Understanding Teen Health and Well-being in ADHD: A Fresh Perspective from the CDC

Recent research from the Centers for Disease Control and Prevention (CDC) highlights distinct health and social-emotional challenges faced by teens diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). This study, published in the Journal of Developmental and Behavioral Pediatrics, offers critical insights directly from the teens themselves, providing a unique view often missed when relying solely on parent or clinical reports. 

Researchers analyzed nationally representative data from July 2021 through December 2022, comparing self-reported experiences of teens aged 12 to 17 with and without ADHD. Approximately 10% of teenagers had an ADHD diagnosis, and the findings reveal specific areas where teens with ADHD face notable difficulties. 

Teenagers with ADHD reported significantly higher rates of bullying victimization and struggles in making friends compared to their peers. Surprisingly, they were less likely to report a lack of peer support, suggesting complexities in how they perceive friendships and social networks. The study underscores the importance of directly engaging teens in assessing their social relationships, rather than solely relying on parental perspectives. 

Sleep difficulties emerged as another critical issue for teens with ADHD. About 80% reported problems like difficulty waking up and irregular wake times, markedly higher than their non-ADHD counterparts. Such disruptions can exacerbate attention difficulties and emotional regulation issues, further complicating daily life for these teens. 

Excessive screen time also stood out, with nearly two-thirds of teens with ADHD spending over four hours daily on screens, excluding schoolwork. This high screen usage is concerning, given its potential negative impact on physical and mental health, including sleep quality and social interactions. 

Notably, the study found no significant differences in physical activity levels or concerns about weight between teens with and without ADHD. This finding contrasts with previous studies that have highlighted lower physical activity among children with ADHD, suggesting the need for continued research on how physical activity is measured and encouraged in this population. 

The study’s authors emphasize the importance of health promotion interventions tailored specifically for teens with ADHD. By directly engaging teens and considering their unique perspectives, interventions can better address social-emotional well-being and healthy lifestyle behaviors, ultimately improving long-term outcomes for this vulnerable group. 

Overall, this research provides compelling evidence for healthcare providers, educators, and families to focus on supporting teens with ADHD in areas of social skills, sleep hygiene, and healthy screen time habits. Such targeted support can significantly enhance the quality of life and health outcomes for adolescents navigating the challenges of ADHD. 

Katz, S. M., Claussen, A. H., Black, L. I., Leeb, R. T., Newsome, K., Danielson, M. L., & Zablotsky, B. (2025). Attention-Deficit/Hyperactivity Disorder and Teen Self-Report on Health Behaviors and Social-Emotional Wellbeing: United States, July 2021–December 2022. Journal of Developmental & Behavioral Pediatrics, 46(2), e155–e161. doi:10.1097/DBP.0000000000001350.

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Driving, Safety, and ADHD

How to Improve Driving Safety for Teens and Adults With ADHD

Drivers with ADHD are far more likely to be involved in crashes, to be at fault in crashes,to be in severe crashes, and to be killed in crashes. The more severe the ADHD symptoms, the higher the risk. Moreover, ADHD is often accompanied by comorbid conditions such as oppositional-defiant disorder, depression, and anxiety that further increase the risk.

What can be done to reduce this risk? A group of experts has offered the following consensus recommendations:

·   Use stimulant medications. While there is no reliable evidence on whether non-stimulant medications are of any benefit for driving, there is solid evidence that stimulant medications are effective in reducing risk. But there is also a rebound effect in many individuals after the medication wears off, in which performance actually becomes worse than if had been prior to medication. It is therefore important to time the taking of medication so that its period of effectiveness corresponds with driving times. If one has to drive right after waking up, it makes sense to take a rapid acting form. The same holds for late night driving that may require a quick boost.

·   Use a stick shift vehicle wherever possible. Stick shifts make drivers pay closer attention than automatic transmissions. The benefits in alertness are most notable in city traffic. But using a stick shift is far less beneficial in highway driving, where shifting is less frequent.

·  Avoid cruise control. Highways can be monotonous, making drivers more prone to boredom and distraction. That is even more true for those with ADHD, so it is best to keep cruise control turned off.

·   Avoid alcohol. Drinking and driving is a bad idea for everyone, but, once again, it's even worse for those with ADHD. Parents should consider a no-questions-asked policy of either picking up their teenager anytime and anywhere, or setting up an account with a ride-sharing service.·   Place the smartphone out of reach and hearing. Cell phone use is as about as likely to impair as alcohol. Hands-free devices only reduce this risk moderately, because they continue to distract. Texting can be deadly. Sending a short text or emoticon can be the equivalent of driving 100 yards with one's eyes closed. Either turn on Do Not Disturb mode, or, for even greater effectiveness, place the smart phone in the trunk.

·   Make use of automotive performance monitors. These can keep track of maximum speeds and sudden acceleration and braking, to verify that a teenager is not engaging in risky behaviors.

·   Take advantage of graduated driver's licensing laws wherever available. These laws forbid the presence of peers in the vehicle for the first several (for example, six) months of driving. Parents can extend that period for teenagers with ADHD, or set it as a condition in states that lack such laws.

·  Encourage practicing after obtaining a learner's permit. Teenagers with ADHD generally require more practice than those without. A pre-drive checklist can be a good place to start. For example:check the gas, check the mirrors, make sure the view through the windows is unobstructed, put cell phone in Do Not Disturb mode and place it out of reach, put on seat belt, scan for obstacles.

·   Consider outsourcing. Look for a driving school with a professional to teach good driving skills and habits.

Experts do not agree on whether to delay licensing for those with ADHD. On the one hand, teenagers with ADHD are 3-4 years behind in the development of brain areas responsible for executive functions that help control impulses and better guide behavior. Delaying licensing can reduce risk by about 20 percent. On the other hand, teens with ADHD are more likely to drive without a license, and no one wants to encourage that, however inadvertently. Moreover, graduated driver's licensing laws only have legal effect on teens who get their licenses at the customary age.

February 22, 2021

How ADHD and ODD Symptoms in Teens Can Affect Long-Term Education Outcomes

A recent Finnish study offers important insights into how symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) in adolescence can shape academic performance, and even influence educational outcomes well into adulthood.  Children and teens with ODD often show a pattern of angry, irritable moods, arguing with adults, and defying rules or requests. They may lose their temper easily, be quick to blame others for mistakes, and deliberately annoy people. 

The researchers followed participants from the Northern Finland Birth Cohort of 1986, a large, population-based study. They looked at over 6,000 teens whose parents reported symptoms of ADHD and ODD when the children were 15–16 years old. The team then tracked their academic performance at age 16 and their highest level of education by age 32.

ADHD, ODD, and Academic Performance

ADHD is well-known for affecting school performance, often linked to difficulties with attention, impulse control, and executive functioning. ODD, characterized by patterns of irritability, defiance, and hostility toward authority figures, is less studied in this context, especially when it appears without ADHD.

The study found that both disorders, whether occurring separately or in combination, were associated with poorer grades at age 16. However, teens with ADHD symptoms performed worse than those with only ODD symptoms. Interestingly, students with both ADHD and ODD symptoms had the most pronounced academic struggles, but their performance didn’t significantly differ from the ADHD-only group at that age.

Long-Term Educational Impact

By age 32, the effects were even more striking. Participants with both ADHD and ODD symptoms were the least likely to attend or graduate from higher education institutions. Only about 10% of them reached that level, compared to over 40% of those without these symptoms.

Even after accounting for other influences, such as parental education, family structure, and additional psychiatric conditions, the findings held. This suggests that the combination of ADHD and ODD symptoms in adolescence may uniquely disrupt the educational path.

For adolescent girls with ODD symptoms, the impact was particularly notable: they were significantly more likely to complete only the mandatory nine years of schooling.

Why This Matters

These results underscore the lasting effects that behavioral and emotional challenges in adolescence can have. While schools often focus on immediate academic outcomes, this study highlights the importance of early identification and support, not just for ADHD but for ODD as well.

Parents and educators play a crucial role in shaping future outcomes for children and adolescents with ADHD. Recognizing early signs of attention problems, emotional dysregulation, or defiance—and responding with appropriate interventions—could help redirect educational trajectories and open up opportunities down the line.

In short, it’s not just about managing classroom behavior. It’s about supporting long-term potential. When ADHD and ODD symptoms show up in adolescence, they don’t just make school harder—they can limit a student’s entire educational future. Early support and understanding can make a lasting difference.

May 29, 2025

Acupuncture for ADHD: A Promising Alternative or Placebo? A Look at Recent Research

Attention Deficit Hyperactivity Disorder (ADHD) is a common condition affecting children and adolescents worldwide, characterized by symptoms such as hyperactivity, impulsivity, and inattention. While traditional treatments like medication and behavioral therapy are often used, some individuals are turning to complementary and alternative therapies (CAM) for help. One such option gaining attention is acupuncture. But does it really work for ADHD?

A recent comprehensive study aimed to evaluate the effectiveness of acupuncture in treating ADHD symptoms. Here’s a breakdown of the findings, with a focus on the age groups included in the research and what these findings could mean for ADHD treatment options.

What the Study Explored

The study in question conducted a systematic review and meta-analysis (SR/MA) of acupuncture trials for ADHD, comparing its effects to traditional treatments such as pharmacotherapy and behavioral therapy. The researchers focused on acupuncture’s impact on core ADHD symptoms like hyperactivity, impulsivity, inattention, and conduct problems, while also exploring how acupuncture might help with other issues, such as learning difficulties and psychosomatic symptoms.

One key feature of this study was the inclusion of a broad age range of participants, specifically children and adolescents. These two groups are the most commonly diagnosed with ADHD, and their responses to treatments can vary significantly. Understanding how acupuncture works for these age groups is critical for evaluating its effectiveness as an ADHD treatment.

Here’s what the study found across the different age groups:

  • Children: Acupuncture appeared to be particularly effective in reducing hyperactivity and impulsivity in younger children with ADHD. These symptoms, often more prominent in younger populations, responded well to acupuncture when used alongside other treatments like medication.

  • Adolescents: For adolescents, acupuncture seemed to improve both hyperactivity and inattention, two symptoms that can often become more challenging as children grow older. This age group also benefited from acupuncture’s ability to reduce side effects from ADHD medications, such as irritability or sleep disturbances.

  • Combined Effects for Both Groups: When acupuncture was used in combination with pharmacotherapy, it also helped reduce side effects such as sleep problems and appetite loss in both children and adolescents. This could make it an attractive adjunctive treatment for those already on medication but experiencing undesirable effects.

  • Inattention and Conduct Problems: For both children and adolescents, acupuncture used in conjunction with either medication or behavioral therapy showed notable improvements in inattention and conduct problems—two of the most difficult symptoms of ADHD to manage.

  • Learning Difficulties and Psychosomatic Symptoms: Interestingly, the combination of acupuncture and medication provided significant improvements in learning difficulties, which are particularly relevant for children with ADHD. Meanwhile, acupuncture paired with behavioral therapy had a positive impact on psychosomatic symptoms, such as anxiety or stress, that often co-occur with ADHD.

Despite these promising results, the study also highlighted several limitations:

  • Study Quality Issues: The quality of the studies reviewed was often low, with many trials lacking the rigorous controls needed for high confidence in their results. For example, only a small number of trials used objective ADHD diagnostic tools, which could lead to biases in assessing acupuncture’s effectiveness.

  • Need for More Research: There is a lack of large-scale, high-quality randomized controlled trials (RCTs) comparing acupuncture with placebo treatments, which makes it hard to determine whether acupuncture’s effects are truly therapeutic or simply a placebo.

Conclusion: Is Acupuncture a Good Option for ADHD?

In short, and as is so often the way of evidence-based medicine, we still can’t say with absolute certainty one way or the other. These studies may show promise in improving hyperactivity, impulsivity, inattention, and conduct problems– in both children and adolescents. However, the evidence is not yet strong enough to recommend it as a primary treatment. While it may serve as a helpful complement to standard therapies, especially for those struggling with medication side effects or access to behavioral therapy, more research is needed to establish its effectiveness.

April 21, 2025

Psychosis Risk and ADHD Medications: What the Latest Research Tells Us

Stimulant medications, such as methylphenidate (Ritalin) and amphetamines (Adderall),  are among the most widely prescribed drugs in the world. In the United States alone, prescription rates have climbed more than 50% over the past decade, driven largely by growing awareness of ADHD in both children and adults. Yet stimulants also have a long history of non-medical use, and concerns about their psychological risks persist among patients, families, and clinicians alike. 

Two major studies now offer the clearest picture yet of what that risk actually looks like, and who it may affect.


The Background: 

Before turning to the research, it helps to understand the landscape. A notable share of stimulant users misuse their medication: roughly one in four takes it in ways other than prescribed, and about one in eleven meets criteria for Prescription Stimulant Use Disorder (PSUD). Counterintuitively, most people with PSUD aren’t obtaining drugs illicitly — they’re misusing their own prescriptions. 

This distinction between therapeutic and non-therapeutic use turns out to be critical when evaluating psychosis risk. 

The Study: 

A comprehensive meta-analysis by Jangra and colleagues pooled data across more than a dozen studies to compare psychotic outcomes in people using stimulants therapeutically versus non-therapeutically. The contrast was striking. 

Among therapeutic users  (more than 220,000 individuals taking stimulants at prescribed doses under medical supervision), psychotic episodes occurred in roughly one in five hundred people. When symptoms did appear, they typically emerged after prolonged treatment or in individuals with pre-existing psychiatric vulnerabilities, and they usually resolved when the medication was stopped. 

Among non-therapeutic users  (over 8,000 participants across twelve studies, many using methamphetamine or high-dose amphetamines), nearly one in three experienced psychotic symptoms. These episodes tended to be more severe, involving persecutory delusions and hallucinations, with faster onset and a greater likelihood of recurrence or persistence. 

The biology underlying this difference is well understood. When stimulants are taken orally at guideline-recommended doses, they produce moderate, gradual changes in neurotransmitter activity central to attention and executive functions. The brain tolerates these changes relatively well. Non-therapeutic use, by contrast, often involves much higher doses that are frequently delivered through non-oral routes such as injection or smoking. This produces a rapid, excessive surge in dopamine activity, which is precisely the neurochemical pattern associated with psychotic symptoms. 

The takeaway here is not that therapeutic stimulant use is risk-free, but that risk is strongly modulated by dose, route of administration, and individual psychiatric history. Clinicians are advised to monitor patients with pre-existing mood or psychotic disorders, particularly carefully. 

A Nationwide Study Focuses on Methylphenidate Specifically:

Where the meta-analysis cast a wide net, a large-scale population study by Healy and colleagues drilled into a specific and clinically pressing question: does methylphenidate (the most commonly prescribed ADHD medication, also known as Ritalin) increase the risk of developing a psychotic disorder? 

To find out, the researchers analyzed Finland's national health insurance database, tracking nearly 700,000 individuals diagnosed with ADHD. Finland's single-payer system made this kind of comprehensive, long-term tracking possible in a way that fragmented healthcare systems rarely allow. 

Critically, the team adjusted for a range of confounding factors that have clouded previous research, including sex, parental education, parental history of psychosis, and the number of psychiatric visits and diagnoses prior to the ADHD diagnosis itself (a proxy for illness severity). After these adjustments, they found no significant difference in the risk of schizophrenia or non-affective psychosis between patients treated with methylphenidate and those who remained unmedicated. This held true even among patients with four or more years of continuous methylphenidate use. 

The Take-Away: 

When considered together, these studies offer meaningful reassurance without encouraging complacency. 

For patients and families weighing ADHD treatment, the evidence suggests that methylphenidate used as prescribed does not increase psychosis risk, even over years of use. The rare cases of stimulant-associated psychosis in therapeutic settings are typically linked to high doses, pre-existing vulnerabilities, or both, and tend to resolve with discontinuation. 

For clinicians, the findings reinforce the importance of baseline psychiatric assessment before initiating stimulant therapy, ongoing monitoring in patients with mood or psychotic disorder histories, and clear patient education about the risks of dose escalation or non-oral use. 

The picture that emerges is one of a meaningful distinction between a medication used carefully within its therapeutic window and a drug misused outside of it. This distinction matters enormously when communicating risk to patients, policymakers, and the public. 

 

Can Certain Types of Physical Activity Improve Motor Skills in Children and Adolescents with ADHD?

ADHD is commonly treated with medication, but these treatments frequently cause side effects such as reduced appetite and disrupted sleep. Psychological and behavioral therapies exist as alternatives, but they tend to be expensive, hard to scale, and generally do little to address the motor difficulties that many children with ADHD experience — things like clumsy movement, poor handwriting, or difficulty with coordination. 

Physical exercise has attracted attention as a more accessible option. But research findings have been mixed, partly because studies vary so widely in how exercise is delivered and what outcomes they measure. This meta-analysis, drawing on 21 studies involving 850 children and adolescents aged 5–20 with a clinical ADHD diagnosis, tries to cut through that noise. 

Two types of motor skills 

The researchers separated motor skills into two broad categories: 

  • Gross motor skills — movements involving large muscle groups, such as running, jumping, throwing, and maintaining balance 
  • Fine motor skills — precise, controlled movements, typically of the hands and fingers, such as handwriting and manual dexterity (the ability to handle objects skillfully) 

The Data: 

Gross motor skills (16 studies, 613 participants) 

Overall, exercise produced medium-to-large improvements in gross motor skills. The strongest gains were in: 

  • Object control (e.g., throwing, kicking) — large improvement 
  • Locomotion (e.g., running, swimming), body coordination, and strength — medium improvements 

No significant gains were found in balance or flexibility. 

Fine motor skills (13 studies, 553 participants):

Exercise also produced medium-to-large improvements in fine motor skills, specifically: 

  • Handwriting: large improvement 
  • Manual dexterity: medium-to-large improvement 
  • Hand-eye coordination: moderate improvement 
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The Results: What Kind of Exercise Works Best? 

Two factors stood out consistently across both gross and fine motor skills: session length and frequency. 

  • Sessions longer than 45 minutes produced roughly twice the benefit of shorter sessions 
  • Three or more sessions per week outperformed less frequent programs for gross motor gains 

The type of exercise mattered; structured programs with clear motor-skill components (rather than unstructured physical activity) yielded stronger results. 

These results are not without caveats, however. The authors urge caution in interpreting these findings. A few key limitations include: 

  • Potential Publication Bias:  Studies showing positive results are more likely to be published, which can inflate apparent benefits. For gross motor skills, adjusting for this bias reduced the effect size from medium-to-large,  to medium. 
  • Active vs. Passive Controls: When exercise was compared against doing nothing (a passive control), improvements looked significant. When compared against regular school activities (an active control), the gains were no longer statistically significant. This is a meaningful distinction: it suggests exercise may be beneficial, but not dramatically more so than simply being physically active in a structured school setting. 
  • Medication status: Most participants were taking ADHD medication, so it’s unclear how well these findings apply to unmedicated children who might stand the most to benefit from structured exercise. 
  • Study quality: Many studies lacked proper randomization, weakening confidence in the conclusions. 

The Bottom Line 

This meta-analysis provides tentative moderate evidence that structured physical exercise can meaningfully support motor skill development in children and adolescents with ADHD — particularly when sessions run longer than 45 minutes and occur at least three times a week. The benefits appear most robust for object control, locomotion, handwriting, and manual dexterity. 

That said, the evidence base still has real gaps. The authors call for better-designed, fully randomized controlled trials with consistent methods, standardized ways of measuring exercise intensity, and greater inclusion of children and adolescents who are not on medication — all of which would help clarify when, how, and for whom exercise works best. 

April 20, 2026

Saudi Study Illustrates Pitfalls of Network Meta-analysis When Evidence Base is Thin

Treatment guidelines for childhood ADHD recommend medications as the first-line treatment for most youth with ADHD. Still, concerns about side effects and long-term outcomes have increased interest in non-pharmacological approaches. Researchers at Saudi Arabian Armed Forces hospitals recently conducted a network meta-analysis comparing several interventions, including mindfulness-based therapy, cognitive behavioral therapy, behavioral parent training, neurofeedback, yoga, virtual reality programs, and digital working memory training. 

Although the authors aimed to “provide a rigorous methodological approach to combine evidence from multiple treatment comparisons,” the study illustrates several pitfalls that arise when network meta-analysis is applied to a thin and heterogeneous evidence base. 

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What Network Meta-analysis Can and Cannot Do:

Network meta-analysis extends conventional meta-analysis by combining: 

  • Direct comparisons (treatment A vs. treatment B tested in clinical trials), and 
  • Indirect comparisons (A vs. B inferred through a common comparator such as placebo or usual care). 

When the evidence network is large and well-connected, this approach can provide useful estimates of comparative effectiveness among many treatments. 

This method is not always best, however, as many networks are sparse. This is especially true in areas such as complementary or behavioral therapies. In sparse networks, estimates rely heavily on indirect comparisons, and single studies can exert disproportionate influence over the results. 

Conventional meta-analysis focuses on heterogeneity, meaning differences in results across studies within the same comparison. 

Network meta-analysis must additionally evaluate consistency, whether the direct and indirect evidence agree. 

However, when comparisons are supported by only one or two studies and the network is weakly connected, statistical tests for heterogeneity and consistency have very little power. In practice, this means the analysis often cannot detect problems even if they are present. 

Sparse networks also make publication bias difficult to evaluate. This concern is particularly relevant in fields dominated by small trials and emerging therapies. 

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Why Such Treatment Rankings Are Appealing, but Potentially Problematic:

Many network meta-analyses summarize results using SUCRA, which estimates the probability that each treatment ranks best. 

SUCRA, or Surface Under the Cumulative Ranking, is a key statistical metric in network meta-analyses. It is used to rank treatments by efficacy or safety. This is achieved by summarizing the probabilities of a treatment's rank into a single percentage, where a higher SUCRA value indicates a superior treatment. Ultimately, SUCRA helps pinpoint the most effective intervention among the ones compared. 

Again, in well-supported networks, SUCRA can provide a useful summary of comparative effectiveness. But in sparse networks, rankings can create an illusion of precision, because treatments supported by a single small study may appear highly ranked simply due to random variation. 

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What Did this New Network Meta-analysis Study?

The study includes 16 trials with a total of 806 participants. But the structure of the evidence network is far weaker than this headline number suggests. 

Based on the underlying studies: 

  • Six interventions are supported by a single trial each (digital cognitive mindfulness training, BrainFit, neurofeedback, online mindfulness-based program, cognitive behavioral therapy, and working-memory training) 
  • Three interventions are supported by two trials each 
  • Only one intervention is supported by three trials (family mindfulness-based therapy) 

This produces a very thin network, in which several interventions rely entirely on single studies. 

Another challenge is that the included trials measure different outcomes. Some evaluate ADHD symptom severity, while others measure parental stress. 

When studies use different outcome scales, meta-analysis typically relies on standardized measures such as the standardized mean difference to allow comparisons across studies. However, the analysis reports only mean-average differences, making it difficult to interpret the relative effect sizes. 

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Study Issues (including Limited Evidence and Risk of Bias): 

The intervention supported by the largest number of studies (family mindfulness-based therapy) was one of the two approaches reported as producing statistically significant results. The other was BrainFit, which is supported by only a single previous trial. 

Despite this limited evidence base, the study ranks interventions using SUCRA: 

  • Family MBT: 92% probability of being best 
  • Behavioral parent training (BPT): 65% 
  • Online mindfulness program: 49% 
  • Cognitive behavioral therapy: 48% 
  • Yoga: 39% 

Notably, none of the runner-up interventions demonstrated statistically significant efficacy. 

The authors acknowledge methodological limitations in the included studies: 

“Blinding of participants and personnel (performance bias) exhibited notable concerns, as blinding for active treatment was not applicable in most studies.” 

Such limitations are common in behavioral intervention trials, but they further increase uncertainty in already small evidence networks. 

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Conclusions:

The study ultimately concludes: 

“This network meta-analysis supports MBT and BPT as effective non-pharmacological treatments for ADHD.” 

However, the evidence underlying these claims is limited. Some analyses rely on very small numbers of studies and participants, and the network structure depends heavily on indirect comparisons. 

Network meta-analysis can be a powerful tool when applied to a large, consistent, and well-connected body of evidence. When the evidence base is sparse, however, the resulting rankings and comparisons may appear statistically sophisticated while resting on a fragile evidentiary foundation.

April 17, 2026