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 was onsite for the 2022 American Psychiatric Association (APA) Annual Meeting in New Orleans, Louisiana, covering expert opinions and the latest research on a wide variety of important psychiatric issues. Here are some highlights from our coverage.

“Why is it that people with ADHD can do some specific things that they happen to be really interested in, or where they feel like, if they don’t take care of this 

 want to see happen is going to happen fast?”

Thomas E. Brown, PhD, of the Brown Clinic for ADHD and Related Disorders and the University of California-Riverside School of Medicine shared with 2022 American Psychiatric Association (APA) Annual Meeting attendees that attention-deficit/hyperactivity disorder (ADHD) may appear to be a problem of motivation, or “willpower,” but it is not. 

More Than a Knockout: Structural Brain Effects in MMA Sparring

In a first-of-its-kind study, researchers looked at the effect of practice sparring on possible brain changes in mixed martial arts (MMA) fighters. The results were presented at the 2022 American Psychiatric Association Annual Meeting by study author Aaron I. Esagoff, a medical student at Johns Hopkins University School of Medicine.

Although previous studies have looked at other sports that involve repetitive brain injury, the real risk for MMA fighters occur during practice sessions, explained Esagoff. Fights/matches only happen a few times per year, but individuals can spend hundreds of hours sparring and practicing. MMA is a hybrid combat sport that includes moves from boxing, wrestling, karate, judo, and jujitsu. 

“I think until we really understand the underlying neurobiology of PTSD, we’re stuck with a situation where the patient gets better, but they don’t get well.”

Charles B. Nemeroff, MD, PhD, Matthew P. Nemeroff Endowed Chair and professor in the University of Texas at Austin (UT Austin) Dell Medical School Department of Psychiatry & Behavioral Sciences, discussed the neurobiology of posttraumatic stress disorder (PTSD) at the 2022 American Psychiatric Association Annual Meeting. In the session—moderated by Edmond Hsin T. Pi, MD—Nemeroff described the diagnosis, epidemiology, and pathophysiology of PTSD, along with notable risk factors and some current and emerging treatments for PTSD. 

Leading the Artificial Intelligence Revolution

“Artificial intelligence (AI) is here to stay, and it’s really very important for the psychiatric field to take a leading role in developing it.”

P. Murali Doraiswamy, MBBS, FRCP, of the Duke University School of Medicine discussed some of the latest developments in AI and its current and potential applications for psychiatry at the 2022 American Psychiatric Association (APA) Annual Meeting. He was joined in a panel discussion by Robert M. Califf, MD, MACC, commissioner of food and drugs for the US Food and Drug Administration (FDA), and moderator Samantha Boardman, MD, psychiatrist and author of 

Everyday Vitality: Turning Stress Into Strength

 coverage from the 2022 APA Annual Meeting 

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Do you have a comment on any of these or other articles? Have a good idea for an article and want to write? Interested in sharing your perspectives? Write to us at 

Catch up on the latest research on ADHD, PTSD, and more with Psychiatric Times.

In Case You Missed It: Highlights From the 2022 APA Annual Meeting

“One-third of kids in middle school and high school in North America are struggling socially—one-third,” Elizabeth Laugeson, PsyD, told attendees of the 2022 American Psychiatric Association Annual Meeting. “Do you think they’re all getting services? Probably not. And if you think about the consequences of this, it’s pretty disturbing.”

Laugeson is the founder and director of the University of California, Los Angeles (UCLA) PEERS Clinic; training director of the Tarjan Center for Developmental Disabilities and Health Sciences; and clinical assistant professor of psychiatry and biobehavioral sciences at the Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, at UCLA. She is also the author of 

The Science of Making Friends: Helping Socially Challenged Teens and Young Adults

The estimated 1 in 54 US children diagnosed with autism spectrum disorder (ASD) may especially experience social difficulties, according to Thomas E. Brown, PhD, of the Brown Clinic for ADHD and Related Disorders and the University of California-Riverside School of Medicine. Brown added that about 50% to 75% of individuals on the autism spectrum also have attention-deficit/hyperactivity disorder (ADHD).

Youth with ASD who exhibit symptoms of ADHD tend to have more difficulty with adaptive behaviors at home, in school, and in their community, and may fall behind in a wide variety of executive functions, including activation, focus, effort, emotion, memory, and action. They also experience several social challenges, including poor social communication, poor social awareness, poor social cognition, less constructive social engagement, and few close meaningful (reciprocal) friendships, according to Laugeson. Youth may experience any or all of these challenges even if they do not meet full DSM criteria for an ADHD diagnosis.

Teaching targeted social skills can help youth with ASD and ADHD, Laugeson added, noting the impact of common issues such as rejection and bullying on mental health, self-esteem, academic performance, and beyond even in youth who are not neurodivergent. “What we know is that peer rejection is one of the strongest predictors of mental health problems,” she said, noting a connection between rejection and depression, anxiety, loneliness, substance abuse, early withdrawal from school, and suicidal ideation and attempts.

Laugeson explained that evidence-based programs teaching targeted social skills, such as the PEERS Clinic at UCLA, can help youth with ASD and ADHD improve in common challenge areas such as social communication, awareness, engagement, and cognition. At PEERS, they work with preschoolers, adolescents, and young adults by teaching them targeted strategies for building friendship and relationship skills, managing conflict, and handling rejection through training, teleconferences, virtual boot camps, and role-play videos and exercises. 

They also help all age groups deal with both direct (verbal, physical) and indirect (cyberbullying, gossip) forms of bullying. “The reality is that every kid gets teased. Even adults get teased. What matters is how you react to it,” Laugeson said, noting that the most common advice youth receive for handling bullies is often ineffective. 

“What are most young people told to do in response to teasing? Ignore it, walk away, tell an adult. But these are not ecologically valid strategies—and yet, this is what adults tell kids to do... It’s an epidemic of bad advice.”

PEERS shows youth the effects of these strategies in comparison to more effective techniques through role-play exercises and videos.

Based on the research, the PEERS approach works. Laugeson shared a recent study on outcomes of PEERS treatment in individuals with ASD, ADHD, and with both ASD and ADHD. All groups demonstrated significant improvements in social skills (ASD: 

<.001) and decreases in features of autism (ASD: 

“Even though the groups started differently at baseline,” she said, “they all improved after this treatment at the same rate.”

Overall, teaching targeted social skills can be helpful to youth who have ASD, ADHD, or both ASD and ADHD, as well as those who are not neurodivergent. “What if conversational skills—and more broadly, social skills—were not an art, but a science? Our research in social skills training for teens and young adults with social difficulties is based on this premise,” Laugeson wrote in 

“We believe that social skills can be taught, much in the way we might teach math or science. By breaking down complex, seemingly sophisticated social skills into concrete rules and steps of social behavior, we can demystify and to some extent decode the ‘art form’ that is social skills.”

How can we help this unique patient population thrive? Experts weigh in at the 2022 APA Annual Meeting.

The Youth Mental Health Crisis: Supporting Patients With ASD and ADHD

“Why is it that people with ADHD can do some specific things that they happen to be really interested in, or where they feel like, if they don’t take care of this 

 want to see happen is going to happen fast?”

Thomas E. Brown, PhD, of the Brown Clinic for ADHD and Related Disorders and the University of California-Riverside School of Medicine shared with 2022 American Psychiatric Association (APA) Annual Meeting attendees that attention-deficit/hyperactivity disorder (ADHD) may appear to be a problem of motivation, or “willpower,” but it is not.

“The central mystery about ADHD is the situational variability of the symptoms…” Brown said. “Every patient I’ve ever seen with ADHD has a few activities in which they have no difficulty utilizing their executive functions, but has a lot of difficulty with doing almost everything else. It comes down to that one phrase: 

Brown compared the problem to “erectile dysfunction of the mind”: “If a task you’re trying to do is something that turns you on or that you’re really interested in, you can perform. But if the task you’re trying to do is not something that’s intrinsically interesting, it doesn’t turn you on and you can’t perform. And if you can’t perform in that situation, it doesn’t matter how much you may say to yourself, ‘I need to do this’ or ‘I should make this happen’—it is simply not possible.”

This can be a challenge for individuals with ADHD at all ages. Although the most difficult times for these individuals tend to be middle school, high school, the first 2 years of college, and when moving away from home, these individuals may also have difficulty as adults with parenting or administrative tasks at work. At any stage, these individuals often have difficulty with the executive functions of activation, focus, effort, emotion, memory, and action.

Understanding that ADHD is not a problem of motivation is important for effective assessment and treatment, according to Brown, who recommended a variety of tools for assessing youth for ADHD, including semi-structured clinical interviews with the patient and a parent; teacher reports; normed ADHD rating scales such as the Behavior Assessment System for Children (BASC) and the Behavior Rating Inventory of Executive Function (BRIEF); and others that can give clinicians considerable data on the patient’s daily functioning. 

Pharmacologic treatment may also be effective, according to fellow presenter Ryan Kennedy, DNP, NP-C, of the Brown Clinic for ADHD and Related Disorders, who noted that, when selecting and fine-tuning medications, it is important to consider many factors such as previous medical trials, growth and appetite, polypharmacy, metabolism, comorbidity, cost/insurance, sensitive body chemistry, and how to monitor effects in other settings.

“Effective treatment of ADHD can and should improve both academic and social learning,” Brown concluded.

Experts discuss the role of motivation and willpower in ADHD at the 2022 APA Annual Meeting.

Willpower and ADHD

The prevalence of attention-deficit/hyperactivity disorder (

) in the worldwide pediatric population has been stable over the past 30 years except in the United States, where cases have increased.

 According to a 2016 parent survey, approximately 6.1 million US children (9.4%) had received a diagnosis of ADHD.

 Worldwide, ADHD is the third most common mental health disorder, following depression and anxiety.

 Overall, girls (5.6%) are less likely to be diagnosed with ADHD than boys (12.9%).

A 2021 global systematic review and meta-analysis suggested that the prevalence of persistent adult ADHD was 2.58% and the prevalence of symptomatic adult ADHD was 6.76%, with 139.84 million and 366.33 million affected adults worldwide in 2020, respectively.

 ADHD appears to impact men more than women. In adults, ADHD appears to decrease as an individual ages.

Etiology is still not clearly understood; however, combinations of genetic, neurological, and environmental factors likely contribute to its pathogenesis and symptom expression.

 Genetic factors are implicated, but the mechanism of action is not completely clear. Family, twin, and adoption studies have strongly suggested that ADHD is highly inheritable. Moreover, genetic studies have documented the gene sets interfering with neurotransmitter pathways in the brain that implicate rare copy number variants or the collection of higher deletions, as well as the duplications impacting gene transcriptions that are more likely to be found in individuals with ADHD.

Pre-, peri-, and postnatal environmental factors play a significant role in the development of ADHD. Some evidence suggests prenatal factors include the mother’s lifestyle during pregnancy.

 For example, prenatal alcohol exposure can lead to hyperactive, disruptive, and impulsive behaviors and increase the risk of psychiatric disorders.

 Maternal smoking during the prenatal developmental period has been linked to increased risk of ADHD

 Perinatal factors, such as very low birthweight, can result in a 2-fold increase in the likelihood of ADHD.

ADHD is conceptualized as a disorder of childhood that gradually diminishes over the lifespan.

 However, several prospective longitudinal studies have challenged the prevailing assumption that childhood ADHD and adult ADHD affect the same individuals, and that they share the same neurodevelopmental vulnerabilities.

 The results of these studies suggest that more than two-thirds of individuals with adult ADHD never had childhood ADHD. Adult ADHD had been generally neglected in epidemiological studies, until recently, as researchers attempt to estimate the true prevalence of ADHD in adults. Furthermore, researchers are exploring whether ADHD is solely a neurodevelopmental disorder that presents in childhood, or whether ADHD can be acquired during other developmental periods. The prevalence of persistent adult ADHD from childhood and that of symptomatic adult ADHD were 2.58% and 6.76% in 2020, respectively.

The diagnostic assessment of ADHD can be complicated, as inattention, impulsivity, and difficulties with concentration can be driven by myriad factors. It is well documented that children and adolescents diagnosed with ADHD often have 1 or more cooccurring disorders

According to a study by Elia and colleagues, oppositional defiance disorder was the most common comorbid disorder at 41%, followed by depression/dysthymia at 22% and general anxiety disorder at 15%.

Approximately 60% to 100% of children with ADHD have 1 or more comorbid disorders that persist into adulthood. Autism spectrum disorder, with a comorbid rate of 42%, and learning disorders (math, reading, and spelling), account for 10% and 92% of comorbidities. Tourette syndrome accounts for 55% comorbidity. Children with ADHD experience major depression at a rate higher than children without ADHD (12% to 50%). Regarding anxiety symptoms, children with ADHD have a prevalence rate between 15% and 35%.

In adults with ADHD, the most common cooccurring psychiatric disorders are bipolar disorder, depression, anxiety disorders, substance use disorders (SUDs), and personality disorders.

 ADHD has a high cooccurring prevalence with bipolar disorder: Estimates range between 9.5% and 21.2%, with bipolar I disorder being more likely.

 ADHD and depression commonly cooccur at even higher rates, ranging from 18.6% to 53.3%.

 Individuals with ADHD are also at higher risk for developing anxiety disorders than the general population, with rates approaching 50%.

 SUDs are likely the most common cooccurring condition with ADHD—specifically, alcohol and/or nicotine, cannabis, and cocaine use.

Research support for the intersection of ADHD and personality disorders is scant compared with the support of other psychiatric cooccurring conditions. However, reports indicate that personality pathology is present in approximately 50% of adults with ADHD—most commonly cluster B and C personality structures—and up to 25% of adults with ADHD have 2 or more personality conditions.

Diagnosing ADHD can be a complicated process. It is imperative to obtain historical information such as academic performance records and previous psychological testing reports, if ever tested.

There are several significant barriers to diagnosis and treatment in ADHD, including overlapping symptomology between ADHD and mood and anxiety disorders, SUDs, learning disabilities, information processing disorders, auditory processing disorders, and psychosocial factors. It is important to note that some individuals overcome ADHD-related deficits by developing and mastering compensating skills. This also can impact the accuracy of ADHD diagnosis.

Evidenced-based assessment includes multi-informant/multimethod procedures and validated measures. This approach should be guided by current research and include test data to support clinical observations and, ultimately, an accurate ADHD diagnosis. 

 highlights several measures used in ADHD assessments.

Treatment considerations should be informed by functional outcomes including symptom reduction, increased quality of life, and improved daily, academic, and occupational functioning.

 Efficiency at working or studying, maintaining stable relationships, containing or curbing impulsivity, and being satisfied with life overall are indicators of improved functioning. Moreover, adherence to treatment is key to successful management of ADHD.

First-line treatments for ADHD are pharmacologic: stimulants and nonstimulants. Stimulant medications include methylphenidate, mixed amphetamine salts, and lisdexamfetamine dimesylate. Nonstimulants used in ADHD treatment include atomoxetine and alpha-2-adrenergic agonists. 

 highlights several ADHD medication options, although the effectiveness of psychopharmacological treatments is beyond the scope of this paper.

For children and adolescents, a well-established body of evidence supports the effectiveness of psychosocial treatments, including behavioral management interventions (eg, parent training, classroom interventions, peer-based interventions), training interventions (eg, cognitive training, neurofeedback, organization), cognitive behavioral therapy (CBT), and physiological treatments (eg, play and other physical activities).

CBT, the preferred nonpharmacological treatment for adult ADHD, consistently reduces its core behavioral symptoms.

Usually first diagnosed in childhood and sometimes persisting into adulthood, ADHD has extensive implications for academic achievement, relationships, finances, and employment. In addition, untreated ADHD carries greater risk of accidental injuries and substance abuse. Thus, careful assessment is of utmost importance to properly diagnose and then treat the disorder.

is an assistant professor and licensed clinical psychologist at Harris Health System in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston, Texas. 

 is a psychology fellow at Baylor College of Medicine.

1. Polanczyk GV, Willcutt EG, Salum GA, et al. 

ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis

2. Danielson ML, Bitsko RH, Ghandour RM, et al. 

Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016

3. Bélanger SA, Andrews D, Gray C, Korczak D. 

ADHD in children and youth: part 1 - etiology, diagnosis, and comorbidity

The prevalence of adult attention-deficit hyperactivity disorder: a global systematic review and meta-analysis

Molecular genetics of attention deficit hyperactivity disorder

6. Stergiakouli E, Hamshere M, Holmans P, et al; deCODE Genetics; Psychiatric GWAS Consortium. 

Investigating the contribution of common genetic variants to the risk and pathogenesis of ADHD

7. Williams NM, Franke B, Mick E, et al. 

Genome-wide analysis of copy number variants in attention deficit hyperactivity disorder: the role of rare variants and duplications at 15q13.3

9. D’Onofrio BM, Van Hulle CA, Waldman ID, et al. 

Causal inferences regarding prenatal alcohol exposure and childhood externalizing problems

Maternal prenatal substance use and behavior problems among children in the U.S.

11. Milberger S, Biederman J, Faraone SV, Chen L, Jones J. 

Is maternal smoking during pregnancy a risk factor for attention deficit hyperactivity disorder in children?

12. Kotimaa AJ, Moilanen I, Taanila A, et al. 

Maternal smoking and hyperactivity in 8-year-old children

Practitioner review: early adversity and developmental disorders

14. Moffitt TE, Houts R, Asherson P, et al. 

Is adult ADHD a childhood-onset neurodevelopmental disorder? evidence from a four-decade longitudinal cohort study

15. Agnew-Blais JC, Polanczyk GV, Danese A, et al. 

Evaluation of the persistence, remission, and emergence of attention-deficit/hyperactivity disorder in young adulthood

16. Caye A, Botter-Maio Rocha T, Anselmi L, et al. 

Attention-deficit/hyperactivity disorder trajectories from childhood to young adulthood: evidence from a birth cohort supporting a late-onset syndrome

. 2005;366(9481):237-248. Published correction appears in 

18. Larson K, Russ SA, Kahn RS, Halfon N. 

Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007

19. Elia J, Ambrosini P, Berrettini W. ADHD characteristics: I. 

Concurrent co-morbidity patterns in children & adolescents

20. Gnanavel S, Sharma P, Kaushal P, Hussain S. 

Attention deficit hyperactivity disorder and comorbidity: a review of literature

21. Katzman MA, Bilkey TS, Chokka PR, et al. 

Adult ADHD and comorbid disorders: clinical implications of a dimensional approach

A systematic review of rates and diagnostic validity of comorbid adult attention-deficit/hyperactivity disorder and bipolar disorder

23. Torgersen T, Gjervan B, Rasmussen K. 

ADHD in adults: a study of clinical characteristics, impairment and comorbidity

24. Mancini C, Van Ameringen M, Oakman JM, Figueiredo D. 

Childhood attention deficit/hyperactivity disorder in adults with anxiety disorders

25. Braaten EB, Beiderman J, Monuteaux MC, et al. 

Revisiting the association between attention-deficit/hyperactivity disorder and anxiety disorders: a familial risk analysis

26. Kessler RC, Adler L, Barkley R, et al. 

The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication

27. Klassen LJ, Bilkey TS, Katzman MA, Chokka P. 

Comorbid attention deficit/hyperactivity disorder and substance use disorder: treatment considerations

28. Olsen JL, Reimherr FW, Marchant BK, et al. 

The effect of personality disorder symptoms on response to treatment with methylphenidate transdermal system in adults with attention-deficit/hyperactivity disorder

29. Rösler M, Ginsberg Y, Arngrim T, et al. 

Correlation of symptomatic improvements with functional improvements and patient-reported outcomes in adults with attention-deficit/hyperactivity disorder treated with OROS methylphenidate

30. Shrestha M, Lautenschleger J, Soares N. 

Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review

31. Pliszka S; AACAP Work Group on Quality Issues. 

Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder

Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder

Behavior management for school-aged children with ADHD

34. Nimmo-Smith V, Merwood A, Hank D, et al. 

Non-pharmacological interventions for adult ADHD: a systematic review

Is it ADHD—or something else? The importance of careful assessment for the proper diagnosis and effective treatment of the third most common mental health disorder worldwide.

ADHD Update: Diagnosis, Assessment, and Treatment Issues

A study found a temporal relationship between methylphenidate (MPH) exposure and risk of depression in children and teenagers with attention-deficit/hyperactivity disorder (ADHD).

The study aimed to test the clinical concern that MPH exposure may increase risk of depression, especially in children. To explore this, the investigators pulled claims data from the Health Insurance Review and Assessment Service database, looking at ADHD medication prescription, depression diagnosis, and antidepressant medication prescription between January 2007 and December 2016. They identified 43,259 individuals between the ages of 6 and 19 who had been diagnosed with ADHD between July and December 2007. Of these, 2330 individuals were deemed eligible for participation in the study. The investigators then conducted a self-controlled case series study examining the occurrence of depression in the participants when they were exposed to MPH compared to when they we were not exposed to MPH.

They found an elevated risk of major depressive disorder (MDD) in participants during the 90 days prior to MPH exposure, with an incidence rate ratio of 12.12 (95% confidence interval; 10.06 to 14.61, 

 < 0.0001). The incidence rate ratio during MPH treatment was 18.06 with a 95% confidence interval of 16.67 to 19.56 (

 < 0.0001), although the rate returned to baseline level after 31 days following the discontinuation of MPH treatment. For participants between ages 6 and 9 years, the incidence rate ratio was 13.11 (95% confidence interval of 9.58 to 17.95) during the 90 days before exposure to MPH and 17.7 (95% confidence interval of 15.6 to 20.08) during MPH treatment; this also returned to baseline level after MPH treatment was discontinued.

The investigators concluded that, although the absolute risk of depression is low, it is a risk that clinicians should consider, particularly during the period immediately after MPH treatment begins.

 “Our findings suggest that use of methylphenidate medication in young people with ADHD is temporally associated with the emergence of depression,” they wrote. “With the increased global use of ADHD drugs, the benefits of methylphenidate should be carefully evaluated against the potential risk of depression in children and adolescents.”

Association between attention deficit hyperactivity disorder medication and depression: a 10-year follow-up self-controlled case study

Investigators observed higher levels of depression in children and adolescents with ADHD during MPH treatment.

Study Examines Relationship Between Methylphenidate and Risk of Depression

Although we have all been challenged by the COVID-19 pandemic, those with underlying mental health and neurodevelopmental diagnoses have faced particular hardship. Individuals with attention-deficit/hyperactivity disorder (ADHD) especially seem to have struggled to effectively adapt to the pandemic, showing more vulnerability to its many challenges.

Individuals with ADHD have showed a higher level of mental health concerns, difficulty adhering to preventive measures, and less economic success during the pandemic, as well as negative impacts on behavioral, emotional, and perceptual skills.

 Other challenges reported by adults with ADHD and caregivers of children with ADHD during the pandemic included social isolation, motivation difficulties, managing boredom, and difficulty engaging with online learning. Individuals with ADHD also reported increased symptom severity with higher risk factors for both major depression and school dropout.

 As the pandemic eases, these individuals are likely to require a high level of support, including therapy, psychiatry, and school and workplace accommodations to attain optimal functioning.

The COVID-19 pandemic forced most students to engage in virtual learning. During that time, caregivers of children with ADHD reported significant changes in the children’s behaviors, suggesting a higher level of underlying emotional dysregulation.

 After returning to school, many children with ADHD have found it harder to adapt. They have required a higher level of support in reacclimating to a set schedule and have needed to rely on executive functioning skills that they may not have had support for during the period of virtual learning.

Due to the combination of online learning, increased access to devices, and, for many, increased hours spent on digital media, it is not surprising to see struggles increase among children with ADHD. It has been suggested that ADHD symptoms, behavioral concerns, executive functioning difficulties, and family struggles all increased as digital media use increased during the pandemic.

 For many, the combination of these challenges and the challenges faced by exhausted parents has caused ongoing conflict even as the pandemic has begun to calm. Families continue to require mental health support for children and coaching for parents to manage these concerns.

The routine changes caused by the COVID-19 pandemic also presented a particular challenge for adults with ADHD. These individuals tend to require a higher level of structure than neurotypical peers and colleagues and are more likely to struggle when changes to routine occur. Creating a new schedule requires the ability to plan, organize, and initiate independently, which can be particularly challenging for those with ADHD, many of whom reported experiencing decreases in motivation and increases in distractions during the pandemic.

The constant access to media and electronics created a difficult distraction for many. The stimuli of “in-person” work was lost, and the ability to “body double”—that is, to work beside another person while completing a nonpreferred task to support engagement and accountability—was diminished. Individuals with ADHD are easily distracted and prone to missing social and environmental cues. The impact of both masking guidelines and frequent changes to these guidelines and other rules have likely increased these challenges and related stress, as well. It is important to support individuals with ADHD as they continue to adapt to changing guidelines, including changes to masking requirements.

Accurate diagnosis of ADHD has also become more challenging because of the COVID-19 pandemic. Now more than ever, it is imperative to explore neurodevelopmental history to determine early signs and traits of ADHD. Even neurotypical individuals have found themselves more distracted and distressed during the COVID-19 pandemic, including those who have not struggled with attention, executive functioning, or related emotional or behavioral dysregulation in the past. As a result, more people sought care for potential ADHD as evidenced by increased inquires to CHADD.

 In some cases, caregivers began noticing their children’s attentional concerns for the first time while virtual learning was in effect. In other cases, caregivers found their child’s ADHD easier to manage without the restrictions of the pandemic. With increasing calls for diagnosis, practitioners have had to take great care to avoid misdiagnosis. It has been imperative to recognize that children may display ADHD symptoms when preferred distractions are nearby, when anxiety is high, when social opportunities are limited, when children are sitting on a screen and exercising infrequently, and when children are internalizing their caregivers’ anxiety.

A final concern related to ADHD during the COVID-19 pandemic has been the response to infection itself. Research shows that individuals with ADHD are at increased risk of acquiring COVID-19, experiencing greater severity of COVID-19 symptoms, and being hospitalized for COVID-19. The same study noted the need for more research on whether individuals with ADHD are at higher risk for long COVID or for neuropsychiatric symptoms resulting from COVID infection.

 Long COVID is an emerging challenge that is in need of additional study. For some, long COVID symptoms include cognitive impairment and memory loss, as well as disturbed sleep and increased anxiety.

 These symptoms mirror those of ADHD and will require accurate diagnosis and treatment.

is a licensed psychologist with Washington Behavioral Medicine Associates, LLC, and director/co-founder of The SOAR Program for Psychotherapy and Testing at WBMA.

is a psychiatrist and the director of Washington Behavioral Medicine Associates, LLC, and the co-founder of The SOAR Program.

Symptoms of ADHD predict lower adaptation to the COVID-19 outbreak: financial decline, low adherence to preventive measures, psychological distress, and illness-related negative perceptions

Top problems of adolescents and young adults with ADHD during the COVID-19 pandemic

Acute stress, behavioural symptoms and mood states among school-age children with attention-deficit/hyperactive disorder during the COVID-19 outbreak

Helping adults and children with ADHD in a pandemic world

Influences of digital media use on children and adolescents with ADHD during COVID-19 pandemic

6. Merzon E, Weiss MD, Cortese S, et al. 

The association between ADHD and the severity of COVID-19 infection

7. Raveendran AV, Jayadevan R, Sashidharan S. 

What are the unique challenges for individuals with ADHD?

ADHD and the COVID-19 Pandemic

A study found that youth with both attention-deficit/hyperactivity disorder (ADHD) and internet gaming disorder experienced more severe ADHD symptomatology than youth with ADHD who did not have internet gaming disorder.

The purpose of this study was to explore the relationship between ADHD and internet gaming disorder, a new category that was introduced in DSM-5 under “Emerging Measures and Models.” To this end, the investigators recruited 108 participants who had been diagnosed with ADHD (mean age 11.7 ± 2.6 years, 96 males) and 147 normal controls (mean age 13.9 ± 3.0 years, 114 males). All participants completed the Internet Gaming Disorder Scale-Short Form (IGDS9-SF) and the Internet Addiction Test (IAT); the participants with ADHD were assessed for clinical severity using the Clinical Global Impression-Severity Score (CGI-S) and the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV). Parents of the participants with ADHD also completed the Child Behavior Checklist (CBCL) and the Conners’ Parents Rating Scale—Revised: Short Form (CPRS-R:S). Finally, participants aged 11 to 18 completed the Use, Abuse, Dependence to Internet (UADI) to give the investigators a qualitative assessment of internet addiction.

The results showed that the participants with both ADHD and internet gaming disorder experienced greater impairment and severity of ADHD symptoms, namely higher prevalence of internalizing symptoms, such as problems with socialization and depression/withdrawal, and higher prevalence of evasion and addiction dimensions. The results also supported previous hypotheses suggesting that patients with ADHD have a higher risk of developing internet gaming disorder, as these participants’ IAT and IGDS9-SF scores were at a more than 2-fold higher rate above the cutoff and a more than 4-fold higher score above the cutoff, respectively.

The investigators concluded, “our findings may be helpful for clinicians managing ADHD patients, providing suggestions for diagnostic assessment, the ascertainment of patients at higher risk, and finally, the definition of different phenotypes within the broad category of [internet gaming disorder], with different therapeutic needs, useful for precision medicine.”

1. Berloffa S, Salvati A, D'Acunto G, et al. 

Internet gaming disorder in children and adolescents with attention deficit hyperactivity disorder

Some of the more severe ADHD symptoms noted were depression/withdrawal, problems with socialization.

Study Explores Link Between ADHD and Internet Gaming Disorder

A study found that 2 in 5 adults, or 42%, with attention-deficit/hyperactivity disorder (ADHD) are in exceptional mental health.

The study aimed to evaluate the prevalence and chances of achieving Corey Keys, PhD’s, framework of complete mental health in individuals with ADHD compared to individuals without ADHD, and to identify the specific factors contributing to complete mental health among individuals with ADHD. The framework of complete mental health includes measures of eudaimonic and hedonic well-being, and considers the role of the absence of mental illness.

 In order to achieve complete mental health, individuals in this study had to report that they had not experienced any mental illness (ie, depression, anxiety, substance use disorders) in the previous year; that they had experienced almost daily life satisfaction or happiness in the past month; and that they had experienced high levels of psychological and social well-being in the past month.

In the study, investigators used 2 subsets from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH) and analyzed a nationally representative sample of Canadians who reported that they had been diagnosed with ADHD (n = 480). They compared this sample to 12,099 respondents without ADHD from Statistics Canada’s Canadian Community Health Survey-Mental System.

 The study found that 42% of individuals with ADHD had achieved complete mental health, compared to 73.8% of individuals without ADHD.

“Although we were surprised and delighted to find that 2 in 5 adults with ADHD were in excellent mental health, they are still lagging far behind their peers without ADHD, for whom 74% were thriving. There is still a long way to go in closing the mental health gap between those with and without ADHD,” said lead author Esme Fuller-Thomson, PhD, professor in the University of Toronto’s Factor-Inwentash Faculty of Social Work and director of the Institute for Life Course and Aging, in a press release. “This study calls attention to this gap, while also emphasizing potential mechanisms to reduce this discrepancy.”

Physical activity, marital status among factors contributing to complete mental health among participants.

ADHD