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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.
Counting umbilical cord vessels is standard in prenatal ultrasounds and confirmed at birth. Single umbilical artery (SUA) occurs in about 1 in 200 cases, with roughly 10% associated with anomalies, including central nervous system defects. Isolated SUA (iSUA) means one artery is missing without other structural issues.
Research on SUA, especially isolated iSUA, and childhood neurodevelopmental disorders (NDD) is limited and inconclusive. iSUA is linked to preterm birth and small-for-gestational age (SGA), both of which are NDD risk factors.
This Norwegian nationwide population study aimed to assess NDD risk in children with iSUA at birth, the influence of sex, and how preterm birth and SGA mediate this relationship.
The nation’s universal single-payer health insurance and comprehensive population registries made it possible to analyze all 858,397 single births occurring from 1999 to 2013, with follow-up continuing through 2019. Among these cases, 3,532 involved iSUA.
After adjusting for confounders such as parental age, education, and maternal health factors, no overall link was found between iSUA and later ADHD diagnosis. However, females with iSUA had about a 40% higher risk of subsequent ADHD compared to those without iSUA, even after adjustment.
The authors concluded, “The present study indicates that iSUA is weakly associated with ID [intellectual disability] and ADHD, and these associations are influenced by sex. This association is mediated negligibly through preterm birth and SGA. The associations were not clinically significant, and the absence of associations of iSUA with other NDD is reassuring. This finding can be useful in the counseling of expectant parents of fetuses diagnosed with iSUA.”
Refractive errors, such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (distorted vision due to irregular curvature of the eye or lens), are common worldwide. These conditions affect 12%, 5%, and 15% of children, and rise significantly in adults to 26.5%, 31%, and 40%. Additionally, strabismus (misalignment of the eyes) and amblyopia (reduced vision in one eye from uneven image formation, often linked to strabismus) occur globally at rates of 2% and 1.4%, respectively.
Visual impairment can affect children’s concentration in school, and studies suggest a link between eye disorders and ADHD.
To investigate this relationship, two researchers – one based in the US and the other in Israel –carried out a nationwide retrospective cohort study using electronic medical records of all insured individuals aged 5 to 30 who were part of Maccabi Health Services, Israel’s second largest health maintenance organization, between 2010 and 2022.
Of over 1.6 million insured members (2010–2020), inclusion/exclusion criteria and propensity score matching for age and sex were applied, along with a one-year wash-out period between the first eye diagnosis and ADHD diagnosis. In total, 221,707 cases were matched with controls without eye disorders at a 1:2 ratio, resulting in a cohort of 665,121 participants.
Overall, those with any previous eye diagnosis were 40% more likely to have a subsequent ADHD diagnosis. This was slightly higher for females (45%) than for males (35%). It was also slightly higher for children and adolescents (42%) than for adults (37%).
More specifically:
The authors concluded that eye disorders are associated with ADHD. They noted these associations were more marked in females and children and adolescents, although, as noted above, those differences were small. They recommended that primary care providers and neurologists consider risk stratification for early screening, and that ophthalmologists refer high-risk patients for ADHD evaluation.
Acid-suppressive medications, including proton pump inhibitors (PPIs) and histamine-2 (H2) receptor antagonists, are often prescribed during pregnancy to treat heartburn and gastroesophageal reflux disease.
Research shows changes in the gut microbiome can negatively affect neurodevelopment. Since acid-suppressive medications alter gut microbiota, maternal use during pregnancy may impact offspring’s neurodevelopment. Because PPIs and H2 receptor antagonists readily cross the placental barrier, they could potentially influence fetal neurodevelopment.
The link between prenatal exposure to acid-suppressive medications and major neuropsychiatric disorders is not well understood. With the use of these medications during pregnancy rising, it is important to assess their impact on children's long-term neurodevelopment. This study examined whether maternal use of acid-suppressive drugs is associated with increased risk of neuropsychiatric disorders in children, using a large, nationwide birth cohort from South Korea.
South Korea operates a single-payer health insurance system, providing coverage for over 97% of its citizens. The National Health Insurance Service (NHIS) maintains a comprehensive database with sociodemographic details, medical diagnoses, procedures, prescriptions, health examinations, and vital statistics for all insured individuals.
A Korean research team analyzed data from over three million mother-child pairs (2010–2017) to assess the risks of prenatal exposure to acid-suppressing medications. They applied propensity scoring to adjust for maternal age, number of children, medical history, and outpatient visits before pregnancy, to minimize confounding factors. That narrowed the cohort to just over 800,000 pairs, with half in the exposed group.
With these adjustments, prenatal exposure to acid-suppressing medications was associated with 14% greater likelihood of being subsequently diagnosed with ADHD.
Yet, when 151,737 exposed births were compared to the same number of sibling controls, no association was found between prenatal exposure and subsequent ADHD, which suggests unaccounted familial and genetic factors influenced the preceding results.
The Take-Away:
Evidence of these medications negatively affecting pregnancies is mixed, mostly observational, and generally reassuring when these medications are used appropriately. Untreated GERD and gastritis, however, have known risks and associations with the development of various cancers. With no evidence of an association with ADHD (or for that matter any other neuropsychiatric disorder), there is no current evidence-based reason for expectant mothers to discontinue use of acid-suppressing medications.
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