Module 7 — ADHD-SIM-24 — Sex, Desire and Attention with ADHD

 

How attention, emotional regulation and tolerance of delay shape intimate life with ADHD, what the evidence on desire, risk and medication actually shows, and why this particular screener runs backwards and has never been validated.

 

ADHD Self-Discovery · Part Three — How ADHD Actually Shows Up · 14 min read, about 28 min with the workbook

 

The big idea

 

If you have ever surfaced halfway through sex and realised your attention had drifted to an unanswered email, or wanted someone badly on Tuesday and felt nothing at all by Friday — this module is about a part of adult ADHD that almost never comes up in an assessment appointment. It is also about a twenty-four item questionnaire we wrote ourselves, which has never been validated, and which you should read more sceptically than anything else in this course.

 

Step 1 — The lesson

 

A. Low is the hard end

 

Almost every screener in this course runs one way. The higher your total, the more of the thing you have. The ADHD-SIM-24 runs the other way, and if you have taken three questionnaires this afternoon, this is where people misread their own result.

 

Twenty-four is the difficult end. One hundred and twenty is the comfortable end. A total of 40 is not a mild score; it sits in the lowest band, the one the page calls High Support Needed. A total of 95 is the reassuring one. Read that twice before you read your number.

 

Diagram — A · Low is the hard end. The three bands are 24 to 56, 57 to 88, and 89 to 120. The colours are doing the work the arithmetic usually does. If you record this score in a spreadsheet next to your other results, it will be the one that points the wrong way.

 

Underneath the total there are four subscales, each running 6 to 30, and each carrying the same three bands: 13 or below is High Support Needed, up to 22 is Growth Zone, and up to 30 is Strong Foundation. They are called Attention & Presence, Impulse Control & Risk, Boundaries & Consent, and Relationship Communication & Satisfaction. Twenty-four items, five to seven minutes.

 

One thing the live page does not tell you is what the response scale is — how many points each item offers, or what the anchors say. That single omission determines every number it hands back. We have not guessed at it here, and you should not either.

 

The larger thing to say is that the ADHD-SIM-24 is our own. It was written in-house at New Path. There is no development paper, no normative sample, no published reliability figure and no validation study of any kind, and the live page carries an explicit disclaimer to that effect. In this course's own grading it is Tier 4: honest, useful for structuring a conversation, and not a measurement in the sense that word normally carries.

 

We built it anyway because the alternative was nothing. The published instruments in this area are research tools, licensed and priced accordingly, and none of them was designed to hand an adult a usable map of their own situation. Most people have never had a structured conversation about any of this, with anyone. Twenty-four questions is a start.

 

B. Two accounts of one relationship

 

The relationship evidence in adult ADHD is real, it is reasonably consistent, and it is more interesting than the headline version. It does not say that people with ADHD are bad partners. It says that two people in the same relationship often give strikingly different accounts of it.

 

The study people usually cite compared 33 married adults with ADHD and their spouses against 26 control couples. The adults with ADHD reported poorer overall marital adjustment and more family dysfunction than controls. Their spouses, on average, reported satisfaction much like the control spouses — although more of them fell into the maladjusted range.¹

 

Diagram — B · Two accounts of one relationship. The person with ADHD rated the marriage worse than their partner did. That is the opposite of the stereotype, in which the partner suffers quietly while the person with ADHD notices nothing. Whatever is happening, the ADHD partner is usually the one keeping score against themselves.

 

A 2021 review of the whole literature reaches a blunt summary: adults with ADHD tend to have shorter and more discordant romantic relationships, the mechanisms behind that are poorly understood, and there is almost no research on how to prevent or treat it.² That last gap is worth holding on to. The problem has been described far more often than it has been helped.

 

When 355 adults with ADHD were asked, in their own words, what was hardest about their romantic relationships, the themes were emotional regulation, task and household load, and rejection sensitivity. The paper takes its title from one of them: I felt like a burden.³ That sentence does more work than any correlation coefficient in this module.

 

The mechanism that keeps surfacing is not attention. It is emotion. A meta-analysis of 13 studies covering 2,535 adults found emotional dysregulation substantially elevated in adults with ADHD against controls, at a pooled Hedges' g of 1.17, with emotional lability the largest component at g = 1.20 and a correlation of r = 0.54 between symptom severity and dysregulation.⁴ That is a large effect by any standard. Emotional dysregulation is not in the diagnostic criteria for ADHD, and it is now widely treated as a core feature regardless.

 

Close to it sits rejection sensitivity. When 43 young adults with ADHD were asked in focus groups what the criteria had missed, they named emotional dysregulation and rejection-sensitive dysphoria as the symptoms nobody had written down.⁵ Honesty requires the other half of that: rejection-sensitive dysphoria is not a diagnosis and has thin empirical support, and a 2026 critical review warns that the term risks stigmatising people, framing something environmental as innate, and confusing clinical language, while the established construct of rejection sensitivity already does the job.⁶ Module 8 takes this apart properly.

 

In an intimate context the practical effect is small and repeated. A neutral "not tonight" arrives as a verdict rather than as a piece of information about someone else's Tuesday. What follows — the withdrawal, the second question asked in a different tone, the silence — is usually what the other person actually reacts to.

 

C. Attention, desire, and the medication question

 

The first subscale is Attention & Presence, and it is the one most people recognise immediately. When 98 adults with ADHD described their sexual experiences in an open-ended study, the traits they named as making satisfaction harder were a need for novelty, difficulty focusing, and reassurance seeking — and the difficulty was worst where none of that was accommodated by the people around them.⁷

 

Attention is not merely a matter of manners here. In the general sexual-response literature it does mechanical work. In one laboratory study, 41 women who were given a body-scan attention task reported greater subjective arousal, and closer agreement between what their bodies did and what they noticed, than women given a visualisation task.⁸ That was not an ADHD sample and it is one small study, so treat it as a direction rather than a fact about you. The direction is that where attention goes is not incidental to what the body does.

 

Hyperfocus is the same setting seen from the other side. The first months of a relationship can be the most attentive anyone has ever been in your company, and the drop that follows gets read by both of you as loss of interest. It is generally not that. It is novelty ceasing to do the work that attention was borrowing from it.

 

Then there is desire, which in ADHD moves in both directions rather than one. A Dutch clinic study of 136 adults with ADHD found that 39 per cent of the men and 43 per cent of the women had symptoms of a sexual dysfunction, and that 17 per cent of men and 5 per cent of women reported other sexual disorders. Exactly one patient had ever had any of it noted before.⁹

 

Diagram — C · Attention, desire, and the medication question. The last figure is the one that matters clinically. Whatever the true prevalence is, almost nobody had been asked. A screener that asks the question at all is doing something the assessment system mostly does not.

 

Reviews of this literature describe the picture as heterogeneous, taking in hypersexuality and hyposexuality alike, shaped by sensory factors, attention, hyperfocus and a pull towards frequent change.¹⁰ A 2026 systematic review of 13 studies, with samples from 64 to 943, found the highest reported figures in ADHD groups were 67.7 per cent for orgasmic dysfunction in women and 39 per cent for premature ejaculation in men; running the association the other way, ADHD reached 34.6 per cent among women with orgasmic disorder and about 42 per cent among men with premature ejaculation, against 3.7 to 5 per cent in controls. Several of the included studies found no significant difference at all, and the heterogeneity was too great to pool.¹¹

 

The single survey that measured three things at once is worth its own sentence. Comparing 139 adults with ADHD against 76 without, it found significantly more hypersexual behaviour in the ADHD group — and no group difference in risky sexual behaviour, and none in sexual dysfunction. In the women, hypersexual behaviour, sexual risk-taking and dysfunction were all closely related to emotional dysregulation rather than to inattention.¹² One measure out of three separated the groups. That is the shape of this evidence: real, patchy, and much smaller than the way it gets reported.

 

Medication is the question we are asked about most, and it has a genuine answer, which is that it goes both ways. A 2025 systematic review of 14 studies of methylphenidate found decreased libido and ejaculatory problems in some groups, particularly where other psychiatric conditions were present, and improved arousal and performance in others, particularly at lower doses or where a dysfunction already existed.¹³ Nobody can tell you in advance which you will be. What follows from that is not caution about medication; it is that this belongs on the list of things you mention at a review appointment, in the same voice you would use about appetite or sleep.

 

D. What the number does not know

 

This is the section to read if you read only one. The ADHD-SIM-24 has no psychometric record whatsoever. No internal consistency coefficient, no test-retest interval, no factor analysis confirming that its four subscales are separable, no comparison against any published measure, no sensitivity, no specificity, no normative sample and no derivation for the two places it cuts the scale. The three band labels are editorial decisions about how to speak to a reader, not empirical categories.

 

Diagram — D · What the number does not know. Everything ticked here is a description of the output. Everything blank is a property the instrument would need before a score could be treated as a measurement. A questionnaire can be worth filling in and still be worth nothing as a number.

 

That is the instrument. The constructs it points at are better evidenced, and the honest way to report them is with the actual sizes rather than the alarming version.

 

Take Impulse Control & Risk. A Taiwanese national cohort followed 17,898 adolescents and young adults with ADHD against 71,592 matched controls and found a hazard ratio of 3.36 for acquiring a sexually transmitted infection, with a 95 per cent confidence interval of 2.69 to 4.21. Among the males, being on ADHD medication was associated with lower risk, at a hazard ratio of 0.70 in the short term and 0.59 in the long term.¹⁴ A rate ratio of that size on an uncommon outcome still leaves the absolute risk low for most individuals, and it describes a group rather than predicting a person. It is a reason to test and to use protection. It is not a statement about anybody's character.

 

The mechanism underneath it is more useful than the ratio. In a study of 275 adults, those with more ADHD symptoms discounted delayed condom-protected sex more steeply than those with fewer, preferring the immediate unprotected option, and discounted delayed money in the same way.¹⁵ That is a problem about delay, not about values. It is also the most actionable finding in this module, because a decision made in advance is not subject to discounting at all.

 

The Boundaries & Consent subscale needs the firmest warning on this page. It must not be read as a risk score. The relevant research is about being harmed rather than causing harm: comparing 97 adults with a childhood history of ADHD against 121 without, more of the ADHD group reported sexual assault victimisation, particularly attempted rape or rape, and the rates were not higher in those whose symptoms had persisted or who carried other risk factors.¹⁶ Responsibility for harm sits entirely with the people who cause it. Much of what this subscale touches is also a matter of what you were taught and never taught, which is education rather than disposition.

 

So what does a low total actually tell you. It tells you that something in this area is currently hard. It does not tell you which thing, and it cannot distinguish between a medication side effect, a depressive episode, pain, a mismatch with one particular person, an unaccommodated attention difference, and never having been given usable information in the first place. Those call for entirely different responses.

 

INSIDE THE INSTRUMENT

 

ADHD-SIM-24 — the ADHD Sexual Intimacy Measure, New Path's own instrument

 

Where it came from

 

Written in-house by the New Path clinical team. There is no development paper, no item-generation protocol and no manual. It is the ADHD counterpart to the ASIM-24 used in Module 11 of our Autistic Self-Discovery course, and it inherits that instrument's architecture: 24 items, four subscales of 6 to 30, a total of 24 to 120, and the band labels High Support Needed, Growth Zone and Strong Foundation. Readers who are AuDHD may well take both. The total bands are identical across the two; the subscale cut points are not, breaking at 13 and 22 here and at 12 and 17 there. The scores are not interchangeable.

 

What it is made of

 

Twenty-four items across Attention & Presence, Impulse Control & Risk, Boundaries & Consent, and Relationship Communication & Satisfaction, each subscale scoring 6 to 30 and summing to 24 to 120. Administration is 5 to 7 minutes. The scale is reverse-oriented: 24 to 56 is High Support Needed, 57 to 88 is Growth Zone, 89 to 120 is Strong Foundation, with subscale breaks at 13 and 22. The live page does not state the item response scale and none has been inferred anywhere in this module.

 

How well it performs

 

Unknown, in every respect that can be measured. No Cronbach alpha, no test-retest coefficient, no exploratory or confirmatory factor analysis, no convergent validity against any published sexual-functioning measure, no sensitivity, no specificity, no cut-off derivation, no item analysis. The live page's own disclaimer that the tool is in development and has not been formally validated is the entire psychometric record.

 

Where it was validated

 

Nowhere. There is no normative sample, no clinical sample, no comparison group and no translation. Scores are raw, not standardised, and not comparable to any published threshold or to any other instrument, including our own ASIM-24.

 

What it cannot do

 

It cannot screen for ADHD, and it cannot screen for a sexual disorder. Every domain it touches is shaped by sex education, relationship history, mood, pain, medication, trauma and the particular person a respondent is currently involved with. Use the ASRS and a full developmental history for the first question and a proper sexual history for the second.

 

It cannot estimate risk, and the Boundaries & Consent subscale must not be used as though it could. The victimisation finding in this literature is a group-level association from a retrospective comparison of 97 against 121 adults,¹⁶ and the sexually transmitted infection finding is a national-cohort hazard ratio of 3.36, 95% CI 2.69 to 4.21.¹⁴ Neither licenses assigning an individual a risk level from six self-report items.

 

Its four subscales have never been shown to be separable. With no factor analysis, the four-way partition is an editorial judgement about how to organise a conversation. Treat a subscale profile as a set of prompts, not as a differentiated profile.

 

It cannot distinguish a medication effect from the condition. Methylphenidate has documented effects in both directions on libido, arousal and ejaculation,¹³ and medication status is associated with lower sexually transmitted infection risk in males in cohort data.¹⁴ A total score taken during a titration says as much about the dose as about the person.

 

The reverse orientation is a live data-entry hazard. Every other screener in this course runs high-is-more. Any record system, spreadsheet or letter that stores this total alongside them will eventually be read backwards, and a reader in the lowest band is the one who most needs the reading to be right.

 

What a clinician does with it

 

Use the four subscale scores as an interview schedule and the total as nothing at all. The clinically useful output is which domain the respondent flags and what it looks like in practice. Two things are worth doing routinely regardless of the score: ask about sexual function in ADHD reviews, given that only one of 136 clinic patients in the Dutch series had ever had it recorded,⁹ and ask about emotional regulation, which carries a pooled Hedges' g of 1.17 against controls⁴ and appears as the strongest correlate of sexual difficulty in women with ADHD in survey data.¹²

 

Validity tier: 4 — built in-house by New Path. Honest and useful, not normed, no published validation. The constructs it points at have a real if uneven evidence base; the instrument that points at them has none, and no number it produces should be recorded as though it were a measurement.

 

Diagram — E · Many roads, one reading. This is the caveat that matters most. A low total is a real signal that something in this area is costing you. It is silent about which of at least six explanations is doing the work, and the first job of any conversation about it is to find out.

 

STRENGTHS LENS

 

You are already doing the difficult half.

 

Nobody arrives at a page about attention and intimacy by accident. Most adults never look at this directly at all — they let it become a private grievance, or a story about not being wanted, and they carry it for a decade. Being willing to name the mechanism, without euphemism and without blaming the person next to you, is the part almost nobody manages. The questionnaire is the easy bit.

 

The same wiring has a second face, and the evidence is quietly clear about what it is. Attention that can be captured completely is worth a great deal when it is aimed at a person. The appetite for novelty that shortens some relationships also keeps others from calcifying. And the two findings with the strongest support in this module — that the driver is emotional regulation rather than inattention, and that the risk mechanism is delay rather than judgement — both describe things that respond to structure. That is unusually good news for a research literature.

 

F. What helps

 

None of this asks you to become a different person, and none of it works by trying harder in the moment, which is the one condition under which ADHD reliably underperforms. The four subscales point at four different jobs, and each of these is small enough to actually do.

 

1. Read the four subscales before you read the total.

 

The total is the least informative number this screener produces, because it averages four unrelated situations into one. A 62 made of three comfortable domains and one very low one calls for something specific; a flat 62 across all four calls for something else. Write the four numbers down separately and ignore the sum.

 

2. Decide the practical things while nothing is happening.

 

The delay-discounting finding is the whole argument for this: the immediate option wins when the decision is made in the moment, so move the decision. Contraception in the drawer rather than in the plan. Testing booked as a recurring appointment rather than as a reaction. What is and is not on the table, said out loud on a Sunday afternoon rather than negotiated at midnight.

 

3. Ask your prescriber about the sexual side, by name.

 

The effects are documented in both directions and they are dose-related, so this is a real conversation rather than an awkward one. Say the specific thing — desire, arousal, difficulty finishing, finishing too quickly — and say when it started relative to the dose. Do not quietly stop taking something and let both problems run at once.

 

4. Build presence into the room instead of trying to concentrate harder.

 

Attention responds to conditions far better than to effort. Phone in another room rather than face down. Fewer competing inputs, not more atmosphere. And where your attention does go, aim it at physical sensation rather than at monitoring how it is going, which is the one place attention reliably makes things worse.

 

5. Compare accounts rather than defending yours.

 

The clearest finding in the relationship literature is that two people in the same relationship describe it differently, and that the ADHD partner is often the harsher judge. Ask your partner to answer the same four domains, then swap. If a rejection reflex fires while you read theirs, that is information about the reflex, not about the sentence — wait a day before acting on your interpretation, and take that part into Module 8.

 

Step 2 — Take the screener

 

Twenty-four questions, five to seven minutes, free and confidential. You will get a total between 24 and 120 plus four subscale scores of 6 to 30 each. Read section A before you read your result: this screener is reverse-oriented, so a low score means more support is needed, which is the opposite of every other questionnaire in this course.

 

Take the ADHD-SIM-24

 

Before you start

 

The ADHD-SIM-24 was built in-house by New Path and the live page states plainly that it is still in development and has not been validated through formal research. It has no normative sample, no published reliability or validity figures, no factor analysis confirming that its four subscales are separable, and no derivation for its cut-off points — the band labels are editorial judgements about how to talk to a reader. It is reverse-oriented: a low score means more support is needed. It is a structured way to describe your own situation and to start a conversation, not a test, and it screens neither for ADHD nor for any sexual disorder. Only a clinician working from a full history can diagnose.

 

Step 3 — Your workbook

 

Your answers save to this device only — we cannot see a word of what you write. This module records the four subscale scores separately from the total, then turns the lowest of them into the specific conditions, decisions and sentences that make a practical difference.

 

Your ADHD-SIM-24 results

 

Took the screener? Put your numbers in below. Remember the direction: a LOW score means MORE support needed, which is the opposite of every other screener in this course. Entirely optional — skip it if you would rather just read.

 

Score bands: 24–56 = High Support Needed; 57–88 = Growth Zone; 89–120 = Strong Foundation

 

Fields: ADHD-SIM-24 · ADHD Sexual Intimacy Measure, 24 items; Total score (24–120) — low is the difficult end; My total (enter 24–120); Attention & Presence (6–30); Attention & Presence (enter 6–30); Impulse Control & Risk (6–30); Impulse Control & Risk (enter 6–30); Boundaries & Consent (6–30); Boundaries & Consent (enter 6–30); Relationship Communication & Satisfaction (6–30); Relationship Communication & Satisfaction (enter 6–30)

 

The four, not the total

 

Section F, item 1. The sum averages four unrelated situations into one number. The shape across the four is the part worth having.

 

Fields: My lowest subscale: Attention & Presence / Impulse Control & Risk / Boundaries & Consent / Relationship Communication & Satisfaction / Two or more are level; My highest subscale: Attention & Presence / Impulse Control & Risk / Boundaries & Consent / Relationship Communication & Satisfaction / Two or more are level; What the lowest one actually looks like in an ordinary week; Tick: I checked the direction before reading my total

 

Presence, not effort

 

Section F, item 4. Attention responds to conditions far better than it responds to trying harder. This is about the conditions.

 

Fields: What reliably pulls my attention away; One condition I could change tonight; When my attention drifts, where does it usually go: Unfinished tasks / Something I said earlier / Monitoring how it is going / Nothing I can name afterwards / It does not drift

 

Decided in advance

 

Section F, item 2. The delay-discounting research says the immediate option wins when the decision is made in the moment. So move the decision.

 

Fields: Practical things I want settled before, not during; Where the thing physically lives, so it needs no decision; Tick: Testing is booked as a recurring appointment, not a reaction

 

The medication conversation

 

Section F, item 3. The documented effects run in both directions and are dose-related, so this is a normal review question rather than an awkward one.

 

Fields: Have I noticed a change since starting or changing a dose: Yes, in one direction / Yes, and it varies / No change I can attribute / I am not taking anything / I have never tracked it; The exact sentence I will say at my next review

 

Two accounts

 

Section F, item 5. The research finding is that the ADHD partner is often the harsher judge of the relationship. This is for checking that against reality rather than assuming it.

 

Fields: Who I would ask; Where I expect their four answers to differ from mine; What fired when I read their version, and what I did with it; Tick: I waited a day before acting on my interpretation

 

Appendix — Research companion

 

Peer-reviewed research

 

4. Beheshti A, Chavanon ML, Christiansen H (2020). Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC Psychiatry, 20(1), 120. DOI 10.1186/s12888-020-2442-7. View the paper Meta-analysis of 13 studies covering 2,535 adults comparing emotion dysregulation in adults with and without ADHD. Adults with ADHD showed substantially elevated emotion dysregulation overall at Hedges' g = 1.17, with emotional lability the largest single component at g = 1.20, and ADHD symptom severity correlated with overall dysregulation at r = 0.54 and with negative emotional responses at r = 0.63. The authors argue emotional dysregulation functions as a core feature of adult ADHD rather than a complication of it. Limitation: only 13 studies entered the pool, the included measures of emotion dysregulation differ substantially from one another, and the designs are cross-sectional so nothing in it establishes direction of effect.

 

15. Berry MS, Sweeney MM, Dolan SB, Johnson PS, Pennybaker SJ, Rosch KS, Johnson MW (2021). Attention-deficit/hyperactivity disorder symptoms are associated with greater delay discounting of condom-protected sex and money. Archives of Sexual Behavior, 50(1), 191-204. DOI 10.1007/s10508-020-01698-8. View the paper Online study of 275 adults, 161 male and 114 female, completing the Sexual Delay Discounting Task and a monetary delay discounting task alongside an ADHD symptom measure. Participants with more ADHD symptoms discounted both delayed money and delayed condom-protected sex significantly more steeply, meaning they more often preferred immediate unprotected sex when a condom would involve waiting, which locates the mechanism in tolerance of delay rather than in attitudes to protection. Limitation: 275 online participants with self-reported symptoms rather than diagnoses, and the sexual outcome is a hypothetical laboratory choice task rather than observed behaviour.

 

13. Bies R, Szewczyk Z, Warchala A, Martyniak E, Krzystanek M (2025). The impact of methylphenidate on sexual functions: a systematic review of benefits and risks. Pharmaceuticals, 18(5), 718. DOI 10.3390/ph18050718. View the paper Systematic review of 14 clinical studies of methylphenidate and sexual functioning. It reports effects in both directions: decreased libido and ejaculatory disorders in patients with psychiatric comorbidity, and improved sexual arousal and performance at lower doses or in patients with pre-existing dysfunction, and it recommends that prescribers raise sexual health explicitly when starting the drug. Limitation: 14 heterogeneous studies with differing designs, doses and outcome measures and no pooled effect estimate, and the review covers methylphenidate only rather than amphetamine-class or non-stimulant medication.

 

9. Bijlenga D, Vroege JA, Stammen AJM, Breuk M, Boonstra AM, van der Rhee K, Kooij JJS (2018). Prevalence of sexual dysfunctions and other sexual disorders in adults with attention-deficit/hyperactivity disorder compared to the general population. Attention Deficit and Hyperactivity Disorders, 10(1), 87-96. DOI 10.1007/s12402-017-0237-6. View the paper Cohort of 136 adults attending a Dutch ADHD clinic who completed sexual dysfunction screening questionnaires, compared against general population survey figures. 39% of male and 43% of female patients had symptoms of a sexual dysfunction, and 17% of males and 5% of females reported other sexual disorders, yet only one male patient had ever received a prior diagnosis, leading the authors to recommend that sexual disorders be assessed routinely during ADHD diagnostic work. Limitation: 136 patients at one clinic compared against external survey norms rather than a matched control group, with no control for medication, mood or comorbidity, so the prevalence figures cannot be read as an ADHD effect.

 

14. Chen MH, Hsu JW, Huang KL, Bai YM, Ko NY, Su TP, Li CT, Lin WC, Tsai SJ, Pan TL, Chang WH, Chen TJ (2018). Sexually transmitted infection among adolescents and young adults with attention-deficit/hyperactivity disorder: a nationwide longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 57(1), 48-53. DOI 10.1016/j.jaac.2017.09.438. View the paper National health insurance cohort of 17,898 adolescents and young adults with ADHD and 71,592 age- and sex-matched controls in Taiwan, followed longitudinally for incident sexually transmitted infection. Those with ADHD had a hazard ratio of 3.36 (95% CI 2.69-4.21) for developing an STI, comorbid substance use disorder raised risk further at HR 1.94, and among males ADHD medication was associated with reduced risk at HR 0.70 for short-term and 0.59 for long-term use. Limitation: a claims-based cohort in one country with no data on sexual behaviour, partner numbers or condom use, so the mechanism is inferred rather than measured, and medication was not randomly assigned.

 

7. Desille AE, Alba B (2026). It's not you, 'it's me': sexual experiences and sexual satisfaction in an ADHD sample. Archives of Sexual Behavior, 55(3), 1391-1400. DOI 10.1007/s10508-025-03386-x. View the paper Qualitative study of 98 adults with ADHD describing their sexual experiences, analysed with latent thematic analysis. Participants attributed reduced sexual satisfaction to neurotype-specific traits including a need for novelty, difficulty focusing and reassurance seeking, with difficulty greatest where those traits went unaccommodated by partners. Limitation: 98 self-selected participants with largely self-reported ADHD status, no comparison group and no quantitative satisfaction measure, so it describes attributions rather than establishing causes.

 

1. Eakin L, Minde K, Hechtman L, Ochs E, Krane E, Bouffard R, Greenfield B, Looper K (2004). The marital and family functioning of adults with ADHD and their spouses. Journal of Attention Disorders, 8(1), 1-10. DOI 10.1177/108705470400800101. View the paper Compared 33 married adults diagnosed with ADHD and their spouses against 26 control couples using standardised marital and family functioning measures. Adults with ADHD reported poorer overall marital adjustment and greater family dysfunction than controls, while their spouses reported average satisfaction similar to control spouses although more of them fell within the maladjusted range. The authors conclude that adults with ADHD hold more negative perceptions of their marriages and that targeted marital and family intervention is needed. Limitation: 59 couples in total, cross-sectional, recruited through a clinic and heavily weighted towards adults already diagnosed and seeking help, so it cannot estimate how common marital difficulty is among adults with ADHD generally.

 

12. Hertz PG, Turner D, Barra S, Biedermann L, Retz-Junginger P, Schottle D, Retz W (2022). Sexuality in adults with ADHD: results of an online survey. Frontiers in Psychiatry, 13, 868278. DOI 10.3389/fpsyt.2022.868278. View the paper Anonymous online survey comparing 139 adults with ADHD against 76 without on risky sexual behaviour, hypersexual behaviour and sexual dysfunction. Adults with ADHD reported significantly more hypersexual behaviour, and there was no group difference on risky sexual behaviour or on sexual dysfunction; in women with ADHD, hypersexual behaviour, sexual risk-taking and sexual dysfunction were all closely related to emotional dysregulation, impulsivity and oppositional symptoms, with weaker and less clear associations in men. Limitation: a self-selected online sample with self-reported diagnostic status and no clinical verification, and the published abstract's group sizes do not sum to the total it reports.

 

8. Velten J, Margraf J, Chivers ML, Brotto LA (2018). Effects of a mindfulness task on women's sexual response. Journal of Sex Research, 55(6), 747-757. DOI 10.1080/00224499.2017.1408768. View the paper Laboratory study of 41 women with a mean age of 27.2 who watched erotic films after either a mindfulness body-scan exercise or a visualisation task. The mindfulness condition produced greater subjective arousal and stronger agreement between subjective and physiological measures of arousal, supporting interventions that direct attention towards physical sensation. Limitation: 41 women, none of them selected for ADHD or for sexual difficulty, in a single laboratory session, so it cannot show that the same manipulation helps anyone outside that setting.

 

11. Verney P, Faugere M, Achour V, Gavat J, Maakaron E, Pailloux L, Van Der Putten L, Lancon C, Korchia T (2026). Sexual dysfunction and attention-deficit/hyperactivity disorder: a systematic review of bidirectional associations. L'Encephale, advance online publication, S0013-7006(26)00084-9. DOI 10.1016/j.encep.2026.02.021. View the paper PRISMA-registered systematic review of 13 observational studies of adults, with samples ranging from 64 to 943, examining sexual dysfunction in ADHD populations and ADHD in sexual dysfunction populations. The highest reported prevalences in ADHD cohorts were 67.7% for female orgasmic dysfunction and 39% for premature ejaculation in men; in sexual dysfunction cohorts ADHD reached 34.6% in women with orgasmic disorder and approximately 42% in men with premature ejaculation against 3.7 to 5% in controls, though several studies reported no significant difference. Limitation: heterogeneity of instruments, samples and definitions prevented any quantitative pooling, and most included studies used clinic samples with self-report ADHD measures rather than structured diagnostic assessment.

 

2. Wymbs BT, Canu WH, Sacchetti GM, Ranson LM (2021). Adult ADHD and romantic relationships: what we know and what we can do to help. Journal of Marital and Family Therapy, 47(3), 664-681. DOI 10.1111/jmft.12475. View the paper Narrative review of the literature on romantic functioning in adults with ADHD, covering documented differences from adults without ADHD and the distal and proximal factors proposed to explain relationship distress. It concludes that adults with ADHD tend to have shorter and more discordant romantic relationships, that the mechanisms remain poorly understood, and that prevention and intervention research for this population is close to absent. Limitation: a narrative rather than systematic review with no pooled effect sizes, drawing on a primary literature dominated by small cross-sectional clinic samples of mostly heterosexual couples.

 

16. Wymbs BT, Gidycz CA (2021). Examining link between childhood ADHD and sexual assault victimization. Journal of Attention Disorders, 25(11), 1612-1622. DOI 10.1177/1087054720923750. View the paper Compared 97 adults with a childhood history of ADHD against 121 adults without on retrospectively reported sexual assault victimisation. Adults with a childhood ADHD history were more likely to report victimisation, particularly attempted rape or rape, and victimisation rates were not higher among those whose ADHD symptoms had persisted or who reported alcohol misuse, drug use or childhood abuse, suggesting the association does not run through those comorbid risks. Limitation: retrospective self-report of both childhood ADHD and victimisation in a young adult sample of 218, cross-sectional, with no measure of situational or perpetrator factors, so it describes an association and identifies no causal pathway.

 

Lived experience

 

5. Ginapp CM, Greenberg NR, MacDonald-Gagnon G, Angarita GA, Bold KW, Potenza MN (2023). Dysregulated not deficit: a qualitative study on symptomatology of ADHD in young adults. PLOS ONE, 18(10), e0292721. DOI 10.1371/journal.pone.0292721. View the source Nine focus groups with 43 young adults aged 18 to 35 with ADHD from the United States and Canada, analysed with interpretative phenomenological analysis. Most participants said the diagnostic criteria failed to capture their experience, and identified attention dysregulation including hyperfocus, and emotional dysregulation including rejection-sensitive dysphoria, as central symptoms that the criteria do not name. Limitation: 43 self-selected participants, 84% of them women, recruited online from two countries, so the themes describe a particular and articulate slice of the population rather than ADHD as a whole.

 

3. O'Brien M, Kini-Seery C, Kelly C, Kilbride K, Wrigley M, Nearchou F, Bramham J (2026). I felt like a burden: an exploration into the experience of romantic relationships for people with ADHD. Journal of Marital and Family Therapy, 52(1), e70097. DOI 10.1111/jmft.70097. View the source Reflexive thematic analysis of open-ended survey responses from 355 adults with ADHD describing how ADHD had negatively affected their romantic relationships. Four overarching themes emerged, including one the authors title Too Much and Never Enough: The Emotional Rollercoaster of Rejection Sensitivity, alongside difficulties with emotional regulation and with task and household management. The paper's title is a participant's own phrase. Limitation: self-selected online sample answering a question framed around negative impact, so it documents the texture of difficulty rather than its prevalence and systematically excludes accounts of relationships that go well.

 

Emerging or contested

 

10. Puszcz A, Platnikow M, Antos Z, Czech M, Kipka A (2025). Sexual functioning in individuals with attention-deficit hyperactivity disorder: a narrative review. Cureus, 17(11), e97194. DOI 10.7759/cureus.97194. View the paper Narrative review by six researchers of literature on ADHD and adult sexual functioning published from 2014 onwards, covering neurobiological mechanisms, comorbidity and pharmacotherapy. It reports that sexual dysfunction in ADHD is heterogeneous and encompasses both hypersexuality and hyposexuality, names sensory factors, attention deficits, hyperfocus and a need for frequent change as predisposing factors, and notes elevated rates of compulsive sexual behaviour disorder and problematic pornography use particularly in men. Limitation: a narrative review with no systematic search protocol, no quality appraisal and no pooled estimates, and it acknowledges that the empirical data on medication effects are limited.

 

6. van Asselt A (2026). Rejection sensitivity dysphoria: a critical reflection. Tijdschrift voor Psychiatrie, 68(3), 127-130. View the paper Critical commentary on rejection sensitivity dysphoria, a term popularised through social media in ADHD and autistic communities rather than through the research literature. It sets out four clinical risks: increased stigmatisation, an emphasis on innate rather than environmental causes, terminological confusion in interprofessional communication, and limited empirical evidence, and recommends using the established rejection sensitivity framework within a biopsychosocial and neurodiversity-affirmative approach instead. Limitation: a short opinion piece in Dutch with no new data, no systematic search and no quantitative appraisal of the evidence it describes as limited.

 

Peer-reviewed = checked by independent experts before publication. Clinical model = an established professional framework, not a single study.

 

Up next

 

Module 8 - RSD-24 — Rejection Sensitive Dysphoria and How It Lands

 

All modules in ADHD Self-Discovery

 

This is the conversation nobody starts. This course was built by clinicians who are part of the New Path family of therapy centers. Attention, desire and the medication question are all things people tell us they have never raised with anyone, and they are considerably easier to say out loud once somebody has asked first. Therapy for clients in California, coaching worldwide, all by telehealth. A conversation costs nothing and there is no pressure. Saving this for later counts too. Talk with the New Path team