Rates of self-harm among teenagers have risen sharply over the last two decades, and several recent studies have indicated that children and adolescents diagnosed with ADHD are significantly more likely to harm themselves than their non-ADHD peers. The reasons behind this concerning correlation are complex, but appear linked to the impulsivity, depression and low self-esteem frequently seen in teenagers and young adults with ADHD. This problem can manifest in different ways, from ADHD cutting and burning oneself to hitting or biting themselves. In some extreme cases, an ADHD child hitting himself or even ADHD hitting own head have been observed as self-punishing behaviors associated with the disorder.
Of particular concern is the finding that rates of ADHD and cutting and other self-injury are much higher among adolescent girls with childhood ADHD than boys with ADHD. This highlights an important gender difference in the expression of ADHD that requires further research.
Understanding the motivations and patterns of self-harm is critical in order to help those with ADHD manage these dangerous behaviors. Learning what may trigger acts of self-injury can provide key insights on risks and prevention. Identifying early warning signs of self-harm tendencies, such as withdrawal or frequent unexplained injuries, is essential for parents and clinicians seeking to intervene with constructive strategies. Awareness of self-harm in the context of ADHD leads to more thoughtful diagnoses, treatment plans and support systems. Ultimately, a deeper knowledge around adolescents' self-harming actions allows us to better address the emotional pain and inner distress driving these behaviors in youth with ADHD.
The Connection Between ADHD and Self Harm
The core symptoms of ADHD, including impulsiveness, emotional dysregulation, and poor focus, can increase tendencies toward self-harming behaviors. The inability to control impulses and moderate emotions may lead some adolescents with ADHD to turn to self-injury as an outlet when overwhelmed. Additionally, common ADHD comorbidities like depression and anxiety can further heighten self-harm risks.
Of note are clear gender differences in how ADHD manifests in self-harm. Research indicates adolescent girls with ADHD tend to internalize feelings of failure and frustration more than their male counterparts. This suggests self-injury may be an attempt to express inner emotional distress outwardly for girls with ADHD. Understanding these gender differences in the ADHD-self harm connection is key, as it points to the need for more gender-specific screening, diagnosis, treatment and support for girls exhibiting ADHD symptoms or self-harm warning signs.
ADHD Symptoms and Self-Harm Relationship
The first clue as to why ADHD and self-harm are linked lies in the spectrum of emotions experienced by children who self-harm; many report strong feelings of guilt, frustration, anger and impulsivity—all emotions which are more prevalent in those who have ADHD. (Where ADHD has not been diagnosed, feelings of failure and low-esteem are often particularly acute.)
Children and teenagers who self-harm are often attempting to take control of their feelings; they see these destructive acts in an oddly positive light, believing that they are capable of relieving the sensations of intense pressure and pain inside them. One can view these actions in the light of attempted preventative therapy: Rather than let negative emotions build up until they become overwhelming, resulting in the largest destructive act possible (suicide), these young people seek to release their pain through engaging in many smaller destructive acts.
Those with ADHD often struggle with emotional dysregulation and impulse control. Difficulty managing intense feelings like anger, anxiety, and frustration can lead to a build-up of painful inner pressure. Self-harming behaviors may provide a temporary sense of relief or control. The impulsivity aspect of ADHD may also reduce inhibitions against self-harm. Without appropriate coping strategies, adolescents with ADHD may turn to self-injury as an accessible way to self-soothe difficult emotions and impulses. Understanding these complex emotional and psychological factors is key to addressing the roots of self-harm in the ADHD population.
Critical Research Insights Regarding Females with ADHD
New findings from UC Berkeley (published in the Journal of Consulting and Clinical Psychology) may shed light on why the rate of self-harm is so much higher for ADHD in girls than for boys. The study, which took place over a ten-year period, revealed that girls with histories of ADHD are more prone to internalize their struggles and feelings of failure. As self-harm is, at its root, a way of expressing internalized pain (as those who engage in these acts see them as “harmless”, because they are not hurting anyone but themselves), it logically follows that those with ADHD who choose to internalize the associated feelings of anger, guilt, depression, etc., would be more prone to self-harming behaviours as well. This study also showed that girls do not simply “outgrow” ADHD and its associated risks; those with combined inattention and hyperactivity-impulsivity during childhood were found to be at much higher risk of self-injury and suicide attempts in early adulthood.
These findings have been corroborated by similar Australian studies which also found that girls with ADHD not only internalize their feelings more than adolescent boys typically do, they also tend to exhibit more internalizing disorders as compared to girls without ADHD.
Additional research has delved deeper into the gender gaps around ADHD and self-injury. A 2019 study in the journal Child Psychiatry & Human Development confirmed the higher rates of self-injury among girls with ADHD compared to boys, finding almost double the risk. The study also found that depression and anxiety were significant mediators between ADHD symptoms and self-harm for girls but not boys. This aligns with the thesis that girls tend to internalize ADHD-related struggles, leading to higher susceptibility for mental health issues that facilitate self-injurious behaviors. Clearly, more gender-aware screening, diagnosis and treatment is essential to support girls with ADHD before critical tipping points into self-harm.
ADHD and Self-Harm: A Statistical Overview
ADHD is thought to affect 5-7% of all children, and it is now proved that ADHD symptoms tend to persist into adulthood. According to recent research, ADHD is often a precursor to low self-esteem and poor academic and job performance, making it a significant public health issue.
A survey of the ISC data bank which analyzed the linkage between ADHD and self-injury, looking specifically at children and adolescents between 5–15 years who had a “diagnosis of external causes of injury and poisoning” (AKA self-harm), found that the likelihood of being diagnosed with ADHD was about four times higher among children and adolescents hospitalized due to suicide and self-harm. Patients who were admitted to hospitals because they had attempted suicide or self-harmed were six times and three times more likely to be diagnosed with ADD, respectively, as compared with other causes of injury. The rates of self-harm in total were discovered to be about 8.5 times higher for children diagnosed with ADHD (as compared to individuals without ADHD).
Unfortunately, while self-harm often begins as a means of preventing suicide, the ISC data bank survey also confirmed existing knowledge linking self-harming tendencies to a greatly increased risk of suicide.
Additional studies reinforce these troubling statistics. A meta-analysis in the American Journal of Psychiatry found that ADHD was associated with a significantly heightened risk of suicidal behaviors, including self-harm. Compared to individuals without ADHD, those with an ADHD diagnosis showed more than double the risk of suicide attempts and deaths by suicide. These risks persisted even after controlling for comorbid conditions like depression and anxiety disorders. Researchers emphasize that suicidality must be carefully monitored in ADHD patients of all ages.
Identifying Self-Harm in Adolescents with ADHD
It is often very difficult to identify children and adolescents who self-harm, as many become very skilled at concealing their behaviour. However, teenagers who seem excessively shy and self-conscious, who cover up even on hot days and refuse to partake in any activity (e.g. swimming) where they might have to expose a large amount of skin, ought to be watched carefully for signs of self-harm.
Likewise, frequent signs of scratching, bruising, or scarring should be treated with due care, as should finding any suspicious sharp object (such as a razor blade) in your child's room.
When looking for potential problems in youth with ADHD, warning signs may include:
- Wearing long sleeves or pants even in warm weather to cover cuts or scars
- Spending increased time alone in their room
- Difficulty concentrating or distracted behavior
- Displaying intense mood swings or explosive emotions
- Expressing feelings of worthlessness, shame or hopelessness
- Withdrawing from friends and family
- Comments about death, dying or suicide
Physical signs requiring attention include:
- Unexplained wounds, burns or cuts on arms, legs or torso
- Frequent bruises, scratches or other injuries
- Blood stains on clothing or accessories
- Possession of razors, knives or other implements that could be used for self-injury
By being vigilant for these emotional and physical indicators, parents and providers can intervene early when self-injury risks emerge in adolescents with ADHD. Sensitive conversations and non-judgmental support are key to keep open lines of communication.
Preventing Self-Harm: Strategies and Interventions
When it comes to preventing self-harm in children and adolescents with ADHD, interventions across multiple environments are key. This includes strategies for early diagnosis and treatment, creating a supportive home environment, implementing school-based prevention, and properly responding if signs of self-injury arise. By taking a comprehensive approach across healthcare, family, education and response systems, we can provide these vulnerable youth with the support they need to stay safe.
Early Diagnosis and Treatment
In those with ADHD, the key to preventing self-harm often lies in diagnosing and treating the ADHD as soon as possible. Additionally, parents and educators should be sure to focus on the child's positive achievements; never place undue attention on his or her learning disability in a solely negative light, but rather try to manage it while also encouraging the child and pointing out those areas where ADHD can also benefit the learning process. The more confident the child feels, the less likely he or she will be to engage in self-harming behaviours. If depression and poor self-esteem arise irrespective of your best efforts, seek professional help for your child as soon as possible.
If you suspect your child may have undiagnosed ADHD, our free online screening tool can help determine if they should be evaluated by a professional. Getting a diagnosis is the first step to accessing the therapies, skill-building and medication that can dramatically improve ADHD symptoms. Keeping ADHD from progressing untreated reduces associated risks like self-injury. Awareness of screening options empowers parents and teachers to get children the help they need before negative behaviors and coping mechanisms take hold.
Early diagnosis and treatment plans for ADHD can help minimize symptoms like impulsiveness and emotional dysregulation that may increase self-harm risks. Ongoing therapy and social skills training are also beneficial to build coping strategies and resilience.
Create a Supportive Home Environment
At home, creating a safe, understanding environment is key. Make sure your child knows you are available to listen without judgment when they are feeling overwhelmed. Help them identify healthy emotional outlets like journaling, art and exercise. Limit access to objects that could be used for self-injury.
Implement School-based Prevention
In schools, train educators on warning signs and make counselors accessible. Peer support groups can reduce isolation. Teach self-soothing techniques like deep breathing alongside academic skills.
If signs of self-injury do emerge, respond calmly with care and concern. A collaborative approach involving the child, parents, doctors and counselors is best to address underlying issues and replace self-harm with healthy coping mechanisms. Ongoing support and building self-esteem can aid recovery.
Classroom Strategies for Preventing ADHD Self-Punishment
Therapists are likewise often useful in helping to create teaching strategies that teachers can use in the classroom to make the ADHD student's experience smoother and more enriching. This is very important in the prevention of self-injury as a great deal of a child's confidence and self-esteem is typically dependent on his or her academic performance. Some of these strategies include:
- Not taking things personally. Teachers must understand that the student's outbursts are not personal or intentional; usually, the student simply cannot help it. Feelings of anger and frustration need to be set by the wayside so that teachers may help these students flourish.
- Remaining vigilant for those times when the child seems focused. If a child is on medication, it's best to be sure to work with the child while the medication is in his or her system. If the child is not on medication, look for moments when he or she seems particularly calm and attentive and try to engage him or her then.
- Identifying distractions. To a young person with ADHD, apparently “normal” things like being seated near a door or window may prove extremely distracting. Additionally, earplugs ought to be suggested if the classroom is frequently noisy, or if the teacher giving instructions during an assignment is actually making it more difficult for the child to focus.
- Setting appropriate boundaries. While it's important to be understanding when a child has ADHD, educators should not simply abandon rules and boundaries altogether; indeed, children with ADHD are in particular need of this structure. Make sure, however, that you give reprimands privately, and take the time to listen to the student when he or she has genuine concerns about a requirement.
Note, however, that you should not punish restlessness; children with Attention Deficit Hyperactivity Disorder cannot help this. Provide them with a means of fidgeting (e.g. using a stress ball) which minimizes distractions for others, and assign to them any “active” duties that arise in the classroom, such as the task of wiping off the chalk board.
- Breaking down tasks. Children with ADHD frequently have impaired planning and organization skills, meaning that they cannot easily plan and carry out tasks in the correct order. To help them work around this, provide checklists with each assignment so that tasks are already broken down into logical segments, starting with the first priority item. Get the child to recite to you how they believe the assignment should be completed, after reviewing the checklist, in order to make sure that he or she is properly understanding the information provided.
- Being clear when giving instructions. Children with Attention Deficit Hyperactivity Disorder retain information best when it is given to them in a clear, concise way (specific, not vague) while eye contact is maintained. Additionally, you should not rely on verbal instruction alone; have the child write notes or provide a written checklist detailing instructions.
- Providing a peer mentor. An older child with ADHD can be a very valuable resource when paired with a younger one, protecting that child against bullying and giving him or her an understanding companion and positive role model.
Implementing ADHD-friendly strategies in the classroom environment can make a significant difference in supporting students with the disorder and reducing risks of negative outcomes like self-harm. When academics become less frustrating and self-esteem is reinforced, students feel more confident and in control. Key techniques like breaking down instructions, allowing movement, and providing mentors create an atmosphere where those with ADHD can focus on their abilities rather than disabilities. This fosters success and resilience that protects against depressive thoughts and self-injurious behaviors. While medication and therapy play a crucial role, everyday educational adaptations make the classroom a source of achievement rather than anxiety for ADHD students. By training teachers on these impactful strategies, we can help students with ADHD thrive academically and emotionally, giving them a solid foundation for mental health and self-regulation as they transition into adulthood. Small adjustments by caring, informed educators in the classroom can set them on a positive path away from self-injury.
Conclusion: The Path Forward
As the prevalence of ADHD and self-harm alike are continuing to rise, it is essential that parents and educators verse themselves on how to detect, treat, and manage these conditions. Through early detection, intervention, and positive learning strategies, the risk of self-harm can be substantially lowered, and children with Attention Deficit Hyperactivity Disorder can grow up feeling a confident mastery of their unique abilities.
References:
- Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, et al. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of Consulting and Clinical Psychology. 2012;80(6):1041-51.
- Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis. PMC - NCBI. 2023.
- Associations of impulsivity, hyperactivity, and inattention with nonsuicidal self-injury and suicidal behavior: longitudinal cohort study following children at risk for neurodevelopmental disorders into mid-adolescence. NCBI. 2022.
- The association of ADHD symptoms to self-harm behaviours: a systematic PRISMA review. PMC - NCBI. 2014.
