Feminine Side of ADHD: Attention disorder has lasting impact on girls

Although hyperactive behavior often abates during the teen years for girls with attention-deficit hyperactivity disorder, many struggle with serious academic, emotional, and social problems related to that condition, a 5-year study finds.

Compared with teenage girls who had no psychiatric disorder, those with ADHD had difficulties that included delinquency, depression, substance abuse, eating disorders, poor mathematics and reading achievement, rejection by peers, and lack of planning skills, reports a team led by psychologist Stephen P. Hinshaw of the University of California, Berkeley.

“ADHD in girls is likely to yield continuing problems in adolescence, even though hyperactive symptoms may recede,” Hinshaw says.

The new findings appear in the June Journal of Consulting and Clinical Psychology.

In 1997, Hinshaw’s team organized the first of three yearly summer camps for 6- to 12-year-old girls, including individuals already diagnosed with ADHD. The project focused on 140 girls with ADHD and 88 girls with no psychiatric disorder, all of whom completed one of the 5-week programs. Staff monitored each girl’s daily behavior and administered a battery of tests without knowing who had an ADHD diagnosis.

Girls with ADHD showed marked problems in academic subjects, in peer relationships, and in planning and time management. Girls’ ADHD symptoms involved disorganized and unfocused behavior more than the disruptive, impulsive acts often observed in boys with this condition.

The latest findings, collected from those same girls 5 years later, come from interviews and questionnaires administered at home to 126 girls with ADHD and 81 girls with no disorder. The researchers also obtained reports on each girl’s behavior from her parents and teachers.

Of girls diagnosed with ADHD as 6-to-12-year-olds, 39, or nearly a third, no longer displayed the condition as teens. The 87 adolescent girls who continued to deal with ADHD grappled with learning problems, psychiatric symptoms, and social difficulties far beyond any observed in teen girls never diagnosed with ADHD, the researchers say. Only about half of the girls who originally displayed symptoms of hyperactivity and impulsiveness did so as teenagers.

The new data mirror earlier reports that hyperactivity in boys with ADHD often recedes during adolescence as problems with inattention grow worse, remarks psychiatrist Benedetto Vitiello of the National Institute of Mental Health in Bethesda, Md. “ADHD is a developmental condition that changes over time in similar ways in boys and girls,” Vitiello says.

In the new study, no specific form of treatment was associated with shedding ADHD between childhood and adolescence.

Treatment effects are difficult to tease out in samples such as this, Hinshaw says. Girls with severe, hard-to-treat ADHD symptoms tend to seek treatment, as do those with mild symptoms who are highly motivated to get help or whose parents are treatment savvy.

As many as 7 million children and teenagers in the United States have been diagnosed at some time in their lives with ADHD. The condition occurs about three times as often in boys as in girls.