Research Recap with Skye: Childhood pain and ADHD

Summary

Hacking Your ADHD - Research Recap with Skye: Childhood Pain and ADHD

Host: William Curb
Guest: Skye Waterson
Date: January 16, 2026

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Episode Overview

In this episode of the "Research Recap" series, William Curb and Skye Waterson deep-dive into a large-scale research study examining whether kids who are later diagnosed with ADHD have higher rates of pain-related medical visits before their diagnosis. The conversation unpacks the study's findings, discusses the complex relationship between pain and ADHD, and reflects on the implications for parents, practitioners, and those living with ADHD.

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Key Discussion Points and Insights

1. Study Design and Scope

• Topic: Childhood pain diagnoses before ADHD is officially identified.
• Research Paper: “Pain Associated Diagnosis in Childhood before the Diagnosis of ADHD”
• Study Size:
  • Initial population: 700,000+
  • Final sample: ~19,000 children diagnosed with ADHD, 37,000 controls.
• Design: Population-based case-control study conducted in Israel.
• Variables Controlled: Socioeconomic status, ethnicity, religious background, access to care.

"They looked at over 700,000 people… narrowed it down to like, almost 19,000 children who were diagnosed with ADHD and then 37,000 who were not to be the control group." — William Curb [01:40]

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2. Types of Pain Investigated

The study looked at a broad range of pain experiences before ADHD diagnosis, including:

• Headaches and migraines
• Eye, ear, and throat pain
• Abdominal pain
• Limb pain (legs, knees, ankles, joints)
• Sprains and injuries

"There were headaches, migraines, eye pain, ear pain, throat pain, abdominal pain, various kinds of pain in your leg, your knees, your ankles, your joints, sprains..." — Skye Waterson [02:58]

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3. Major Findings

Statistically Significant Patterns

• Rates of Pain-Related Medical Visits:
  • 50% higher for headaches
  • 30% higher for ear pain
  • 14% higher occurrence of prior abdominal pain diagnoses
  • 35% higher for limb pain
  • 40% higher for joint pain

"They were about 50% higher for headaches or 30% higher for ear pain...all of these things had at least some level of having more likely to have... needing more pain management." — William Curb [03:32]

• The results were both statistically and clinically significant.
• These diagnoses occurred prior to ADHD being recognized, ruling out bias from already knowing a child had ADHD.

"The interesting thing about this was this was prior to the ADHD diagnosis... these people did not know that they had ADHD until later." — Skye Waterson [04:13]

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4. Interpreting the Pain/ADHD Connection

Subjectivity & Challenges of Measuring Pain

• Pain is subjective and hard to measure—some children may be dismissed as "acting out."
• It can be easy for both parents and medical professionals to overlook pain if no visible injury exists.

"A lot of people with chronic pain are kind of ignored... unless there's like a wound, it's hard to tell that there's something wrong." — William Curb [05:21]
"It's very subjective." — Skye Waterson [05:39]

Theories for the Overlap

• Neurodevelopmental Differences:
  Children with ADHD may have brains that process pain differently.
• Neuroinflammation as a Common Factor:
  Ongoing research into whether inflammation affecting the brain might also affect pain sensitivity.
• Sensory Processing:
  ADHD brains can have lower thresholds for sensory input, making it harder to ignore discomfort.
• Behavioural Factors:
  Impulsivity in ADHD can lead to more injuries (e.g., falls, sports trauma).
• Diagnosing Challenges:
  Could pain distractibility be misinterpreted as inattentive ADHD?

"There was some postulation about neurodevelopmental changes in the brain that could be affecting it..." — Skye Waterson [05:50]
"It's harder for people with ADHD to ignore incoming sensory information. And so pain is going to be at the forefront of our brain more." — William Curb [07:38]

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5. Practical and Clinical Implications

Recognizing Red Flags

• Frequent pain-related visits may be a clue for clinicians and parents that a child should be assessed for ADHD.
• Not meant as a diagnostic tool, but potentially an early warning sign.

Impact on Life and Diagnosis

• Experiences of pain could cause or worsen inattention and other behavioral symptoms.
• Pain and emotionality: Kids with ADHD often feel emotions (and pain) more intensely.

"You can be like kids in pain, they're not being, especially kids with ADHD, they're not being dramatic. That is probably more likely... not something for diagnostic, but a red flag." — William Curb [10:35]

Chronic Injury Accumulation

• Childhood injuries due to ADHD impulsivity may cause lingering chronic pain into adulthood.

"If you're doing enough damage to yourself as a child that it can keep lasting. ... I have a lot of these things that, you know, continue to cause me pain years later." — William Curb [09:17]

Subjectivity and Validation

• Pain is personal and subjective, making it easy to overlook or invalidate someone’s experience.
• Raising awareness is key so families know what to look for and advocate for care.

"It's very subjective. It's very much somebody else's personal experience, which makes it very hard to measure. And one of the reasons that we wanted to bring it up here today..." — Skye Waterson [09:53]

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6. Notable Quotes & Memorable Moments

| Timestamp | Quote | Speaker | |-----------|-------|---------| | 01:40 | "They looked at over 700,000 people… narrowed it down to like, almost 19,000 children who were diagnosed with ADHD and then 37,000 who were not to be the control group." | William Curb | | 03:32 | "They were about 50% higher for headaches or 30% higher for ear pain...all of these things had at least some level of having more likely to have… needing more pain management." | William Curb | | 04:13 | "The interesting thing about this was this was prior to the ADHD diagnosis... these people did not know that they had ADHD until later." | Skye Waterson | | 05:21 | "A lot of people with chronic pain are kind of ignored... unless there's like a wound, it's hard to tell that there's something wrong." | William Curb | | 07:38 | "It's harder for people with ADHD to ignore incoming sensory information. And so pain is going to be at the forefront of our brain more." | William Curb | | 10:35 | "You can be like kids in pain, they're not being, especially kids with ADHD, they're not being dramatic... maybe this is a... red flag. Oh, this kid gets in, is hurt a lot." | William Curb |

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7. Key Takeaways

• There is a clear association between increased medical visits for pain and a later ADHD diagnosis in children, especially for headaches, limb pain, and joint pain.
• The reason for this relationship remains unclear—possibilities include biological brain differences, heightened sensory sensitivity, emotional intensity, and behavioral factors like impulsive injuries.
• Awareness of this connection is important for parents, educators, and clinicians to avoid dismissing or overlooking pain in children—especially those who may be evaluated for or living with ADHD.
• Further research is needed to understand the mechanisms, but being alert to patterns of pain may aid early intervention.

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8. Resources

• Further ADHD resources and support available at unconventionalorganization.com.

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Episode Tone:
Warm, conversational, curious, and supportive. Both William and Skye share personal insights and remain respectful of the complexity and subjectivity of both ADHD and pain experiences.

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For listeners new to the topic:
This episode is an excellent, accessible entry point for understanding the under-recognized link between childhood pain and the ADHD experience. It offers practical context, validation, and jumping-off points for further exploration.

Transcript

[William Curb]

Welcome to Hacking youg adhd. I'm your host, William Curb, and I have adhd. On this podcast, I dig into the tools, tactics and best practices to help you work with your ADHD brain. Today I'm joined by Sky Waterson for our Research Recap series. In this series, we take a look at a single research paper and dive into what the paper says, how it was conducted, and try and find any practical takeaways. In this episode, we're going to be discussing a paper called Pain Associated Diagnosis in Childhood before the Diagnosis of adhd. So what we're going to be looking at is exactly what the paper's talking about. Did kids who eventually did get diagnosed with adhd, did they show higher rates of pain related medical visits before their ADHD diagnosis? And this is kind of an important question to ask because around a quarter of chronic pain patients are also diagnosed with adhd. All right, let's get into it.

[Sky Waterson]

Yeah. So this paper is so interesting because it's about the pain diagnosis before the adhd. And they looked at this, you know, they looked at a lot of different kinds of pain, so headaches, multiskellular pain, they looked at tension headaches, all those kinds of things in, in kids specifically. What they were looking for was, you know, they wanted to see comprehensively if people were, you know, who were later diagnosed as having adhd, were getting medication for this kind of thing or getting, you know, support for this. And it was a population based case control study. So a lot of members got included in the overall group.

[William Curb]

Yeah. Because they looked initially at over, like they looked at. Yeah. Over 700,000 people. Yeah, yeah. But then they, like, narrowed it down to like, almost 19,000 children who were diagnosed with ADHD and then 37,000 who were not to be the control group.

[Sky Waterson]

Yeah. So this was a big study.

[William Curb]

Yeah. And they had a lot of data to kind of really tease out what they were seeing.

[Sky Waterson]

Yeah, yeah. In terms of both what they were seeing with the pain, but also different experiences of pain, which I think is useful to know because, you know, pain is, is. It comes in many forms and it's not something I've personally experienced, but it is something that, like you said, is very common with adhd.

[William Curb]

Yeah. And it's also something that they, like, you really do have to control for because they, you know, had to grow for, like, socioeconomic status. Because one of the things you're going to be going in to get more treatment for pain if your parents have the money for it. And like, just, you know, because also this Was the study was done in Israel. So they have more of a homogeneous population there. So that. But they still have to control for things, you know, like their ethnic background and religious. Like, you know, how were you raised? What. How does that change if you're going to get treatment?

[Sky Waterson]

And so to give you a sense of some of the different pain things that they looked at, there were headaches, migraines, eye pain, ear pain, throat pain, abdominal pain, various kinds of pain in your leg, your knees, your ankles, your joints, sprains, which was interesting because that one, you know, you see more in kids who fall over and do things. So what did they find? You know, Cause this is kind of a con. Continuation of our strange things you didn't know were connected to ADHD conversation. So what did they find?

[William Curb]

They were about 50% higher for headaches or 30% higher for ear pain. Um, and so, yeah, all of these things had at least some level of having more likely to have. Needing more pain management. Yeah, I think that that is an important caveat here. It's not, we're not experiencing more pain. We're requiring more pain management. So, I mean, that does imply more pain because, you know, if we're getting treatment or getting, you know, ibuprofen or something over the counter, that, that, that does imply that there's more pain happening. But what we're really looking at is not the level of pain, but level of pain management.

[Sky Waterson]

Yeah, yeah. And it was interesting because when they looked at this, overall, they found that, you know, not only significantly, statistically significant associations between ADHD and a whole range of pain, but also clinically meaningful effect sizes. Children diagnosed ADHD had a 14% higher occurrence of prior abdominal pain diagnoses. 35 of limb pain, 40% joint pain. Yes. So they were finding a lot of different experiences, which, you know, it's quite significant. And again, the reason, because there was a lot of. There was a lot to be to be clear, there was a lot of studies on ADHD and pain. But one of the things we're always trying to do is we're trying to find the best study to bring to this conversation to have with you guys. The interesting thing about this was this was prior to the ADHD diagnosis, so often when we're having this conversation, people would say, oh, well, you know, if you, if you have adhd, you know, people could say a lot of negative things about, you know, now you've got this diagnosis, maybe you think you have this, et cetera, et cetera. But these people did not know that they had ADHD until later.

[William Curb]

Yeah, it was one of those. And this also plays into the. A lot of people with chronic pain are kind of ignored. And because pain is one of those things you, like, unless there's like a wound, it's hard to tell that there's something wrong.

[Sky Waterson]

Yeah, it's very subjective.

[William Curb]

Yeah, it's, you know, like, oh, you're just acting out to get attention. And this is like. No, these. This was a consistent thing where they needed to get management for it.

[Sky Waterson]

Yeah, yeah, yeah. And so then the question becomes, is there an interplay between ADHD and pain? And, you know, there was some postulation about neurodevelopmental changes in the brain that could be affecting it. Because we do know that ADHD is, you know, something that is physically affecting the brain. And so there's possibility that it is also affecting the way that the brain experiences pain, which was very, very interesting.

[William Curb]

Yeah, well, because when we think of it as neurodevelopmental, like, that means that how our brain is developing is different. But how your brain develops can also predict how the rest of your body is going to develop. And if you're having these things where you're like, oh, maybe where more sensitive to pain because of how this development happens, you know, and that could be something that we grow out of or don't at this point. We don't know, but it is. And it's something that. Is that we can think about.

[Sky Waterson]

Yeah, exactly. The other theory that they had, which was a forefront theory, was neuroinflammation as a common denominator for ADHD and altered pain perception. But again, these are all theories. Like, this paper doesn't have any understanding of why this is happening. It doesn't even understand necessarily what's coming first, just that it was able to study these two things separately. And so we're left in a space where, in terms of takeaways and understanding, there does seem to be a connection. Like I said, we didn't talk about it here, but there are a lot of papers on this topic that do discuss the connection between ADHD and pain and experiences of pain. But in terms of why that's still. The jury's still out on that.

[William Curb]

Yeah. And I could definitely also say, just like, you know, the idea of, like, we have more sensory issues, it's harder for people with ADHD to ignore incoming sensory information. And so pain is going to be at the forefront of our brain more. We're not going to be able to ignore it like a neurotypical person would and so then are going to need more management for it.

[Sky Waterson]

Yeah. And sometimes we are going, you know, except in the case of hyperfocus, where if you are hyper focusing, you might, you know, fall over, spray your scalp and not notice until later. You know, there's. There's also that kind of. What. What do they call it? Like, the attention is kind of random, if that makes sense. Like, where you're paying attention. And there's also conversations that could be had around. Well, if you're experiencing a lot of pain in childhood, could that make it harder for you to focus? Could that be picked up as adhd? It does depend on how you're testing the adhd. Like, you would assume a clinical diagnosis of ADHD would be testing for that kind of thing and rolling it out as part of the process. But I imagine that that would come up as a potential conversation as well.

[William Curb]

Yeah. Oh, and one other aspect of the pain that I was just popping is. Yeah. Also the. If you're doing enough damage to yourself as a child that it can keep lasting. Whereas, like. Oh, yeah, I'm, you know, because I've done an AC separation on this shoulder. I've dislocated this shoulder five or six times, torn my quad. I've twisted both my ankles. I won to the point where the doctor was like, oh, this would be much better if you had broken it. And I'm like. Because it pulled the tendon so tight it chipped the bone.

[Sky Waterson]

Yeah.

[William Curb]

So I'm like, I have a lot of these things that, you know.

[Sky Waterson]

Yeah.

[William Curb]

Continue to cause me pain years later because.

[Sky Waterson]

Yeah.

[William Curb]

And so. And a lot of those probably happened because of being very impulsive. Some of them did not. We're not quite impulsive. Just sports injuries.

[Sky Waterson]

But so there's a. It's a complicated relationship. And I think also, you know, if you. If you are experiencing pain, like. We are not. We are not chronic pain, Havers. At least I'm not. I assume we haven't talked about.

[William Curb]

I have old injuries, but not like any condition that causes chronic pain.

[Sky Waterson]

Yeah. So your experience and how you experience it is probably going to be very different. And I mean, this is exactly the conversation about pain that we started right at the beginning is it's very subjective. It's very much somebody else's personal experience, which makes it very hard to measure. And one of the reasons that we wanted to bring it up here today because, like, so many things, I mean, the purpose of having these conversations is so that someone can listen to this and be like, oh, my gosh I had no idea because you're not, you know, scrolling the Internet for new academic papers on ADHD all the time. So we wanted to bring this to you so that you had something and maybe this would be like a beginning of a, a journey that you go down and look into a little bit more deeply.

[William Curb]

Yeah. Because you can be like kids in pain, they're not being, especially kids with adhd, they're not being dramatic. That is probably more likely that even the kids that are not diagnosed, maybe this is a. Not something for diagnostic, but a red flag. Oh, this kid gets in, is hurt a lot. Yeah. Maybe something worth looking into and that, you know, thinking like, oh yeah, maybe we're processing things different and that's why we're doing it could be sensory aspect, it could be the emotional aspect where a lot of people with ADHD experience their emotions a lot more strongly and pain brings up a lot of emotions.

[Sky Waterson]

Yeah.

[William Curb]

It can also be, you know, disruptive for sleep.

[Sky Waterson]

There's a lot that is very true.

[William Curb]

That this paper suggests to look into because while we don't have like the definition behind it's like, oh, this could be very. Why they're distractible, why they're irritable, why they're oppositional.

[Sky Waterson]

Yeah, yeah, 100%. So hopefully this is a good start for a lot of people. This conversation foreign. Hello. So you were just listening to a research recap. I'm Skye Waterson of Unconventional Organization. If you like that, there's lots more information about ADHD and support for you at unconventionalorganization.com you can go ahead and check that out. Lots of free resources, lots of strategies, and if you want to join our programs, you can do that as well. And we'll see you there. Unconventional Organization.

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