Girls with ADHD tend to experience 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 on Child and Adolescent Psychopathology.
The new study was motivated by 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 sought to investigate how these symptoms change over time and whether pubertal development has an effect on their trajectories.
“Puberty and adolescence are frequently times when youth experience increased difficulties with mental health and overall functioning,” said study author Ashley G. Eng, a clinical psychology doctoral candidate at the University of Kentucky.
“This tends to be especially true for girls with ADHD. However, very little is known about why puberty and adolescence are particularly difficult time periods for this population. It’s also important that we differentiate between adolescence (age in years) and pubertal stage (biological process) as they have different impacts. The overarching theme of my program of research is to investigate factors that are contributing to the increased difficulties we see in girls with ADHD as they progress through puberty and their teenage years.”
To conduct the study, the researchers analyzed data from the Oregon ADHD Cohort. The study included 849 children (ages ranged from 7 to 13) at the beginning and 305 children when the study ended eight years later. The 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 Pubertal Development Scale.
The researchers found that boys tended to have more hyperactivity, impulsivity, and inattention symptoms compared to girls. However, girls experienced higher levels of impairment in their daily lives.
“I was surprised to see that despite boys having higher levels of ADHD symptoms, it was the girls that had higher levels of impairment,” Eng told PsyPost.
The researchers observed that inattention symptoms remained stable over time. On the other hand, hyperactivity and impulsivity decreased as the children aged, particularly for males. Additionally, the study showed that depressive symptoms increased as the children aged, with a larger increase observed in girls.
Pubertal development was also related to symptom trajectories, with females experiencing an increase in ADHD-related impairment and depressive symptoms as they matured, while males showed a decline in hyperactivity symptoms.
The findings provide two key takeaways, according to Eng: “First, the trajectory of ADHD symptoms may look different in boys and girls. Second, although generally ADHD symptoms decline as youth age, girls with ADHD often experienced increases in impairment and depression as they progressed through puberty.”
The study suggests that hormonal changes during puberty, particularly in females, may play a role in the increase of depression and higher levels of impairment in girls with ADHD. Girls may also need to exhibit additional behavioral and emotional problems to receive an ADHD diagnosis compared to boys.
Overall, this study provided valuable insights into the trajectory of ADHD symptoms and co-occurring depressive symptoms during childhood and adolescence. It demonstrated the influence of pubertal development and sex on these trajectories. 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, meaning some participants dropped out, which may have affected the generalizability of the findings. The study also relied on parent 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,” Eng explained. “Based on other research, we know that these monthly shifts in hormones can have large impacts on social, emotional, and cognitive functioning. However in this study, we utilized annual parent reports of puberty (i.e., skin changes, growth spurts, breast growth) rather than measuring day to day circulating hormone levels.”
“Therefore, we may not have been able to fully capture the complexity of within-person changes that we might expect to see in girls at this time. Another study I am currently working on examines day-to-day hormone levels and ADHD symptoms in girls at different pubertal stages across a menstrual cycle.”
“It’s 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 as opposed to gender identity due to the focus on hormones in this study,” the researcher added. “Therefore, the terms used to describe individuals in this study may not accurately represent how these individuals identify. As a field, we are striving to be more inclusive 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 Symptoms of ADHD, Depression, and Impairment in Children and Adolescents: An Eight-Year Longitudinal Study“, was authored by Ashley G. Eng, Jenny M. Phan, Elizabeth A. Shirtcliff, Tory A. Eisenlohr-Moul, Patrick K. Goh, and Michelle M. Martel.
