March 3, 2024

Adolescent girls with ADHD show higher levels of impairment and depression, despite boys having more ADHD symptoms

Girls with ADHD tend to have higher levels of impairment and depressive symptoms as they progress through puberty, despite boys having higher levels of ADHD symptoms, according to new research published in. Research in Child and Adolescent Psychopathology.

The new study fueled the desire to better understand the trajectory of ADHD symptoms, impairment, and co-occurring depressive symptoms in children from 7 to 18 years of age. The researchers tried to investigate how these symptoms change over time and whether pubertal development affects their trajectories.

“Puberty and adolescence are often times when young people experience increased difficulties with mental health and overall functioning,” said study author Ashley G. Eng, a doctoral candidate in clinical psychology at the University of Kentucky.

“This tends to be especially true for girls with ADHD. However, little is known about why puberty and adolescence are particularly difficult times for this population. It is also important that we distinguish between adolescence (age in years) and the pubertal phase (biological process) as they have different effects. The overarching theme of my research program is to investigate factors that contribute to the increased difficulties we see in girls with ADHD as they progress through puberty and adolescence.”

To conduct the study, the researchers analyzed data from the Oregon ADHD Cohort. The study included 849 children (aged 7 to 13) at the start and 305 children when the study ended eight years later. Participants were assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS) interview, which measured ADHD symptoms, depressive symptoms, and overall impairment. They also completed the Children’s Depression Inventory and the Pubertal Development Scale.

The researchers found that boys tended to show more symptoms of hyperactivity, impulsivity and inattention compared to girls. However, girls had higher levels of impairment in their daily lives.

“I was surprised to see that while boys have higher levels of ADHD symptoms, it was the girls who had higher levels of impairment,” Eng told PsyPost.

The researchers noted that the symptoms of inattention remained stable over time. On the other hand, hyperactivity and impulsivity decreased as children got older, especially for males. In addition, the study showed that the symptoms of depression increased as the children got older, and that it increased more in girls.

The development of puberty was also associated with symptom trajectories, with ADHD-related impairment symptoms and depressive symptoms increasing with maturity, while males showed a decrease in hyperactivity symptoms.

The findings provide two takeaways, according to Eng: “First, the trajectory of ADHD symptoms may look different in boys and girls. Second, although ADHD symptoms generally decrease with advancing age, girls with ADHD often experience increased impairment and depression as they progress through puberty.”

The study suggests that hormonal changes during puberty, especially in women, may play a role in the increase in depression and higher levels of impairment in girls with ADHD. Girls may also need to show additional behavioral and emotional problems to receive a diagnosis of ADHD compared to boys.

Overall, this study provided valuable insights into the co-occurring trajectory of ADHD symptoms and depressive symptoms during childhood and adolescence. He showed the influence of pubertal and sexual development on these pathways. The findings contribute to a better understanding of ADHD and depressive symptoms in youth, which can inform the development of targeted interventions and support strategies.

However, there are limitations to the study. There was attrition over time, which meant that some participants dropped out, potentially affecting the generalizability of the findings. The study also relied on parental ratings of pubertal development and did not measure actual hormone levels.

“During puberty, hormonal levels are changing and in girls, hormones begin to shift on a cyclical basis as they begin menstruation,” explained Eng. “Based on other research, we know that these monthly shifts in hormones can have a major impact on social, emotional and cognitive functioning. However, in this study we used annual parental reports of puberty (ie skin changes, growth spurt, breast development) rather than measuring day-to-day circulating hormone levels.”

“Therefore, we may not have been able to fully reflect the complexity of the within-person changes that we might expect to see in girls at this time. Another study I’m currently working on examines day-to-day hormone levels and ADHD symptoms in girls at different stages of puberty over a menstrual cycle.”

“It is important to note that although we use the terms female/male and girl/boy in our study, we are actually referring to biological sex assigned at birth rather than gender identity due to the focus on hormones in this study,” said the researcher. “Thus, the terms used to describe individuals in this study may not accurately reflect how those individuals identify. As a broad field, we are trying to be more comprehensive in our research and remove as much biased language as possible, but we still have a long way to go.”

The study, “Aging and Pubertal Development Differentially Predict NHEA Symptoms, Depression, and Impairment in Children and Adolescents: An Eight-Year Longitudinal Study“, written by Ashley G. Eng, Jenny M. Phan, Elizabeth A. Shirtcliff, Tory A. Eisenlohr-Moul, Patrick K. Goh, and Michelle M. Martel.

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