Online sexual abuse, sexting, and bullying among adolescents with and without ADHD: A cross-sectional study in a Turkish sample

This study aimed to examine the relationship between online sexual abuse exposure, risky sexual behaviors, and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in adolescents diagnosed with ADHD. The research included 118 adolescents with ADHD and 117 healthy controls, all assessed by child psychiatrists using the 'Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children' (K-SADS) to confirm diagnoses, comorbid conditions. This cross-sectional, epidemiological study utilized sociodemographic data forms, the Online Sexual Abuse Scale, and the Conners Parent Rating Scale for data collection. Online sexual abuse was categorized into four subtypes: online sexual victimization, receiving sexually explicit messages (passive sexting), sending sexually explicit messages (active sexting), and online sexual bullying behavior. Data analysis using logistic regression revealed that academic failure independently increased the likelihood of engaging in risky sexual behaviors by 2.1 times in both ADHD and control groups, underscoring the critical role of academic performance in moderating online sexual risk exposure. The ADHD group exhibited a significantly higher prevalence of online sexual abuse compared to controls (50 % vs. 31.6 %). Specifically, rates of online sexual victimization (33.1 % vs. 17.1 %) and passive sexting (38.1 % vs. 23.9 %) were notably higher among adolescents with ADHD. Older adolescents in the ADHD group showed increased rates of passive sexting, while girls experienced higher rates of online sexual victimization compared to boys. Furthermore, treatment status, duration of ADHD diagnosis, and medication use were examined in relation to online sexual behaviors. The impact of untreated ADHD was evident, with untreated individuals demonstrating a higher risk of both victimization and perpetration in online settings. This highlights the urgent need for targeted interventions to mitigate these risks in ADHD populations. The long-term consequences of online sexual abuse in adolescents are profound, contributing to increased psychosocial dysfunction, emotional distress, and potential trajectories toward antisocial behaviors. Given that a significant proportion of incarcerated individuals exhibit undiagnosed or untreated ADHD, early identification and intervention are crucial to preventing both victimization and perpetration in digital environments. Failure to address ADHD-related impulsivity and risky behaviors could lead to an alarming overrepresentation of individuals with ADHD in online sexual exploitation cases. In conclusion, adolescents with ADHD face a disproportionately higher risk of online sexual abuse compared to their peers. Targeted prevention strategies, early intervention, and comprehensive ADHD management-including educational support and treatment-are essential to reducing this risk. Future studies should further investigate the mechanisms underlying these associations to develop more effective preventive strategies.