ADHD: Girls More Prone to Self-Injury as an Adult

Girls with Attention Deficit Hyperactivity Disorder (ADHD) – and their families – often look forward to the likely decline in visible symptoms such as fidgety or disruptive behavior as they mature into young women.

However, new findings from University of California (UC) Berkeley caution that, as they enter adulthood, girls with histories of ADHD are more prone to internalize their struggles and feelings of failure – a development that can manifest itself in self-injury and even attempted suicide.

"Like boys with ADHD, girls continue to have problems with academic achievement and relationships, and need special services as they enter early adulthood," said Stephen Hinshaw, UC Berkeley professor of psychology and lead author of a study that reports after 10 years on the largest-ever sample of girls whose ADHD was first diagnosed in childhood. "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 new UC Berkeley study, assessing the girls 10 years after it began, examined 140 of them, ages 17-24, comparing their behavioral, emotional and academic development to that of a demographically similar group of 88 girls without ADHD. It also gauged 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.

The study's major finding was that the group with combined inattention and hyperactivity-impulsivity during childhood was by far the most likely to manifest self-injury and suicide attempts in early adulthood. In fact, the study pointed out, more than half of the members of this subgroup were reported to have engaged in self-injurious behavior, and more than one-fifth had attempted suicide, Hinshaw said.

For the latest study, the researchers conducted intensive interviews with the subjects and their families. Those interviews include personal reports on behaviors such as self-harm and suicide attempts, drug use, eating habits and driving behavior. Researchers also measured key cognitive functions such as executive planning skills, which include goal-setting and monitoring, planning and keeping on task despite distractions.

While many girls in the study showed improvement in ADHD symptoms during the 10-year period, certain problems persisted and new ones emerged, suggesting that careful monitoring and treatment are essential, Hinshaw said.

"The overarching conclusion is that ADHD in girls portends continuing problems, through early adulthood," the study concluded. "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." That said, Hinshaw added, "ADHD is a treatable condition, as long as interventions are monitored carefully and pursued over a number of years."; University of California - Berkeley

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