ADHD & Self-Harm: High Risk for Adolescent and Young Adult Self-Harm Is Salient

Self-harm (SH) is often associated with attempts at stress relief and is commonly observed among individuals on the autism spectrum. Historically, there has been a general assumption that self-injurious behaviours are primarily seen in intellectually impaired autistic children—not cognitively able autistic adults.

However, self-harm is complex and multifaceted, frequently serving overlapping functions such as managing emotional overwhelm and meltdowns, stimming, responding to sensory overload, or occurring as impulsive, repetitive blunt trauma.

When it comes to ADHD and self-harm, however, the clinical conversation - and indeed the literature - remains limited. The extant limited research has demonstrated a significant link between ADHD and presentations of self-harm, underscoring the importance of screening, particularly for girls who present to emergency departments with self-injury, for underlying ADHD.

While much attention has been focused on girls, our clinical experience indicates that boys with ADHD also engage in self-harming behaviours. However, they are often more reluctant to disclose these experiences due to stigma surrounding male vulnerability.

A recent Australian study by Goh et al. (2024) found that boys with ADHD are at significantly greater risk of self-harm and suicidal behaviours compared to girls, revealing a notable gender disparity. The study also showed that a childhood diagnosis of ADHD around age 10 is associated with increased risk of suicidal thoughts, plans, and attempts by age 14. This relationship is partially mediated by depression and bullying at age 12, indicating critical targets for early intervention.

Our Suggestions

Screening for ADHD in Self-Harming Youth

Clinicians should actively screen for ADHD in adolescents who present with self-harming behaviours—particularly when the presentation involves impulsivity, emotional dysregulation, or chronic difficulties with peer relationships. Girls, in particular, may be underdiagnosed due to less overt hyperactivity and more internalising symptoms, while boys may underreport due to stigma.

Assessment Beyond Attention and Concentration

Diagnostic formulations for ADHD should look beyond the core symptoms of inattention and hyperactivity. Many adolescents with ADHD also experience significant emotional dysregulation, low self-esteem, rejection sensitivity, and co-occurring depression or anxiety—all of which can contribute to self-harming behaviours. Clinicians should incorporate screening for emotional symptoms, trauma history, and bullying experiences into ADHD assessments.

Support During the Transition to Adulthood

Young adults with ADHD are particularly vulnerable to self-harm during the transition from adolescence to independence. This period is often marked by increased executive demands, loss of structured support from home and school, and heightened emotional and social stress. Clinicians should remain vigilant for undiagnosed or poorly managed ADHD in young adults presenting with self-harming behaviours—especially those struggling with work, study, or relationships. Screening, ongoing psychological support, and tailored interventions that promote self-regulation and life skills are critical during this developmental stage.

Indicative References

Allely, C.S. The association of ADHD symptoms to self-harm behaviours: a systematic PRISMA review. BMC Psychiatry 14, 133 (2014). https://doi.org/10.1186/1471-244X-14-133

Lin, P.-I., Wu, W. T., Azasu, E. K., & Wong, T. Y. (2024). Pathway from attention‑deficit/hyperactivity disorder to suicide/self‑harm. Psychiatry Research, 337, Article 115936. https://doi.org/10.1016/j.psychres.2024.11593

Marsden, S. J., Eastham, R., & Kaley, A. (2025). (Re)thinking about self-harm and autism: Findings from an online qualitative study on self-harm in autistic adults. Autism : the international journal of research and practice, 29(1), 247–258. https://doi.org/10.1177/13623613241271931

O'Grady, S. M., & Hinshaw, S. P. (2021). Long-term outcomes of females with attention-deficit hyperactivity disorder: increased risk for self-harm. The British journal of psychiatry : the journal of mental science, 218(1), 4–6. https://doi.org/10.1192/bjp.2020.153

Ward, J. H., & Curran, S. (2021). Self-harm as the first presentation of attention deficit hyperactivity disorder in adolescents. Child and Adolescent Mental Health, 26(3), 269–270. https://doi.org/10.1111/camh.12471