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June 13, 2025
The Spanish National Health Survey tracks health care outcomes through representative samples of the Spanish population.
A Spanish research team used survey data to explore the relationship between ADHD symptoms and dental and gum health in a representative sample of 3,402 Spanish children aged 6 to 14.
While previous studies have found associations between ADHD and poor dental health, they have not fully accounted for such important determinants of poor oral health as socioeconomic status, dental hygiene, or diet.
The team therefore adjusted for sociodemographic factors, lifestyle variables, and oral hygiene behaviors. More specifically, they adjusted for sex, age, social class, parental education, exposure to tobacco smoke, consumption of sweets, consumption of sugary drinks, use of asthma or allergy medication, adequate oral hygiene behavior of children, adherence to regular dental visits, parental adequate oral hygiene behavior, and parental adherence to regular dental visits.
With those adjustments, children with ADHD symptoms had over twice the incidence of dental caries (cavities) as their counterparts without ADHD symptoms.
Tooth extractions and dental restorations also occurred with over 40% greater frequency in children with ADHD symptoms.
Gum bleeding, a sign of gum disease, was more than 60% more common among children with ADHD symptoms than among their non-ADHD peers.
Importantly, excluding children with daily sugar consumption, which left 1,693 children in the sample, made no difference in the outcome for cavities.
Excluding children with poor oral hygiene habits, which left 1,657 children in the sample, those with ADHD had 2.5-fold more caries than their non-ADHD counterparts.
Excluding children of low social class, which left 1,827 children in the sample, those with ADHD had 2.6-fold more caries than their non-ADHD counterparts.
Turning to a different method to address potential confounding factors, the team used nearest-neighbor propensity score matching to create virtual controls. This compared 461 children with ADHD to 461 carefully matched children without ADHD.
This time, children with ADHD symptoms had just under twice the incidence of cavities as their counterparts without ADHD symptoms, but 60% more tooth extractions and about 75% more dental restorations. The difference in gum bleeding became nonsignificant.
Noting that “The increased risk of caries was maintained when the analyses were restricted to middle/high social class families and children with low sugar intake, good oral hygiene behaviors and regular dental visits,” the team concluded, “Children with ADHD symptoms in Spain had worse oral health indicators than those without ADHD symptoms. Our results suggest that the association of ADHD symptoms with caries was independent of socioeconomic level, cariogenic diet, frequency of toothbrushing, and dental visits.”
Lucía Fernández-Arce, José Manuel Martínez-Pérez, Miguel García-Villarino, María Del Mar Fernández-Álvarez, Rubén Martín-Payo, and Alberto Lana, “Symptoms of Attention Deficit Hyperactivity Disorder and Oral Health Problems among Children in Spain,” Caries Research (2025), 59(1):35-45, https://doi.org/10.1159/000541013.
In recent years, there has been growing interest in understanding the connection between our gut microbiota (the community of microorganisms in our digestive system) and various neurodevelopmental disorders like autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). A new study by Shunya Kurokawa and colleagues dives deeper into this area, comparing dietary diversity and gut microbial diversity among children with ASD, ADHD, their normally-developing siblings, and unrelated volunteer controls. Let's unpack what they found and what it means.
The Study Setup
The researchers recruited children aged 6-12 years diagnosed with ASD and/or ADHD, along with their non-ASD/ADHD siblings and the unrelated non-ASD/ADHD volunteers. The diagnoses were confirmed using standardized assessments like the Autism Diagnostic Observation Schedule-2 (ADOS-2). The study looked at gut microbial diversity using advanced DNA extraction and sequencing techniques, comparing alpha-diversity indices (which reflect the variety and evenness of microbial species within each gut sample) across different groups. They also assessed dietary diversity through standardized questionnaires.
Key Findings
The study included 98 subjects, comprising children with ASD, ADHD, both ASD and ADHD, their non-ASD/ADHD siblings, and the unrelated controls. Here's what they discovered:
Gut Microbial Diversity: The researchers found significant differences in alpha-diversity indices (like Chao 1 and Shannon index) among the groups. Notably, children with ASD had lower gut microbial diversity compared to unrelated neurotypical controls. This suggests disorder-specific differences in gut microbiota, particularly in children with ASD.
Dietary Diversity: Surprisingly, dietary diversity (assessed using the Shannon index) did not differ significantly among the groups. This finding implies that while gut microbial diversity showed disorder-specific patterns, diet diversity itself might not be the primary factor driving these differences.
What Does This Mean?
The study highlights intriguing connections between gut microbiota and neurodevelopmental disorders like ASD and ADHD. The lower gut microbial diversity observed in children with ASD points towards potential links between gut health and the pathophysiology of ASD. Understanding these connections is crucial for developing targeted therapeutic interventions.
Implications and Future Directions
This research underscores the importance of considering gut microbiota in the context of neurodevelopmental disorders. Moving forward, future studies should account for factors like co-occurrence of ASD and ADHD, as well as carefully control for dietary influences. This will help unravel the complex interplay between gut microbiota, diet, and neurodevelopmental disorders, paving the way for innovative treatments and interventions.
In summary, studies like this shed light on the intricate relationship between our gut health, diet, and brain function. By unraveling these connections, researchers are opening new avenues for understanding and potentially treating conditions like ASD and ADHD.
In December 2016, the U.S. Food and Drug Administration (FDA) warned “that repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children’s brains.” The FDA adds, “Health care professionals should balance the benefits of appropriate anesthesia against the potential risks, especially for procedures lasting longer than 3 hours or if multiple procedures are required in children under 3 years,” and “Studies in pregnant and young animals have shown that using these drugs for more than 3 hours caused widespread loss of brain nerve cells.”
That raises a concern that such exposure could lead to increased risk of psychiatric disorders, including ADHD.
Noting “There are inconsistent reports regarding the association between general anesthesia and adverse neurodevelopmental and behavioral disorders in children,” a South Korean study team conducted a nationwide population study to explore possible associations through the country’s single-payer health insurance database that covers roughly 97% of all residents.
The team looked at the cohort of all children born in Korea between 2008 and 2009, and followed them until December 31, 2017. They identified 93,717 children in this cohort who during surgery received general anesthesia with endotracheal intubation (a tube inserted down the trachea), and matched them with an equal number of children who were not exposed to general anesthesia.
The team matched the unexposed group with the exposed group by age, sex, birth weight, residential area at birth, and economic status.
They then assessed both groups for subsequent diagnoses of ADHD.
In general, children exposed to general anesthesia were found to have a 40% greater risk of subsequently being diagnosed with ADHD than their unexposed peers.
This effect was found to be dose dependent by several measures:
All three measures were highly significant.
The authors concluded, “exposure to general anesthesia with ETI [endotracheal intubation] in children is associated with an increased risk of ADHD … We must recognize the possible neurodevelopmental risk resulting from general anesthesia exposure, inform patients and parents regarding this risk, and emphasize the importance of close monitoring of mental health. However, the risk from anesthesia exposure is not superior to the importance of medical procedures. Specific research is needed for the development of safer anesthetic drugs and doses.”
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The U.S. government released a sweeping document titled The MAHA Report: Making Our Children Healthy Again, developed by the President’s “Make America Healthy Again” Commission. Chaired by public figures and physicians with ties to the current administration, the report presents a broad diagnosis of what it calls a national health crisis among children. It cites rising rates of obesity, diabetes, allergies, mental illness, neurodevelopmental disorders, and chronic disease as signs of a generation at risk.
The report's overarching goal is to shift U.S. health policy away from reactive, pharmaceutical-based care and toward prevention, resilience, and long-term well-being. It emphasizes reforming the food system, reducing environmental chemical exposure, addressing lifestyle factors like physical inactivity and screen overuse, and rethinking what it calls the “overmedicalization” of American children.
While some of the report’s arguments are steeped in political rhetoric and controversial claims—particularly around vaccines and mental health diagnoses—others are rooted in well-established public health science. This blog aims to highlight where the MAHA Report gets the science right, especially as it relates to childhood health and ADHD.
Although the MAHA Report contains several debatable assertions, it also outlines six key public health priorities that are well-supported by decades of research. If implemented thoughtfully, these recommendations might make a meaningful difference in the health of American children:
Reduce Ultra-Processed Food (UPF) Consumption
UPFs now make up nearly 70% of children’s daily calories. These foods are high in added sugars, refined starches, unhealthy fats, and chemical additives, but low in nutrients. Studies—including a 2019 NIH-controlled feeding study—show that UPFs promote weight gain, overeating, and metabolic dysfunction. What can help: Tax incentives for fresh food retailers, improved school meals, front-of-pack labeling, and food industry regulation.
Promote Physical Activity and Limiting Sedentary Time
Most American children don’t get the recommended 60 minutes of physical activity per day. This contributes to obesity, cardiovascular risk, and even mental health issues. Physical activity is known to improve attention, mood, sleep, and self-regulation. What can help: Mandatory daily PE, school recess policies, walkable community infrastructure, and screen-time education.
Addressing Sleep Deprivation
Teens today sleep less than they did a decade ago, in part due to screen use and early school start times. Sleep loss is linked to depression, suicide risk, poor academic performance, and metabolic problems. What can help: Later school start times, family education about sleep hygiene, and limits on evening screen exposure.
Improving Maternal and Early Childhood Nutrition
The report indirectly supports actions that are backed by strong evidence: encouraging breastfeeding, supporting maternal whole-food diets, and improving infant nutrition. These are known to reduce chronic disease risk later in life.
ADHD is one of the most discussed neurodevelopmental disorders in the MAHA Report, but many of its claims about ADHD are misleading, oversimplified, or inconsistent with decades of scientific evidence, much of which is described in the International Consensus Statement on ADHD, and other references given below.
This is true. Diagnosis rates have risen over the past two decades, due in part to better recognition, broadened diagnostic criteria, and changes in healthcare access. Diagnosis rates in some parts of the country are too high, but we don’t know why. That should be addressed and investigated. MAHA attributes increasing diagnoses to ‘overmedicalization’. That is a hypothesis worth testing but not a conclusion we can draw from available data.
These have been associated with ADHD but have not been documented as causes. ADHD is highly heritable, with genetic factors accounting for 70–80% of the risk. Unlike genetic studies, environmental risk studies are compromised by confounding variables. There are good reasons to address these issues but doing so is unlikely to reduce diagnostic rates of ADHD.
❌ Inaccurate: ADHD medications don’t work long-term.
The report criticizes stimulant use but fails to note that ADHD medications are among the most effective psychiatric treatments, especially when consistently used. They cite the MTA study’s long term outcome study of kids assigned to medication vs. placebo as showing medications don’t work in the long term. But that comparison is flawed because during the follow-up period, many kids on medication stopped taking them and many on placebo started taking medications. Many studies document that medications for ADHD protect against many real-world outcomes such as accidental injuries, substance abuse and even premature death.
Despite the issues discussed above, the MAHA Report can indirectly help children and adults with ADHD by pushing for systemic changes that reduce ultra-processed food consumption, increase physical activity, and motivate better sleep practices.
In other words, you don’t need to reject the diagnosis of ADHD to support broader changes in how we feed, educate, and care for children. A more supportive, less toxic environment benefits everyone—including those with ADHD.
The Background:
Many studies have tried to determine whether exercise improves executive function in children and adolescents with ADHD, but their conclusions have not always agreed. To bring the evidence together more clearly, the research team re-analyzed the available randomized controlled trials using a statistical approach designed to handle the kinds of data common in this field.
Executive functions are skills that help us control attention and behavior. The three core components are inhibitory control (the ability to stop or override impulses), working memory (holding and manipulating information in mind), and cognitive flexibility (switching between tasks or perspectives). Because a single study often reports multiple tests that tap these different skills, one study can contribute several related results (called effect sizes). Traditional meta-analysis typically treats each effect size as independent; when they are actually correlated, that can bias the combined estimate or force reviewers to discard useful data.
To avoid those problems, the team used a three-level meta-analysis. In this model, variance in the data is separated into three sources:
(1) sampling variance: the random error in each measured effect
(2) within-study variance: differences between multiple effect sizes reported in the same study
(3) between-study variance: differences in effects from one study to another
Accounting for all three levels makes it possible to include every eligible effect size from each study, which preserves information and statistical power and reduces the risk that correlations among effect sizes will overstate results.
The Study:
The review focused on long-term exercise interventions and also tested whether certain factors might change (or moderate) the effects. These potential moderators included participant age, which executive-function subcomponent was measured, the type of exercise, how long each session lasted, the total length of the intervention, and how often sessions occurred.
To be included, studies had to be randomized controlled trials (RCTs) of children or adolescents aged 6–18 diagnosed with ADHD. RCTs randomly assign participants to an intervention or a comparison group and are considered a strong design for testing cause-and-effect. The exercise programs had to be structured and last at least six weeks. Comparison groups varied by study and could include usual care, medication, sedentary activities, health education, waiting lists, or everyday life without the specific exercise program. Fifteen studies including 658 participants met these criteria.
The Results:
The three-level meta-analysis showed that long-term exercise interventions were associated with moderate-to-strong improvements in overall executive function. When statistical outliers were removed, the result remained positive: 13 RCTs with 598 participants showed moderate improvements. In plain terms, this suggests improvements that are noticeable and meaningful on average, not just tiny changes that are unlikely to matter in daily life.
Those moderate gains appeared across all three executive-function domains (inhibitory control, working memory, and cognitive flexibility, meaning the benefits were not limited to a single cognitive skill. The authors also examined exercise type:
“Open-skill” activities, which require reacting to changing situations (for example, many team sports, martial arts sparring, or racket sports), produced moderate-to-large improvements.
“Closed-skill” activities, which are more predictable and repetitive (for example, running or stationary cycling), showed only small, non-significant improvements in this analysis.
The review also found dose-related patterns. Interventions lasting at least twelve weeks were about three times more effective than interventions of six to twelve weeks, and sessions longer than an hour were about twice as effective as shorter sessions. Benefits were largest among adolescents aged 13 and older.
These patterns suggest that longer, more intensive programs, and those that involve open-skill activities, may produce larger gains. However, the authors caution that the overall certainty of the evidence was low. “Low certainty” means that limitations in the available studies (for example, small sample sizes, variability in methods, or possible bias) make it difficult to be confident that the observed effects will hold up exactly the same way in future research. Some subgroup findings (age, intervention duration, and others) were based on only a small number of effect sizes, so those moderator results should be treated as exploratory rather than definitive.
The Take-Away:
In short, this three-level meta-analysis suggests that regular, structured exercise (particularly longer programs and open-skill activities) may help improve executive functions in children and adolescents with ADHD. The evidence is promising but not yet strong enough to be considered conclusive, and the authors recommend more, larger randomized trials to confirm specifically which types and doses of exercise are most effective. Moreover, neither this meta-analysis or others show that exercise can replace standard treatments for reducing the core symptoms of ADHD (inattention, hyperactivity, impulsivity).
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When a patient sits down in an examination room today, their physician is rarely the first voice they have heard regarding their symptoms. More often, an algorithm got there first.
According to a nationwide survey by The Physicians Foundation conducted with Medscape, medical misinformation is no longer a peripheral nuisance; it is a daily clinical crisis. Nearly all surveyed physicians (99.9%) reported that their patients had been influenced by medical misinformation over the past year.
While misinformation affects every discipline from oncology to cardiology, few conditions sit as squarely in the algorithmic crosshairs as ADHD. From viral 30-second video clips trivializing complex executive dysfunction to predatory wellness campaigns attacking evidence-based medications, the attack on evidence directly threatens the well-being of children and adults living with ADHD.
Key Findings from The Physicians Foundation
The survey, which captured perspectives from over 1,000 practicing physicians, paints a sobering picture of how unverified information disrupts modern medicine:
The challenge is especially acute in communities already facing systemic healthcare hurdles:
As the survey illustrates, 38% of rural physicians encounter "a great deal" of health misinformation, far exceeding their suburban (21%) and urban (25%) peers. In rural and underserved regions, where access to developmental pediatricians and psychiatrists is already scarce, online narratives frequently fill the void left by provider shortages.
Why ADHD Is Ground Zero for Health Misinformation
Despite decades of neurobiological research confirming its validity, ADHD remains uniquely vulnerable to digital distortions in three distinct ways:
1. The Dueling Traps: "Life Hack" Trivialization vs. Denialism
Social media platforms host billions of views under ADHD-related tags. While digital awareness has helped destigmatize mental health, it frequently collapses nuanced clinical criteria into broad, relatable personality traits such as zoning out during a boring meeting, misplacing keys, or feeling restless.
This creates two opposing misinformation hazards:
2. Medication Stigma and Treatment Nonadherence
The survey found that 49% of doctors frequently encounter medication nonadherence and 45% face treatment refusal due to misinformation.
In ADHD care, this finding is acutely visible around stimulant pharmacotherapy. First-line stimulant medications have high response rates and extensive safety profiles spanning decades. Yet online narratives persistently frame them as dangerous narcotics, accusing parents of "drugging their children" or claiming medications permanently alter a child's brain.
Terrified parents frequently delay initiating care or discontinue effective regimens without clinical oversight, turning instead to unproven, expensive alternative supplements, unverified nootropics, or restrictive elimination diets.
3. Escalating Anxiety and Parental Guilt
With 66% of physicians observing increased patient anxiety driven by online health claims, the emotional toll on families cannot be overstated. Parents of newly diagnosed children are inundated with contradictory advice: one post warns that failing to medicate guarantees academic failure, while another claims that medicating guarantees addiction.
Adults navigating a new diagnosis experience similar distress, second-guessing their lived experiences and feeling deep shame over their executive dysfunction.
4. The 15-Minute Primary Care Bottleneck
Because pediatricians and family physicians handle most ADHD diagnoses and management, the survey’s warning that 70% of primary care providers feel hamstrung by misinformation hits ADHD patients first.
Deconstructing a viral video, explaining the difference between therapeutic stimulant dosing and substance misuse, and addressing years of internalized stigma takes time. In a standard 15-to-20-minute primary care visit, providers are forced to choose between rushing through diagnostic assessments or leaving patients' misinformed fears unaddressed.
Rebuilding the Partnership: Steps for Patients, Families, and Providers
Addressing the erosion of trust requires practical, collaborative shifts from both sides of the examination table:
For Patients and Caregivers
For Healthcare Providers and Systems
Medical misinformation thrives in the gap between a patient's vulnerability and the clinical system's time constraints. By recognizing how digital noise distorts ADHD, patients and clinicians can work together to replace viral anxiety with evidence-based care.
The Background:
Adults with ADHD often struggle more at work than their peers without ADHD. They tend to underperform on job tasks, advance less in their careers, miss more workdays, and face higher rates of unemployment. Research from several countries, including Japan, points to two main channels through which ADHD erodes workplace productivity: absenteeism, or missing work entirely, and presenteeism, showing up but performing below one’s usual capacity. Both problems typically trace back to ADHD’s core symptoms: difficulty sustaining attention, managing time, staying organized, and navigating relationships with coworkers and supervisors.
Stigma compounds these challenges. Employers and the public often have limited understanding of how ADHD manifests in adults, which can translate into unfair treatment or diminished job opportunities. That fear of judgment, in turn, discourages some people from seeking a psychiatric evaluation in the first place, delaying diagnosis and treatment, and with it, delaying access to support that could improve both their work performance and daily functioning.
Japan does offer medical care and workplace support for adults with ADHD. Options include social skills training, which teaches practical strategies for communication and collaboration; self-reliance support programs that help with daily living and job management; and, in more severe cases, a disability pension for those unable to work. Still, it remains unclear whether these employment-support services are robust enough to help people who want to work actually secure and hold onto steady jobs.
The impact of ADHD extends beyond the individual diagnosed. Supporting a family member with ADHD can be emotionally and logistically demanding, often cutting into a caregiver’s own capacity to work and earn, meaning that the economic toll of ADHD ripples outward.
The Research:
Most prior research on the economic costs of ADHD, in both children and adults, has come from the United States and Europe, focusing on medical expenses, lost productivity, and social support spending. Until recently, no one had attempted a comparable estimate for adult ADHD in Japan or elsewhere in Asia.
To address that gap, a Japanese research team conducted a cross-sectional observational study (meaning they gathered data at a single point in time and examined existing patterns rather than testing an intervention). They drew on three sources: a retrospective review of medical insurance claims, a web-based survey of affected individuals, and official government statistics. Combining these, they estimated annual costs from a societal perspective, accounting for medical expenses, lost work productivity, and government welfare spending, as well as productivity losses among family caregivers.
The claims analysis relied on JMDC, a nationwide database of insurance receipts and medical examination records spanning multiple health insurers and covering 14 million residents. Within it, the researchers identified 30,730 adult outpatients diagnosed with ADHD.
The Results:
Annual medical costs per adult with ADHD (combining outpatient visits and medication) averaged 284,000 yen (about $1,750). Scaling this figure to match the age and sex distribution of Japan’s adult population produced a nationwide estimate of 74 billion yen (about $455 million).
A separate web-based survey found that, after statistical matching, nearly half of adults with ADHD received a disability pension, yielding a nationwide estimate of 95 billion yen (about $585 million) in ADHD-related pension payments. Including public employment support services, total social welfare spending reached 390 billion yen (about $2.4 billion).
Workplace productivity losses were substantial as well. With an unemployment rate more than four percentage points higher than the general population, unemployment-related losses among adults with ADHD totaled an estimated 50 billion yen. Lower average incomes among those employed accounted for a further 315 billion yen. Once absenteeism and presenteeism were factored in, total productivity losses reached 570 billion yen (about $3.5 billion).
Family members bore a comparable burden: productivity losses among adult relatives of people with ADHD were estimated at 540 billion yen (about $3.3 billion).
Taken together, these figures point to a nationwide socioeconomic burden of 1.6 trillion yen (roughly $11 billion), equivalent to nearly $30,000 per adult with ADHD.
The Take-Away:
“This study, the first estimate of the annual socioeconomic burden of adult ADHD in Japan, underscores the necessity of providing appropriate support to adult patients with ADHD and their families and the prevention of comorbidities,” the research team concluded. “In particular, measures to support participation in the workplace to improve patients’ quality of life and reduce the social and economic burden should be explored. Furthermore, it is hoped that estimating the annual socioeconomic burden of adult ADHD will help clarify policy priorities in Japan.”
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