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January 26, 2022
This systematic review of the literature identified seven studies addressing ADHD and sexuality.
Sexual function
A Dutch study compared 136 persons with ADHD with two large surveys of the general Dutch population. They used both a self-report questionnaire, the Questionnaire for screening Sexual Dysfunction and a non-validated questionnaire especially constructed for the study. They found that males with ADHD reported a 50 percent higher rate of frequent masturbation than males in the general population. Both males and females were less than half as likely to be satisfied with their sex life. That was almost certainly linked to the fact that ADHD participants in the sample were less likely to be in a relationship.
A second study compared 79 ADHD participants with controls. Using a validated questionnaire, the Diagnostic Interview Schedule, to assess sexual function, they found a significant positive correlation between ADHD and the items "sex drive more than the average" and "recurrent thoughts about sex' by comparison with the control group.
A third study used two validated inventories “ the Derogates Sexual Functioning Inventory and the Social Sexual Orientation Inventory“ to assess sexual function among 27 young adult males. They found their sex drive to be higher than in the control group.
Another study, also with 27 ADHD patients, compared them with two other groups, one with fiber mitosis (benign connective tissue cancers), and the other with both ADHD and fibromatosis. They used the validated Life Satisfaction Questionnaire to assess sexual function and found that those with ADHD reported lower sex life satisfaction.
On the other hand, the only large study, with over 14,000 participants, using a non-validated questionnaire to assess sexual function, found negligible associations between ADHD and the number of sexual partners, the frequency of having sex with one's partner, and the frequency of masturbation.
Sexual dysfunctions
The Dutch study mentioned above, comparing 136 ADHD outpatients with two large surveys of the general Dutch population, used a validated self-report questionnaire, the Questionnaire for screening Sexual Dysfunctions, and a non-validated questionnaire, specially designed for the study, the Questionnaire for screening Sexual Problems. It found the rate of sexual dysfunction among both males and females with ADHD to be over twice the level in the general population. Men were four times as likely to report problems with orgasm, 50 percent more likely to report premature ejaculation, and over ten times as likely to report sexual aversion. Women were over three times as likely to report sexual excitement problems, over twice as likely to report problems with orgasm, and over three times as likely to report sexual aversion. No significant differences existed between patients treated with psychostimulants and those without such treatment.
A second study, which used a validated questionnaire to compare 79 ADHD participants with controls, found significant correlations between ADHD and aversion to sex for men but none for women.
On the other hand, a third study, comparing 32 subjects with ADHD with 293 controls, found no significant difference in the prevalence of sexual dysfunctions. It used clinical interviews to assess ADHD, and a non-validated questionnaire to assess sexual dysfunctions.
A fourth study took a very different approach. It compared 38 individuals with premature ejaculation to 27 controls. It found more than ten times the rate of ADHD symptoms among those with premature ejaculation than in the control group. Significantly, it measures premature ejaculation directly, with a stopwatch.
Conclusion
The authors concluded, "This article provides the first systematic review of sexual health among subjects with ADHD and shows that the quality of sexual health among subjects with ADHD seems poor," but acknowledged "several limitations to our review. There are only a few studies for the topics we reviewed. For many studies, the sample size was small. The methodology and measurement instruments differed, which created a potential bias."
Indeed, the study with the largest sample size found negligible associations between ADHD and sexual function, contradicting studies with small sample sizes.
Only four of the studies, all with small sample sizes, examined sexual dysfunctions. Two found strong associations with ADHD, one found none, and the fourth had mixed results.
This points to a compelling need for further research on ADHD and sexuality, with larger sample sizes.
Lorenzo Soldati, MD, Francesco Bianchi-Demicheli, MD, Pauline Schockaert, MAS, John Köhl, MAS, MylèneBolmont, Ph.D., Roland Hasler, Ph.D., and Nader Perroud, MD, “SexualFunction, Sexual Dysfunctions, and ADHD: A Systematic Literature Review,” Journal of Sexual Medicine(2020),https://doi.org/10.1016/j.jsxm.2020.03.019.
Although ADHD was conceived as a childhood disorder, we now know that many cases persist into adulthood. My colleagues and I charted the progression of ADHD through childhood, adolescence, and adulthood in our "Primer" about ADHD,http://rdcu.be/gYyV. Although the lifetime course of ADHD varies among adults with the disorder, there are many consistent themes, which we described in the accompanying infographic. Most cases of ADHD startin uterobefore the child is born. As a fetus, the future ADHD person carries versions of genes that increase the risk for the disorder. At the same time, they are exposed to toxic environments. These genetic and environmental risks change the developing brain, setting the foundation for the future emergence of ADHD.
In preschool, early signs of ADHD are seen in emotional lability, hyperactivity, disinhibited behavior, and speech, language, and coordination problems. The full-blown ADHD syndrome typically occurs in early childhood, but can be delayed until adolescence. In some cases, the future ADHD person is temporarily protected from the emergence of ADHD due to factors such as high intelligence or especially supportive family and/or school environments. But as the challenges of life increase, this social, emotional, and intellectual scaffolding is no longer sufficient to control the emergence of disabling ADHD symptoms. Throughout childhood and adolescence, the emergence and persistence of the disorder are regulated by additional environmental risk factors such as family chaos along with the age-dependent expression of risk genes that exert different effects at different stages of development. During adolescence, most cases of ADHD persist and by the teenage years, many youths with ADHD have onset with a mood, anxiety, or substance use disorder. Indeed, parents and clinicians need to monitor ADHD youth for early signs of these disorders. Prompt treatment can prevent years of distress and disability. By adulthood, the number of comorbid conditions has increased, including obesity, which likely has effects on future medical outcomes.
The ADHD adult tends to be very inattentive by showing fewer symptoms of hyperactivity and impulsivity. They remain at risk for substance abuse, low self-esteem, occupational failure, and social disability, especially if they are not treated for the disorder. Fortunately, there are several classes of medications available to treat ADHD that are safe and effective. And the effects of these medications are enhanced by cognitive behavior therapy, as I've written about in prior blogs.
Although there has been much research documenting that ADHD adults are at risk for other psychiatric and substance use disorders, relatively little is known about whether ADHD puts adults at risk specifically for somatic medical disorders.
Given that people with ADHD tend toward being disorganized and inattentive, and that they tend to favor short-term over long-term rewards, it seems logical that they should be at higher risk for adverse medical outcomes. But what does the data say?
In a systematic review of the literature, Instances and colleagues have provided a thorough overview of this issue. Although they found 126 studies, most were small and were of "modest quality". Thus, their results must be considered to be suggestive, not definitive for most of the somatic conditions they studied.
Also, they excluded articles about traumatic injuries because the association between ADHD and such injuries is well established. Using qualitative review methods, they classified associations as being a) well-established; b) tentative, or c) lacking sufficient data.
Only three conditions met their criteria for being a well-established association: asthma, sleep disorders, and obesity.
They found tentative evidence implicating ADHD as a risk factor for three conditions: migraine headaches, celiac disease, and diseases of the circulatory system.
These data are intriguing, but cannot tell us why ADHD people are at increased risk for somatic conditions. One possibility is that suffering from ADHD symptoms can lead to an unhealthy lifestyle, which leads to increased medical risk. Another possibility is that the biological systems that are dysregulated in ADHD are also dysregulated in some medical disorders. For example, we know that there is some overlap between the genes that increase the risk for ADHD and those that increase the risk for obesity. We also know that the dopamine system has been implicated in both disorders.
Instances and colleagues also point out that some medical conditions might lead to symptoms that mimic ADHD. They give sleep-disordered breathing as an example of a condition that can lead to the symptom of inattention.
But this seems to be the exception, not the rule. Other medical conditions co-occurring with ADHD seem to be true comorbidities, rather than the case of one disorder causing the other. Thus, primary care clinicians should be alert to the fact that many of their patients with obesity, asthma, or sleep disorders might also have ADHD.
By screening such patients for ADHD and treating that disorder, you may improve their medical outcomes indirectly via increased compliance with your treatment regime and an improvement in health behaviors. We don't yet have data to confirm these latter ideas, as the relevant studies have not yet been done.
There is a growing interest (and controversy) in 'adult-onset ADHD. No current diagnostic system allows for the diagnosis of ADHD in adulthood, yet clinicians sometimes face adults who meet all criteria for ADHD, except for age at onset. Although many of these clinically referred adult-onset cases may reflect poor recall, several recent longitudinal population studies have claimed to detect cases of adult-onset ADHD that showed no signs of ADHD as a youth (Agnew-Blais, Polanczyk et al. 2016, Caye, Rocha, et al. 2016). They conclude, not only that ADHD can onset in adulthood, but that childhood-onset and adult-onset ADHD may be distinct syndromes(Moffitt, Houts, et al. 2015)
In each study, the prevalence of adult-onset ADHD was much larger than the prevalence of childhood-onset adult ADHD). These estimates should be viewed with caution. The adults in two of the studies were 18-19 years old. That is too small a slice of adulthood to draw firm conclusions. As discussed elsewhere (Faraone and Biederman 2016), the claims for adult-onset ADHD are all based on population as opposed to clinical studies.
Population studies are plagued by the "false positive paradox", which states that, even when false positive rates are low, many or even most diagnoses in a population study can be false.
Another problem is that the false positive rate is sensitive to the method of diagnosis. The child diagnoses in the studies claiming the existence of adult-onset ADHDused reports from parents and/or teachers but the adult diagnoses were based on self-report. Self-reports of ADHD in adults are less reliable than informant reports, which raises concerns about measurement error. Another longitudinal study found that current symptoms of ADHD were under-reported by adults who had had ADHD in childhood and over-reported by adults who did not have ADHD in childhood(Sibley, Pelham, et al. 2012). These issues strongly suggest that the studies claiming the existence of adult-onset ADHD underestimated the prevalence of persistent ADHD and overestimated the prevalence of adult-onset ADHD. Thus, we cannot yet accept the conclusion that most adults referred to clinicians with ADHD symptoms will not have a history of ADHD in youth.
The new papers conclude that child and adult ADHD are "distinct syndromes", "that adult ADHD is more complex than a straightforward continuation of the childhood disorder" and that adult ADHD is "not a neurodevelopmental disorder". These conclusions are provocative, suggesting a paradigm shift in how we view adulthood and childhood ADHD. Yet they seem premature. In these studies, people were categorized as adult-onset ADHD if full-threshold add had not been diagnosed in childhood. Yet, in all of these population studies, there was substantial evidence that the adult-onset cases were not neurotypical in adulthood (Faraone and Biederman 2016). Notably, in a study of referred cases, one-third of late adolescent and adult-onset cases had childhood histories of ODD, CD, and school failure(Chandra, Biederman, et al. 2016). Thus, many of the "adult onsets" of ADHD appear to have had neurodevelopmental roots.
Looking through a more parsimonious lens, Faraone and Biederman(2016)proposed that the putative cases of adult-onset ADHD reflect the existence of subthreshold childhood ADHD that emerges with full threshold diagnostic criteria in adulthood. Other work shows that subthreshold ADHD in childhood predicts onsets of full-threshold ADHD in adolescence(Lecendreux, Konofal, et al. 2015). Why is onset delayed in subthreshold cases? One possibility is that intellectual and social supports help subthreshold ADHD youth compensate in early life, with decompensation occurring when supports are removed in adulthood or the challenges of life increase. A related possibility is that the subthreshold cases are at the lower end of a dimensional liability spectrum that indexes risk for onset of ADHD symptoms and impairments. This is consistent with the idea that ADHD is an extreme form of a dimensional trait, which is supported by twin and molecular genetic studies(Larsson, Anckarsater, et al. 2012, Lee, Ripke, et al. 2013). These data suggest that disorders emerge when risk factors accumulate over time to exceed a threshold. Those with lower levels of risk at birth will take longer to accumulate sufficient risk factors and longer to onset.
In conclusion, it is premature to accept the idea that there exists an adult-onset form of ADHD that does not have its roots in neurodevelopment and is not expressed in childhood. It is, however, the right time to carefully study apparent cases of adult-onset ADHD to test the idea that they are late manifestations of a subthreshold childhood condition.
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When a patient sits down in an examination room today, their physician is rarely the first voice they have heard regarding their symptoms. More often, an algorithm got there first.
According to a nationwide survey by The Physicians Foundation conducted with Medscape, medical misinformation is no longer a peripheral nuisance; it is a daily clinical crisis. Nearly all surveyed physicians (99.9%) reported that their patients had been influenced by medical misinformation over the past year.
While misinformation affects every discipline from oncology to cardiology, few conditions sit as squarely in the algorithmic crosshairs as ADHD. From viral 30-second video clips trivializing complex executive dysfunction to predatory wellness campaigns attacking evidence-based medications, the attack on evidence directly threatens the well-being of children and adults living with ADHD.
Key Findings from The Physicians Foundation
The survey, which captured perspectives from over 1,000 practicing physicians, paints a sobering picture of how unverified information disrupts modern medicine:
The challenge is especially acute in communities already facing systemic healthcare hurdles:
As the survey illustrates, 38% of rural physicians encounter "a great deal" of health misinformation, far exceeding their suburban (21%) and urban (25%) peers. In rural and underserved regions, where access to developmental pediatricians and psychiatrists is already scarce, online narratives frequently fill the void left by provider shortages.
Why ADHD Is Ground Zero for Health Misinformation
Despite decades of neurobiological research confirming its validity, ADHD remains uniquely vulnerable to digital distortions in three distinct ways:
1. The Dueling Traps: "Life Hack" Trivialization vs. Denialism
Social media platforms host billions of views under ADHD-related tags. While digital awareness has helped destigmatize mental health, it frequently collapses nuanced clinical criteria into broad, relatable personality traits such as zoning out during a boring meeting, misplacing keys, or feeling restless.
This creates two opposing misinformation hazards:
2. Medication Stigma and Treatment Nonadherence
The survey found that 49% of doctors frequently encounter medication nonadherence and 45% face treatment refusal due to misinformation.
In ADHD care, this finding is acutely visible around stimulant pharmacotherapy. First-line stimulant medications have high response rates and extensive safety profiles spanning decades. Yet online narratives persistently frame them as dangerous narcotics, accusing parents of "drugging their children" or claiming medications permanently alter a child's brain.
Terrified parents frequently delay initiating care or discontinue effective regimens without clinical oversight, turning instead to unproven, expensive alternative supplements, unverified nootropics, or restrictive elimination diets.
3. Escalating Anxiety and Parental Guilt
With 66% of physicians observing increased patient anxiety driven by online health claims, the emotional toll on families cannot be overstated. Parents of newly diagnosed children are inundated with contradictory advice: one post warns that failing to medicate guarantees academic failure, while another claims that medicating guarantees addiction.
Adults navigating a new diagnosis experience similar distress, second-guessing their lived experiences and feeling deep shame over their executive dysfunction.
4. The 15-Minute Primary Care Bottleneck
Because pediatricians and family physicians handle most ADHD diagnoses and management, the survey’s warning that 70% of primary care providers feel hamstrung by misinformation hits ADHD patients first.
Deconstructing a viral video, explaining the difference between therapeutic stimulant dosing and substance misuse, and addressing years of internalized stigma takes time. In a standard 15-to-20-minute primary care visit, providers are forced to choose between rushing through diagnostic assessments or leaving patients' misinformed fears unaddressed.
Rebuilding the Partnership: Steps for Patients, Families, and Providers
Addressing the erosion of trust requires practical, collaborative shifts from both sides of the examination table:
For Patients and Caregivers
For Healthcare Providers and Systems
Medical misinformation thrives in the gap between a patient's vulnerability and the clinical system's time constraints. By recognizing how digital noise distorts ADHD, patients and clinicians can work together to replace viral anxiety with evidence-based care.
The Background:
Adults with ADHD often struggle more at work than their peers without ADHD. They tend to underperform on job tasks, advance less in their careers, miss more workdays, and face higher rates of unemployment. Research from several countries, including Japan, points to two main channels through which ADHD erodes workplace productivity: absenteeism, or missing work entirely, and presenteeism, showing up but performing below one’s usual capacity. Both problems typically trace back to ADHD’s core symptoms: difficulty sustaining attention, managing time, staying organized, and navigating relationships with coworkers and supervisors.
Stigma compounds these challenges. Employers and the public often have limited understanding of how ADHD manifests in adults, which can translate into unfair treatment or diminished job opportunities. That fear of judgment, in turn, discourages some people from seeking a psychiatric evaluation in the first place, delaying diagnosis and treatment, and with it, delaying access to support that could improve both their work performance and daily functioning.
Japan does offer medical care and workplace support for adults with ADHD. Options include social skills training, which teaches practical strategies for communication and collaboration; self-reliance support programs that help with daily living and job management; and, in more severe cases, a disability pension for those unable to work. Still, it remains unclear whether these employment-support services are robust enough to help people who want to work actually secure and hold onto steady jobs.
The impact of ADHD extends beyond the individual diagnosed. Supporting a family member with ADHD can be emotionally and logistically demanding, often cutting into a caregiver’s own capacity to work and earn, meaning that the economic toll of ADHD ripples outward.
The Research:
Most prior research on the economic costs of ADHD, in both children and adults, has come from the United States and Europe, focusing on medical expenses, lost productivity, and social support spending. Until recently, no one had attempted a comparable estimate for adult ADHD in Japan or elsewhere in Asia.
To address that gap, a Japanese research team conducted a cross-sectional observational study (meaning they gathered data at a single point in time and examined existing patterns rather than testing an intervention). They drew on three sources: a retrospective review of medical insurance claims, a web-based survey of affected individuals, and official government statistics. Combining these, they estimated annual costs from a societal perspective, accounting for medical expenses, lost work productivity, and government welfare spending, as well as productivity losses among family caregivers.
The claims analysis relied on JMDC, a nationwide database of insurance receipts and medical examination records spanning multiple health insurers and covering 14 million residents. Within it, the researchers identified 30,730 adult outpatients diagnosed with ADHD.
The Results:
Annual medical costs per adult with ADHD (combining outpatient visits and medication) averaged 284,000 yen (about $1,750). Scaling this figure to match the age and sex distribution of Japan’s adult population produced a nationwide estimate of 74 billion yen (about $455 million).
A separate web-based survey found that, after statistical matching, nearly half of adults with ADHD received a disability pension, yielding a nationwide estimate of 95 billion yen (about $585 million) in ADHD-related pension payments. Including public employment support services, total social welfare spending reached 390 billion yen (about $2.4 billion).
Workplace productivity losses were substantial as well. With an unemployment rate more than four percentage points higher than the general population, unemployment-related losses among adults with ADHD totaled an estimated 50 billion yen. Lower average incomes among those employed accounted for a further 315 billion yen. Once absenteeism and presenteeism were factored in, total productivity losses reached 570 billion yen (about $3.5 billion).
Family members bore a comparable burden: productivity losses among adult relatives of people with ADHD were estimated at 540 billion yen (about $3.3 billion).
Taken together, these figures point to a nationwide socioeconomic burden of 1.6 trillion yen (roughly $11 billion), equivalent to nearly $30,000 per adult with ADHD.
The Take-Away:
“This study, the first estimate of the annual socioeconomic burden of adult ADHD in Japan, underscores the necessity of providing appropriate support to adult patients with ADHD and their families and the prevention of comorbidities,” the research team concluded. “In particular, measures to support participation in the workplace to improve patients’ quality of life and reduce the social and economic burden should be explored. Furthermore, it is hoped that estimating the annual socioeconomic burden of adult ADHD will help clarify policy priorities in Japan.”
The Background:
Motor vehicle crashes remain one of the most significant public health challenges in the United States. In 2022 alone, nearly 44,000 people died on American roads, and more than 2.6 million crash-related injuries required emergency care. Most people are familiar with the usual suspects: drunk driving, speeding, and distracted driving from phones. These risks are well-documented and the focus of ongoing public safety campaigns.
But a serious risk factor has been flying under the radar: untreated ADHD. Despite receiving little attention from the public, policymakers, or transportation safety agencies, it may belong in the same conversation as these better-known dangers.
ADHD is not currently recognized by the National Highway Traffic Safety Administration as a driving risk factor; yet inattention and impulsivity, two of its defining features, are consistently cited as common contributors to crashes. Beyond these core symptoms, adults with ADHD may also experience emotional dysregulation, which can further impair driving behavior.
The Research:
Prior studies on ADHD and crash risk have produced estimates ranging from a 5% to a 70% increase. This massive heterogeneity has made it difficult to draw firm conclusions. This new meta-analysis set out to offer some clarity on these numbers.
Researchers focused specifically on adults aged 18 to 65 with a formal ADHD diagnosis who were not receiving treatment, comparing them to controls without ADHD. Four studies met these criteria, collectively covering more than 2.75 million people.
The Results:
The findings were striking: untreated ADHD was associated with a 93% increase in crash risk (95% confidence interval: 88%–99%). There was no evidence of publication bias. Although there was meaningful variation across studies, most of it stemmed from the smallest study (just 36 participants) which reported an outlier estimate of a 16-fold increase.
To put the 93% figure in context: a separate meta-analysis found that alcohol use is associated with a 150% increase in crash risk. Another way to understand just how significant this risk really is, untreated ADHD raises crash risk by more than half as much as alcohol does.
The analysis also found a dose-response relationship between ADHD symptom severity and crash risk: each incremental increase in symptom severity corresponded to a 5–6% higher crash risk. At the highest severity levels, crash risk approached that associated with alcohol use. This gradient reinforces that we're not looking at a binary distinction between “has ADHD” and “doesn’t” — the worse the symptoms, the greater the danger on the road.
The Takeaway:
These findings have practical implications for patients, families, clinicians, and policymakers alike. Untreated ADHD is not a minor footnote in the driving safety literature; rather, it is a substantial, measurable, and potentially modifiable risk factor. The question of whether and how it should be factored into licensing policy, clinical practice, and public health messaging deserves serious attention.
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