Abstract
Introduction:
ADHD is typically characterised by inattention, impulsivity, and hyperactivity, often persisting into adulthood and influencing occupational performance, social interactions, and mental well-being. This scoping review and narrative synthesis aims to address a critical knowledge gap by systematically mapping the existing research on ADHD in military contexts with regard to psychosocial and occupational outcomes. As such, the aims of this study were (a) to aggregate findings regarding ADHD and psychosocial and occupational outcomes of military personnel and (b) to critically review and provide an account of the methodological quality of these studies.
Methods:
A systematic search across four electronic databases (PubMed, PsycINFO, Embase and CINAHL) detected and retrieved 1,956 studies. After removal of duplicates, 1,263 titles and abstracts were screened. Following this, 106 articles progressed to full text review, and a total of 51 studies were included in the current scoping review and narrative synthesis.
Results:
The review indicated that ADHD is strongly associated with comorbid conditions such as post-traumatic stress disorder (PTSD), depression, and substance use disorders, though the extent to which these outcomes are attributable to ADHD versus broader environmental factors remains debated. Occupational functioning outcomes are similarly complex, with some studies reporting challenges in training, career progression, and retention, while others highlight the adaptability and strengths of personnel with ADHD when adequately supported.
Conclusions:
While ADHD presents both occupational and psychosocial challenges for military personnel, existing research primarily focuses on impairment rather than adaptation or strengths. Future studies should adopt a more holistic approach, incorporating neuroaffirmative principles, environmental factors, and individual variability with a view to informing current practices.
Background
ADHD is typically characterised by persistent patterns of inattention, hyperactivity, and impulsivity that can significantly impact an individual’s daily functioning (American Psychiatric Association [APA], 2013, 2022). ADHD is among the most prevalent developmental disorders, affecting approximately 2.5% to 5% of adults globally (Faraone et al., 2021). Historically framed through a deficit-based model emphasising impairments and dysfunctions, contemporary neuroaffirmative perspectives recognise ADHD as a variation in cognitive processing rather than an inherent disorder requiring correction (Bertilsdotter Rosqvist et al., 2023; Dwyer, 2022; Dwyer et al., 2024; Friedel et al., 2025; McLennan et al., 2025). This approach acknowledges both the relative challenges and strengths associated with ADHD, such as creativity, resilience, and adaptability (Bradley et al., 2025; Sedgwick et al., 2019). Despite this, ADHD is often associated with significant psychosocial and occupational difficulties, particularly when environmental demands do not align with neurodivergent cognitive styles (Fruchter et al., 2019). Individuals with ADHD have been reported to experience lower academic attainment, higher rates of job instability, and difficulties in interpersonal relationships, underscoring the need for structural accommodations and tailored interventions (Biederman et al., 2012; Hotte-Meunier et al., 2024; Sarkis, 2014).
Although ADHD persists into adulthood in a significant proportion of individuals, its manifestation changes over time, with hyperactive symptoms often diminishing while inattention, disorganisation, and executive dysfunction become more pronounced (Klein et al., 2012). These features contribute to challenges in occupational and social domains, particularly in structured environments requiring sustained attention, rule adherence, and rapid decision-making (Chan & Langberg, 2024). Given the military’s emphasis on discipline, hierarchical command structures, and high-pressure operational demands, the experiences of military personnel with ADHD warrant specific examination.
The prevalence and impact of ADHD in military populations remain underexplored, though limited evidence suggests that military personnel may exhibit higher rates of ADHD compared to civilians (Kessler et al., 2014). An alternative hypothesis is that certain aspects of military service, such as structured routines, clear hierarchies, and high-intensity environments, may be particularly appealing to individuals with ADHD, thereby contributing to their overrepresentation in military populations. A neuroaffirmative lens challenges the assumption that ADHD is inherently incompatible with military service; rather, it suggests that the interaction between ADHD-related traits and military structures is complex and context-dependent. While rigid training environments may provide external scaffolding that supports cognitive functioning in some individuals with ADHD, the unpredictability and cognitive demands of deployment may exacerbate difficulties, leading to variable occupational and psychosocial outcomes (Larson et al., 2011). Additionally, military personnel with ADHD may be at increased risk for comorbid conditions such as post-traumatic stress disorder (PTSD) due to shared neurocognitive vulnerabilities, including difficulties with emotional regulation and impulse control (Antshel et al., 2013; Harrington et al., 2012).
Despite policy changes that have eased enlistment restrictions for individuals with a history of ADHD (Krauss et al., 2006), there is limited research on long-term outcomes for military personnel with ADHD, particularly in relation to retention, performance, and post-deployment adjustment. Existing studies highlight both potential strengths, such as resilience in structured training environments, and risks, such as heightened relapse rates of ADHD symptoms and increased susceptibility to operational stressors (Larson et al., 2011; Rice et al., 2013). Understanding the occupational and psychosocial outcomes of military personnel with ADHD requires a nuanced approach that integrates neuroaffirmative perspectives, recognising both barriers and opportunities for adaptation within military contexts.
Military organisations differ substantially across cultural and institutional contexts in their recruitment practices, training models, and support structures. These variations have important implications for neurodivergent personnel, including individuals with ADHD. While some military systems rely on restrictive entry criteria, others emphasise broader recruitment followed by training, role differentiation, and accommodation. The extent to which individuals with ADHD thrive may therefore depend less on diagnosis alone than on the degree of alignment between individual neurocognitive profiles and organisational environments. This review foregrounds the heterogeneity of military contexts to frame subsequent discussion of how cultural norms and structural flexibility influence outcomes for personnel with ADHD.
The aim of this scoping review and narrative synthesis is to provide an account of existing literature with explores ADHD within military contexts. As such, the primary objective underpinning this aim is to aggregate empirical evidence on psychosocial and occupational outcomes reported by military personnel related to ADHD. A secondary objective is to provide a comprehensive evaluation of the quality of the research methodology utilised in the studies included within the review. This approach will offer valuable insights into how ADHD influences career trajectories, psychological well-being, and functional performance within the military, while also identifying directions for future research and evidence-based interventions. By systematically evaluating the available evidence, this review has the potential to inform clinical practice, policy development, and military support programmes; particularly in relation to ADHD management, workplace accommodations, and strategies to enhance the well-being of affected personnel.
Method
Design
A scoping review was completed following guidance from the JBI scoping review methodology group (Aromataris & Munn, 2020; Khalil et al., 2021; Peters et al., 2020). Reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRIMSA-ScR; Tricco et al., 2018). Following the systematic search, a narrative synthesis was applied in accordance with the protocol outlined in the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews (Popay et al., 2006).
Search Strategy
Eligible studies were identified and retrieved in accordance with the following criteria, that is, Population, Concept and Context. These criteria combine to form the PCC search tool, which was utilised as it is recommended “as a guide to construct clear and meaningful objectives and eligibility criteria for a scoping review” (Pollock et al., 2023). Table 1 contains the specific criteria established for the present study. The search was restricted to papers which are in the English Language. This was due to translator inaccessibility, as a result of time and resource limitations. Searches for relevant articles were carried out in four electronic databases: PubMed, PsycINFO, Embase and CINAHL. When conducting the searches, search terms were combined using Boolean terms “AND” “OR.” MeSH terms, thesaurus terms, emtree terms, and subject headings were utilised to ensure the search was comprehensive. Final searches were carried out across all included databases on the 02/08/2024. Other search strategies included: tracking citations of key studies (forward searching) and examining reference lists of key studies (backwards searching).
PCC Criteria Utilised for Current Study.
Screening Process
Inclusion and Exclusion Criteria
Inclusion criteria included the following: (a) studies that report research evidence that evaluates the impact of ADHD on outcomes in military personnel, or the impact of implementation of ADHD intervention which impacts on outcomes in military personnel, (b) articles had to be published peer reviewed empirical studies, including experimental and observational designs, such as qualitative, quantitative, cross-sectional, cohort, and longitudinal if identified, (c) studies had to be in the English language. Exclusion criteria included the following: (a) studies with a non-military sample including conscripts who had not yet started military service, (b) studies that report on ADHD symptoms without description of screening measures or diagnostic process, and (c) non-empirical studies such as single case studies or dissertations, conference extracts, book chapters and reviews, unpublished studies, and grey literature.
Screening
All references were exported to EndNote and transferred to Covidence (Veritas Health Innovation, 2019) for duplicate removal and screening. Title and abstract screening were conducted independently by two study authors, yielding 96.27% agreement (Cohen’s κ = .73). Articles meeting inclusion criteria advanced to full-text review, which was independently conducted by one researcher, with a second researcher reviewing a random subset comprising 35% (n = 37) to ensure reliability (inter-reviewer agreement 94.59%, Cohen’s κ = .92). Discrepancies were resolved through discussion or consultation with a third reviewer. A PRISMA flow diagram documents the inclusion and exclusion process. Finally, the reference lists of included studies were examined to identify additional relevant studies.
Data Extraction
An individualised data extraction form was designed according to the objectives of the present study. This included information such as: general information on the study: title, authors, contact address, funding sources, year of publication, place(s) and year(s) in which study was conducted; general information about participants, for example, gender, age, sample size; information on diagnostic criteria for ADHD; method of ADHD diagnosis; prevalence rates of ADHD in Defence Forces and any other mental health comorbidities; type of instrument for measurement of ADHD (e.g., interview; direct observation, psychometric measure); information on intervention, for example, type of intervention, aim of intervention, mode of delivery, duration/frequency/length of intervention, professionals involved in delivering intervention; and outcomes related to mental health, occupational functioning, career progression and retention. Two authors jointly pilot-tested the data extraction tool and quality assessment on a sample of the total articles (n = 2, 4% of included studies). Following this, one author independently extracted study data from all included articles. After which, a random sample of five studies (10% of included studies) were audited by another author to ensure reasonable consistency in data extraction and quality appraisal.
Quality Appraisal
Although critical appraisal is not a necessary step for scoping reviews (Aromataris & Munn, 2020), the methodological rigour of included studies was assessed to provide contextual insights into the quality of the evidence and enhance the utility of this review. In this study, we employed the quality appraisal tool originally developed by Hawker et al. (2002) to conduct an assessment of the methodological rigour of studies identified through our systematic search. This tool was selected for its applicability across diverse research paradigms. We used a modified version of the tool, incorporating adaptations outlined by O’Connor et al. (2021). The appraisal framework evaluates studies across nine domains: title and abstract quality, introduction and objectives, methodology and data collection, sampling strategy, data analysis, ethical considerations and potential bias, findings and results, generalisability or transferability, and the implications and utility of findings (Hawker et al., 2002). Each domain is rated on a four-point scale (“Very Poor” to “Good”), yielding a total score ranging from 9 to 36. Since Hawker et al. (2017) did not specify cut-offs for overall study quality, we applied the classification system used by Braithwaite et al., an adaptation of Lorenc et al.’s (2014) original framework. Under this system, studies scoring 30–36 points were categorised as “High Quality,” 24–29 points as “Medium Quality,” and 9–23 points as “Low Quality.”
Risk of Bias
Due to the inherent risk of bias in the study designs included in this synthesis, a formal bias assessment was not performed for the purpose of article exclusion. Instead, potential sources of bias, including publication and reporting bias, were systematically identified during the quality analysis and integrated into the overall evaluation of study quality presented in the results section.
Analysis and Synthesis
The current scoping review presents frequency counts of populations, characteristics of studies, and other fields of data (Munn, Peters et al., 2018; Munn, Stern et al., 2018). Latest guidance encourages “creative approaches . . . to convey results to the reader in an understandable way” (Pollock et al., 2023). As such, key findings were condensed and presented in a review table for clarity. Furthermore, this scoping review implements narrative synthesis in accordance with the Popay et al.’s (2006) guidelines to collate, summarise and analyse the findings of included studies. This process involved a preliminary synthesis, exploration of relationships within and between the studies, and assessment of the robustness of the synthesis overall. The narrative synthesis will move beyond simply summarising the main features of included studies, presenting the data in such a way that these enable investigations into similarities and differences between studies, while assessing the data and strength of the evidence.
Results
Article Selection
The Prisma Flow Diagram (Figure 1) depicts the screening and selection procedure. Our search across databases detected and retrieved 1956 studies. After removal of duplicates, 1263 titles and abstracts were screened. After which, 106 articles progressed to full text review. Forty-six studies were deemed eligible for data extraction. Review of the reference lists of each of these articles indicated five further studies were eligible for inclusion in the synthesis. Table 2 displays the included publications with key extracted information and findings. A narrative synthesis of the included studies structured around the research questions is presented below.
Prisma flow diagram outlining the screening and selection process.
Key Extracted Data of Included Studies in Narrative Synthesis.
Overview of Synthesised Articles
The 51 included studies came from eight countries, across four continents. The United States of America contributed the highest number of studies (n = 29), followed by Israel (n = 11), Finland (n = 4), Korea (n = 3), Singapore (n = 1), Taiwan (n = 1), South Africa (n = 1), and United Kingdom (n = 1).
All included studies employed quantitative research designs with observational methodologies. Studies were categorised by research design using a forced choice response protocol. Cohort studies (n = 22) provided longitudinal data, offering insights into temporal relationships among variables. Cross-sectional studies (n = 19) examined prevalence and associations at specific time points. Case-control studies (n = 3) facilitated comparative analyses to identify potential risk factors. Further prevalence studies (n = 3) contributed epidemiological data on ADHD. Intervention-based research was limited, with only two randomised controlled trials (RCTs) evaluating treatment efficacy. One non-randomised experimental study and a single retrospective chart review, utilising existing medical records, further expanded the evidence base.
Sample sizes varied considerably across studies depending on the study design, ranging from 36 participants to 682,110 participants. In terms of gender, most studies predominantly include male participants with some samples being exclusively male. There are some studies that include both males and females, but none that focus solely on female military personnel. Participant ages vary vastly among included studies, with many studies focusing on young adults aged 18 to 25 and others including veterans with mean ages ranging from approximately 20 to over 70. Due to the nature of the scoping review, the most investigated population across studies were military personnel with a range of involvement from active-duty, veteran, and a combination of both, alongside some studies that included civilian participants. A few studies explored specific groups of active-duty personnel, such as navy divers and aircrew cadets. In terms of ADHD sample, many included studies had specificity to ADHD, and include groups with and without ADHD diagnoses, or participants with ADHD symptoms or treatment history. However, some studies comment on psychiatric diagnoses more generally, in which case the findings relevant to ADHD have been extracted specifically.
The analysis of extracted data revealed a diverse array of measures used to assess ADHD, including clinical diagnostic tools, screening instruments and self-report scales. Many studies (n = 22) reported ADHD diagnoses made by clinicians through structured interviews or comprehensive psychological assessments (e.g., Composite International Diagnostic Interview [CIDI]) or by utilising military records and databases to identify individuals with a history of ADHD. Meanwhile, screening measures (e.g., Adult ADHD Self-Report Scale [ASRS]) were commonly used for initial identification and large-scale epidemiological studies. Several studies incorporated measures for depression, anxiety, and PTSD, indicating a comprehensive approach to ADHD assessment. Notably, instruments such as the ICD-10 and DSM-based clinical interviews were often reported as the gold standard for diagnosis, supported by standardised rating scales for symptom evaluation.
Quality of Studies
The initial quality appraisal of included studies using the Hawker et al. (2002) tool indicated that the majority of studies (n = 45) were of high quality, with a smaller number classified as medium quality (n = 5; Cipollone et al., 2020; Kimbrel et al., 2017; Lomas & Gartside, 1997; Sarfati et al., 2019; Van Wijk & Meintjes, 2021) and one study (Sayers et al., 2021a) falling into the low-quality category. The key issues identified through this appraisal process were primarily related to reporting rather than fundamental flaws in study design.
One of the most notable reporting issues concerned the documentation of ethical procedures. Similarly, issues with the reporting of sample characteristics were frequently noted, with some studies failing to provide clear demographic or clinical data on participants. Another area identified for improvement in study reporting was the articulation of findings in relation to their practical implications for research and practice. While most studies provided a discussion of results, the explicit linking of findings to actionable recommendations or broader theoretical frameworks was often underdeveloped.
A further in-depth quality review identified that some studies exhibited potential biases. One commonly observed issue was the dual role of researchers who also acted as clinicians. Another notable area of potential bias related to funding sources, with some studies explicitly discussing how funding might have influenced study design, analysis, or interpretation of findings.
Methodologically, the majority of studies employed robust research designs, but certain limitations were noted. A key concern was sample size variability, with some studies lacking sufficient statistical power to produce generalisable results. Additionally, a considerable number of studies relied on retrospective designs, which can introduce recall bias and limit the reliability of findings. The reliance on screening tools rather than comprehensive diagnostic protocols for assessing ADHD symptomatology was another issue identified in several studies.
Narrative Synthesis of Results
ADHD Prevalence and Diagnosis
ADHD is a significant concern within military populations, though prevalence rates vary across studies. Research such as that by Sayers et al. (2021a) indicates a decrease in ADHD prevalence among active-duty military members over time (from 3.9% in 2014 to 2.8% in 2018), though other studies report higher rates. Notably, a substantial portion of military personnel with ADHD are not diagnosed upon enlistment, with Sayers et al. (2021b) finding that 64.8% of those with ADHD were not identified during initial screenings. The studies also reveal that ADHD is often diagnosed later in life, with diagnoses often not occurring until adulthood (Noh et al., 2018). This finding suggests that ADHD in military personnel may often go undiagnosed during active service, contributing to subsequent psychosocial challenges post-service. Kok et al. (2019) further emphasise that ADHD symptoms are common in active-duty personnel and are not limited to the youngest cohorts, with prevalence estimates ranging between 7.6% and 9.0% depending on diagnostic methods. Similarly, Kosasih et al. (2015) found a 10.6% prevalence of ADHD among a veteran population, aligning with findings from Hanson et al. (2012). These studies highlight variability in ADHD prevalence rates, largely influenced by differences in assessment methodologies.
ADHD and Mental Health Co-morbidities and Outcomes
Studies consistently demonstrate a high prevalence of co-occurring conditions such as post-traumatic stress disorder (PTSD), depression, anxiety, and substance use disorders in military personnel with ADHD. However, research suggests that these associations are mediated by shared neurobiological vulnerabilities, symptom overlap and diagnostic challenges, and environmental stressors (Hanson et al., 2012; Seo et al., 2014; Tai & Gau, 2017; Yeom et al., 2020).
A consistent finding across studies is the high co-occurrence of ADHD and PTSD among military personnel. Some findings suggest an interaction effect, where ADHD traits (e.g., risk-taking, impulsivity) influence how individuals experience and respond to traumatic events, potentially increasing PTSD susceptibility (Z. W. Adams et al., 2017; Harrington et al., 2012; Howlett et al., 2018; Knight et al., 2025). Meanwhile, Gurvits et al. (2000) examined the neurological links between PTSD and ADHD and considered the neurobiological vulnerabilities shared by both conditions. Additionally, the overlap between ADHD and PTSD symptoms, particularly inattention and hyperactivity (Harrington et al., 2012), can cause diagnostic overshadowing and complicates the differential diagnosis and treatment, highlighting the challenges faced in clinical settings.
There is evidence suggesting that ADHD, particularly when combined with co-morbid mental health conditions, may increase the risk of suicidal ideation (Tai & Gau, 2017). However, Evans et al. (2022) found no significant association between ADHD symptoms and non-suicidal self-injury (NSSI) in a sample of veterans with psychiatric disorders, and suggest that disorders characterised by negative affect, such as depression, may be more relevant than those characterised by impulsivity, such as ADHD, in predicting NSSI. While ADHD itself is not directly linked to suicidal behaviour, past ADHD diagnoses significantly predict persistent suicidal thoughts and self-harm (Nock et al., 2018).
Studies highlight increased rates of cigarette and alcohol dependence among individuals with ADHD, though not all develop substance use disorders (SUDs). Research indicates that military personnel with ADHD report higher consumption of substances such as alcohol, energy drinks, and caffeine, with motivations for use differing by substance. In this context, inherent risk refers to a direct liability to SUD that operates independently of symptom management, whereas self-medication reflects a behavioural pathway in which substances are used to cope with inattention, impulsivity, or emotional dysregulation. Caffeine and energy drinks may function as forms of self-medication, partially mimicking the effects of ADHD pharmacotherapy by increasing dopamine and enhancing alertness and focus. In contrast, alcohol use may be more closely associated with relaxation, numbing distress, or managing inner restlessness. Together, these patterns suggest that ADHD functions as a distal risk factor whose influence on SUD risk is mediated by symptom-related distress and coping motives rather than as a uniform, independent cause, underscoring the need for targeted harm-reduction strategies (Cipollone et al., 2020). Military culture and occupational stress exposure may further shape these behaviours, complicating direct interpretations of ADHD–SUD associations.
These findings indicate that ADHD-related risks in military populations are best understood within a multifactorial framework, in which shared neurobiological vulnerabilities, symptom overlap with co-occurring conditions, and exposure to environmental and occupational stressors interact to shape clinical outcomes. From a clinical perspective, this complexity highlights the importance of careful differential diagnosis and assessment of comorbid mental health conditions, as well as treatment approaches that address both ADHD symptoms and the broader psychological and contextual factors that may influence risk.
Treatment and Medication Considerations
Pharmacological treatments such as methylphenidate (MP) and atomoxetine are widely used within military ADHD populations. Research explores both their efficacy and associated risks, highlighting the need for individualised management strategies. The use of stimulants, particularly MP, has been linked to improvements in some aspects of functioning but is also associated with an increased risk of PTSD (Crum-Cianflone et al., 2015). Studies suggest that untreated ADHD increases stress fracture risk, while MP treatment may reduce such risks, potentially due to improved concentration and coordination. However, another study indicated an association between chronic MP use and increased risk of stress fractures and restorative dental treatments (Schermann, Gurel, et al., 2018). This duality in medication effects necessitates further investigation into the potential risks and benefits of pharmacological treatments within military contexts. To note, the majority of medication related studies were that of a cross-sectional study design (including cohort studies and case control), which have limitations in determining causality due to various confounding variables.
ADHD and Occupational Functioning in the Military
Research on ADHD and occupational functioning in military settings highlights a complex interplay between individual characteristics and the structured military environment. Research suggests that individuals with ADHD demonstrate poorer performance in military settings, including higher rates of medical unfitness, increased sick days, and more frequent medical visits (Fruchter et al., 2019). ADHD has also been linked to greater disciplinary actions and poorer team leadership evaluations (Halt et al., 2023). Furthermore, ADHD is associated with higher attrition rates from military service (Sayer et al., 2021b). In relation to training and career progression, some studies report lower ratings of career prospects among military personnel with ADHD, though there is no definitive evidence of reduced success in service. However, pre-enlistment unemployment and variations in education levels appear higher among individuals with ADHD, indicating potential pre-existing occupational barriers. Meanwhile, Olinover et al. (2022) found that structured environments and interpersonal feedback enhance decision-making in combat leaders with ADHD, highlighting the importance of accommodations in enabling effective performance and potential leadership advantages. As such, this study notes that these occupational functioning difficulties may reflect systemic challenges rather than individual capability. This supports a broader neurodiversity perspective, which argues that environmental fit plays a crucial role in occupational success. Future research should explore how flexible training models and individualised support systems impact retention, performance and career progression for military personnel with ADHD.
Protective and Resilience Factors
Despite challenges, studies identify multiple protective factors that contribute to resilience in military personnel with ADHD. For example, traits such as sense of coherence, ego-resiliency, and positive affect have been found to promote adaptation in military settings (Al-Yagon & Toren, 2025). Furthermore, adequate social and leadership support is linked to improved outcomes. For instance, having an understanding and accommodating commander significantly enhances resilience and occupational functioning (Fruchter et al., 2019) Meanwhile, strong family support networks emerge as a critical buffer against negative psychosocial outcomes.
Discussion
This scoping review and narrative synthesis provided an updated account of the empirical literature which examines the impact of ADHD on psychosocial and occupational outcomes within military personnel. A total of 51 studies were identified and included in this synthesis.
Recognising the country of publication is crucial for contextualising findings in a scoping review on ADHD and military occupational functioning, as military structures, policies, and societal attitudes towards neurodiversity vary significantly across nations. The roles and expectations of military personnel differ widely across countries. For instance, the United States, which contributes the majority of studies (n = 29), has an all-volunteer force with specialised roles and a structured medical disqualification system for ADHD. In contrast, Israel (n = 11), Finland (n = 4), and Korea (n = 3) enforce mandatory conscription, meaning individuals with ADHD may be required to serve, albeit with restrictions or accommodations. These differing military systems influence how ADHD is perceived, diagnosed, and managed within service contexts. Countries with mandatory conscription, such as Israel, Finland, and Korea, include individuals with ADHD in their military populations by default, necessitating policies on enlistment waivers, accommodations, or exemptions. For example, Israel’s military has specific ADHD screening and adjustment protocols, which may lead to distinct psychosocial and occupational outcomes compared to voluntary service nations like the U.S. and U.K. In contrast, nations without conscription may see ADHD as a disqualifying factor for military service, skewing research towards those who have successfully managed symptoms and enlisted voluntarily.
Furthermore, the political climate and societal attitudes towards disability and neurodiversity can shape research focus and military policies. The high number of U.S. studies may reflect greater funding for military mental health research and ongoing debates on ADHD-related enlistment policies. Countries with heightened security concerns, such as Israel and South Korea, may have different thresholds for excluding or accommodating personnel with ADHD, driven by operational demands. Furthermore, the presence of only a single study each from Singapore, Taiwan, South Africa, and the U.K. suggests that research in these regions is either limited or that ADHD is not a primary concern in military policy discussions. Understanding the country of publication helps interpret findings within their military, social, and political contexts. Differences in service structures, conscription policies, and national security priorities shape how ADHD is managed and studied in military populations. Consequently, findings from one country may not be directly generalisable to another, emphasising the need for contextual awareness when assessing the impact of ADHD on military functioning.
The predominance of quantitative research designs in the included studies reflects a strong emphasis on observational methodologies, particularly cohort and cross-sectional studies. This methodological preference provides valuable epidemiological insights into ADHD among military personnel, yet it also presents inherent limitations. While cohort studies offer longitudinal perspectives on ADHD-related psychosocial and occupational outcomes, the reliance on observational data limits the ability to establish causality. Cross-sectional studies, though useful for identifying prevalence rates and associations, cannot account for temporal dynamics or long-term impacts. The scarcity of intervention-based research, including randomised controlled trials, suggests a significant gap in the literature regarding effective treatments and support strategies for military personnel with ADHD. Future research should aim to incorporate experimental and mixed-methods approaches to enhance understanding and intervention efficacy.
The demographic composition of the included studies also raises important considerations. The overwhelming focus on male military personnel, with a notable absence of studies dedicated exclusively to female service members, highlights a gender imbalance in research. Given that ADHD presents differently across genders, the lack of female-specific data limits the generalisability of findings. Additionally, the wide age range of participants, spanning from young recruits to older veterans, introduces variability in ADHD manifestation and its impact over the course of a military career. Differences in age cohorts necessitate further investigation into developmental trajectories and long-term consequences of ADHD within military populations.
The variability in ADHD assessment tools across studies further complicates the synthesis of findings. While clinical diagnoses based on structured interviews and psychological assessments provide a robust framework, the reliance on self-report measures introduces potential biases, particularly in military settings where stigma and career concerns may influence disclosure. The heterogeneity in measurement instruments underscores the need for standardised diagnostic criteria and assessment tools to facilitate comparability across studies. Additionally, the inclusion of studies that broadly examine psychiatric comorbidities suggests that ADHD-specific findings may sometimes be embedded within wider mental health discussions. This highlights the importance of disaggregating ADHD data from general psychiatric research to ensure clarity in interpreting its distinct occupational and psychosocial effects.
Overall, the findings underscore the need for more diverse methodological approaches, greater representation of female military personnel, and standardised ADHD assessment tools. Addressing these gaps will strengthen the evidence base and contribute to a more nuanced understanding of ADHD’s impact on military occupational functioning and psychosocial outcomes.
Quality of the Research Methodology
The findings of this quality assessment suggests that the overall credibility of the scoping review is strong, as most studies met high methodological standards. However, the presence of medium- and low-quality studies highlights areas where caution is needed when interpreting findings, particularly in cases where weaker studies contribute significantly to the evidence base. This critical appraisal highlights key areas where improvements in study design and reporting could enhance the robustness and applicability of future research. The lack of detailed ethical reporting, while not necessarily indicative of ethical shortcomings, suggests a need for greater transparency in documenting ethical considerations. Clearer ethical disclosures would allow for more thorough assessment of study rigour and adherence to ethical standards.
Issues related to sample reporting also have broader implications. The omission of detailed demographic and clinical data not only affects the transferability of findings but also limits the potential for meta-analysis and replication. Future studies should prioritise comprehensive participant descriptions to ensure that findings can be meaningfully applied across diverse populations.
The presence of biases, such as the dual researcher-clinician role and potential funding influences, underscores the importance of reflexivity in research. While many studies acknowledged these concerns, further steps, such as explicitly discussing measures taken to mitigate bias, could strengthen the credibility of findings. In addition, the reliance on retrospective designs introduces concerns about recall bias, emphasising the need for more prospective studies to provide higher-quality evidence.
The widespread use of screening tools instead of full diagnostic protocols for ADHD assessment is another significant limitation. While screening tools serve as useful preliminary measures, they do not replace comprehensive clinical assessments necessary for accurate diagnosis and differentiation from other conditions. Future research should strive to incorporate validated diagnostic methods to improve the reliability of ADHD-related findings.
Overall, while the included studies largely demonstrated methodological rigour, the identified limitations highlight important areas for improvement. Addressing these issues through enhanced reporting, increased transparency, and stronger methodological approaches will help ensure that future research in this field is both credible and actionable for practitioners, policymakers, and researchers alike.
Aggregated Findings Regarding ADHD in Military Personnel
The synthesis of existing research highlights the multifaceted impact of ADHD on both psychosocial and occupational outcomes in military personnel. While ADHD is associated with increased risk for comorbid conditions, such as PTSD, depression, and substance use disorders, the degree to which these outcomes are attributable to ADHD versus broader environmental and systemic factors remains debated. Occupational functioning outcomes also present a complex picture, with some studies reporting challenges in training, career progression, and retention, whereas others emphasise the adaptability and strengths of personnel with ADHD when adequately supported.
Emerging Trends in the Literature
The analysis of publication trends within the included studies reveals a notable increase in research on ADHD, particularly within military populations. This surge aligns with a broader rise in ADHD research over the past few decades, indicating an expanding recognition of the disorder's impact on various groups, including military personnel. The studies span from 1976 to 2024, covering nearly five decades of research on ADHD, which reflects a growing interest in the disorder across diverse contexts. A significant increase in publications is observed from the 2000s onwards, particularly in the 2010s. This suggests a heightened focus on ADHD, potentially linked to improved diagnostic techniques, greater awareness of the disorder, and a more sophisticated understanding of its persistence into adulthood. The most recent publications, from 2024, highlight the ongoing momentum in ADHD research, especially in understanding its complexities in military contexts, where the intersection of ADHD and occupational functioning remains a critical area of study.
A critical consideration when interpreting the findings of this scoping review is the evolving conceptualisation and diagnostic classification of ADHD over the past five decades. The terminology and criteria used to define ADHD have changed substantially, reflecting shifts in psychiatric nosology and advances in understanding neurodevelopmental differences. Early research often referred to constructs such as “minimal brain damage,” “minimal brain dysfunction,” “hyperactivity,” or “learning/behavioral disabilities,” terms applied inconsistently and lacking standardised criteria. In the DSM-II (APA, 1968), the diagnosis of Hyperkinetic Reaction of Childhood focused primarily on excessive motor activity and restlessness. This conceptualisation shifted in the DSM-III (APA, 1980) to Attention Deficit Disorder (ADD), which for the first time distinguished attentional difficulties as core symptoms and allowed subtyping based on the presence or absence of hyperactivity.
In the DSM-III-R (APA, 1987), the disorder was renamed ADHD, with revised symptom lists and a single combined category. Subsequent editions, including DSM-IV (APA, 1994) and DSM-IV-TR (APA, 2000), introduced subtypes (predominantly inattentive, predominantly hyperactive-impulsive, and combined presentation) and further clarified diagnostic thresholds. The most recent DSM-5 (APA, 2013) retained the ADHD nomenclature but made several important changes: symptom examples were updated to better reflect adult manifestations (e.g., difficulty sustaining attention during meetings), the age of onset criterion was raised from 7 to 12 years, and the number of symptoms required for adult diagnosis was reduced to five instead of six. DSM-5 also emphasised that ADHD could persist across the lifespan and co-occur with other neurodevelopmental and psychiatric conditions.
This taxonomic progression means that studies included in this review have relied on heterogeneous diagnostic labels, criteria, and assessment tools over time. Earlier research may have applied narrower or less precise criteria, potentially under- or overestimating prevalence, functional impacts, and comorbidities. Additionally, screening measures evolved in parallel, from teacher reports and unstructured observations to structured clinical interviews and validated rating scales, creating further variability in measurement and classification. These methodological and conceptual inconsistencies complicate direct comparisons across studies and underscore the need for cautious interpretation of historical findings. Recognising this context is essential for situating the evidence base, understanding sources of variability in reported outcomes, and informing the development of more consistent approaches to ADHD assessment and diagnosis in military populations.
While the majority of included studies adopt a deficit-based framework when examining ADHD in military personnel, emerging trends suggest a gradual shift toward a more holistic and neuroaffirmative perspective that recognise ADHD as a cognitive difference rather than an inherent impairment. Although the term “neuroaffirmative” is rarely explicitly used, several studies challenge traditional narratives and incorporate principles that align with this approach by acknowledging strengths, resilience, and the impact of environmental factors on functioning. In particular studies have demonstrated that military personnel with ADHD can exhibit high levels of adaptability, crisis response skills, and hyperfocus under certain conditions (e.g. Al-Yagon & Toren, 2025; Fruchter et al., 2019; Olinover et al., 2022). Future research should explore how military structures can better leverage these strengths through tailored training and career development programmes.
A more recent study suggests that military structural factors, such as rigid training regimens, systemic challenges, and high-stress environments, may exacerbate ADHD-related difficulties rather than ADHD itself being the primary driver of occupational difficulties (Olinover et al., 2022). This underscores the importance of considering institutional policies (e.g., eligibility criteria for enlistment, medication regulations, and workplace accommodations) when evaluating ADHD-related outcomes. Future investigations should examine how policy adjustments could better support neurodivergent personnel, reducing unnecessary attrition while maintaining operational effectiveness.
The relationship between ADHD and PTSD is gaining increasing attention, with studies exploring whether shared neurobiological vulnerabilities or diagnostic complexities account for their high co-occurrence (Howlett et al., 2018). Emerging research suggests that ADHD traits may not only heighten susceptibility to PTSD following trauma exposure but may also influence how individuals process and recover from trauma. This evolving area of inquiry has significant implications for both clinical assessment and intervention strategies within military mental health services.
Areas of Omission in the Literature
A major limitation in the current body of research is the predominance of cross-sectional designs, which restrict the ability to draw conclusions about the long-term impact of ADHD on military careers and psychosocial well-being. There is a need for longitudinal studies that track military personnel with ADHD from enlistment through various career stages, identifying factors that contribute to resilience or risk over time. This would provide a clearer understanding of how ADHD interacts with military structures and whether early career support can mitigate adverse outcomes.
The variability in assessment tools across studies introduces potential biases in reported prevalence rates and associated outcomes. The reliance on self-report measures in some studies may lead to overestimation of comorbidity rates due to symptom overlap (e.g., between PTSD hyperarousal and ADHD impulsivity). Conversely, studies using retrospective medical records may underrepresent ADHD prevalence due to diagnostic underreporting in military settings. The absence of standardised diagnostic protocols for ADHD in military populations makes cross-study comparisons difficult and highlights the need for more robust assessment methodologies, including neuropsychological testing.
While many studies emphasise the risks associated with ADHD in military contexts, fewer investigate protective factors and pathways to success. Research suggests that supportive leadership, structured work environments, and targeted accommodations can enhance occupational outcomes for personnel with ADHD, but these findings remain underexplored. More research is needed to identify the specific military roles or occupational settings where individuals with ADHD may thrive, as well as interventions that foster resilience and career longevity.
There is a notable gap in research regarding gender differences in ADHD-related outcomes within military populations. Most studies primarily focus on male-dominated samples, reflecting broader trends in military research. However, ADHD presents differently across genders, with women often exhibiting more internalising symptoms (e.g., anxiety, depression) rather than externalising behaviours. Additionally, racial and cultural factors that may influence ADHD diagnosis, treatment access, and occupational experiences within the military remain underexamined. Future research should address these disparities to ensure a more comprehensive understanding of ADHD across diverse military personnel.
Critical Reflection on the Narrative Synthesis
This narrative synthesis required careful methodological considerations. Given the heterogeneity of the included studies, a narrative synthesis was the most suitable approach, as synthesis methods should align with the nature of the available literature (Munn et al., 2018). However, this approach carries inherent risks of bias due to subjective decision-making (Campbell et al., 2019; Popay et al., 2006). Potential sources of subjectivity include the selection and interpretation of study findings, quality assessments, identification of methodological limitations, and the integration of results into overarching themes.
To enhance the rigour of this synthesis, several measures were implemented. Piloting and auditing tools ensured consistency in data extraction and quality appraisal. Additionally, this review maintains transparency by providing a clear and replicable account of key decisions, including study screening, exclusion criteria, and rationale for the chosen synthesis approach. Transparency is a critical strength, as a lack of clear reporting is a common limitation in narrative syntheses (Campbell et al., 2019).
Another key consideration is the theoretical framing of the included studies. The literature largely adopts a medical model focused on deficits and symptom management, with limited emphasis on strengths-based or neuroaffirmative perspectives. While some studies acknowledge potential benefits of ADHD-related traits in military environments and explore protective factors like resilience and self-regulation, the overall discourse remains deficit-oriented. There is little discussion of environmental accommodations, functional adaptations, or the lived experiences of military personnel with ADHD, highlighting a gap in the field. Future research should integrate neuroaffirmative frameworks that emphasise support, acceptance, and the role of contextual factors in shaping outcomes.
By maintaining methodological transparency and critically examining dominant narratives in the literature, this synthesis provides a nuanced understanding of ADHD in military contexts. It also underscores the need for future research to move beyond symptom reduction toward a more holistic exploration of psychosocial and occupational outcomes.
Strengths and Limitations of the Overall Review and Synthesis
A key strength of this scoping review was the implementation of quality appraisal tools to systematically assess study rigour. By applying established frameworks, this review ensured a structured evaluation of methodological quality, enhancing the reliability of its findings. Additionally, adherence to best practice guidelines for synthesising non-randomised and qualitative research, particularly the methodological recommendations outlined by Popay et al. (2006), further strengthened the review’s credibility. These approaches contributed to the transparency and trustworthiness of the synthesis, increasing confidence in the transferability of the findings.
Despite the strengths of this scoping review, several limitations must be acknowledged. First, while previous research suggests that language restrictions in systematic reviews and meta-analyses do not necessarily introduce systematic bias (Jüni et al., 2002; Morrison et al., 2012), the exclusive inclusion of studies published in English may have resulted in potential bias (Rasmussen & Montgomery, 2018). Future reviews in this area should consider incorporating studies published in other languages to enhance comprehensiveness. Second, given the already extensive scope of this review, grey literature, including theses and preprints, was not included. As a result, the findings may be subject to publication bias, as studies reporting significant effects are more likely to be published in peer-reviewed journals (Dalton et al., 2016). However, the inclusion of grey literature remains a debated practice, as such sources often lack rigorous peer review, potentially introducing additional methodological concerns (Paez, 2017). Third, the use of a generic quality assessment tool (Hawker et al., 2002) could be considered a limitation. While these tools facilitate the evaluation of diverse study designs, they have been criticised for lacking specificity in detecting methodological issues unique to research approaches and for producing scores that may obscure individual sources of bias (Katrak et al., 2004; Quigley et al., 2019). Nevertheless, such tools remain valuable in synthesising evidence across varied methodologies, aligning with the aims of this review (Katrak et al., 2004; Remington, 2020).
Research and Clinical Implications
This scoping review identifies several critical gaps in the evidence base concerning ADHD in military populations. The existing literature is dominated by cross-sectional designs and clinically derived samples, with a notable absence of large-scale longitudinal research examining ADHD across the full military career trajectory, including post-service transition. Longitudinal studies are needed to clarify how ADHD-related traits interact with occupational demands over time and to determine their cumulative effects on performance, mental health outcomes, and retention.
Research to date provides limited insight into heterogeneity within military populations. Differences between personnel at various career stages: pre-enlistment, active duty, and veteran status; as well as variation across roles, ranks, and service branches, remain insufficiently examined. ADHD in non-combat and support roles is particularly underrepresented in the literature, despite the operational importance of these positions. Future research should adopt stratified approaches that account for role type and career stage to enhance ecological validity. Furthermore, future research could also benefit from mapping possible trajectories from ADHD to functional outcomes while also incorporating age, sex, and other confounding variables.
The review also highlights a paucity of qualitative and mixed-methods research capturing the lived experiences of military personnel with ADHD. This methodological gap limits understanding of how ADHD is navigated within highly structured, hierarchical environments and how military culture shapes disclosure, coping strategies, and access to support. Mixed-methods approaches integrating objective performance indicators with qualitative accounts may provide a more comprehensive understanding of ADHD in military contexts.
Cross-national comparative research remains limited but is essential for understanding how ADHD is conceptualised, assessed, and accommodated across different military systems. Comparative studies may help identify policy- and culture-specific facilitators and barriers to effective support. Additionally, much of the literature adopts a predominantly deficit-based framing of ADHD. Further research is required to investigate potential strengths associated with ADHD, such as adaptability, creativity, and rapid decision-making, and their relevance to specific military tasks and environments.
Greater incorporation of public and patient involvement, alongside interdisciplinary collaboration between researchers, clinicians, military institutions, and neurodiversity advocates, may enhance the relevance and applicability of future research.
Furthermore, the findings of this scoping review have important implications for clinical practice and organisational support across the military career continuum. Evidence suggests that ADHD is frequently under-recognised or misinterpreted within military populations, potentially due to stigma, limited diagnostic awareness, and the performance-oriented nature of military culture. Enhanced, context-sensitive screening and assessment procedures may improve early identification, particularly during pre-enlistment and initial training phases, while also supporting accurate diagnosis during active service and post-service care.
Management of ADHD in military settings is likely to require multimodal, evidence-based interventions that are responsive to operational constraints. Pharmacological treatments remain a cornerstone of ADHD management; however, their use within military contexts must be guided by clear clinical protocols and risk assessments. Non-pharmacological interventions with an established evidence base such as cognitive-behavioural therapy, executive function skills training, and mindfulness-based approaches may be particularly relevant in addressing attentional regulation, impulsivity, and emotional control. Despite their promise, there remains a need for rigorous evaluation of these interventions within military and veteran populations.
Workplace accommodations represent a further important consideration. Reasonable and task-focused adjustments, such as structured routines, clear and concise communication, task prioritisation tools, and assistive technologies may support performance and reduce functional impairment among personnel with ADHD. Importantly, accommodations should be tailored to role demands and career stage. During active duty, adjustments may focus on task execution and operational efficiency, whereas veteran populations may benefit from accommodations that support reintegration into civilian employment and healthcare systems.
Career-stage considerations are critical to effective support. At the pre-enlistment stage, transparent and equitable assessment processes are necessary to balance operational requirements with inclusion. During active service, leadership awareness and informed supervisory practices are central to facilitating disclosure, reducing stigma, and ensuring access to support. For veterans, continuity of care, accurate diagnostic recognition, and coordinated clinical services are essential to address long-term functional and psychosocial outcomes.
At an organisational level, the findings highlight the potential value of formalised policies addressing ADHD assessment, intervention, and accommodation across the service lifecycle. Policies informed by contemporary neurodevelopmental and occupational health research may contribute to greater consistency in practice and improved outcomes for both individuals and organisations. While further empirical work is required, adopting evidence-informed and inclusive frameworks may enhance well-being, occupational functioning, and long-term retention among military personnel with ADHD.
Footnotes
Ethical Considerations
Ethical approval was not required for this study as it is a scoping review of publicly available literature and did not directly involve human participants or the use of identifiable personal data.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: However, it should be noted that two of the authors are employed by the Irish Defence Forces. This affiliation did not influence the conduct or conclusions of the study.
Data Availability Statement
Not applicable.