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February 19, 2022
While romantic relationships can bring contentment and stability to adults with psychological disorders, conflict in such relationships adds incremental risk for developing depressive, anxiety, and substance use disorders. Moreover, persons with ADHD are more prone to such conflict than those without ADHD.
ADHD symptoms are negatively associated with satisfaction in dating relationships. One study found that female college students, blind to ADHD status, were less interested in male students with ADHD-Inattentive presentation than peers without ADHD. Another study found that college students who self-reported significant inattentive and hyperactive-impulsive symptoms also reported lower romantic relationship satisfaction than students not reporting such symptoms. A third study likewise found an inverse association between college student-reported inattentive symptoms and romantic relationship satisfaction, although it found no such association for self-reported hyperactive/impulsive symptoms.
This in turn has behavioral implications. One study found that college students with clinically elevated symptoms of inattention, hyperactivity/impulsivity, or both, reported higher levels of hostile conflict behavior with their partners than students without clinically elevated symptoms. Another study placed young couples through conflict resolutions. Couples in which one partner had ADHD demonstrated more negative and less positive conflict resolution behavior, and reported lower relational satisfaction, than couples in which neither partner had an ADHD diagnosis.
Worse yet, ADHD is a risk factor for dating violence. Two studies found that young adult males diagnosed with ADHD as children self-reported engaging in more frequent verbal and physical intimate partner violence than did their normally developing peers. Two more studies reported that men and women diagnosed with ADHD as children were at greater risk of becoming victims of such violence.
Adults with ADHD are also more likely to engage in risky sexual behavior. On average, they initiate sexual intercourse between one and two years earlier. They tend to have more partners and to make less frequent use of contraception than non-ADHD peers. As a result, adults with ADHD are also more likely to have unplanned pregnancies and to acquire sexually transmitted diseases.
Given these findings, it is hardly surprising that adults with ADHD report lower marital satisfaction than their normally developing peers. One study reported that 24 out of every 25 spouses of adults with ADHD felt their partner's symptoms interfered with their functioning in one or more domains, including general household organization/time management, child-rearing, and communication. Most studies have found that extramarital affairs, separation, and divorce are more frequent among couples in which one partner has ADHD.
ADHD is known to be highly heritable. That introduces further challenges. One study found that parents of children with ADHD are twice as likely to divorce by the time their child is eight years older than parents of children without ADHD. Another study found that disruptive child behavior is linked to parents arguing among themselves. This pattern was especially pronounced with parents who themselves had elevated ADHD symptoms. However, another study found that when both parents had ADHD symptoms, they were less likely to argue than when only one parent had such symptoms, or when neither did.
The authors note that there have been few longitudinal studies of the relationship to the behavior of adults with ADHD and that these are badly needed. This would help to understand how alcohol consumption relates to the development of relationship problems, for example.
Second, they point out that little is known about which subpopulations in the large population of adults with ADHD may be especially at risk for romantic relationship problems. Gender and history of maltreatment do not appear to be significant influences, but there is some evidence that alcohol and drug abuse may be a factor, as well as underachievement in adolescence. Moreover, the literature to date has focused on heterosexual Caucasian couples. There is a need for research with larger, more heterogeneous, population samples, and in particular with racial/ethnic minorities and LGBTQ+ adults.
Third, they suggest a need for further research on mediators between ADHD and romantic relationship problems. There are reasons to suspect a key role for emotion dysregulation and deficits in inhibitory controls. But studies to date have relied on self-reporting, which introduces respondent bias. Future studies should obtain ratings of ADHD and relationship functioning from other informants. There is also a need for studies focusing not just on younger adults, but also on older ones. Another critical need is for clinical trials testing the effectiveness of different interventions aiming to improve romantic relationship functioning.
The authors conclude, "Given that success in romantic relationships is considered by many to be a major developmental task and that ADHD persists for many affected individuals into adulthood, research on romantic adjustment of affected adults is surprisingly limited. The majority of existent published research points, however, to a robust association between ADHD and negative outcomes such as lower satisfaction in relationships, maladaptive conflict resolution styles, higher rates of relational dissolution, and behavioral issues such as unsafe sex and IPV."
Brian T. Wymbs, Will H. Canu, Gina M. Sacchetti, Loren M. Ranson, "Adult ADHD and romantic relationships: What we know and what we can do to help", Journal of Maritaland Family Therapy(2021),https://doi.org/10.1111/jmft.12475.
Methylphenidate is an effective treatment for ADHD in adults who also have bipolar disorder (BD), but it carries a potential risk of triggering manic episodes. Current guidelines therefore recommend using it only alongside mood-stabilizing medication. A new study using French nationwide claims data sought to test and extend those recommendations with greater statistical power than previous research.
The study built on findings by Viktorin et al. (2017), who observed that adults with BD not taking mood stabilizers had more than a sixfold higher risk of manic events (defined as hospitalization for mania or a new antimanic prescription) within six months of starting methylphenidate. Patients on mood-stabilizing treatment, by contrast, showed nearly half the baseline risk in the first three months. Those findings were limited, however, by small event counts (fewer than 61 manic episodes) and an effect that did not persist beyond the initial three-month window.
To build on this, researchers drew on the French National Health Data System (which is a claims database covering more than 60 million people) spanning 2008 to 2024. The final sample included 6,022 adults with BD (56% women) who had started methylphenidate. Using a self-controlled design, the study compared each patient's rate of manic events in the six months before their first methylphenidate prescription with the rate in the six months after, effectively eliminating stable individual differences as a confound.
Patients were classified as receiving continuous mood-stabilizing treatment if they had been dispensed at least two courses of specific antipsychotics (aripiprazole, olanzapine, or quetiapine) or mood stabilizers (lithium or valproate) in the nine months before starting methylphenidate, including at least one dispensation in the final six months of that window.
The results largely confirmed the earlier findings. Among the 2,745 patients not on mood stabilizers, the rate of inpatient mania diagnosis was 5.1 times higher in the first three months after starting methylphenidate, though this elevation fell to a non-significant level over the subsequent three months. Patients receiving continuous mood-stabilizing treatment showed no statistically significant change in mania risk across the full six-month post-initiation period. A formulation-specific pattern also emerged: patients without mood-stabilizing treatment had a 2.5-fold higher risk associated with extended-release methylphenidate, while no significant risk increase was seen with the immediate-release formulation or in treated patients regardless of formulation.
The authors conclude that methylphenidate at doses below 30 mg does not appear to elevate manic relapse risk when prescribed alongside mood stabilizers. The elevated risk seen in untreated patients, particularly with extended-release formulations, must be interpreted cautiously, given limited statistical power and the likelihood that it partly reflects the natural fluctuation of manic relapse over time. The authors flag this as an inherent limitation of self-controlled survival analyses when studying drug-induced mania, where temporal trends in the underlying condition can be difficult to disentangle from treatment effects.
The FDA has approved a new once-daily pill called centanafadine (trade name SIMTRIYO®). Approved for adults and kids aged 6 and older (weighing at least 44 lbs / 20 kg), centanafadine is a new category of ADHD treatment that aims to give fast results with fewer of the downsides of traditional stimulants.
To understand why centanafadine is unique among medications for ADHD, it helps to look at how ADHD brain chemistry works:
Stimulants like Ritalin and Adderall work mainly in the dopamine system. Nonstimulants like atomoxetine, viloxazine, clonidine and guanfacine work mainly on the norepinephrine system. Centanafadine is the first drug in a new class called NDSRIs (Norepinephrine, Dopamine, and Serotonin Reuptake Inhibitors). We can describe its effects as follows:
What Did Clinical Trials Show?
The FDA approved centanafadine based on studies involving thousands of adults, teens, and children. Here are the key findings:
Centanafadine showed some improvement in ADHD symptoms within the very first week of taking it although a full effect takes about six weeks.
In adult trials, taking 200 mg or 400 mg daily led to significant improvements in real-world skills:
In trials with children (ages 6–12) and teens (ages 13–17), centanafadine significantly reduced core ADHD symptoms like hyperactivity, impulsivity, and lack of focus compared to a placebo.
About 30% to 40% of adults with ADHD also suffer from anxiety. Traditional stimulants can make anxiety worse. In a trial specifically designed for adults dealing with both ADHD and anxiety, centanafadine effectively treated ADHD symptoms without firing up their anxiety, which might be due to its serotonin boost.
Does Centanafadine have Side Effects?
While Centanafadine was well-tolerated by most people in studies, like any prescription medication, it comes with important safety guidelines.
Prescribing Warnings:
Common Side Effects:
Other Warnings:
The Bottom Line
Overall, centanafadine is a new step forward in how we treat ADHD. Because it acts differently in the brain than traditional treatments, patients who struggle with stimulant-related anxiety or side effects may find it useful to explore with their doctor.
A landmark nationwide study from South Korea has uncovered a significant link between prenatal exposure to air pollution — specifically nitrogen dioxide (NO2) — and an increased risk of ADHD in children.
While researchers have long suspected that air pollutants interfere with fetal brain development through inflammation and oxidative stress, this study is one of the largest and most comprehensive of its kind, following nearly 1.5 million births for up to 13 years.
Why South Korea?
South Korea provided a unique countrywide “laboratory” for this research due to two key infrastructure strengths:
Key Findings: The “Smoking Gun” of NO2
While the study looked at several pollutants, nitrogen dioxide — a byproduct of fossil fuel combustion in cars and power plants — emerged as the primary concern.
Pollutant
Association with ADHD Risk
Nitrogen Dioxide (NO2)
Strongest Link: Every 1-ppb (part-per-billion) increase in exposure linked to a 22% rise in risk.
Sulfur Dioxide (SO2)
Minimal Link: Only a slight 4% increase per ppb.
Ozone (O3) carbon monoxide (CO), & particulates
No significant association was found.
The scale of the NO2 risk is particularly striking. Over the typical range of exposure levels found in the study (an interquartile range of 13 ppb), the data suggest a threefold increase in ADHD risk for children in the highest-exposure groups compared to the lowest.
Accounting for Other Factors
To ensure the results weren’t skewed by other variables, the researchers controlled for a wide range of confounders including:
The authors emphasized the strong association between maternal nitrogen dioxide exposure and ADHD, while also noting the small but significant association with sulfur dioxide.
The Take-Away: A New Frontier for Public Health
Historically, air quality laws have been designed to protect our lungs and hearts. However, this study adds to a growing body of evidence suggesting that the brain is likewise vulnerable.
In a commentary on the findings, expert George Ayoub argued that “neurodevelopment should be explicitly considered” when governments perform cost-benefit analyses on air quality regulation. My view is a bit different. The association is intriguing but the study does not establish cause and effect. Many statistically significant environmental risk associations for neurodevelopmental disorders have disappeared after controlling for maternal risk for ADHD. I hope this research team will do those analyses if feasible.
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