Children and adolescents with attention–deficit hyperactivity disorder (ADHD) have a higher likelihood of contact with child welfare services (CWS). Evidence on whether pharmacological treatment of ADHD reduces such contact is limited.

To estimate the causal effect of pharmacological treatment of ADHD on CWS contact.

In this quasi-experimental study, we used nationwide registry data covering all individuals aged 5–14 years and diagnosed with ADHD during 2009–2011 in Norway. We used linear probability models and instrument variable analyses to estimate the associations and causal effects of pharmacological treatment on CWS contact up to 4 years after diagnosis. As instrument variable analysis uses natural variation in treatment decisions between clinics as pseudo-randomisation, estimates inform effects for children and adolescents at the margin of treatment, i.e. patients whose treatment is more influenced by variation in treatment practice, e.g. due to less severe or atypical symptom presentation.

A total of 5930 children and adolescents aged 5–14 years were diagnosed with ADHD between 2009 and 2011 (mean (s.d.) age 10.1 (2.4) years; 4380 males (73.9%)). Instrument variable analyses showed a reducing effect of pharmacological treatment on the use of supportive interventions by 11.9 percentage points (95% CI: −20.12, −3.80) and out-of-home-placement by 3.30 percentage points (95% CI: −6.44, −0.15) at 2-year follow-up. This corresponds to the numbers needed to treat estimates of 8 and 30, respectively.

Pharmacological treatment of ADHD reduces CWS contact among children and adolescents at the margin of treatment, lowering the probability of receiving supportive interventions and out-of-home placements. Findings suggest that medication reduces behavioural symptoms, which may improve the family coping mechanism and reduces the need for CWS involvement.

ISRCTN11891971.

Children with attention-deficit/hyperactivity disorder (ADHD) frequently exhibit impairing emotional dysregulation along with inattention and hyperactivity. We aim to parse the heterogeneity of behavioral and emotional dysregulation in ADHD using latent brain factors based on cortical thickness (CT), and examine associated differences in intrinsic functional connectivity (iFC).

Data were collected from 123 children (39 ADHD, 47 ADHD with impairing emotional outbursts [ADHD + IEO], 37 neurotypical controls [NT], 5–9.9 years old). First, exploratory factor analysis revealed latent behavioral factors. Using Latent Dirichlet allocation, we decomposed heterogeneous CT patterns into parsimonious latent brain factors. We further investigated the functional relevance of brain regions showing structural differences in the ADHD + IEO group and examined associations between brain and behavioral latent factors.

Among the four behavioral factors identified (Externalizing, Emotion Dysregulation, Internalizing, and Surgency/Impulsivity), the dominant factor – Externalizing behavior – significantly differentiated the ADHD + IEO from the ADHD and NT groups. A conjunction analysis of the three brain factors revealed significantly thicker CT in the dorsolateral prefrontal cortex for ADHD + IEO compared to NT. Using this region as a seed, we found reduced functional connectivity primarily in the default mode network, which differentiated ADHD + IEO and ADHD groups. Structural brain and iFC measures showed significant associations with the Externalizing behavior factor.

Parsing the neurobiology underlying the heterogeneous presentation of ADHD requires integrating multiple modalities and analytical methods. This study demonstrates that combining behavioral, structural, and functional data reveals unique neural features associated with behavioral and emotional dysregulation.

Neurodivergence encompasses neurodevelopmental conditions including autism, attention-deficit hyperactivity disorder (ADHD) and Tourette syndrome. Particular physical traits, notably those linked to joint hypermobility, have an established association with both neurodivergence and bipolar affective disorder.

This case-control study tested, first, whether the presence of joint hypermobility predicted bipolar affective disorder and, secondly, whether neurodivergent characteristics were important in understanding this relationship.

Data were collected from 52 participants with self-reported clinical diagnoses of bipolar affective disorder and from a comparison group of 54 participants without diagnosis of bipolar affective disorder. All participants were assessed on screening instruments for autism (Ritvo Autism Asperger Diagnostic Scale; RAADS-R), ADHD (Wender Utah Rating Scale; WURS) and joint hypermobility. Group differences were explored, and odds ratios calculated for the presence of bipolar and neurodivergence given the presence of hypermobility. A mediation analysis was performed to determine the contribution of neurodivergent characteristics to the relationship between joint hypermobility and bipolar affective disorder.

The presence of joint hypermobility significantly predicted the presence of bipolar disorder (odds ratio 5.1; 95% CI = 2.1, 12.4). In the bipolar affective disorder group, the prevalence of likely autism and ADHD was greater (84.6 and 65.4% respectively) than in the comparison group (22.2 and 3.7% respectively). The odds ratio for a diagnosis of bipolar affective disorder was 18.2 (95% CI = (6.70, 49.41)) in those meeting the threshold for likely autism; and 46.89 (95% CI = 9.96, 220.74) in participants meeting the threshold for likely ADHD. Mediation analysis showed that autistic, ADHD and pooled neurodivergent characteristics mediated the link between joint hypermobility and bipolar affective disorder.

This suggests a potential mechanism for affective pathophysiology, through developmental characteristics associated with joint hypermobility. The appreciation of interacting physical and neurodivergent traits to the expression of psychiatric illness has implications for diagnostic formulation, personalised medicine and service design.

Mental health difficulties affect the well-being of doctors and compromise the delivery of healthcare. However, large-scale data on doctors’ mental health needs are limited.

Describe patterns of self-referrals for mental health support among doctors in England and explore associations with demographic factors, speciality, neurodevelopmental and mental health indicators.

Observational study using data from doctors who self-referred for mental health difficulties to a national service in England over a 4-year period. Logistic regression was used to explore associations between speciality and mental health indicators.

Of the 16 815 doctors who self-referred during the study period, 80% were under the age of 49 and 70.6% were female with the two largest ethnicities being 65.1% White and 22.7% Asian. Women were more likely to report higher scores for depression (odds ratio 0.90, 95% CI = 0.84 to 0.97), anxiety (odds ratio 0.78, 95% CI = 0.72 to 0.84) and psychological distress (odds ratio 0.78, 95% CI = 0.70 to 0.87), but males were more likely to screen positive for attention-deficit hyperactivity disorder (ADHD) symptoms. Doctors in general practice accounted for 46.3% of referrals. Compared with them, doctors in most other specialities had higher odds of elevated mental health scores across all measures, including ADHD.

The findings highlight a significant mental health burden among self-referring doctors, particularly for females and doctors in non-general practice specialities. Tailored and easily accessible support strategies that account for both demographic and professional contexts are essential to address the diverse mental health needs of the medical workforce.

Attention-deficit hyperactivity disorder (ADHD) in childhood is associated with various adverse long-term outcomes.

We aimed to examine the independent associations between ADHD symptoms at age 14–16 years and long-term mental health and psychosocial functioning outcomes in a 40-year birth cohort study.

Study members from the Christchurch Health and Development Study, a population-based New Zealand birth cohort study (N = 1265 at birth) were followed to age 40 years. Generalised estimating equations were used to model associations between ADHD symptoms at age 14–16 years and outcomes at age 18–40. Adjusted models were fitted to account for confounding by antecedent individual and familial risk factors, and coexisting symptoms of conduct disorder or oppositional defiant disorder.

Adolescents in the highest quartile for ADHD symptoms at age 14–16 years were at elevated risk of substance use disorder, depression, suicidal ideation, criminal offending and unemployment across early adulthood. They also had lower income, home ownership, relationship stability and living standards. The size of these associations attenuated after adjusting for confounding factors and the effect of coexisting conduct disorder and oppositional defiant disorder. However, in adjusted models, ADHD symptoms remained associated with elevated odds of substance use and criminal offending outcomes, with odds ratios ranging from 1.4 to 1.6.

Higher levels of adolescent ADHD symptoms are associated with substance use problems and criminal offending in adulthood. Long-term secondary prevention activities are needed to detect and manage coexisting problems among adults with a history of ADHD.

Mental health awareness efforts are increasing, especially for ADHD. There is growing evidence that such efforts may also cause unnecessary self-diagnosis and worsening symptoms for some disorders; however, there are no validated approaches to avoid these potential harms without reducing the awareness efforts themselves. We developed a multifaceted intervention, called nocebo education. The intervention was based on the principles of the nocebo effect, where negative expectations may cause symptom misattribution and worsening. We tested whether teaching about the nocebo effect could mitigate the potential false self-diagnosis and symptom worsening from ADHD awareness.

In a double-blind randomized controlled trial with a week-long follow-up (NCT06638411), 215 healthy young adults (77% women) were randomized to participate in a group workshop on either ADHD awareness, ADHD combined with nocebo education, or control (sleep). We measured changes in self-diagnosis and ADHD symptoms immediately after the workshop (self-diagnosis), and 1-week later (self-diagnosis and symptoms).

ADHD group reported substantially higher self-diagnosis scores immediately $ ({\beta}_{\mathrm{standardised}}=0.80\;\left[0.58,1.02\right],p<.001 $) and 1 week after the workshop $ (\beta =0.50\;\left[0.28,0.72\right],p<.001 $) compared to controls. These effects persisted despite no changes in reported symptoms. Nocebo education halved the false self-diagnosis scores immediately after the workshop ($ \beta =0.45\;\left[0.23,0.67\right],p<.001 $) and eliminated the false self-diagnosis entirely at follow-up $ (\beta =0.16\;\left[-0.06,0.38\right],p=.08 $).

We show that being exposed to ADHD awareness reliably increases false self-diagnosis among healthy young adults for at least one week; a brief nocebo education intervention is efficacious in substantially reducing and later eliminating it. Nocebo education is a promising adjunct for balanced awareness efforts that could be applied in various contexts.

Methylphenidate (MPH), a commonly used stimulant for the treatment of attention deficit and hyperactivity disorder (ADHD) in children and adolescents, has been associated with adverse effects on weight, height, blood pressure (BP) and heart rate (HR). This study aimed to investigate whether children with ADHD prescribed MPH by a specialist ADHD service showed a change in health data percentiles compared to their pre-treatment measures, and to investigate for any correlation with MPH dose, years prescribed MPH and gender.

In this retrospective observational study health data percentiles (weight, height, BP and HR) were analysed for change between two timepoints: prior to MPH initiation (T1) and at the most recent clinic appointment (T2). Correlations between health data percentile changes and MPH dose, treatment duration, baseline growth centiles and gender were studied.

The cohort consisted of 123 youth (age 5-17.5 years) prescribed MPH (mean dose 0.67 ± 0.32 mg/Kg). Over the treatment period (2.5 ± 2.1 years) weight (P = 0.001) and height (P = 0.007) centiles significantly reduced, BP centiles did not change, while HR centiles increased (P < 0.0001). Weight centile reduction was correlated with higher MPH dose (P < 0.0001) and this effect attenuated with longer duration of MPH treatment (P = 0.005). Height centile reduction was more pronounced in the taller cohort (P = 0.008).

This study supports international guidelines for physical health monitoring of young people prescribed MPH, specifically the conversion of health data to percentiles for accurate monitoring and early identification of concerning trends. Future integration of digital approaches are necessary for rapid and accurate physical health monitoring.

Knowledge of the impact of perimenopause on women with attention-deficit/hyperactivity disorder (ADHD) is lacking. We compared levels of perimenopausal symptoms and prevalence of severe perimenopausal symptoms among women with and without ADHD across age groups.

In this cohort study, we used data from the population-based Stress-and-Gene-Analysis cohort study. ADHD diagnosis was self-reported at baseline and 5-year follow-up. At follow-up, we assessed ADHD symptoms using the Adult ADHD Self-Report Scale, perimenopausal symptoms (psychological, somatic, and urogenital) using Menopause Rating Scale (MRS), and general physical symptoms using Patient Health Questionnaire. We described mean scores and mean difference on MRS among women with and without ADHD with linear regression models and contrasted the prevalence of severe perimenopausal symptoms among women with and without ADHD, calculating prevalence ratios (PRs) with 95% confidence intervals (CIs) using modified Poisson regression models.

Women with ADHD (n = 535) had higher total perimenopausal symptom scores (18.0 vs. 13.0, p < 0.01) than women without ADHD (n = 4,857). The difference was most pronounced among women aged 35–39 years (19.0 vs. 12.5, p < 0.01). The prevalence of severe perimenopausal symptoms was significantly higher among women with ADHD compared to those without, both overall (54.2% vs. 30.1%, PR = 1.80, 95% CI = 1.64–1.98) and on all subdimensions (psychological: 58.6% vs. 36.0%, PR = 1.63, 95% CI = 1.51–1.76; somatic: 30.4% vs. 13.9%, PR = 2.20, 95% CI = 1.88–2.57; uro-genital: 43.2% vs. 27.5%, PR = 1.57, 95% CI = 1.40–1.77).

Women with ADHD have higher prevalence of severe perimenopausal symptoms. These symptoms present at an earlier age than among women without ADHD, indicating an earlier onset age of perimenopause in ADHD.