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May 5, 2021
Research on ADHD has extensively explored various aspects of the condition, yet surprisingly little attention has been devoted to its impact on romantic relationships. Despite over 25,000 articles on ADHD listed in PubMed, only a small number examine topics such as love, sex, and relationship dynamics.
One study by Brunner and colleagues analyzed ADHD symptoms and romantic relationship quality in 189 college students. The findings indicated that students with high levels of hyperactivity-impulsivity and inattentiveness reported lower relationship quality compared to peers with fewer ADHD symptoms. Similarly, a study of 497 college students revealed that ADHD symptoms were linked to the use of maladaptive coping strategies in relationships, resulting in reduced romantic satisfaction.
In research involving young adults, ADHD symptoms were associated with greater negativity and reduced positivity during conflict resolution tasks within romantic partnerships. Higher levels of ADHD symptoms were predictive of lower relationship satisfaction. However, couples where the ADHD partner displayed only inattentive symptoms experienced fewer relational challenges, suggesting that the severity and type of symptoms significantly influence outcomes.
Regarding sexual behavior, studies highlight distinct patterns among individuals with ADHD. Adolescents with ADHD, regardless of gender, report nearly double the number of lifetime sexual partners compared to their non-ADHD peers. These findings align with research by Barkley and colleagues, who observed that ADHD predicted earlier sexual activity and parenthood. Similarly, Flory and colleagues, in a retrospective study, found that childhood ADHD was associated with earlier sexual initiation, more sexual partners, casual relationships, and unintended pregnancies.
A broader study of over 1,000 adults found that ADHD was associated with less stability in romantic relationships, difficulty providing emotional support, higher rates of sexual dysfunction, and increased divorce rates.
Although the body of research on ADHD and romantic relationships is relatively small, it consistently highlights the significant impact of ADHD on love, sex, and relational dynamics, often presenting unique challenges for those affected.
Bruner, M. R., A. D. Kuryluk, et al. (2014)."Attention-Deficit/Hyperactivity Disorder Symptom Levels and RomanticRelationship Quality in College Students." J Am Coll Health: 1-11.
Biederman, J., S. V. Faraone, et al. (2006)."Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community." J Clin Psychiatry67(4):524-540.
Canu, W. H., L. S. Tabor, et al. (2014)."Young Adult Romantic Couples' Conflict Resolution and Satisfaction Varieswith Partner's Attention-Deficit/Hyperactivity Disorder Type." JMarital FamTher40(4): 509-524.
Rokeach, A. J. Wiener (2014). "The Romantic Relationships of Adolescents with ADHD." J Atten Disord.
Barkley, R. A., M. Fischer, et al. (2006). "Young adult outcome of hyperactive children: adaptive functioning in major life activities." J Am Acad Child AdolescPsychiatry45(2): 192-202.
Flory, K., B. S.Molina, et al. (2006). "Childhood ADHD predicts risky sexual behavior in young adulthood." J Clin Child AdolescPsychol35(4): 571-577.
Overbey, G. A., W. E. Snell, Jr., et al. (2011)."Subclinical ADHD, stress, and coping in romantic relationships of university students." J Atten Disord 15(1): 67-78.
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.
For years, a persistent concern has shadowed the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD): Does the medication eventually stop working? Patients often report that their symptoms seem to return despite consistent use, leading to "dose escalation" or "medication holidays." A new systematic review from Sam Cortese’s team published in CNS Drugs finally puts these concerns to the test by synthesizing decades of empirical research.
Before diving into the findings, you must understand two often-confused phenomena:
The review analyzed 17 studies covering over 10,000 individuals, and the results provide a much-needed reality check for the clinical community.
The researchers found preliminary evidence that acute tolerance (tachyphylaxis) can occur within a 24-hour window.
The most important finding is that tolerance does not commonly develop to the therapeutic effects of ADHD medication in the long term. In one landmark study following children for up to 10 years, only 2.7% of participants lost their response to methylphenidate without a clear external explanation. Doses, when adjusted for natural body growth, remained remarkably stable over years of treatment.
Consistent with the lack of therapeutic tolerance, the body does not become tolerant to the physical side effects of stimulants. Increases in heart rate and blood pressure typically persist for as long as the medication is taken. This underscores why clinicians must continue monitoring cardiovascular health throughout the entire duration of treatment.
If it’s Not Tolerance, What Is It?
If "tolerance" isn't real, why do some patients feel their medication is failing? The review suggests clinicians look at these alternative explanations:
Why This Matters
These results provide clinicians the confidence to tell patients that their medication is unlikely to "wear out" permanently. Rather than immediately increasing a dose when symptoms flare, the first step should be a "clinical deep dive" into the patient's lifestyle, stress levels, and adherence.
For researchers, the review highlights a major gap: most existing studies are small, dated, or of low quality. There is a dire need for robust, longitudinal studies that track both the brain's response and the patient's environment over several years.
For people with ADHD, while your body might get "used to" the initial "buzz" of a stimulant within hours, its ability to help you focus and manage your life remains remarkably durable over the years.
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