ADHD Girls Grow Up with Mood Problems

John M. Grohol, PSYD

Date: 26 February 2010 Time: 09:52 AM ET

We've long heard about the negative impact of attention deficit disorder (ADHD) on children and teens. We know ADHD can lead to academic problems, problems with friends and socializing, significant sleep problems, and serious concerns in other areas of a child’s or teen’s life, such as increased criminality for those with ADHD.

But what does the future hold for them? Do these children grow up to be well-adjusted adults?

We know from previous research (e.g., Biederman et al., 2006; Faraone et al., 2006) that by young adulthood, most people who were diagnosed with ADHD as a child or teen continue to suffer from attention deficit disorder symptoms. Previous studies have also shown that boys with ADHD have a significantly greater lifetime risk for antisocial, mood and anxiety disorders compared to those who were not diagnosed with ADHD.

But what about girls? Little has been known about their lifetime risks if diagnosed with attention deficit disorder. Are they the same, better or worse than boys'?

In a recently published study (Biederman et al., 2010), researchers set out to answer that question. They assessed 262 child and teenage girls — both those with an ADHD diagnosis and those without — initially, and then 11 years later on a range of mental health issues. Assessment was done with a standardized structured diagnostic interview (called the SCID), commonly used in this type of research. It allows researchers to get a pretty clear diagnostic picture of an individual. Although the researchers weren’t able to re-interview every research subject at the 11-year followup, they had a good 69 to 75 percent follow-up rate.

After controlling for the baseline mental health problems the researchers detected in individuals at the initial assessment, girls diagnosed with ADHD were significantly more likely to suffer 11 years later from antisocial, mood, anxiety, developmental and eating disorders than girls without ADHD. Girls with attention deficit disorder were far more likely than those without to have future problems with depression, anxiety and antisocial behavior.

A girl diagnosed with ADHD as a child or teen suffers from major or clinical depression and anxiety disorders at much higher rates — 20-25 percent — than a boy with ADHD (3-8 percent). Professionals call this "co-morbidity" — when two disorders occur together. A girl with ADHD is far more likely to develop depression or anxiety than a girl without ADHD, or any boy in general.

Now here's the depressing part of the researchers' findings — 93 percent of the girls with ADHD had received some form of treatment. Most — 71 percent — received a combination of medication and psychotherapy, 21 percent received medication alone and 1 percent received psychotherapy alone.

There are three ways to interpret this data. One is that despite our best knowledge and efforts, we’re still not doing a very good job in helping treat people with ADHD, especially when it comes to addressing related problems. Two, that we’re so focused on treating the presenting problem — attention deficit disorder — that we miss seeing the developing signs of other mental health concerns. Or three, that people with ADHD are simply predisposed — due to genetics, family background and upbringing, or some other reason — to getting more mental health problems.

The researchers also found that at the 11 year follow-up, a full 62 percent of the girls could still likely be diagnosed with ADHD.

These findings are consistent with prior research findings that found ADHD is a significant risk factor for major depression (which is the most common mood disorder diagnosed), anxiety disorders, and other mental health concerns. I think this data adds to the existing research showing that we’re missing something important here, as well as the ineffectiveness of many current treatment strategies for attention deficit disorder.