Attention-deficit/hyperactivity disorder (ADHD) may conjure up the image of a restless, unfocused school boy. But the disease affects girls as well, and a recent study indicates that when it does, the disorder may persist and be associated with a variety of behavioral and mental health consequences. During adolescence, girls in whom ADHD was diagnosed in childhood were more likely to show symptoms of eating disorders, depression, and substance use disorders than a matched comparison group of girls without the neurobehavioral condition, according to the 5-year follow-up study.1
"For so long people thought girls really couldn't have ADHD, and if they did, it would be a transitory condition. We are finding that it is not transitory, it is persisting," said Stephen Hinshaw, PhD, chair of the department of psychology at the University of California, Berkeley, and lead author of the federally funded study.
Looking at more than 10 domains of functioning in the prospective follow-up study, the researchers found that the girls whose ADHD was diagnosed during childhood continued to show greater psychiatric symptomatology across multiple symptom areas (ADHD, externalizing, internalizing, eating, substance abuse, and dependence) as well as "larger functional impairments (global, social skills, peer relations, academic performance, self-perceptions, and service utilization rates) than did comparison girls."
Even though there was no comparison group of boys in their baseline and follow-up studies, Hinshaw said the researchers were able to look at national norms in follow-up studies of boys with ADHD. Comparisons revealed that girls with ADHD may actually have "a wider range of negative outcomes than boys."
"It is known that boys with ADHD as they grow up have a big risk for delinquency and school failure, and, depending upon the study, a medium to big risk for substance abuse," he added. "Our [adolescent] girl sample had a big risk for all of those."
In addition, the girls showed greater risk than boys for internalizing disorders, such as depression and anxiety symptoms, as well as for eating pathology and continued social rejection.
Childhood to adulthood
The recently published follow-up study is part of a series of studies examining whether girls with ADHD display continued symptomatology and impairment across the life span, Hinshaw said.
1. Hinshaw SP, Owens EB, Sami N, Fargeon S. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into adolescence: evidence for continuing cross-domain impairment. J Consult Clin Psychol. 2006; 74:489-499.
2. Hinshaw SP. Preadolescent girls with attention-deficit/hyperactivity disorder: I. Background characteristics, comorbidity, cognitive and social functioning, and parenting practices. J Consult Clin Psychol. 2002;70: 1086-1098.
3. Centers for Disease Control and Prevention (CDC). Mental Health in the United States. Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder--United States, 2003. MMWR Weekly. 2005;54:842-847.
4. Jensen PS, Hinshaw SP, Swanson JM, et al. Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): implications and applications for primary care providers. J Dev Behav Pediatr. 2001;22:60-73.