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Development of sexual identity during adolescence is a major process of transition in individual life which in cases of ADHD specifically interacts with other ontogenetic, pathological and psychosocial conditions.

According to recent findings growing consumption of internet pornography mainly in male ADHD population is closely related to compulsive sexual behavior and hypersexuality. Development of sexual identity is a major process of transition in individual life that is mainly established during adolescence, and it is related to various physiological, anatomical and behavioral changes leading to development of sexual activities and fantasies 1 — 4.

Mainly, sexual maturation, various emotional changes, development of abstract thinking, sexual identity, self-consciousness and also anatomical changes related to rapid physical growth 5 — 7. This complex developmental process is related to various internal and external factors, including various ontogenetic, neuropathological, social and environmental conditions that may influence sexual functions and behavior 2 , 5 , 7 — One of these specific pathological influences that may negatively affect normal development of sexual functioning and behavior is Attention Deficit and Hyperactivity Disorder ADHD mainly because executive dysfunctions usually related to ADHD may cause various problems mainly related to impulsivity and hypersexuality, aggressive behavior and other problems which may negatively affect psychological development of sexual identity and sexual functioning 7 , 13 , According to recent meta-analyzes ADHD manifests worldwide and affects at about 5.

The core symptoms of ADHD are inattention, hyperactivity and impulsivity and the disease is closely associated with various problems in daily performing and social functioning and adaption 19 , 20 including difficulties in academic and professional life, and interpersonal relationships in comparison to individuals without ADHD 19 — Nevertheless, the diagnosis of ADHD as a developmental disorder according to the DSM-5 requires clear evidence that the symptoms may reduce the quality of life and everyday functioning mainly associated with a variety of risks factors 22 — Usually individuals with ADHD manifest poor school performance and their professional success is often negatively impaired in comparison to individuals without ADHD 25 , In addition, there is evidence that ADHD also increases the risk of criminal behavior and various forms of rule violations 27 , 28 as well as significant deficits in interpersonal relationships 5 , 7 , 29 — In this context, some studies also reported lower relational satisfaction, impaired quality of romantic relationships, higher rate of separations and divorces, increased risk of intimate partner violence and verbal violence 29 , 34 and more maladaptive coping strategies in ADHD individuals 3 , 4 , 6 , 35 , Additionally, people with ADHD are reported to be victims of sexual violence more frequently Regarding a direct influence of ADHD on development of sexual functions recent findings suggest that no differences were found regarding the age of puberty onset in children with ADHD, and ADHD does not appear to be associated with delayed or impaired sexual maturation in comparison with children without ADHD 38 — Although ADHD likely has no direct influence on individual development and on sexual maturation in comparison to individuals without ADHD there is evidence that psychological development of sexual identity and functions is significantly affected by ADHD 7 , 13 , In addition ADHD has frequent manifestations of comorbidities mainly mood disorders and anxiety disorders 15 , 32 , 39 , 41 , 42 and a frequent comorbid disorder related to ADHD is hypersexuality 7 , 13 , Some studies also show positive associations between impulsivity and hypersexuality 1 , 4 , 42 , 43 and inattentive symptoms also may be related to hypersexuality 32 , 44 , Other studies indicate that conduct problems during childhood and adolescence could also be a relevant factor of the relationship between ADHD and sexual risk behaviors 13 , 53 , In addition conduct problems are often associated with increased impulsive behaviors 7 , 13 , 55 — In this context, some findings suggest that risky sexual behaviors in ADHD individuals represent a dysfunctional form of emotional regulation 7 , 13 , 59 , 60 , which may be also a relevant risk factor for sexual victimization 61 — According to recent findings hypersexuality is frequently related to compulsive form of sexual behavior CSB usually characterized by unsuccessful effort to control excessive sexual behavior that may lead to various psychopathological symptoms and negatively affect close relationships and partnership, and significantly decrease quality of life 1 , 3 , 4 , 6 , 47 , 61 , 62 , 66 , 73 — In this context, some studies indicate a strong association between ADHD and CSB 7 , 13 , 59 , 60 , 80 , 81 and other findings show that ADHD represents a risk factor for problematic pornography use PPU as a manifestation of hypersexual phantasies 1 , 3 — 6 , For example, a recent study examining the motivations behind Internet porn use found that men revealed much stronger motivations than women and those with more erotophilic tendencies were more motivated to use Internet pornography 6 , In the 11th edition of the International Classification of Diseases ICD , PPU is characterized by persistent, excessive, or compulsive use of pornographic content and intensive participation in it, despite distress and adverse consequences 7 , 13 , 59 , 60 , 78 , 80 , 81 , 87 , 89 — Nevertheless, some researchers consider the conceptualization of PPU as an impulse control disorder or a highly addictive form of sexual behavior 39 , 94 , Some studies also suggest that ADHD symptoms may represent significant predictive factor for PPU 5 — 7 , 96 — 98 which is in agreement with other findings documenting that impulsivity, problematic sexual behaviors, CSB, hypersexuality are significantly related to PPU 1 , 3 — 6 , 84 , For example, Niazof et al.