J Atten Disord [JOURNAL]
Sun
200 papers
Symptoms of Anxiety in Adults with ADHD: A Systematic Review and Meta-Analysis of Case-Control Studies.
Hoskins JI, Gooch D, Gilligan-Lee KA
J Atten Disord · 2026 Jul · PMID 42400277 · Publisher ↗
OBJECTIVE: Research suggests there is a higher prevalence of anxiety in individuals with ADHD compared to those without ADHD. However, estimated prevalence rates vary greatly due to differences in methodologies used acro...
OBJECTIVE: Research suggests there is a higher prevalence of anxiety in individuals with ADHD compared to those without ADHD. However, estimated prevalence rates vary greatly due to differences in methodologies used across studies. This study is the first meta-analysis investigating differences in anxiety measure scores between adults with and without ADHD, and possible moderators of this effect. METHOD: Our analysis included 58 studies that compared anxiety scores in adults with/without ADHD ( = 18,821; = 112). RESULTS: The average effect size (Hedges's ) of anxiety scores in those with ADHD relative to controls was 0.77 ( = 0.066); a medium effect. The only significant moderator was the type of comparison group used, with comparisons to non-clinical control groups ( = 0.954, = 0.08) yielding significantly larger effects than comparisons to clinical control groups ( = 0.437, = 0.09). None of the other moderator variables examined (Method of characterising ADHD, Anxiety Measure Type, Anxiety Measure Focus, Age or Gender) moderated the effect. There was some evidence of publication bias, therefore results should be interpreted with this in mind. CONCLUSION: Overall, this study indicates that ADHD is associated with higher levels of anxiety symptomology. This has important implications in the diagnosis and treatment of individuals presenting with ADHD or anxiety, including the consideration and screening of each of these conditions as potentially co-occurring with the other. Adaptions made to clinical practice in line with this would better support this population, improve symptom management and overall quality of life. Suggestions for future research are discussed.
Students' Experiences of Living with ADHD at University: A Meta-Ethnography.
Mestichelli M, Pepall E, Tran T … +3 more , Stanley M, Cairns A, O'Sullivan TA
J Atten Disord · 2026 Jun · PMID 42332946 · Publisher ↗
While the prevalence of attention deficit hyperactivity disorder (ADHD) among university students varies depending on the population studied, it has been estimated at approximately 16%. University students with ADHD may...
While the prevalence of attention deficit hyperactivity disorder (ADHD) among university students varies depending on the population studied, it has been estimated at approximately 16%. University students with ADHD may find that the condition affects their academic performance, social interactions, and well-being. This meta-ethnographic review synthesizes findings from 25 qualitative studies to explore the lived experiences of university students with ADHD. The studies, published between 2000 and 2023, were predominantly conducted in the United States with sample sizes ranging from 4 to 135 students. Students came from a broad range of academic disciplines and included undergraduates, recent graduates, and attendees of various post-secondary institutions. Findings show that difficulties with organization, time management, and maintaining focus during lectures or while completing assignments are common struggles. These students also face challenges transitioning into university life, particularly in terms of academic expectations and social participation. Whilst universities often provide accommodations such as extended test times, these supports are often too generic and insufficient, failing to address the specific needs of individual students. Furthermore, stigma around ADHD can exacerbate challenges. Tailored accommodations, such as check-ins or more flexible assessment formats, together with effective peer support programs, enhance academic success. Targeted support for the transition to the workplace may help students feel more confident as they complete their degrees. Additionally, addressing societal stigma can contribute to creating a more neurodiverse-friendly environment. There is an urgent need for universities to rethink support structures and ensure a more inclusive academic experience for students with ADHD.
Feasibility and Acceptability of Group-Based Cognitive-Behavioral Intervention for Executive Self-Management in College Students With ADHD: Replication in a Public Urban Setting.
Solanto MV, Rostain AL, O'Neill S … +4 more , Tate MA, Hernandez M, Kamareddine Z, Workman ARC
J Atten Disord · 2026 Jun · PMID 42312718 · Publisher ↗
OBJECTIVE: The purpose of this study was to examine the acceptability, feasibility, and replicability of a manualized group cognitive-behavioral intervention designed to enhance executive self-management in college stude...
OBJECTIVE: The purpose of this study was to examine the acceptability, feasibility, and replicability of a manualized group cognitive-behavioral intervention designed to enhance executive self-management in college students with ADHD. Whereas the first trial of this intervention was conducted in a private university in a small city in the Netherlands, the current open trial was administered at an urban, public college in the northeast United States. A simultaneous goal of the study was to train PhD-level psychologists to administer the intervention. METHODS: Forty-one students meeting rigorously assessed DSM-5 criteria for ADHD were enrolled in one of six 12-week treatment groups that addressed time-management, organization, and planning, and also targeted procrastination, distractibility, and negative automatic thoughts. Strategies were also included to improve attention to and retention of reading materials and guidance in organizing and writing essays. Each group was co-led by an experienced therapist and one of three clinical psychologists undergoing training. Pre- and post-treatment measures included number and severity of inattentive and hyperactive-impulsive symptoms as assessed on a structured diagnostic interview (AISRS) and via a self-report (CAARS) questionnaire, as well as measures of executive skills (BRIEF-A, LASSI-III). At the end of treatment, students rated the helpfulness of each of the program's components and strategies, and provided a personal narrative of the most important effects of the program on their daily functioning and personal well-being. RESULTS: Thirty-six of the 41 enrollees fully or partially completed the treatment and provided post-treatment data for the analyses. Repeated measures ANOVA yielded significant main effects for decreases in clinician-rated and self-rated number and severity of inattentive symptoms. Change in executive self-management was associated with change in ADHD Inattention severity after controlling for pre-treatment inattention. Significant improvement was also observed on the BRIEF-A Metacognitive Index and LASSI-III composite score. Overall, 67% of students rated the group program as "very helpful" and 30% as "moderately helpful." CONCLUSIONS: The results of this study demonstrate the feasibility and acceptability of the intervention. Pre- to post-treatment reductions in clinician- and self-rated ADHD symptoms and executive self-management skills were observed, although, of course, conclusions regarding efficacy/effectiveness cannot be drawn from uncontrolled trials. This replication of the group CBT intervention in a public, urban setting, with training of interventionists, supports the feasibility of the treatment, and warrants a large-scale randomized controlled trial against an active control group to evaluate efficacy, with potential for dissemination across college campuses generally (ClinicalTrials.gov ID NCT05588505).
Association of Inflammatory Biomarkers With ADHD and Moderating Effect of Leisure-Time Physical Activity in Adolescents: A Cross-Sectional Study Based on NHANES.
Pan K, Jin S, Gao X … +5 more , He C, Shi B, Zhang M, Wei Y, Quan M
J Atten Disord · 2026 Jun · PMID 42312484 · Publisher ↗
INTRODUCTION: Research findings on specific inflammatory markers (e.g., CRP) in ADHD show considerable heterogeneity. Meanwhile, the potential moderating role of leisure-time physical activity (LTPA) in this relationship...
INTRODUCTION: Research findings on specific inflammatory markers (e.g., CRP) in ADHD show considerable heterogeneity. Meanwhile, the potential moderating role of leisure-time physical activity (LTPA) in this relationship is underexplored. METHODS: Based on data from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2004, 4,817 adolescents aged 12 to 19 were included. This study used logistic regression analysis and restricted cubic splines (RCS) to explore the association between inflammatory biomarkers and ADHD. Interactive analyses were performed to assess the moderating effect of LTPA on this relationship. Furthermore, subgroup analyses were conducted to validate the robustness of the observed effects. RESULTS: After adjusting for all confounding factors, each 1 mg/L increment in C-reactive protein (CRP) was associated with a 9% higher ADHD risk ( = 1.09, 95% CI [1.01, 1.18]). The chronic low-grade inflammation (CLGI) group exhibited a 57% higher risk of ADHD ( = 1.57, 95% CI [1.14, 2.15]) compared to the non-GLGI group. The non-linear analysis further revealed that the risk of ADHD reached its peak when CRP was 2.75 mg/L ( = 1.89, 95% CI [1.39, 2.57]). Compared with the group engaging in less than 60 min of LTPA daily, the association between ADHD and CRP was moderated in the "LTPA ≥60 min/day" group ( for interaction = .04). CONCLUSIONS: Elevated CRP levels are positively associated with ADHD. More than 60 min/day LTPA may moderate the association between CRP and the risk of ADHD.
ADHD Diagnosis Patterns: Comorbidities and the Impact of Relative Age on Diagnosis Likelihood.
Westman E, Prami T, Kallio A … +7 more , Iso-Mustajärvi I, Peltonen EJ, Jukka J, Raittinen P, Korhonen MJ, Puustjärvi A, Leppämäki S
J Atten Disord · 2026 Jun · PMID 42304582 · Publisher ↗
BACKGROUND: Attention deficit hyperactivity disorder (ADHD) has been associated with comorbid conditions, especially psychiatric comorbidities. On the other hand, getting an ADHD diagnosis has been linked to children's r...
BACKGROUND: Attention deficit hyperactivity disorder (ADHD) has been associated with comorbid conditions, especially psychiatric comorbidities. On the other hand, getting an ADHD diagnosis has been linked to children's relative age. The aim of this study was to describe diagnostic patterns of ADHD patients of all ages, and to compare comorbidity and birth month between ADHD patients and matched controls. METHODS: This nationwide study cohort included incident ADHD patients with records of ADHD medication and/or ADHD diagnosis in Finland during 2015 to 2020, and with no such records during 2010 to 2014. Four controls were matched with each patient based on age, gender, and place of residence. RESULTS: Altogether 66,146 incident ADHD patients and 256,270 matched controls were identified, and their average follow-up time was 3.5 years. Mean age at the first ADHD diagnosis was 15.9 years for males and 22.3 for females. Prior to being diagnosed with ADHD, patients visited health care remarkably more often than controls. Comorbid diagnoses were the most prevalent at index date, and compared to controls, the prevalence of these comorbidities within 3 years preceding the index date increased more in ADHD patients. The odds of ADHD increased with later birth months across all age-gender groups, except among girls under 6 years of age. The association was more pronounced among males. CONCLUSION: ADHD is associated with a significant comorbidity burden across all age groups, even before ADHD diagnosis. Individuals who are younger in relative age are more likely to be diagnosed with ADHD.
Can the Neurodiversity Approach Apply to ADHD? Exploring the Lived Experience of ADHD as Neurodivergence.
van der Oord S, Vanaken GJ, French B
J Atten Disord · 2026 Jun · PMID 42273891 · Publisher ↗
INTRODUCTION: Neurodiversity proponents claim ADHD is a value-neutral, minority neurotype subject to marginalization and discrimination. This paper explores, guided by lived-experiences it's applicability to ADHD and con...
INTRODUCTION: Neurodiversity proponents claim ADHD is a value-neutral, minority neurotype subject to marginalization and discrimination. This paper explores, guided by lived-experiences it's applicability to ADHD and contrasts it with the medical model and the overmedicalization critique. Here, ADHD is respectively considered as a deficit-to-be-cured or a societal problem compromising identity, fostering stigma and inducing medication use. METHODS: We conducted a narrative review of in-depth interview studies with ADHD adolescents and adults focused on experiencing: core ADHD characteristics, disablement, diagnosis and medication and evaluated which approach to ADHD matches best the lived experience of ADHD. RESULTS: In these lived experiences (1) ADHD characteristics are generally not experienced as universal deficits (2) disability primarily stems from an invalidating mismatch between the ADHD person and their neuronormative environment (3) the ADHD diagnostic label brings both beneficial and disadvantageous consequences and (4) using medication requires balancing its bodily and identity impact, while needing it to navigate unaccommodating environments and meeting self-determined goals. DISCUSSION: We conclude that considering ADHD as mere difference instead of as a universal deficit reflects people's lived experience and eases the self-acceptance of an ADHD diagnosis. Also, conceiving of disability as a person-environment mismatch, rather than as purely individual nor as induced by labeling, provides a helpful framework for the balancing act of medication use. Since ADHD and autistic experiences don't match entirely, we outline future debates among neurodiversity proponents. Overall, we believe the neurodiversity approach to ADHD is a promising and destigmatizing alternative inspiring new research, clinical and societal pathways.
A Systematic Review of Lived Experiences of Receiving a Diagnosis of ADHD in Adulthood.
McGill L, Jardim-Lalor I, O'Connor C
J Atten Disord · 2026 May · PMID 42216788 · Publisher ↗
OBJECTIVE: With rising numbers of adults seeking and receiving ADHD diagnoses, understanding their first-hand experiences of the diagnostic process is key for sensitive support and service design. This systematic review...
OBJECTIVE: With rising numbers of adults seeking and receiving ADHD diagnoses, understanding their first-hand experiences of the diagnostic process is key for sensitive support and service design. This systematic review collates, evaluates and synthesises the existing evidence-base on lived experiences of adult ADHD diagnosis. METHOD: Keyword searches of six databases generated 10,357 citations, which were subjected to a systematic screening process that identified 21 relevant studies. Findings were analysed using thematic synthesis. RESULTS: Analysis generated three overarching themes, elaborating how diagnostic experiences are shaped by adults' , and Personally, diagnosis was widely experienced as a pivotal identity event, triggering biographical reflection that could foster greater self-compassion, but also grief, anger and identity confusion. Socially, diagnosis facilitated interpersonal understanding and communication, but also exposed adults to stigma and introduced dilemmas about diagnostic disclosure. Systemically, adults experienced the diagnostic process as beset by barriers and delays, and reported highly variable access to post-diagnosis supports or treatment. CONCLUSION: Results suggest receiving an ADHD diagnosis in adulthood is a complex relational process that can be both validating and destabilising, with variation in experiences resulting from individual biographies, interpersonal resources, stigma climates, and service structures.
Attention Deficit Hyperactivity Disorder (ADHD) in Military Contexts with regard to Psychosocial and Occupational Outcomes: A Scoping Review.
Bateman L, Bramham J, Keating M … +1 more , Lenihan F
J Atten Disord · 2026 May · PMID 42216782 · Publisher ↗
INTRODUCTION: ADHD is typically characterised by inattention, impulsivity, and hyperactivity, often persisting into adulthood and influencing occupational performance, social interactions, and mental well-being. This sco...
INTRODUCTION: ADHD is typically characterised by inattention, impulsivity, and hyperactivity, often persisting into adulthood and influencing occupational performance, social interactions, and mental well-being. This scoping review and narrative synthesis aims to address a critical knowledge gap by systematically mapping the existing research on ADHD in military contexts with regard to psychosocial and occupational outcomes. As such, the aims of this study were (a) to aggregate findings regarding ADHD and psychosocial and occupational outcomes of military personnel and (b) to critically review and provide an account of the methodological quality of these studies. METHODS: A systematic search across four electronic databases (PubMed, PsycINFO, Embase and CINAHL) detected and retrieved 1,956 studies. After removal of duplicates, 1,263 titles and abstracts were screened. Following this, 106 articles progressed to full text review, and a total of 51 studies were included in the current scoping review and narrative synthesis. RESULTS: The review indicated that ADHD is strongly associated with comorbid conditions such as post-traumatic stress disorder (PTSD), depression, and substance use disorders, though the extent to which these outcomes are attributable to ADHD versus broader environmental factors remains debated. Occupational functioning outcomes are similarly complex, with some studies reporting challenges in training, career progression, and retention, while others highlight the adaptability and strengths of personnel with ADHD when adequately supported. CONCLUSIONS: While ADHD presents both occupational and psychosocial challenges for military personnel, existing research primarily focuses on impairment rather than adaptation or strengths. Future studies should adopt a more holistic approach, incorporating neuroaffirmative principles, environmental factors, and individual variability with a view to informing current practices.
Effectiveness of Usual-Care Multimodal Cognitive Behavioral Therapy for Adolescents With Attention-Deficit/Hyperactivity Disorder Rated by Parents and Patients.
Walter D, Matthias EK, von Wirth E … +7 more , Dachs L, Goertz-Dorten A, Rademacher C, Schuermann S, Woitecki K, Wolff Metternich-Kaizman T, Doepfner M
J Atten Disord · 2026 May · PMID 42186955 · Publisher ↗
OBJECTIVE: Highly controlled, randomized controlled trials (RCTs) have provided evidence of the efficacy of multimodal cognitive behavioral therapy (CBT) including pharmacotherapy in adolescents with attention-deficit/hy...
OBJECTIVE: Highly controlled, randomized controlled trials (RCTs) have provided evidence of the efficacy of multimodal cognitive behavioral therapy (CBT) including pharmacotherapy in adolescents with attention-deficit/hyperactivity disorder (ADHD). However, the effectiveness under routine care conditions has not been sufficiently evaluated. The present study investigates this transfer of evidence from randomized controlled trials to routine clinical practice investigating a large clinically referred sample of adolescents with ADHD receiving a CBT treatment under routine care conditions. METHODS: In a sample of = 420 adolescents with ADHD, we analyzed changes in parent- and self-rated emotional and behavioral symptoms during routine treatment at a university outpatient clinic using paired -tests, effect sizes, and comparisons to a historical waitlist control group. The treatment included multimodal CBT for all patients and pharmacotherapy for about a quarter of patients. Results were compared to a historical waitlist control group. RESULTS: In the total sample, small to medium pre-post effect sizes emerged for parent-rated ( = 0.47-0.68) and self-rated ( = 0.37-0.47) emotional and behavioral symptoms. For adolescents who rated in the clinical range at the start of treatment, large effect sizes were found for ADHD symptoms ( = 0.80-1.28), and the comparison with the control group revealed moderate to large effect sizes in favor of the treated sample ( = 0.52-0.93). On the whole, symptom change did not differ between patients with versus without additional pharmacotherapy. CONCLUSIONS: The findings suggest that routine outpatient treatment based on CBT principles may be effective for adolescents with ADHD, thus supporting the results of previous RCTs.
Sex Differences in the Association Between Attention-Deficit Hyperactivity Disorder and Physical Diseases in Childhood and Adolescence Using Nationwide Birth Cohorts.
Villumsen MD, Bilenberg N, Steinhausen HC
J Atten Disord · 2026 May · PMID 42109088 · Publisher ↗
OBJECTIVE: To examine the effect of attention-deficit hyperactivity disorder (ADHD) on sex differences in the hazard risk of a physical disease (PD) in childhood and adolescence, per ICD-10 criteria. METHOD: The Danish p...
OBJECTIVE: To examine the effect of attention-deficit hyperactivity disorder (ADHD) on sex differences in the hazard risk of a physical disease (PD) in childhood and adolescence, per ICD-10 criteria. METHOD: The Danish population born from 1984 to 1995, comprising over 800,000 individuals, was studied for the 13 different ICD-10 PD categories with ADHD as a time-dependent exposure in time-to-event settings. Time from birth to first episode PD, emigration, death, or 31st December 2017, whichever occurred first, was analyzed by use of piecewise Cox models. RESULTS: Individuals with an ADHD diagnosis had higher or similar hazard risk than undiagnosed individuals throughout follow-up. Across all PD categories, baring malignant neoplasms, ADHD-diagnosed individuals had a higher hazard risk from teen age. In the general population, females had higher hazard risk of most PDs from teen age or early adolescence, while males had higher hazard risk in early childhood. Dispersed modification occurred in the hazard difference between sex post-ADHD diagnosis. For eye and adnexa diseases in childhood, males had about a 15% added hazard that of females in the general population, while females had twice the hazard of males among those diagnosed with ADHD. In the general population of young adulthood, females faced a hazard risk of endocrine, nutritional, and metabolic diseases nine times higher than that of males, with an ADHD diagnosis reducing this ratio by half. CONCLUSION: The time-dependent ADHD diagnosis alters sex differences in the vulnerability to certain PD categories at various ages, while ADHD considerably increases vulnerability to all PDs except malignant neoplasms.
Behavioral and Self-Report Measures of Spontaneous Mind Wandering Predict Different Aspects of ADHD in Adults.
Minamoto T, Hayashi T, Al-Mamun MA
J Atten Disord · 2026 May · PMID 42095638 · Publisher ↗
OBJECTIVE: Studies have provided evidence that mind wandering (MW) is involved in the symptomatology of attention deficit/hyperactivity disorder (ADHD). One of the notable categorizations of MW is based on the dimension...
OBJECTIVE: Studies have provided evidence that mind wandering (MW) is involved in the symptomatology of attention deficit/hyperactivity disorder (ADHD). One of the notable categorizations of MW is based on the dimension of intentionality, in which intentional MW is labeled as deliberate MW (D-MW) while the unintentional form is called spontaneous MW (S-MW). S-MW has been reported to be associated with lapses of attention or impulsive behaviors in individuals with ADHD. Using self-report and behavioral measures, the present study aimed to replicate the finding that scores on the S-MW scale predict those on the ADHD Self-Report Scale (ASRS) and to examine whether task performance under the S-MW state similarly predicts the scores on the ASRS scores. METHOD: The participants completed the ASRS and the D-MW and S-MW scales several days before performing the laboratory task (i.e., the continuous counting Stroop task). During the Stroop task (576 trials × 2 blocks), experience sampling probes were presented (20/block), which requested the participants to report their attentional state (i.e., concentrated, D-MW, S-MW, or other). RESULTS: A univariate analysis showed that the accuracy of the Stroop task was remarkably lower under S-MW than under D-MW. Multiple regression analyses showed that scores on the S-MW scale and the accuracy of the Stroop task in the S-MW state independently predicted the ASRS scores. CONCLUSION: These results may indicate that individuals with ADHD could suffer from two different types of interference stemming from S-MW.
Inattention in Pediatric Attention-Deficit/Hyperactivity Disorder and Anxiety: Neurophysiological Evidence for Distinct and Overlapping Cognitive Mechanisms.
Pranjić M, Peisch V, Li Y … +3 more , Troxel M, Lee K, Arnett AB
J Atten Disord · 2026 May · PMID 42095637 · Publisher ↗
BACKGROUND: Although inattention characterizes both pediatric attention deficit hyperactivity disorder (ADHD) and anxiety disorders, it is unclear whether the underlying neurocognitive mechanisms are shared or distinct....
BACKGROUND: Although inattention characterizes both pediatric attention deficit hyperactivity disorder (ADHD) and anxiety disorders, it is unclear whether the underlying neurocognitive mechanisms are shared or distinct. We compared behavioral performance and event-related potentials (ERPs) indexing discrete stages of attention across children with ADHD-only, Anxiety-only, co-occurring ADHD+Anxiety, and typically developing (TD) peers. METHODS: One hundred eleven children (7-11 years) completed three computerized attention tasks while high-density electroencephalography (EEG) was recorded. Behavioral indices (accuracy, reaction time, post-error slowing) and ERP/EEG markers of attentional engagement (aperiodic exponent), stimulus discrimination (N2), action selection (P3), performance monitoring (error-related negativity; ERN) and evaluation (error positivity; Pe) were analyzed. RESULTS: Relative to TD children, all clinical groups showed reduced modulation of the pre-stimulus aperiodic exponent by cognitive load and attenuated N2 amplitudes across tasks, indicating shared alterations in dynamic arousal and stimulus discrimination. Distinct patterns between the ADHD and Anxiety groups were identified at the attentional engagement, performance monitoring, and performance evaluation phases. The Anxiety-only group displayed steeper pre-stimulus aperiodic exponents preceding correct versus incorrect trials, larger ERN amplitudes relative to the ADHD+Anxiety group, and reduced Pe amplitudes relative to the TD group and ADHD+Anxiety groups, suggesting heightened error detection, but reduced conscious appraisal. In contrast, the ADHD-only group showed reduced post-error slowing, indicating weaker self-monitoring and adaptive control. CONCLUSIONS: Inattention in ADHD and anxiety is driven by both shared and distinct neurophysiological mechanisms. Shared alterations in early attentional engagement and stimulus processing coexist with disorder-specific differences in error monitoring and behavioral adjustment. These results position multimodal neurophysiological biomarkers as valuable tools for differential diagnosis and for guiding targeted interventions.
Randomized Controlled Trial of a Peer-Delivered High School Preparatory Intervention for ADHD.
Sibley MH, Van Dreel S, Coxe SJ … +9 more , Ortiz M, Aaronson B, Matlack A, Rainwater T, Kircher BE, Langberg J, Lyon A, Yi A, Yeguez CE
J Atten Disord · 2026 May · PMID 42087566 · Publisher ↗
OBJECTIVE: The high school transition is a period of academic and socioemotional vulnerability for adolescents with ADHD. Standard high school interventions for ADHD typically demonstrate access and engagement challenges...
OBJECTIVE: The high school transition is a period of academic and socioemotional vulnerability for adolescents with ADHD. Standard high school interventions for ADHD typically demonstrate access and engagement challenges. Peer-delivered interventions may overcome staff time and resource shortages while increasing adolescent engagement. A previously tested peer-delivered model (STRIPES;16 weekly psychosocial sessions with a peer) showed promising effects but suboptimal engagement. METHOD: This development trial evaluates enhancements to STRIPES (STRIPES+) adding a 1-week peer-led school orientation and six parent training sessions. Ninth grade students meeting current ADHD symptom and impairment criteria ( = 72) were randomized to STRIPES+ versus school services as usual (SSU). Engagement metrics were evaluated and group × time 1-year outcome trajectories were compared using Linear Mixed Models. RESULTS: Student and peer, but not parent, attendance was strong. STRIPES+ was feasible and acceptabled to students and peers. Compared to SSU, STRIPES+ demonstrated significant gains for school materials organization ( = 0.01, = 0.01, = .040, = 0.51), use of a daily planner ( = 0.64, = 0.31, = .042, = 0.38), self-reported sense of academic autonomy ( = 0.02, = 0.01, = .018, = .61), and reductions in parent academic assistance across three indices ( = -0.02, = 0.01, = .014, = 0.50; = -0.01, = 0.04, = .023, = 0.50; = -0.01, = 0.00, = .021, = 0.34). There was no acute impact on primary academic or ADHD symptom outcomes. CONCLUSIONS: Use of peer interventionists may be an effective engagement strategy for adolescents with ADHD. STRIPES+ engaged target mechanisms but students demonstrated similar 1-year school outcomes to SSU. A developmentally advantageous transfer of academic responsibility from parents to adolescents was noted in STRIPES+ relative to SSU. The long-term impact of STRIPES+ on promoting increasing academic autonomy through high school should be evaluated. CLINICALTRIALS: gov ID:NCT04571320.
An Exploratory Study of Functional Outcome in Stimulant Treatment of ADHD in Adults.
Weiss MD, Newcorn JH, Chokka P … +3 more , Cataldo M, Bhaskar S, Donnelly GAE
J Atten Disord · 2026 May · PMID 42084377 · Publisher ↗
OBJECTIVE: The objective of this analysis was to describe the effects of methylphenidate-mediated symptom improvement on functional impairments in adults with ADHD. METHODS: This is an exploratory study of self-reported...
OBJECTIVE: The objective of this analysis was to describe the effects of methylphenidate-mediated symptom improvement on functional impairments in adults with ADHD. METHODS: This is an exploratory study of self-reported functional impairment on the Weiss Functional Impairment Rating Scale (WFIRS-S) in 351 ADHD adults treated in a forced dose, double blind (DB), randomized, parallel clinical trial of a 16-hr methylphenidate stimulant (PRC-063) for 4 weeks followed by open-label (OL; N = 147) for 6 months. RESULTS: During the 4-week DB period, there was a statistically significant response to medication versus placebo in the WFIRS-S domain of "work." Forty percent of DB subjects, assigned a random dose of medication, showed functional improvement as defined by the Minimal Clinical Important Differences (MCID) of the WFIRS. At the end of DB, one third of subjects had scores below symptomatic and functional impairment thresholds and two thirds by the end of OL. Although the OL period was uncontrolled, when all subjects had been dose optimized with sufficient time for functional impairment to manifest, all WFIRS functional domains showed clinically-relevant improvements from baseline to end of the 6-month OL ( < .0001). There was a fair-to-moderate correlation between change in symptoms and change in function, but ADHD symptoms were about twice as sensitive to change. The strongest predictor of improvement in function was greater improvement in ADHD symptoms. Younger age predicted greater functional impairment. CONCLUSION: This study of the relationship between change in symptoms and functional outcome illustrates that improvement in symptoms may be associated with an almost cotemporaneous improvement in function, that increases over time. Identification of subjects who are symptom responders with residual functional impairment suggests the need for additional intervention to target residual functional difficulty. Further research needs to replicate this methodology using an individually dose optimized design to demonstrate full potential for change and to confirm the domains of functioning in adults with ADHD that are most responsive to stimulant treatment. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT02139124.
Evaluating the Effect of ADHD on Occupational Outcomes in the U.S. Marine Corps.
Carnes N, McAnany J, Khodr Z … +3 more , Biggs A, Bonkowski J, Barkho W
J Atten Disord · 2026 May · PMID 42076884 · Publisher ↗
OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) can potentially disqualify individuals for military service. However, some past research suggests the performance of individuals with ADHD in military service ma...
OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) can potentially disqualify individuals for military service. However, some past research suggests the performance of individuals with ADHD in military service may be comparable to individuals without ADHD. The objective of the present research is to evaluate the effect of ADHD on occupational outcomes in the first enlistment term. We hypothesized that ADHD would be associated with weak or small performance decrements. METHOD: Study 1 ( = 51,845) linked Recruit Assessment Program (RAP) survey data collected from U.S. Marine recruits between 2013 and 2018 with up to 4-years of active duty career records from the Defense Manpower Data Center. The RAP survey is a cross-sectional, baseline survey of mental, physical, and behavioral health-including self-reported ADHD diagnosis. Study 2 ( = 161,507) utilized the Career History Archival Medical and Personnel System (CHAMPS) to obtain a study population of all active duty U.S. Marine Corps enlistees who accessed between 2013 and 2018 with follow-up through 2023. ADHD cases were identified by diagnoses and prescriptions captured in CHAMPS medical data. Estimated propensity scores and military characteristics were adjusted for to mitigate confounding. RESULTS: Across both studies, Marines with ADHD (2.0%-3.2%) performed at a comparable level to Marines without ADHD. The differences in occupational outcomes (e.g., promotions, demotions, deployments, and attrition) generally fell within ±3% and failed to reach statistical significance despite high statistical power. Subgroup analyses in Study 2 suggested those with treated ADHD performed significantly better than those with untreated ADHD. CONCLUSION: Complementing past work using medical waivers, the present research suggests those with a prior or current ADHD diagnosis are just as likely to perform successfully in the U.S. Marine Corps as those without ADHD.
Psychometric Evaluation of the Spanish Translation of the Disruptive-Behavior Disorder Rating Scale.
Ramirez C, Schatz NK, Fernandez O … +4 more , Phillips BM, Lonigan CJ, Fabiano GA, Gallo RF
J Atten Disord · 2026 Apr · PMID 42052920 · Publisher ↗
INTRODUCTION: Evidence-based assessments for ADHD include the collection of standardized ratings of Diagnostic and Statistical Manual of Mental Disorders symptoms. There is limited research on ADHD diagnostic procedures...
INTRODUCTION: Evidence-based assessments for ADHD include the collection of standardized ratings of Diagnostic and Statistical Manual of Mental Disorders symptoms. There is limited research on ADHD diagnostic procedures in Hispanic/Latino children and a growing concern that ADHD may be underdiagnosed due to language barriers that exist between parents and the standardized measures. To address this gap, we examined potential language related biases in the assessment of ADHD among Spanish-speaking parents. METHODS: The sample was 107 Hispanic/Latino, Spanish-speaking parents of children in kindergarten or first grade. The Spanish translated versions of the Disruptive Behavior Disorders Rating Scale (DBD-RS), Strength and Difficulties Questionnaire (SDQ), and Impairment Rating Scale (IRS) were administered to assess ADHD symptoms, concurrent validity, and the influence of time since arrival in the United States on parent ratings. RESULTS: The Spanish DBD-RS demonstrated strong internal consistency for both Inattention (α = .85) and Hyperactivity/Impulsivity (α = .85) subscales. Parent ADHD ratings were positively correlated with SDQ Hyperactivity/Inattention scores ( = .38, < .001), supporting concurrent validity. In regression analyses, parent time in the U.S. significantly predicted IRS impairment scores beyond ADHD symptoms (Δ = .036, = .035). CONCLUSION: Despite limitations such as reliance on self-report measures and cultural heterogeneity in the sample, this research contributes to understanding ADHD assessment in an under-studied ethnic group. Our findings contribute to ongoing efforts to refine diagnostic tools and promote equitable access to ADHD evaluations that are culturally appropriate for Hispanic/Latino children.
Racial and Ethnic Heterogeneity in Grit's Relations With ADHD Symptom Severity and Impairment: Indications of Decreased Relevance in Asian Versus White College Students.
Wong AWWA, Goh PK, Mellor GS … +4 more , Tsang J, Banerjee M, Khaireddin MM, Hartung CM
J Atten Disord · 2026 Apr · PMID 42026821 · Publisher ↗
OBJECTIVE: Grit is a potential resilience factor that might help expand ADHD's conceptualization and inform empowering interventions. Yet, no work has examined how components of grit, particularly consistency of interest...
OBJECTIVE: Grit is a potential resilience factor that might help expand ADHD's conceptualization and inform empowering interventions. Yet, no work has examined how components of grit, particularly consistency of interests (COI), may relate to ADHD symptom severity and impairment. Additionally, it is unclear whether these relations may differ with respect to one's race and ethnicity. Thus, the current study aimed to examine whether race and ethnicity moderate grit and COI's relations with ADHD symptom severity and impairment in college students. METHODS: Participants, aged 18 to 25 years, were derived from two samples of a multisite college ADHD study: Exploratory Sample ( = 1,771; = 19.21, = 1.40) and Confirmatory Sample ( = 3,809; = 19.11, = 1.31). All participants self-reported ADHD symptom severity, functional impairment, and levels of grit. RESULTS: Examination of main effects across samples revealed that grit and COI were significantly and negatively associated with ADHD symptom severity. Further, in a sample of participants with five or more ADHD symptoms ( = 1,153; = 19.22, = 1.41), follow-up analyses investigating impairment revealed that grit had a significant, positive relation with impairment, and COI had a significant, negative relation with impairment. Grit's relations with ADHD symptom severity and impairment were generally consistent across race and ethnicity. Yet, there was a significant moderating effect with respect to the White versus Asian comparison concerning COI-ADHD relations. Follow-up analyses revealed that the strength of these relations was significantly weaker in Asian college students. CONCLUSION: Results provided greater specificity in grit's role as a resilience factor for ADHD and highlighted the need for further exploration of resilience factors to inform more comprehensive conceptualizations of ADHD in Asian college students.
ADHD Symptoms, Internalizing Symptoms, and Friendship Features in Emerging Adults: The Moderating Effect of Cognitive Disengagement Syndrome Symptoms.
Greenberg NF, Becker SP, Luebbe AM … +4 more , Kofler MJ, Burns GL, McDonald KL, Jarrett MA
J Atten Disord · 2026 Apr · PMID 42026819 · Publisher ↗
OBJECTIVE: Previous research has revealed that individuals with ADHD exhibit difficulties in social functioning including obtaining and maintaining quality friendships. Cognitive disengagement syndrome (CDS) symptoms and...
OBJECTIVE: Previous research has revealed that individuals with ADHD exhibit difficulties in social functioning including obtaining and maintaining quality friendships. Cognitive disengagement syndrome (CDS) symptoms and internalizing symptoms frequently co-occur with ADHD symptoms and negatively influence social functioning, yet relatively little is known about how these symptoms uniquely relate to friendship features. METHODS: The present study sought to examine associations among these variables in a large, multi-site sample of emerging adults. Participants ( = 4,756; 18-29 years; 72.7% female; 79.8% White) enrolled in five universities in the United States completed measures of ADHD, CDS, internalizing symptoms, and friendship features. RESULTS: Moderated conditional effects modeling revealed that internalizing symptoms accounted for significant variance in the association between ADHD symptoms and friendship features in all models. CDS symptoms were a significant moderator of the association between ADHD symptoms and friendship features (both positive and negative) such that there was a weaker association between ADHD symptoms and friendship impairment at higher levels of CDS symptoms. CONCLUSION: Our findings suggest that CDS symptoms may buffer the association between ADHD and friendship features. Future research should continue to explore the associations among ADHD, CDS, and internalizing symptoms and their impact on friendship functioning.
Associations between ADHD Symptoms and Psychiatric Symptoms in Children: Effects of Functional Impairment and Temperament.
Lynch JD, Subedi S, Zimon M … +2 more , Peisch V, Arnett AB
J Atten Disord · 2026 Apr · PMID 42026817 · Publisher ↗
OBJECTIVE: ADHD is a highly prevalent neurodevelopmental disorder that is associated with elevated rates of co-occurring psychiatric symptoms. The present study evaluated the role of functional impairment in mediating th...
OBJECTIVE: ADHD is a highly prevalent neurodevelopmental disorder that is associated with elevated rates of co-occurring psychiatric symptoms. The present study evaluated the role of functional impairment in mediating the association between ADHD symptoms and psychiatric symptoms, as well as the moderating role of temperament traits. METHOD: Participants included two cohorts: an early childhood longitudinal sample (ages 2-4 years; = 93) and a middle childhood cross-sectional sample (ages 7-11 years; = 92). Both cohorts were oversampled for ADHD diagnosis or concerns. ADHD symptom severity, psychiatric symptoms, functional impairment, and temperament were assessed by caregiver report. Linear mediation and moderated mediation models were conducted, with ADHD symptom severity as the independent variable, functional impairment as the mediator, and psychiatric symptoms as the dependent variable; additionally, baseline psychiatric symptoms were covaried in the longitudinal early childhood analysis. RESULTS: Across both samples, we found significant mediation effects for depression and aggression. In the middle childhood sample, functional impairment also fully mediated the association between ADHD and anxiety symptom severity. In the moderated mediation models, negative affect enhanced indirect effects on depression in early childhood and aggression in middle childhood. There were no protective effects of surgency. CONCLUSIONS: Intervention specifically targeting functional impairment in this population has key clinical implications as it may help reduce the elevated risk of psychiatric comorbidity in the ADHD population, particularly in children with elevated levels of negative emotionality who are seemingly at highest risk.
Understanding the Relationship Between Early Elementary Children's ADHD Symptoms and Teachers' Needs Supportive Practices.
Kang M, Bédard AV, Pyle A … +3 more , Guay F, Martinussen R, Plamondon A
J Atten Disord · 2026 Jul · PMID 41983470 · Full text
OBJECTIVE: Many children with diagnosed and subclinical ADHD struggle with low academic motivation in early elementary. Fortunately, teachers' needs' supportive practices (NSPs) can mitigate motivational challenges and p...
OBJECTIVE: Many children with diagnosed and subclinical ADHD struggle with low academic motivation in early elementary. Fortunately, teachers' needs' supportive practices (NSPs) can mitigate motivational challenges and protect against disengagement and underachievement. Teachers' NSPs include autonomy support, structure, and positive student-teacher relationships that target children's motivational resources (i.e., autonomy, competency, and relatedness) needed to engage with school materials. Particularly, autonomy support practices fuel children's feelings of autonomy, structure caters to feelings of competency, and positive student-teacher relationships provide feelings of belonging. Yet, it is unknown how ADHD symptoms in early elementary are associated with teachers' NSPs. METHODS: One hundred and fifty-four first-grade students and 25 teachers from three school boards participated. We assessed children's perception of their teachers' autonomy support and structure and their standardised achievement. We also assessed teachers' perceptions of students' ADHD symptoms, student-teacher relationship quality, and conduct problems. Three linear regression analyses were performed with ADHD symptoms as the predictor and NSPs as the dependent variable. Sex, conduct problems, and achievement scores were included as covariates. RESULTS: Sex (i.e., males), greater teacher-reported ADHD symptoms, and more teacher-reported conduct problems were associated with worse teacher-reported student-teacher relationship quality. Teacher-reported ADHD symptoms were positively related to student-reported autonomy support, while teacher-reported conduct problems were negatively associated with student-reported autonomy support. Teacher-reported ADHD symptoms and key covariates did not predict student-reported structure. CONCLUSION: Our study illustrates the need to further evaluate how best to support teachers managing disruptive behaviours in early elementary to protect the motivational needs of young children with ADHD symptoms.
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