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UC Berkeley Press Release

Struggles persist for adolescent girls with ADHD

– As they enter adolescence, girls with Attention Deficit Hyperactivity Disorder (ADHD) show fewer symptoms of hyperactivity. But they continue to lag behind their peers academically and have a greater proclivity for other behavioral and emotional disorders as well as for substance abuse, according to new research from the University of California, Berkeley.

In a much-anticipated, five-year follow-up study of one of the largest samples of girls with ADHD ever examined, UC Berkeley researchers found not only that difficulties for girls suffering from the disorder persist during their teens, but that insidious new problems can emerge. These findings are published in the June issue of the Journal of Consulting and Clinical Psychology.

"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," said the study's lead author, Stephen Hinshaw, who is a UC Berkeley professor of psychology and chair of the psychology department.

"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," he added.

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

The childhood study, funded by a grant from the National Institute of Mental Health (NIMH), included a sample of 140 girls with ADHD and 88 without the disorder. The girls were aged six to 12. Together, they attended five-week camps where they were closely monitored as they partook 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.

Published in 2002 in the Journal of Consulting and Clinical Psychology, the initial study found that girls with ADHD are more likely to struggle academically and to be rejected by their peers, compared to the comparison peer group. 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 had remained large in all cases, and had actually widened in math and reading skills. Moreover, in many cases, risky behaviors had surfaced.

"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," Hinshaw said. "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 teenage ADHD behavior, Hinshaw warned, adolescence can be 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, demands for independence are increasing exponentially," he said.

For the follow-up study, the researchers spent two half-days with each of the girls as well as with their parents and caregivers, conducting intensive interviews and tests. The girls' classroom teachers also provided information. The objective was to learn how the girls, whose ages ranged between 12 and 17, were doing emotionally, socially and academically. The investigators also measured key cognitive functions such "executive planning skills," which include time-budgeting, adjusting to changes and goal-setting.

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

His research team has won a new NIMH grant for a 10-year follow-up study of the same girls. It is set to begin later this year.

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

As many as 7 million children in the United States have been diagnosed with this developmental and behavioral disorder, which is characterized by poor concentration, distractibility, hyperactivity, impulsiveness, aggression and other symptoms that are inappropriate for the child's age. The treatment regimens that have received the greatest research evidence are stimulant medications and various forms of behavior therapy.

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 said.

In addition to Hinshaw, authors of the study are Elizabeth Owens, Nilofar Sami and Samantha Fargeon, all of UC Berkeley's psychology department and Institute of Human Development.