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Key points
- Boys with ADHD tracked into adolescence and young adulthood have shown higher rates of partner pregnancies and STIs than those without ADHD.
- Studies of teens and young women with ADHD have found they have higher rates of early, presumably unplanned pregnancies before age 20.
- Sexually active young people with ADHD would do well to equip themselves with contraception with STI protection for themselves and their partner.
- Sexually active young people with ADHD can also coordinate appropriate contraception and STI protection with their partners to ensure their use.
The science-informed consensus is that ADHD is a neurodevelopmental syndrome of impaired self-regulation. What this means in the real world is that individuals with ADHD have greater difficulties organizing and sustaining behaviors across time to achieve desired goals and other objectives.
This description explains study findings on health issues faced by adults with ADHD, as good health maintenance requires organization and follow-through over time, including preventative visits and screenings to avoid difficulties, the unsexy proposition of the hassle to take steps to ensure something that is not a problem for you now stays that way. If you do everything right, nothing happens.
Sexual health and behavior in men with ADHD
Sexual health, including unplanned pregnancy, is a health issue for which prevention is paramount, particularly for adults with ADHD. The rates of unplanned pregnancy in samples of teens and young adults with ADHD are unnerving.
A study of children diagnosed with ADHD tracked into adolescence and adulthood revealed a marked risk for teen pregnancy: 38 percent among teens with ADHD versus 4 percent for the non-ADHD control group, chiefly partner pregnancies.1 Sexually transmitted infections (STI) also were much more common in the ADHD group: 17 percent versus 4 percent.
Other sexual behavior measures for which the ADHD group was at greater risk were early initiation of sexual activity, more sexual partners, more reported casual sex, and less use of contraception. When participants were 27 years old, those diagnosed with ADHD in childhood (now with either persistent ADHD or non-persistent ADHD, i.e., no longer exhibiting full diagnostic criteria) still reported a greater frequency of getting pregnant or getting someone else pregnant.
Another study compared young adult males (18-26 years old) divided by whether they had a childhood diagnosis of ADHD or not.2 The results were strikingly similar, with childhood ADHD predicting greater risk for earlier age of sexual initiation, more sexual partners, more casual sex, and more partner pregnancies. These studies were almost completely comprised of males with ADHD. Later studies focused on women.
Sexual health and pregnancy in women with ADHD
More recent nationwide studies have examined the risk for early pregnancy, presumably unplanned, in samples of young women. Adolescent Taiwanese females with ADHD tracked into young adulthood were more prone to both pregnancy (by age 30) and early pregnancy (before age 20) compared with matched, non-ADHD controls.3 These risks were lower among females with ADHD on stable, long-term medication regimens.
A second study used Swedish registries to identify girls and women (12-50 years old) who gave birth for the first time between 2007 and 2014.4 Teenage births were more common among women and girls with ADHD compared with non-ADHD controls, 15.3 percent to 2.8 percent; they were also more prone for perinatal risk factors than controls, such as cigarette smoking during the third trimester, either lower or higher than recommended body mass indexes, and alcohol or substance use disorders.
Suggestions for prevention
The issue of prevention of unplanned pregnancies is interlaced with that of prevention of STIs for adults with ADHD and their sexual partners, with or without ADHD. Considering the documented sexual health risks, one’s ADHD diagnosis would seem relevant to discuss with a sexual partner to coordinate preventative measures in the spirit of mutual health. Any sexually active teen or young adult with ADHD (or expecting to be) of any sexual orientation should equip themselves and have handy appropriate contraception that provides protection from STIs, the latter consideration for same-sex or other couplings in which there is no concern for pregnancy. It is recommended that an individual with ADHD has a sexual protection technology that works for them and carries one appropriate for any prospective partner(s), not unlike carrying an epi-pen for allergic reaction, just in case.
Yes, these suggestions not only require self-organization and advance planning, which is a challenge for adults with ADHD but also to account for a known or not yet known partner, too. Such preparation for what “might happen” is akin to a “go bag” of the sort recommended in the event of natural disasters, but the preparations discussed here are proactive rather than reactive. This discussion is not the fodder of romantic greeting cards but involves intimate discussions about important relationships and public health issues and corresponding plans that will pay off in the long run—with nothing happening that you don’t want to have happen.
References
1Barkley et al. (2008). ADHD in adults: What the science says. Guilford.
2Flory et al. (2006). Childhood ADHD predicts risky sexual behavior in young adulthood. Journal of Clinical Child and Adolescent Psychology, 35(4), 571-577. https://doi.org/10.1207/s1534424jccp3504_8
3Hua et al. (2021). Early pregnancy risk among adolescents with ADHD: A nationwide longitudinal study. Journal of Attention Disorders, 25(9), 1199-1206. doi: 10.1177/10870547119900232
4Skoglund et al. (2019). Association of attention-deficit/hyperactivity with teenage birth among women and girls in Sweden. JAMA Network Open, 2(10), e1912463. doi:10.1001/jamanetworkopen.2019.12463
