As girls with ADHD become adults, they are especially prone toward internalizing their problems and feelings of inadequacy — that in turn can lead to self-injury and even attempted suicide, according to new findings from the University of California, Berkeley.
In the US, over 5 million children (about one in 11) ages 3-17 have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. The disorder is characterized by distractibility, poor concentration, impulsiveness and hyperactivity.
The research was based on the largest-ever sample of girls whose ADHD was first diagnosed in childhood.
“Like boys with ADHD, girls continue to have problems with academic achievement and relationships, and need special services as they enter early adulthood,” said lead study author Stephen Hinshaw, UC Berkeley professor of psychology.
“Our findings of extremely high rates of cutting and other forms of self-injury, along with suicide attempts, show us that the long-term consequences of ADHD females are profound,” he added.
The findings are consistent with previous research by the UC Berkeley team showing that, as girls with ADHD get older, they exhibit fewer visible symptoms of the disorder, but continue to suffer in less visible ways.
The study challenges the idea that girls can “outgrow” ADHD, and highlights the need for long-term monitoring and treatment of the disorder, said Hinshaw.
Beginning in 1997, Hinshaw and his colleagues followed a racially and socio-economically diverse group of girls (ages 6-12) with ADHD in the San Francisco Bay Area through early childhood summer camps, adolescence and now early adulthood.
Ten years later, 140 of the girls were given an evaluation, ages 17-24, in which researchers compared their behavioral, emotional and academic development to that of a demographically similar group of 88 girls without ADHD.
The study also measured the symptoms of two major ADHD subtypes: those who entered the study with poor attention alone versus those who had a combination of inattention plus high rates of hyperactivity and impulsivity.
Most importantly, researchers found that the girls with combined inattention and hyperactivity-impulsivity during childhood were significantly more likely to attempt self-injury and suicide in early adulthood.
Furthermore, over half of the members of this group were reported to have engaged in self-injurious behavior, and more than one-fifth had attempted suicide, Hinshaw said.
“A key question is why, by young adulthood, young women with ADHD would show a markedly high risk for self-harm. Impulse control problems appear to be a central factor,” said the authors.
In the first study on this group, published in 2002, the 6- to- 12-year old girls attended five-week camps where they were closely watched as they engaged in art and drama classes and outdoor activities.
Girls who had been taking ADHD medication volunteered to go off the drug treatment for much of the summer camp study. The counselors and staff observing all the participants were not informed as to which girls had been diagnosed with ADHD.
According to the findings, girls with ADHD were more likely to struggle academically and to be rejected by the other kids, compared to the comparison peer group.
When these girls were 12 to 17 and experiencing early to mid-adolescence, the fidgety and impulsive symptoms seemed to drop. But the learning gap between these girls and their non-ADHD peers had widened, and eating disorders and substance abuse had also come into play.
For the latest study, in which 95 percent of the original sample of girls participated, the researchers interviewed the participants and their families about behaviors such as self-harm and suicide attempts, drug use, eating habits and driving behavior.
“The overarching conclusion is that ADHD in girls portends continuing problems, through early adulthood,” said the authors.
“Our findings argue for the clinical impact of ADHD in female samples, the public health importance of this condition on girls and women, and the need for ongoing examination of underlying mechanisms, especially regarding the high risk of self-harm in young adulthood.”
Hinshaw also added, “ADHD is a treatable condition, as long as interventions are monitored carefully and pursued over a number of years.”
The study is published in the Journal of Consulting and Clinical Psychology.