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Girls with ADHD continue to struggle academically and socially in adolescence, Berkeley researchers confirm

| 19 July 2006

As many as 7 million children in the United States have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), which is characterized by poor concentration, distractibility, hyperactivity, impulsiveness, aggression, and other symptoms that are inappropriate for the child's age.

Now, in a much-anticipated, five-year follow-up study of one of the largest samples of girls with ADHD ever examined, Berkeley researchers have found not only that difficulties for girls suffering from the disorder, such as lagging behind their peers academically, persist during their teens, but that insidious new problems can emerge - including other behavioral and emotional disorders.

"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," says the study's lead author, Stephen Hinshaw, a professor of psychology and chair of the psychology department.

"But we can't get fooled into thinking things are fine," he adds. "Delinquent and depressed behaviors, risk of substance abuse, symptoms of eating disorders, high need for services, difficulties with peers - we found that problems hit girls with ADHD harder than they did for the comparison group without the condition."

The findings are published in the June issue of the Journal of Consulting and Clinical Psychology. In addition to Hinshaw, authors of the study are Elizabeth Owens, Nilofar Sami, and Samantha Fargeon, all of Berkeley's psychology department and Institute of Human Development.

Since 1997, Hinshaw and his team have tracked a racially and socio-economically diverse group of girls with ADHD into adolescence, comparing them with girls who did not meet the criteria for ADHD but were otherwise demographically matched.

The childhood study included a sample of girls ages 6 to 12: 140 girls with ADHD and 88 without. Together they attended five-week camps where they were closely monitored as they participated in art and drama classes and outdoor activities. Those taking ADHD medication volunteered to go off the drug treatment for much of the summer camp study. The counselors and staff observing all 228 girls and monitoring their interactions did not know which of them had been diagnosed with ADHD.

The initial study, published in 2002, found that girls with ADHD are more likely than their unafflicted peers to struggle academically and to encounter social rejection. Results also suggested that girls are underdiagnosed for the disorder because they are more prone to "inattentive-type" ADHD, which is marked by disorganized and unfocused behavior rather than the disruptive, impulsive conduct seen in boys.

The latest findings show that these problems clearly persist into adolescence. According to five-year follow-ups of 209 of the girls in the study, although the fidgety, impulsive symptoms exhibited during childhood had subsided in many cases, the learning gulf between girls with ADHD and their "normal" peers remained large in all cases, and had actually widened in math and reading skills. Moreover, in many cases risky behaviors had surfaced.

Although the news is sobering, many of the girls with ADHD did show improvement across the five-year follow-up interval. A few made substantial recoveries. But on average, problems persisted and new ones emerged, which suggests that careful monitoring and treatment are essential, Hinshaw says.

"Girls with ADHD have impairments that are not transitory but persist through adolescence. And they are persisting in areas of function that are really crucial for success in adulthood," Hinshaw says. "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."

Parents coping with difficult teenage ADHD behavior find adolescence tricky as they try to strike a balance between encouraging their daughters to stick to their treatment regimen (which may involve medication, family therapy, school supports, or a combination) while supporting their need for autonomy. "At the very time adolescence is occurring for these kids," Hinshaw says, "demands for independence are increasing exponentially."

Hinshaw says he hopes these new findings will underscore the need for long-lasting professional intervention for children with ADHD. He also hopes to convince families struggling with the disorder that it's a misconception that ADHD is not a "real" condition - and to persuade them that diagnosis and treatment are crucial.

His research team has won a new National Institute of Mental Health grant for a 10-year follow-up study of the same girls, set to begin later this year. Some of the girls in the study are also participating in a brain-imaging project at Berkeley designed to pinpoint the source of poor executive-function skills, a common component of ADHD.