “extremely severe pain” (a rating of 9-10 on a 10-point scale) reported ADHD symptoms. No relationship was found between autistic traits and chronic pain.

The study, conducted by researchers at the University of Tokyo, included 958 adult patients who received treatment for chronic pain at 13 multidisciplinary pain centers in Japan. The average age of participants was 58 years, and 40.6% were male. They completed surveys related to chronic pain characteristics, ADHD and ASD symptoms, and other psychological conditions.

Of the pain clinic patients:

• 17.1% showed ADHD symptoms
• 27.4% of patients with severe pain showed ADHD symptoms
• 4.4% showed ASD symptoms

Taking into consideration the consistently high false-negative rate of the ASRS survey for ADHD symptoms (31.3%), the study researchers speculate that the true proportion of participants who may meet diagnostic criteria for ADHD could be higher than what was observed in the study. They offer that an estimated 24.9% of all participants in this study, and 39.9% of those with extremely severe pain could potentially meet the diagnostic criteria for ADHD in a clinical setting. The Centers for Disease Control (CDC) estimates that 2% to 5% of adults in the general population experience ADHD symptoms.

Adjusting for the presence of anxiety, depression, and pain catastrophizing significantly decreased the link between ADHD symptoms and severe pain, causing researchers to conclude: “Emotional and cognitive factors may play a key mediating role.”

ADHD Medications May Improve Chronic Pain

The confirmation of a strong association between ADHD symptoms and chronic pain may shed light on potential treatment paths for intractable pain in patients. Prior research conducted by the same group found that ADHD medication shows efficacy in improving chronic pain among patients with ADHD.^{2, 3}

The University of Tokyo researchers write: “Given that ADHD medications can improve both chronic pain and associated cognitive dysfunction in individuals with comorbid ADHD, the screening and management of ADHD symptoms should be considered a priority in the clinical care of individuals with persistent chronic pain.”

An important limitation of the study was that researchers relied on self-reported symptoms of ADHD and autism spectrum disorder (ASD), rather than formal diagnoses.

Debilitating, Unresponsive Chronic Pain

The study’s findings confirm an association long observed by clinicians. “In our practice, we frequently encounter patients with chronic pain who do not respond well to conventional treatments,” said lead author Satoshi Kasahara, M.D., Ph.D., of the University of Tokyo Hospital, in a press release. “Among these patients, many show characteristics commonly seen in ADHD, such as inattention, hyperactivity or impulsivity, and difficulties with emotional regulation.”

This unrecognized link was the topic of a recent ADDitude webinar, “When Everything Hurts: Chronic Pain in Neurodivergent Youth,” led by Gloria Han, Ph.D., and Anna C. Wilson, Ph.D., who explained the myriad connections between emotional and cognitive factors characteristic of ADHD and complex, chronic pain.

“The brain and nervous system work to keep us safe by shifting between two branches: the sympathetic system, which activates the fight-or-flight response to mobilize the body during challenges, and the parasympathetic system, which calms and regulates us,” wrote Han and Wilson in a related ADDitude article. “Chronic pain occurs when the fight-or-flight system stays activated, amplifying pain signals, intensifying danger perception, disrupting sleep and mood, and further dysregulating the body – creating a cycle of overactivation.”

The chronic pain experienced by many neurodivergent adults and children is often broad-ranging and multi-systemic. Katy, mother to a 17-year-old daughter who recently received an ADHD diagnosis and has been experiencing pain all her life, describes the pain as persistent soreness all over her daughter’s body.

“From about ages 9 to 12, at different times, she was in physical therapy for knee pain, hip pain, and shoulder pain,” Katy said. “At around age 10, she had about 9 months of horrible GI issues, and at ages 12 to 14, she had about 2 years’ worth of migraines. Most likely, it’s been related to chronic inflammation; when she would take ibuprofen, it helped.”

Because of its broad-spectrum nature, the chronic pain is sometimes met with skepticism from doctors. “My 9-year-old child experiences chronic stomach pain. She describes it as a dull ache radiating from her core throughout her body, into her arms and legs,” said Jenny, an ADDitude reader in Kansas. “We have tried so many different approaches and treatments. I feel as though none of her providers are on her side.”

A source of hope for suffering patients can be found in the University of Tokyo study’s finding that ADHD medications may mitigate the pain, an assertion echoed through the anecdotal reports of readers. “The chronic pain is debilitating. We have been to all kinds of doctors, specialists, homeopathic, alternative methods,” said Selena, an ADDitude reader in Utah. “The only thing that helps is ADHD medications — and they make a miraculous difference.”

Sources

¹Kasahara, S., Aono, S., Takatsuki, K. et al. Attention-deficit/hyperactivity disorder and autism spectrum disorder in chronic pain: a study in Japanese pain centers. Sci Rep 16, 10544 (2026).
²Kasahara, S. et al. Innovative therapeutic strategies using ADHD medications tailored to the behavioral characteristics of patients with chronic pain. Front. Pharmacol. 16, 1500313 (2025).
³Kasahara, S. et al. Case report: atomoxetine improves chronic pain with comorbid post-traumatic stress disorder and attention deficit hyperactivity disorder. Front. Psychiatry 14, 1221694 (2023).

ADHD medications, particularly stimulants, are the most effective treatments in all of psychiatry. In the short term, they significantly reduce ADHD symptoms; in the long term, they protect against a multitude of negative outcomes.

While these medications deliver clear benefits, concerns remain about their possible side effects – among them, potential cardiovascular issues associated with long-term use. There is high-quality research on stimulants and heart health, and here I will place these findings in context.

ADHD Meds and Heart Health

Most ADHD medications – stimulants and non-stimulants – have small average effects on blood pressure and heart rate after weeks or a few months of use.¹ These findings are based on the results of more than 100 randomized controlled trials, the most rigorous type of clinical study. Blood pressure in medicated individuals appears elevated mainly during the daytime, suggesting that the cardiovascular system isn’t continuously stressed and may recover at night when the medication has worn off.²

[Read: Heart Health and ADHD – On Cardiovascular Risks and Treatments]

To clarify the connection between cardiovascular disease and extended use of stimulant or non-stimulant medication for ADHD, a comprehensive study followed more than 278,000 people with ADHD over 14 years.³ Three findings stand out from this research:

• People who take ADHD medication long-term face a slightly increased risk for hypertension compared to those who do not take these medications.
• Hypertension risk is dose-dependent; the higher the dose of medication, the greater the risk for high blood pressure.
• Taking ADHD medication long-term does not increase risk for arrhythmia, heart attacks, or thromboembolism.

Guidelines for Professionals

High quality, rigorous research indicates that, at a group level, ADHD medication use may slightly increase the risk for high blood pressure, but not for other cardiovascular events. Given the clear benefits these medications provide – from improved academic function and protection against injury to reduced mortality – the risk-benefit ratio is reassuring for people who take ADHD medications.

That said, all decisions regarding ADHD medication use should consider the individual’s pre-existing or familial cardiac conditions and be made in consultation with a cardiovascular specialist. Other guidelines include the following:

• Monitor blood pressure and pulse before and during ADHD treatment with all medications, not just stimulants.
• Use the minimum effective dose of ADHD medication.
• High blood pressure is not an absolute contraindication to ADHD medication, If hypertension is observed after starting medication, decrease the dose or stop the medication and refer the patient to a specialist who can check for and treat hypertension. The patient may be able to resume the ADHD medication after treatment. Hypertension can also be treated before starting ADHD medication.
• Taking medication for high blood pressure is not a contraindication for ADHD medication. It is acceptable to take medication for ADHD in addition to medication for hypertension so long as blood pressure is stabilized and monitored.

ADHD and Heart Health: Next Steps

• Free Download: Healthy Lifestyle Changes for Adults with ADHD
• Read: Understanding Cardiovascular Disease in Women with ADHD
• Read: Can I Take ADHD Medications If I Have a Heart Condition?

Samuele Cortese, M.D, Ph.D., is a professor at the University of Southampton in the United Kingdom and an adjunct professor at New York University. He was part of a team that created a platform on the latest ADHD research and evidence-based interventions at ebiadhd-database.org

ADDITUDE IS HUMAN
Artificial intelligence does not write or edit any content published by ADDitude. Our 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.

Sources

¹ Farhat, L. C., Lannes, A., Del Giovane, C., Parlatini, V., Garcia-Argibay, M., Ostinelli, E. G., Tomlinson, A., Chang, Z., Larsson, H., Fava, C., Montastruc, F., Cipriani, A., Revet, A., & Cortese, S. (2025). Comparative cardiovascular safety of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet. Psychiatry, 12(5), 355–365. https://doi.org/10.1016/S2215-0366(25)00062-8

²Buitelaar, J. K., van de Loo-Neus, G. H. H., Hennissen, L., Greven, C. U., Hoekstra, P. J., Nagy, P., Ramos-Quiroga, A., Rosenthal, E., Kabir, S., Man, K. K. C., Ic, W., Coghill, D., & ADDUCE consortium (2022). Long-term methylphenidate exposure and 24-hours blood pressure and left ventricular mass in adolescents and young adults with attention deficit hyperactivity disorder. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 64, 63–71. https://doi.org/10.1016/j.euroneuro.2022.09.001

³Zhang, L., Li, L., Andell, P., Garcia-Argibay, M., Quinn, P. D., D’Onofrio, B. M., Brikell, I., Kuja-Halkola, R., Lichtenstein, P., Johnell, K., Larsson, H., & Chang, Z. (2024). Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases. JAMA psychiatry, 81(2), 178–187. https://doi.org/10.1001/jamapsychiatry.2023.4294