Psyched Perspectives: ADHD in Underrecognized Populations, With Paige Walton, MD

Paige Walton, MD, joined host Frank Clark, MD, on this episode of Psyched Perspectives to discuss disparities in attention-deficit/hyperactivity disorder (ADHD) diagnosis, the impact of screen time on ADHD symptoms, and the newly approved medication centanafadine (Simtriyo).

Walton said untreated ADHD can affect a child's self-esteem and academic performance and, left unaddressed, carries downstream risks in adulthood such as substance misuse, unsafe driving, and impaired employment and financial functioning, making early identification important. Hyperactive, disruptive behavior in boys tends to draw earlier attention in the classroom, while several other groups are frequently missed. Girls with ADHD, she explained, more often present with inattentive, internalizing symptoms and daydreaming rather than overt hyperactivity, and many compensate by working excessively hard to maintain grades before symptoms surface as anxiety or perfectionism.¹ "They tend to be quieter, they're more on the inattentive side—so they're daydreaming, they might struggle with being disorganized, paying attention," Walton said. She also described disparities among racial and ethnic minority groups, citing limited access to care, cultural attitudes toward mental health and medication, and clinician bias as contributing factors; Walton cautioned that ADHD in these populations can be mislabeled as conduct disorder or oppositional defiant disorder, which carries different treatment implications.

On screen time, Walton described a bidirectional relationship with ADHD: screens do not cause the disorder, but heavy use can worsen inattention and emotional dysregulation, while children with ADHD are drawn to the novelty of the device and immediate reward and may struggle to disengage.

Walton noted that centanafadine, a norepinephrine-, dopamine-, and serotonin-reuptake inhibitor, was recently approved for ADHD, adding a novel mechanism distinct from traditional stimulants and nonstimulants such as atomoxetine and viloxazine.²

For nonpharmacologic management, Walton emphasized sleep, along with regular exercise, adequate nutrition, and predictable routines using tools such as alarms and visual calendars. On caffeine, Walton advised monitoring intake in patients taking stimulants: "we have to be really careful with monitoring how much caffeine our patients are drinking because it can really impact those side effects, can have some cardiac risks." She generally recommended no more than 200 mg daily, adjusted to individual tolerance.

Dr Walton is a double board-certified child and adolescent psychiatrist and adult psychiatrist practicing at Sweetgrass Psychiatry in Mount Pleasant, South Carolina. She also serves as an affiliate assistant professor at the Medical University of South Carolina.

Dr Clark is an outpatient psychiatrist at Prisma Health-Upstate and clinical associate professor at the University of South Carolina School of Medicine, Greenville. He served on the American Psychiatric Association's Task Force to Address Structural Racism Throughout Psychiatry, and he currently serves as the Diversity and Inclusion section editor and advisory board member for Psychiatric Times.

References

1. Almekhlafi K, Jain S. Unveiling gender disparities in ADHD: a literature review on factors and impacts of late diagnosis in females (2010-2023). J Women Ment Health. 2024;1(1):9-21.

2. Walters J. FDA approves centanafadine for ADHD in children, adolescents, and adults. Psychiatric Times. July 24, 2026. https://www.psychiatrictimes.com/view/fda-approves-centanafadine-for-adhd-in-children-adolescents-and-adults