February 19, 2022
While romantic relationships can bring contentment and stability to adults with psychological disorders, conflict in such relationships adds incremental risk for developing depressive, anxiety, and substance use disorders. Moreover, persons with ADHD are more prone to such conflict than those without ADHD.
ADHD symptoms are negatively associated with satisfaction in dating relationships. One study found that female college students, blind to ADHD status, were less interested in male students with ADHD-Inattentive presentation than peers without ADHD. Another study found that college students who self-reported significant inattentive and hyperactive-impulsive symptoms also reported lower romantic relationship satisfaction than students not reporting such symptoms. A third study likewise found an inverse association between college student-reported inattentive symptoms and romantic relationship satisfaction, although it found no such association for self-reported hyperactive/impulsive symptoms.
This in turn has behavioral implications. One study found that college students with clinically elevated symptoms of inattention, hyperactivity/impulsivity, or both, reported higher levels of hostile conflict behavior with their partners than students without clinically elevated symptoms. Another study placed young couples through conflict resolutions. Couples in which one partner had ADHD demonstrated more negative and less positive conflict resolution behavior, and reported lower relational satisfaction, than couples in which neither partner had an ADHD diagnosis.
Worse yet, ADHD is a risk factor for dating violence. Two studies found that young adult males diagnosed with ADHD as children self-reported engaging in more frequent verbal and physical intimate partner violence than did their normally developing peers. Two more studies reported that men and women diagnosed with ADHD as children were at greater risk of becoming victims of such violence.
Adults with ADHD are also more likely to engage in risky sexual behavior. On average, they initiate sexual intercourse between one and two years earlier. They tend to have more partners and to make less frequent use of contraception than non-ADHD peers. As a result, adults with ADHD are also more likely to have unplanned pregnancies and to acquire sexually transmitted diseases.
Given these findings, it is hardly surprising that adults with ADHD report lower marital satisfaction than their normally developing peers. One study reported that 24 out of every 25 spouses of adults with ADHD felt their partner's symptoms interfered with their functioning in one or more domains, including general household organization/time management, child-rearing, and communication. Most studies have found that extramarital affairs, separation, and divorce are more frequent among couples in which one partner has ADHD.
ADHD is known to be highly heritable. That introduces further challenges. One study found that parents of children with ADHD are twice as likely to divorce by the time their child is eight years older than parents of children without ADHD. Another study found that disruptive child behavior is linked to parents arguing among themselves. This pattern was especially pronounced with parents who themselves had elevated ADHD symptoms. However, another study found that when both parents had ADHD symptoms, they were less likely to argue than when only one parent had such symptoms, or when neither did.
The authors note that there have been few longitudinal studies of the relationship to the behavior of adults with ADHD and that these are badly needed. This would help to understand how alcohol consumption relates to the development of relationship problems, for example.
Second, they point out that little is known about which subpopulations in the large population of adults with ADHD may be especially at risk for romantic relationship problems. Gender and history of maltreatment do not appear to be significant influences, but there is some evidence that alcohol and drug abuse may be a factor, as well as underachievement in adolescence. Moreover, the literature to date has focused on heterosexual Caucasian couples. There is a need for research with larger, more heterogeneous, population samples, and in particular with racial/ethnic minorities and LGBTQ+ adults.
Third, they suggest a need for further research on mediators between ADHD and romantic relationship problems. There are reasons to suspect a key role for emotion dysregulation and deficits in inhibitory controls. But studies to date have relied on self-reporting, which introduces respondent bias. Future studies should obtain ratings of ADHD and relationship functioning from other informants. There is also a need for studies focusing not just on younger adults, but also on older ones. Another critical need is for clinical trials testing the effectiveness of different interventions aiming to improve romantic relationship functioning.
The authors conclude, "Given that success in romantic relationships is considered by many to be a major developmental task and that ADHD persists for many affected individuals into adulthood, research on romantic adjustment of affected adults is surprisingly limited. The majority of existent published research points, however, to a robust association between ADHD and negative outcomes such as lower satisfaction in relationships, maladaptive conflict resolution styles, higher rates of relational dissolution, and behavioral issues such as unsafe sex and IPV."
Brian T. Wymbs, Will H. Canu, Gina M. Sacchetti, Loren M. Ranson, "Adult ADHD and romantic relationships: What we know and what we can do to help", Journal of Maritaland Family Therapy(2021),https://doi.org/10.1111/jmft.12475.
Recent research suggests that inflammation may play a role in ADHD. Inflammation, marked by elevated proteins and cytokines, affects brain development and structure. Evidence suggests it plays a role in the development of ADHD, making the study of inflammatory markers crucial.
The platelet-to-lymphocyte ratio (PLR) is a cost-effective test for predicting outcomes of chronic inflammation and neuroimmune diseases. Studies show PLR may be an important inflammatory marker in the pathophysiology of ADHD in children.
The Study:
A Chinese study team used the National Health and Nutrition Examination Survey (NHANES) database maintained by the National Center for Health Statistics of the United States to investigate the association between PLR and ADHD in children aged 6–14.
The team identified ADHD through prescriptions of ADHD medications.
After exclusions for missing information, the study encompassed 1,455 children.
The authors adjusted for the following potential confounders: sex, age, race, poverty-to-income ratio, maternal age at childbirth, smoking during pregnancy, asthma, health insurance status, dietary inflammatory index, monocyte count, segmented neutrophil count, eosinophil count, and basophil count.
They also split the PLR results into quartiles, with the first quartile having the lowest readings.
Prescriptions of ADHD medications were twice as frequent among children in the second quartile as they were among children in the first quartile. They were four times as frequent among children in the third quartile than among children in the first quartile.
Conclusion:
The team concluded, “These findings further support the potential role of inflammation in the onset and development of ADHD, providing preliminary evidence for PLR as a potential biomarker for ADHD and suggesting its possible use in identifying high-risk populations. However, considering the limitations of this study, future research should be designed as larger-scale, prospective, multi-center randomized controlled trials to validate these findings and further explore the relationship between inflammatory mechanisms and ADHD.”
In other words, this study suggests that while high PLR values may serve as a potential biomarker for ADHD, particularly in specific high-risk groups, further research is needed to confirm these findings and fully understand the role of inflammation in ADHD development. Larger, more robust studies will be crucial to validating PLR as a reliable tool for identifying at-risk populations.
ADHD is the most prevalent neurodevelopmental disorder. Nearly 1% of pregnant women in the Nordic countries and more than 1% in the United States are prescribed ADHD medications, ranking these among the most commonly used medications during pregnancy. However, the safety of exposing a fetus to ADHD medications is still uncertain, prompting many expectant mothers to stop using them out of fear for their unborn child’s well-being.
The Study:
A European research team conducted a comprehensive nationwide study on the safety of ADHD medications during pregnancy using populations from Sweden and Denmark. The Swedish population was studied first, followed by inclusion of a separate study of the Danish population. Results were then combined through meta-analysis. Nordic countries, with their single-payer national health insurance systems and national population registers, facilitate the tracking of residents’ health from birth to death, thus providing robust data for such studies.
The team accounted for various potential confounders, including maternal age, year of delivery, whether the mother was a first-time parent, self-reported smoking during pregnancy, and any psychiatric history. They also considered psychiatric inpatient or outpatient treatment received within two years before pregnancy, as well as the dispensing of other psychotropic medications during pregnancy, including antidepressants, antipsychotics, antiseizure medications, and anti-anxiety medications. Additionally, they examined the highest level of maternal education and civil status at delivery (married or cohabiting compared to single, divorced, or widowed).
Out of 861,650 Swedish children, 2,257 were exposed to ADHD medications during pregnancy. Another 3,917 were born to mothers who discontinued ADHD medications before pregnancy.
Children exposed to ADHD medications had lower rates of ADHD, autism spectrum disorder, and overall neurodevelopmental disorders; however, none of these differences were significant.
Limiting the analysis to siblings to control for family environmental influences and genetics likewise found no significant differences.
A meta-analysis combining the Swedish results with a separately conducted nationwide population study in neighboring Denmark similarly found no significant differences between children exposed to ADHD medications during pregnancy and children born to mothers who discontinued ADHD medications before pregnancy.
Conclusion:
The team concluded, “Overall, our study provides reassuring evidence that continuing ADHD medication during pregnancy does not increase the risk of long-term NDDs [neurodevelopmental disorders] in offspring."
A new large-scale study has shed light on which treatments for attention-deficit/hyperactivity disorder (ADHD) in adults are most effective and best tolerated.
Researchers analyzed 113 randomized controlled trials involving nearly 15,000 adults diagnosed with ADHD. These studies included medications (like stimulants and atomoxetine), psychological therapies (such as cognitive behavioral therapy), and newer approaches like neurostimulation.
The Findings
Stimulant medications (lisdexamfetamine and methylphenidate) as well as selective norepinephrine reuptake inhibitors (SNRI) (atomoxetine) were the only treatments that consistently reduced core ADHD symptoms—both from the perspective of patients and clinicians. It may be worth noting that atomoxetine, while effective, was less well tolerated, with more people dropping out due to side effects.
Psychological therapies such as CBT, mindfulness, and psychoeducation showed some benefits, but mainly according to clinician ratings—not necessarily from the patients themselves. Neurostimulation techniques like transcranial direct current stimulation also showed some improvements, but only in limited contexts and with small sample sizes. Interestingly, none of the treatments—medication or otherwise—made a clear impact on long-term quality of life or emotional regulation.
Conclusion
So, what does this mean for people navigating ADHD in adulthood? Stimulant medications remain the most effective treatment for managing ADHD symptoms day-to-day but nonstimulant medication are not far behind, which is good given the problems we’ve had with stimulant shortages. This study also supports structured psychotherapy as a viable treatment option, especially when used in conjunction with medication.
The study emphasizes the importance of ongoing, long-term research and the need for treatment plans that are tailored to the individual ADHD patient– Managing adult ADHD effectively calls for flexible, patient-centered care.
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