Attention-deficit/hyperactivity disorder (ADHD)continues to be misunderstood as mainly a male childhood condition, yet increasing evidence reveals it persists more often into adulthood than previously thought and manifests distinctly in girls and women.
Compared to males, females with ADHD tend to display less outward hyperactivity and more inward symptoms of inattention and disorganization.
Girls with ADHDmay have a high risk for internalizing problems like anxiety or depression and exhibit self-injury more frequently.
Yet the long-termoutcomes for womenwho exhibited ADHD symptoms in girlhood have rarely been investigated.
Persistent ADHD symptoms like disorganization and inattention can significantly impair occupational functioning for women diagnosed in childhood. Even when less outwardly hyperactive, girls with ongoing ADHD struggle silently in many settings from school to workplace.
Key Points
Rationale
Attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized as a lifelong neurodevelopmental condition rather than just a childhood disorder.
Yet the majority of long-term follow-up studies have focused almost exclusively on males (Biederman et al., 2010).
Compared to boys, girls show a different developmental course of ADHD (Owens, Cardoos, & Hinshaw, 2015) and gender-specific outcomes in other domains like internalizing disorders or self-injury (Hinshaw & Kranz, 2009).
Understanding adult outcomes, specifically among females with childhood ADHD, is imperative.
Method
This study followed 140 girls rigorously diagnosed with ADHD in childhood and 88 matched comparisons over 16 years.
ADHD diagnosis and symptom counts were determined throughstructured interviewsand validated rating scales. At the final follow-up around age 25, the researchers obtained self-, parent-, and/or clinician-reports assessing functioning in 10 outcome domains.
Sample
The sample of girls with (n = 140) and without (n = 88) childhood ADHD did not differ significantly on age or other demographics except for slightly higher IQ scores among comparisons. Retention through the final wave was over 92%.
Statistical Analysis
Analyses examined group differences in adult outcomes based on childhood diagnostic status (ADHD vs. non-ADHD) and symptom trajectory (desisters, persisters, partial persisters).
The significance level was set to .001 for omnibus tests, and false discovery rate correction was applied within domains for post-hoc tests to minimizeType I errorinflation.Effect sizeswere computed for all contrasts.
Results
Girls with persistent childhood ADHD showed the worst functioning across almost all domains except substance use and driving outcomes.
These differences were statistically significant and typically large, with effect sizes ranging from about .6 to 1.5 standard deviations worse than comparisons.
Girls with partial symptom persistence showed moderately impaired functioning in some domains relative to comparisons.
Girls with childhood ADHD that fully remitted (“desisters”) did not differ significantly from comparisons on most adult outcomes but did show medium-sized deficits in educational achievement (ds = -.59 to -1.18) and health domains (ds = .49 to .59).
Insight
This study indicates childhood ADHD in females poses a long-term risk for impairments in multiple domains of functioning if it persists but shows specificity regarding poor adult outcomes when it remits after childhood.
It also reveals ongoing ADHD symptoms are responsible for additional adult problems beyond the residual effects of childhood ADHD alone.
Strengths
Limitations
Implications
Conclusions
Remitted childhood ADHD predicts more circumscribed adverse outcomes.
Further research should identify predictors of remittance versus persistence of ADHD in girls and clarify mechanisms linking childhood ADHD to long-term difficulties.
Overall, this study highlights that ADHD in girls, especially when it continues past childhood, has profound effects across multiple domains and developmental stages.
References
Biederman, J., Petty, C. R., Monuteaux, M. C., Fried, R., Byrne, D., Mirto, T., . . . Faraone, S. V. (2010). Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder: 11-year follow-up in a longitudinal case-control study.The American Journal of Psychiatry, 167, 409–417.http://dx.doi.org/10.1176/appi.ajp.2009.09050736
Hinshaw, S. P., & Kranz, R. (2009).The triple bind: Saving our teenage girls from today’s pressures.New York, NY: Ballantine Books.
Owens, E., B., Cardoos, S. L., & Hinsahw, S. P. (2015). Developmental progression and gender differences among individuals with ADHD. In R. A. Barkley (Ed.),Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 4th Edition(pp. 223- 255). New York: The Guilford Press.
Learning check
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
