ADHD & Risky Behavior
People with ADHD have been found to partake in risky behavior, such as substance use, dangerous sexual behaviors, reckless driving, and unsafe stunts at higher rates than their neurotypical peers . When engaging in a risk, both neurotypical and neurodivergent people conduct individualized risk assessments to evaluate how likely a negative outcome is and whether a potential benefit outweighs it. There are a number of factors that are understood to connect risk-taking and ADHD, including comorbid behavioral disorders, executive functioning and decision-making issues, sensation-seeking, peer pressure, insufficient parental observation, and hesitation to partake in challenging tasks .
Weber’s Behavioral Decision Theory is a version of psychological risk-return theory that describes the choice to engage in risk-taking behavior as involving an analysis regarding potential positive and negative outcomes as they are perceived subjectively by the individual . There are also attitudes towards these perceptions of risks and benefits that affect the amount of weight we attribute to each when deciding whether or not to actually engage in the action . Whether an individual perceives risk or benefit with more weight will ultimately factor into the frequency with which they make the choice to partake in or avoid risky behavior . Some factors specifically associated with ADHD have been found to have a differential effect on judgment concerning risky behavior, including previous experiences and feedback from them, the individual’s emotional state, time between the point of decision-making and the actualization of the outcome, sensation-seeking as a personal trait, and the level of control .
Studies have found that predominantly hyperactive and impulsive people with ADHD engaged more frequently in risky behaviors than those who were predominantly inattentive, supporting other research which associates these attributes with behaviors like substance use . Sensation-seeking, defined as “a tendency to pursue intense novel and complex experience, despite the risk of suffering physical and nonphysical damages,” has been largely attributed to a continuous state of under-arousal and boredom-evasion, prompting a pursuit of positive and rewarding stimulation . People with ADHD may therefore weigh the potential benefits of a risky decision more heavily than its risks because they seek the rewarding stimulation more than they fear the possible negative outcomes .
People with ADHD who engage in risky behaviors often feel guilt or shame due to the realization of negative results. But ADHD brains have patterns of cognition that idealize outcomes and skew the individual’s assessment of risk, so it makes sense for expectations and reality to not always align. If you or your loved ones are concerned about your engagement in risky behaviors, consulting with a specialist may help you identify ways to address these patterns. Stimulant medication often prescribed to treat ADHD has been shown to reduce the risk of engaging in risky activities like the use of substances, car accidents, crime, conduct issues, and aggression, and behavioral treatment has demonstrated similar results . A variety of resources exist to help address risk engagement for people with ADHD, and a specialist may be able to help you identify the one that is right for you.
 Haack, Lauren & Maliken, Ashley. (2020). “Risky Behaviors Associated with ADHD.” Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
 Shoham, Rachel; Sonuga-Barke, Edmund; Yaniv, Ilan; Pollak, Yehuda. (2021). “What Drives Risky Behavior in ADHD: Insensitivity to its Risk or Fascination with its Potential Benefits?” Journal of Attention Disorders, 25(4). DOI: 10.1177/1087054720950820
 Shoham, Rachel; Sonuga-Barke, Edmund; Yaniv, Ilan; Pollak, Yehuda. 2021. “ADHD Is Associated With a Widespread Pattern of Risky Behavior Across Activity Domains.” Journal of Attention Disorders, 25(7). DOI: 10.1177/1087054719875786
 Spiegel, Tali & Pollak, Yehuda. (2019). “Attention Deficit/Hyperactivity Disorder and Increased Engagement in Sexual Risk-Taking Behavior: The Role of Benefit Perception.” Frontiers in Psychology, 10(1043). DOI: 10.3389/fpsyg.2019.01043