2026 ECNP Congress

PS02-2146

Hand tremor in adults with attention-deficit hyperactivity disorder: clinical and substance-related correlates

Mateusz Kozioł — J. Jóźwiak · Military Institute of Medicine - National Research Institute, Day Ward for Neurotic Disorders- Department of Psychiatry- Combat Stress and Psychotraumatology, Warsaw, Poland

2026 ECNP Congress

Introduction

Tremor is a rhythmic, involuntary oscillatory movement requiring careful clinical interpretation [1]. Attention-deficit hyperactivity disorder (ADHD) is usually described in terms of inattention, impulsivity and executive dysfunction, but motor and sensorimotor abnormalities may also be present in adulthood, including impaired manual dexterity [2]. Anxiety and depressive disorders are common in adult ADHD [3], stimulant-related movement disorders have been reported [4], and evidence for cannabinoids in mental disorders remains limited [5]. Hand tremor in adults with ADHD is therefore relevant but poorly characterised. Clarifying these associations may help distinguish clinically relevant tremor from nonspecific motor complaints in psychiatric assessment.

Aims

We aimed to estimate the frequency of self-reported hand tremor in adults with ADHD and examine its associations with demographic variables, generalised anxiety disorder, depressive episodes and substance use.

Methods

We analysed data from 1246 adults with ADHD. Hand tremor was coded as absent or present. Bivariate associations were tested using Pearson’s chi-square tests and Cramer’s V. Age differences were assessed with the Mann-Whitney U test. Multivariable logistic regression estimated odds ratios (ORs) with 95% confidence intervals (CIs). The primary adjusted model included age, sex, lifetime generalised anxiety disorder, lifetime depressive episode, amphetamine use, alcohol use and tetrahydrocannabinol (THC) use. A sensitivity model replaced lifetime clinical variables with variables assessed at ADHD diagnosis. Calibration was assessed using the Hosmer-Lemeshow test.

Results

Hand tremor was reported by 406/1246 participants (32.6%). Tremor was more frequent in women than men (35.5% vs 28.5%; χ²(1)=6.73, p=0.010), whereas age did not differ between groups (U=172679.50, p=0.522). Generalised anxiety disorder was more frequent among participants with tremor across all timeframes: lifetime (78.6% vs 65.4%; χ²(1)=22.62, p<0.001), within two years before ADHD diagnosis (63.5% vs 52.6%; χ²(1)=13.28, p<0.001) and at ADHD diagnosis (53.0% vs 44.2%; χ²(1)=8.49, p=0.004). Lifetime depressive episode was associated with tremor in bivariate analysis (82.3% vs 74.9%; χ²(1)=8.50, p=0.004), but depressive episodes closer to diagnosis were not associated with tremor. In the primary multivariable model (n=1238), lifetime generalised anxiety disorder remained independently associated with tremor (OR=1.66, 95% CI 1.24-2.22, p<0.001). THC use was also independently associated with tremor (OR=1.57, 95% CI 1.16-2.14, p=0.004), while amphetamine use was not (OR=0.89, p=0.427). Alcohol use showed a non-significant trend-level association (OR=1.31, p=0.057). Model fit was acceptable (Hosmer-Lemeshow p=0.132). In the sensitivity model, anxiety at ADHD diagnosis remained associated with tremor after adjustment for substances (OR=1.43, 95% CI 1.11-1.83, p=0.006).

Conclusions

Self-reported hand tremor was common in this adult ADHD sample. Generalised anxiety disorder was the most consistent associated clinical factor, with THC use also independently associated. Depressive episodes and amphetamine use were not retained as independent correlates. These findings support further investigation of motor-somatic symptoms in adult ADHD. Routine enquiry about tremor may therefore be useful when evaluating anxiety and substance-related factors in adults with ADHD.

References

  1. Bhatia, K.P., Bain, P., Bajaj, N.P.S., Elble, R.J., Hallett, M., Louis, E.D., Raethjen, J., Stamelou, M., Testa, C.M., Deuschl, G., 2018. Consensus statement on the classification of tremors. Movement Disorders 33 (1), 75-87. https://doi.org/10.1002/mds.27121
  2. Fietsam, A.C., Tucker, J.R., Kamath, M.S., Huang-Pollock, C., Wang, Z., Neely, K.A., 2022. Manual dexterity and strength and in young adults with and without attention-deficit/hyperactivity disorder. Neuroscience Letters 766, 136349. https://doi.org/10.1016/j.neulet.2021.136349
  3. Fu, X., Wu, W., Wu, Y., Liu, X., Liang, W., Wu, R., Li, Y., 2025. Adult ADHD and comorbid anxiety and depressive disorders: a review of etiology and treatment. Frontiers in Psychiatry 16, 1597559. https://doi.org/10.3389/fpsyt.2025.1597559
  4. Nam, S.H., Lim, M.H., Park, T.W., 2022. Stimulant induced movement disorders in attention deficit hyperactivity disorder. Journal of the Korean Academy of Child and Adolescent Psychiatry 33 (2), 27-34. https://doi.org/10.5765/jkacap.210034
  5. Wilson, J., Dobson, O., Langcake, A., Mishra, P., Bryant, Z., Leung, J., Dawson, D., Graham, M., Teesson, M., Freeman, T.P., Hall, W., Chan, G.C.K., Stockings, E., 2026. The efficacy and safety of cannabinoids for the treatment of mental disorders and substance use disorders: a systematic review and meta-analysis. The Lancet Psychiatry 13 (4), 304-315. https://doi.org/10.1016/S2215-0366(26)00015-5