The Impact of ADHD on Mental Health

National Library of Medicine: Journal of Attention Disorders

Mental Health in Adults With ADHD: Examining the Relationship With Cardiorespiratory Fitness

The study involved 72 participants who completed questionnaires and assessments on ADHD and mental health symptoms.

Conclusion: Those with ADHD have significantly worse mental health outcomes compared to controls – with 50% reporting severe to extremely severe symptoms of depression, anxiety and stress. Cardiorespiratory fitness was also lower and worse with depression, anxiety and stress in both groups. Generally, the higher the ratings for ADHD, stress and depression, the worse the cardiovascular fitness.

The researchers noted: 

• 5% of adults globally have ADHD
• 80% of people with ADHD also have another metal health problem at some point in their lives, including anxiety, depression, substance abuse and personality disorders. ADHD makes it much harder to diagnose or devise a treatment plan for those other problems.
• Medications for ADHD generally don’t mix well with medications for those other conditions, especially anxiety and depression.
• Treatments that include physical activity generally have a “potent” impact on ADHD, depression and anxiety.
• However, the link between heart fitness and ADHD now complicates the use of exercise in treatment. 
• 80% of those with ADHD were taking medications, but two-thirds of those on the ADHD meds reported greater anxiety and stress symptoms.  But only one of those patients were taking medications for the anxiety or stress.
• ADHD is associated with lower performance in school and work and lower socioeconomic status. 
• The association between fitness and perceived stress was only observed for people with mild ADHD symptoms and disappeared for those with more severe ADHD symptoms.

Conclusion: “In our sample, participants with ADHD had poorer mental health than neurotypical controls. However, having higher fitness was associated with better mental health. Specifically, among those with less severe ADHD symptoms, higher CRF was associated with less depression, anxiety, and perceived stress. Future research is needed to examine the causal relationship between fitness and mental health in adults with ADHD, while also accounting for individual differences in the severity of both ADHD and mental health symptoms.”

The link between mental health and ADHD is strong – so why aren’t we paying attention?

Adults with high levels of ADHD symptoms are more likely to have anxiety and depression than adults with high levels of autistic traits, new research finds.

ADHD often occurs with anxiety and depression, according to a 2023 study by researchers at the University of Bath in England.  In fact, ADHD is more likely to come linked to other mental health conditions than other neurodevelopmental conditions like autism. 

ADHD characterized by inattention and/or hyperactivity and impulsivity and connects an estimated 3-9% of the population. The research was published in the peer-reviewed journal Scientific Reports. 

Study: 40% of people with ADHD are in ‘exceptional’ mental

From Psychiatric Times: 

This perhaps surprising Canadian study found that despite the link between ADHD and depression and anxiety in other studies – ADHD can also come linked to strong mental health. The study was based on a comparison between 500 people with ADHD and 12,000 other responses from people without the condition, through the Canadian Community Health Survey. The study found 43% of people with ADHD had achieved “complete mental health” compared to 74% of those without ADOD.

The people with ADHD who ranked high for mental health were more likely to be married, physically active and free from chronic pain, with no lifetime history of anxiety or depression, no history of abuse in childhood to use spirituality to cope with the challenges of daily life. 

Overall, women with ADHD were more likely to struggle with mental health issues than me.

Centers for Disease Control Data and Statistics on ADHD

• An estimated 7 million US children (11.4%) aged 3-17 have been a some point diagnosed with ADHD, according to a 2022 survey. This includes 15% of boys and 8 % of girls.
•  Both black and white children were more likely than Asian Children to diagnosed – 12% vs. 4%. About 10% of Native American and Hispanic children have been diagnosed.
• About 60% of diagnosed cases are considered severe. Severe ADHD is more likely to occur with other problems like learning disorders, anxiety or depression.
• Between 58% and 92% of children diagnosed with ADHD get any treatment, depending on the state. About 54% take medication, 44% get behavioral treatment. Girls are more likely to receive treatment than boys.
• Doctors recommend behavior therapy for children younger than six diagnosed with ADHD and a combination of behavior therapy and medication for older children – preferably in combination.
• Some 78% of children with ADHD in the study also had some other condition. That includes behavior problems (44%), anxiety (39%), depression (19%), Tourette syndrome (1%), learning disability 37%), developmental delay (22%), speech or language disorder (15%), autism spectrum disorder (14%) and intellectual disability (4%).

Family resilience decreases problems associated with ADHD

Journal of Affective Disorders

Highlights: 

• Positive parental environments facilitating brain maturational processes for youth apply also to adolescents with ADHD; such effects of positive parenting may also reduce ADHD children’s behavioral and mental health problems.
• Family resilience may serve as a protective factor that leads to decreasing conduct problems, despite experiencing adversity in childhood.
• Teaching families ways to cope with adversities such as a child’s diagnosis of ADHD, manage behaviors, and/or other adverse experiences in children’s environments, has great potential to reduce adolescents’ conduct and mental health problems.

The study was published in the Journal of Affective Disorders in 2021 by researchers from the University of Florida and the University of Texas School of Public Health based on data from the 12016 and 2017 National Survey of Children’s Health.

The researchers summarized findings from other studies, including: 

• 9.4% of children 2-17 have ADHD. 
• Genetics account for about a third of cases, with multiple genes involved.
• The odds of developing ADHD increase with the number of traumatic exposures in childhood, with each added ACE increasing the odds of aggressive behavior and attention problems, according to a study by the National Child traumatic Stress Network.
• Researchers are still investigating “resilience,” qualities that seem to protect children from the impact of these traumas. 
• Family resilience is also protective – both in development of symptoms and severity of symptoms. 
• Family resilience includes things like family problem-solving strategies, hopeful attitudes, flexibility in adjusting to change, communication, demonstrating truthfulness, practicing spirituality, promoting equality, prioritizing physical and emotional health and seeking social support.
• Family coherence is associated with family well being, especially if good communications helped kids develop coping strategies and seek social support.
• Youths with poor parent-child relationships were more likely to develop depression and other problems lasting into mid-life.

The current study was based on 4,169 children with ADHD identified in the National Survey of Children’s Health for 2016 and 2017.  The study found that kids with ADHD from families with low resilience scores were three times more likely to have other problems, like depression, anxiety and drug use. And children with for our more Adverse Childhood Experiences with ADHD were twice as likely to have other conditions. 

What are the causes of ADHD?

Medical News Today

The causes of ADHD are not precisely known, but a combination of genetics and environmental factors probably accounts for most cases, according to the research summary.  Among the findings: 

Genetics:

• Genes may account for 74% of ADHD. One international study has identified 7,300 genetic variants that may increase the risk. 
• ADHD tends to run in families – and identical twins are more likely to both develop ADHD than non-identical twins.
• The genes may not always result in ADHD – but increase the risk posed by other environmental factors.

Brain Development and function:

• A 2017 imaging study found that overall brain volume and specific brain regions were slightly smaller in people who developed ADHD.
  
  
• The slightly smaller areas of the brain were generally associated with movement, reward processing, emotional regulation and emotion and motivation.
• MRI studies found impairments in brain networks managing attention, timing, working memory and cognitive control.
• A 2009 study found lower levels of dopamine, associated with motor function, memory and focus and executive function.
• Som evidence suggests higher levels of proteins known as dopamine transporters could account for the lower dopamine levels – although the relationship between ADHD and dopamine remains unclear.
• A 2018 study found that in children aged 3-7 hospitalized overnight for traumatic brain industry had an increased risk of ADHD for up to seven years after the injury. Almost two-thirds of the injured children later developed ADHD.

Prenatal and early life factors: 

• A 2015 study found children exposed to alcohol in the womb were 1.55 times more likely to have ADHD.
• Children whose mothers smoked during pregnancy were almost three times as likely to develop ADHD although a later study concluded the exposure was unlikely to be what actually caused the ADHD.
• Exposure to certain neurotoxins like pesticides might also increase risk, according to a 2016 study. That includes the organophosphates in pesticides.
• Babies weighing less than 3.3 pounds at birth were twice as likely to develop ADHD in a 2018 review study. Babies born weighing less than 2.2 pounds were four times as likely.
• A 2013 study found an increased risk of later developing ADHD for babies who lack oxygen at birth.
• A 2022 study found that babies born before 40 weeks of pregnancy have an increased risk of developing ADHD symptoms.
• People who had multiple adverse childhood experiences like child abuse and neglect, witnessing violence and living in an unsafe or unstable environment were more likely to develop ADHD.
• Studies have debunked some myths about ADHD, including any link between eating sugar as a child, excessive TV or a lack of parental discipline.