Let’s talk about sex education for children and teens with ADHD (attention deficit hyperactivity disorder), as we get asked about it in my free Facebook sex education group for parents, that parent group.
But before we get started, I want to give you a quick refresher on what ADHD is and the traits you may see in your child or teen. This information is relevant as it affects how you will teach sex education (so they understand and remember what you say). Plus, it also gets you thinking about how their ADHD traits may affect their experiences of love, sex and relationships.
So let’s get started!
Just in case this is relevant… I also have some other sex-ed resource lists that may help you! I have a list of sex education resources for autistic children and teens as well as another for sex education resources for children and teens with FASD (fetal alcohol spectrum disorder). And another list of sex education resources for children with a disability.
How ADHD affects children and teens
ADHD is a neurodevelopmental condition, which means it relates to or involves the development of a person’s nervous system.
So what does the nervous system do? Essentially, it’s the communicator between your body and your brain. It controls your motor functions (movement), senses, thought processes and awareness and plays a part in how you learn and what you remember (memory). Your nervous system is also responsible for regulating your internal physical state, such as your body temperature. ADHD is a condition in which your nervous system has developed differently and functions differently from that of most people. It involves all aspects of how your mind and body works.
There are three recognised types of ADHD: impulsive/hyperactive, inattentive and combined.
So for children and teens, their ADHD traits may include having a short attention span and being easily distracted, making careless mistakes (like in their schoolwork), appearing forgetful or losing things, being unable to stick to tasks that are tedious or time-consuming, appearing to be unable to listen to or carry out instructions, constantly changing activity or task, having difficulty organising tasks, being unable to sit still, especially in calm or quiet surroundings, constantly fidgeting, being unable to concentrate on tasks, excessive physical movement, excessive talking, being unable to wait their turn, acting without thinking, interrupting conversations, and little or no sense of danger. CHADD in the USA has two parent guides. One on parenting a child with ADHD, which includes parenting tips and things to consider. And another on parenting teens with ADHD. This one is more useful as it talks about how the pattern of ADHD traits may change for tweens and teens, as well as the challenges they face in regard to school life, social functioning and home life. Plus, it has parenting tips in regard to behaviour management, driving, medication, boosting their confidence, disclosing their ADHD diagnosis and their future.
The most important thing to remember (especially if you have more than one child with ADHD), is that ADHD affects everyone differently. So the traits your child has and how they affect them will be unique for them.
Sexual outcomes for children and teens with ADHD
In this section, we are going to look at how ADHD can affect sexual behaviours in teens and young adults. I am going to refer to Dr Russell Barkley’s summary of what we know from the research about risky sexual behaviour and ADHD (current as of September 2023). Dr Barklay is a neuropsychologist, and an influential researcher in ADHD. He is now retired but still keeps abreast of what’s happening with ADHD, and continues to be an advocate for families and people with ADHD.
So, let’s have a look at what Dr Barkley has to say about what research is telling us about sexual behaviour and ADHD. (Or you can watch his video instead.)
What the research tells us
The incidence of sexual dysfunction is no different for people with ADHD (than for people without ADHD). He does refer to one research paper, that suggests that people with ADHD may be more predisposed to premature ejaculation, but more research is needed.
Children with ADHD may be sexually active from a younger age than their peers (possibly earlier if they have a conduct disorder). They also have more lifetime sexual partners than someone without ADHD and are more likely to have casual sex as well as extramarital affairs (sex outside of a committed relationship). They are less likely to use contraception and are more likely to have an unintended pregnancy. They also have a much higher risk of contracting a sexually transmitted infection (STI). They are more likely to be a first-time parent before age 21.
Dr Barkley suggests that this is probably related to impulsiveness, low conscientiousness, and the lack of regard for future consequences that predisposes them to these early risks of pregnancy and having a child at a younger age. He also feels these risks are exacerbated by other disorders like conduct disorder and substance use disorders, alcohol in particular. Research also shows that over half of these teens don’t have custody of that child, as it is either being raised by grandparents or placed for adoption. He suggests this is partially because they are still children and less mature than their peers (because of their executive functioning).
The 30% Rule. When you have an adolescent with ADHD, Dr Barklay suggests you should think of their executive functioning as being up to less than 30% of their chronological age. So a six-year-old may only have the executive functions of a four-year-old, a nine-year-old may only have the executive functions of a six-year-old, a fifteen-year-old may only have the executive function of a 10-year-old, and an eighteen-year-old may only have the executive function of a twelve-year-old.
This is helpful to know because, for most adolescents, the brain is fully developed by their mid-twenties. But if you have ADHD, your brain won’t be fully developed until much later, in your late twenties.
Research also shows that by the age of 27, just over half of young adults with ADHD will have children, which shows a continuation of this pattern of risky sexual behaviour into adulthood. Overall, there is a clear pattern for all sexes to show a pattern of riskier sexual behaviour. And for females, there is a greater risk of sexual victimisation (this includes child sexual abuse, unwanted sexual touching, sexual assault and rape).
My thoughts on the research
My thoughts on this. Yes, this is alarming in regard to the sexual future of children with ADHD. But I want to point something out to you. Most children don’t receive sex education at home, let alone school. So, my educated guess is that most of this research is based on children who missed out on sex education and didn’t have an adult to talk with about love, sex, and relationships as they grew up. And research tells us that riskier sexual decisions are made when kids are left uneducated.
Something I’ve noticed over my years of working in sexology is that sex education protects children and helps them to make better sexual decisions. And the kids making risky sexual decisions? Nine times out of the, they were the kids who didn’t have sex-ed conversations with their parents.
So sex education is your opportunity to have a positive impact on your child’s future! And please don’t underestimate the power of your sex-ed conversations. Every word you say counts. Even the ones where all you get is an eye roll 🙄 or a grunt in return!
Sex education when your child has ADHD
Let’s look at how sex education may be different when a child has ADHD.
Before puberty, it isn’t really any different when your child has ADHD. Other than ensuring they have a good understanding of consent and body safety before their teens. And you will want to have already started talking to them about porn and create family rules about internet safety. If you can manage this, it will make sex education easier once puberty starts and they become adolescents. Teens are more likely to accept boundaries around the internet and sexuality when there are rules they are already familiar with. I also have resources to help you with talking about porn and establishing internet safety rules.
Puberty is when it all begins to change.
Why?
Because puberty is when your sex-ed conversations are more about sex. Puberty will start to change your child’s body from a child to an adult and make them fertile and capable of creating a new life. It will also rewire their brain so they become more interested in sex. They’ll have sexual feelings, masturbate because of sexual feelings, start having crushes and finally start thinking about sex as something they may want to do (unless they are asexual). So, conversations are needed to support healthy sexual development and to prevent risky sexual behaviour.
What parents can do (about the research)
So far, we’ve looked at what the research tells us about the sexual outcomes for children and teens with ADHD. And it is a little scary!
But you aren’t helpless. As there are things you can do (as a parent) to change your child’s future. As sex-ed conversations will actually protect your child and prepare them for a sexual future.
And that is what we are now going to talk about: what you can do to support your child to have a healthy sexual future.
So, we are going to return back to Dr Barkley’s summary of what we know from the research about risky sexual behaviour and ADHD. As he doesn’t just scare you with what the research has to say. He also has eight common-sense recommendations for parents on what they can do to prevent these outcomes for their young person with ADHD. Sadly, very little research has evaluated ways to improve sexual outcomes for young people with ADHD, and there are only a couple of studies on the impact of medication in changing sexual behaviour.
So, let’s have a look at Dr Barkley’s eight recommendations for parents. (Or you can watch his video instead, his recommendations start at 9:44 minutes.)
1. Parents should be informed and talking
Dr Barkley’s first recommendation is that parents should be educated about the risks a young person with ADHD faces (unintended pregnancies, STIs, sexual victimisation). And that these risks increase when alcohol is involved. He also reminds us that professionals who work with children should be more aware of these risks so that they, too, can have conversations with young people who have ADHD.
My suggestion is that sex education should start from a young age for children with ADHD. So all of the usual sex education topics, and making sure they know the correct names of their private body parts as well as fully understand consent, their feelings, body safety, where babies come from as well as how babies are made, internet safety (including porn), and that puberty will be happening in their future. Plus, do start sharing your sexual values when appropriate. (If this is overwhelming, check out my parent masterclass, a beginner’s guide to sex education.)
As puberty begins, you should talk more about consent, body safety, online porn, sexting, sexual feelings, masturbation, crushes and liking someone, peer group pressure, how a pregnancy happens and also sex. Sharing your sexual values is super important, as well as placing firm boundaries so you can keep them safe but still allow them to thrive and become independent.
As your child becomes a teenager, you should start to talk more about dating, sexual consent, sexual decision-making, being ready for sex, contraception, safe sex, peer group pressure, the effect of alcohol and drugs on decision-making, pornography, sexual attraction and sexual activities. I also think your child needs to understand the sexual outcomes of ADHD and how their ADHD behaviours may affect their ability to make safe sexual decisions. Knowledge empowers teens to make smart sexual decisions.
Don’t forget the 30% rule. Your teen with ADHD may start to look like an adult, but they still have the executive function of a child.
2. Parents should be supervising social and dating activities
Dr Barkley’s second recommendation is that parents should be supervising their teen’s social and dating activities.
My suggestion is that you encourage them to socialise at home. Make their friends (regardless of their gender) welcome in your home, and encourage your child to invite them over. Try suggesting things like a pizza and movie night at your place, or tenpin bowling on a Saturday afternoon where they bowl, and you discretely supervise from the cafe, or a gaming afternoon around your kitchen table (and you’ll provide treats). Getting them to hang out at your house means you know where they are and what they’re up to.
Offer to drive and pick up them and their friends so you get to know their friends better, but it also provides you with an opportunity to gauge how your child behaves when with peers. It’s also a good opportunity to discover what’s happening in their social world. Turn on some music (so they don’t feel that you are listening in), stay out of their conversation (so no asking questions or commenting), and they’ll usually start talking. And you can listen in!!!!
Start talking about dating early. Be curious about what their friends are up to regarding romantic relationships, and explore what dating and having a crush on someone may mean. I think it is also super important to talk about what other teens are up to and ensure they have a realistic understanding of what they are up to. Explain that many teens will brag and exaggerate about their dating and sexual activities as they are trying to look more mature and grown up. (The SSASH Survey has the latest research on the sexual behaviours of teenagers.)
If you get a whiff of a romantic relationship developing, be curious and explore what this new relationship means to them, and listen more than talk. And if you are already welcoming their friends into your house, extend this also to include a romantic partner.
3. If dating, encourage them to date with a group of friends
Dr Barkley’s third recommendation is that parents delay allowing their teens to go out on dates as a couple (as in just the two of them alone). Instead, they should encourage more group dating situations, where parents can discretely supervise a group of their peers on a date.
I suggest being curious if they start talking about ‘liking someone’. Don’t be judgemental or tell them what to do. Just listen, ask some questions, and gently try to explore what’s going on and how they feel about it. Try suggesting that they go out as a group of friends initially rather than start dating.
If you haven’t already thought about dating, then now is the time to start thinking about how to handle it. You will also need to be talking about sexual readiness, safe sex, contraception, sexual consent and respectful behaviour.
Don’t forget the 30% rule. Your teen with ADHD may start to look like an adult, but they still have the executive function of a child.
4 & 5. Parents should educate teens about sex, the risks they face and contraception
Dr Barkley’s fourth and fifth suggestion is that parents should be talking directly with their teens about sexual behaviours, risky sexual behaviours and contraception.
I agree, as teens can’t make smart decisions about something that they know nothing about. Information isn’t permission to be sexual. It simply empowers them to make smart sexual decisions. But you need to be super careful that this doesn’t become a scare tactic (as that won’t work).
Start talking more about dating, sexual consent, sexual decision-making, being ready for sex, contraception, safe sex, peer group pressure, the effect of alcohol and drugs on decision-making, pornography, sexual attraction and sexual activities. I also think your child needs to understand the sexual outcomes of ADHD and how their ADHD behaviours may affect their ability to make safe sexual decisions. Knowledge empowers teens to make smart sexual decisions. I have resources for talking about these things in my sex education lists for 13 year olds, 14 year olds, 15 year olds, 16 year olds, 17 year olds, and 18 year olds.
Try different strategies to talk with your child to make your conversations more natural. Sex education books are also a useful resource for ensuring they get accurate information.
Don’t forget the 30% rule. Your teen with ADHD may start to look like an adult, but they still have the executive function of a child.
6. Talk about how alcohol use increases risk
Dr Barkley’s sixth suggestion is that parents should be talking with teens about how alcohol will increase the possibility of making risky sexual decisions, as well as making them vulnerable to sexual victimisation.
I suggest that you find lots of teachable moments for starting conversations about consent, sexual assault, alcohol and also drugs. If you are watching a movie or television with your teen, use it as an opportunity to talk about how alcohol and sex usually result in making decisions you may regret. If comfortable, share stories of your own experiences as a young person.
If they are taking medication for their ADHD, you will need to find out how it is affected by alcohol and other drugs (illicit, prescribed and over-the-counter). If it isn’t safe, discuss this with your teen so they know what to expect and why they shouldn’t.
I also think it is important to talk about stimulant medication and how it can be a coveted drug for people without ADHD. In people who don’t have ADHD, stimulant medication produces an excess amount of dopamine, which gives them feelings of euphoria and increased energy levels. So if people know they have this medication, they may ask for it or offer to buy it from this. If they do this, they are breaking the law and could be charged with distributing drugs. They will probably also lose access to their ADHD medication, which will then have a huge impact on their daily life. The implications of this are very serious. So talk about it before it happens and help them work out how to respond in a way that is saving face.
7. Medication management to reduce impulsive conduct & increase self-control
Dr Barkley’s seventh suggestion is that parents consider ADHD medication, as studies are suggesting they will reduce the risk of unintended pregnancy by reducing impulsive behaviour and improving their ability to regulate their behaviour.
ADHD medication is a personal decision. Some parents allow it to be prescribed, whereas others won’t. You know your child best, so monitor their ADHD traits and if you notice them escalating or changing (in a detrimental way) as they go through adolescence, then it is something you may have to consider. So weigh up the pros and cons, and decide what is more important.
My suggestion is to talk to your child’s treating doctor about how ADHD medication may help your teen’s behaviour as they go through adolescence. And get a second opinion if you need to. If your child is already on medication, monitor their behaviour and see if you can notice when they haven’t taken their medication if the effects have worn off. Spotting this and sharing it with your child and explaining the changes you see in their behaviour may be helpful for them. Sometimes, we don’t notice our own behaviour until someone points it out to us.
Talk with your child about how important it is to take their medication as prescribed. Encourage them to take notice of their body and when the effects of their medication are wearing off. Medication is very personal, and what works for one person may not for another. So it’s important that they start listening to their body so that they can manage their medication in the most effective way.
8. Consider HPV vaccination
Dr Barkley’s eighth suggestion is that parents consider human papillomavirus vaccination (HPV) to reduce their teens future risks for cervical cancer (for people with a uterus), and throat and rectal cancers (for all people).
I agree, as the HPV vaccination is an important vaccine for all teens (regardless of whether they have a cervix or not). It will protect them against genital warts and most types of cervical cancer. It also protects against cancer of the vagina, vulva, penis or anus caused by HPV. The HPV vaccine also protects against mouth, throat, head and neck cancers caused by HPV.
Children’s books (about sex education)
There aren’t any sex education books that have been written for children with ADHD. And honestly, I’m not surprised as I don’t think they need a separate (or special) book that has been written just for them. Any sex education book will do, and there are quite a few (sorted into ages and/or topics) in this list of sex education books for children. These are all books I’ve personally reviewed, and each book has a video where I show you inside the book.
Now, something that has surprised me is that there isn’t a sex education book for teens with ADHD. A book that talks about how ADHD may affect sexual pleasure as well as love, sex and relationships. Something that talks about how their symptoms of ADHD may make them more vulnerable to sexual victimisation. I will keep my eyes open for something, and if I find it, I’ll include it in this blog post.
Now, something I did find was some sex and relationship books for adults. I’ve spent a couple of hours looking through them, and I’m not that impressed with what I’ve seen. But I have ordered two sex books for adults with ADHD, so if I think they are any good, I’ll include them in this blog post.
Sex ed resources for children and teens
I’m sorry, but I haven’t found any sex education resources targeting children and teens with ADHD. There are some sex education resources for autistic children and teens that you can adapt, as many of them are also created for neurodivergent children. And there are even more in my sex education resources list for children and teens with a disability.
Sex ed resources for parents of kids with ADHD
Child development and ADHD
Ages & stages of ADHD. ADDitude from the USA has a special report on the ages and stages of ADHD. I think it is useful as it provides a timeline of essential skills at each phase of life, plus parallel ADHD-related challenges and expert strategies that span academics, relationships, emotions, organization, and beyond. There is a guide for children aged 6 to 12 years, teens aged 13 to 17 years, and young adults aged 18 to 24 years.
Developmental milestones. Understood in the USA, has extensive guides on developmental milestones for kids with ADHD, which include physical, cognitive, social and emotional milestones. You will find lists for 1 to 2 year olds, 2 year olds, 3 year olds, 4 year olds, 5 year olds, first graders, second and third graders, fourth and fifth graders, middle schoolers and high schoolers.
Sex education of children and/or teens with ADHD
Sex education. From Parenting ADHD & Autism in the USA, a podcast interview with Dr Ari Tuckman where they talk about relationships, sex and teens with ADHD.
Dating & teens. From Understood in the USA, a blog post on how to help your teen with ADHD to avoid dating trouble spots, to stay safe and for dating to be a positive experience.
Love & teens. From Understood in the USA, a blog post about ADHD and falling in love, and how parents can support their teen to handle the ups and downs of being in love.
Puberty. The In It podcast from Understood in the USA, has a 36-minute podcast episode about ADHD and puberty and what to expect. I was quite impressed with the range of topics they talk about!
Puberty. Some blog posts from ADDitude in the USA, about how puberty affects ADHD symptoms and what parents of boys should watch out for as their son passes through puberty.
Porn & teens. From ADDitude in the USA, a blog post about porn and teens and how to factor in ADHD.
Queer teens. From Understood in the USA, a blog post that will help parents support their LGBTQIA+ child and start talking about gender, sexuality and neurodivergence.
Risky decision making and teens. A blog post from ADDitude in the USA, about increased risky behaviour in teens with ADHD. As teens with ADHD are at a higher risk for car crashes, substance use disorder, teen pregnancy and self-harm, they explain how proper medication use can dramatically lower their risks.
Sex and intimacy when you have ADHD
Sex & ADHD. The International Society of Sexual Medicine (ISSM) has an evidence-based blog post about how ADHD may affect sexuality and what you can do to achieve a fulfilling sex life.
Sex & ADHD. An informative blog post that talks about how ADHD can affect your sex life. What I like about this blog post is that they look at the different symptoms of ADHD and then explain how it can affect sexual desire, arousal and orgasm. As a parent, it will give you insight into some of the issues your child may one day face.
Sex. A blog post from ADDitude in the USA, on how parents can talk to teens about sex mindfully.
Sex and intimacy. The ADHD Aha! podcast from Understood in the USA, has a 15 minute episode on sex, intimacy and ADHD with Catie Osborne (also known as Catieosaurus), a sex therapist who talks about ADHD and intimacy on TikTok .
Sex and ADHD. An ADHD Guide from WebMD, about how ADHD can affect your sexual relationships.
Resource List
Sex, relationships, gender & more. Joseph Falkner, a speech-language pathologist from Flexible Mind Therapy in the USA has the most extensive list of resources I have ever seen. I don’t think it’s been updated though since 2020, but despite this it is till a very extensive list! You’ll also find resources for autistic children (as well as for children with ADHD) so keep scrolling down the list if the ADHD resources aren’t at the top.. There are resource lists on Relationships, Sexuality, and Gender Identity, another for Women and Girls, as well as Parenting Individuals with Neurodiversities.