Adolescent girls struggle with ADHD

New research from researchers at the University of California – Berkeley shows that when entering adolescence, girls with attention deficit hyperactivity disorder (ADHD) exhibit fewer symptoms of hyperactivity. However, they continue to lag behind peers academically and have a greater tendency toward other emotional and behavioral disorders as well as for substance abuse.

UC Berkeley researchers, in a long-awaited, five-year follow up study of one of the largest samples of girls with ADHD ever examined, found not only difficulties for girls with ADHD persist during adolescence, but that other stealthily treacherous new problems can develop.

The study’s lead author, Stephen Hinshaw, a UC Berkeley professor of psychology and chair of the psychology department says, “As girls with ADHD mature into adolescence, on average they don’t show as many visible symptoms of the condition, especially the most noticeable form – hyperactive behavior.”

Continuing, he said, “But we can’t get fooled into thinking things are fine. Delinquent and depressed behaviors, risk for substance abuse, symptoms of eating disorders, high need for services, difficulties with peers – these problems hit girls with ADHD harder than they did for the comparison group without the condition.”

Hinshaw and colleagues have followed a racially and socio-economically diverse group of girls with ADHD since 1997 through adolescence, and compared them with girls who did not meet the ADHD criteria but were otherwise demographically matched.

The childhood study, which the National Institute of Mental Health (NIMH) funded, consisted of a sample group of 140 girls with ADHD and 88 without the disorder. The girls were age 6-12. Together the girls attended five-week camps where researchers closely observed them as they took part in outdoor activities and art and drama classes. Those taking ADHD medication volunteered to go off the drug treatment for much of the study. The staff and counselors observing all 228 girls and monitoring their interactions did not know which had been diagnosed with ADHD.

In 2002 the initial study, published in the Journal of Consulting and Clinical Psychology, found that girls with ADHD are more likely to struggle in school and be rejected by their peers than girls in the comparison group. The results also found that girls are likely under-diagnosed for the disorder because they are more prone to “inattentive-type” ADHD, a type marked by unfocused and disorganized behavior rather than the impulsive, disruptive behavior seen in boys.

The new findings show these conditions clearly carry over from childhood into adolescence. According to five-year follow ups of 209 of the girls involved in the study, impulsive, nervous-like behaviors had subsided mostly, the learning gap between girls with ADHD and their non-ADHD peers was large in all the cases, and had actually widened in math and reading. As well, in many cases, risky behaviors had developed.

Hinshaw said, “Girls with ADHD have impairments that are not transitory but that persist through adolescence. And they are persisting in areas of function that are really crucial for success in adulthood. They’re behind academically and socially. Even if symptoms improve, underlying deficits seem chronic, and we need to do a lot more for early intervention.”

For parents coping with difficult behavior in their ADHD teens, warns Hinshaw, adolescence can be difficult in trying to strike a balance between encouraging their daughters to stick with treatment regimens – which could involve family therapy, medication, school supports, or a combination thereof – while supporting the girls’ need for autonomy.

Hinshaw said, “At the very time adolescence is occurring for these kids, demands for independence are increasing exponentially.”

In the follow-up study, the research team spent two half-days with each of the girls as well, as their parents and caregivers, and conducted intensive interviews and tests. The girls’ teachers also provided information for the researchers. The objective was to learn how the girls, ranging from age 12 to 17, were getting along emotionally, socially and academically. The team also measured key cognitive functions like “executive planning skills,” which included adjustment to changes, time management and goal setting.

Hinshaw said he hopes the new findings will reiterate the need for long-term professional intervention for children with ADHD and convince families struggling with the disorder that it’s a misconception that ADHD is not a “real” disorder – and that diagnosis and treatment are crucial.

Hinshaw and his team have won a new NIMH grant for a 10-year follow-up study of these same girls, which is set to begin later in the year.

Some girls in the study are also participating in a UC Berkeley brain imaging study to pinpoint the source of poor executive functioning skills, which is a common component of ADHD.

Up to 7 million American children have been diagnosed with ADHD, which is characterized by distractibility, hyperactivity, poor concentration skills, impulsive behavior, aggression and other symptoms that are inappropriate for the child’s age. Treatment options that have received the greatest clinical evidence are stimulant medications and various types of behavior therapy.

Many of the girls with ADHD in the study did show improvement across the five-year follow-up interval, with a few making substantial recoveries. However, on average, problems persisted and new ones emerged, suggesting that careful monitoring and treatment are critical.

© Copyright 2007 Insight Journal Online Magazine.

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