Girls with ADHD at risk for self-injury, suicide attempts as young adults

Young women diagnosed with attention deficit hyperactivity disorder as girls, particularly the type with early signs of impulsivity, were three to four times more likely to attempt suicide and two to three times more likely to report injuring themselves than comparable young women in a control group, according to the findings, published online in the Journal of Consulting and Clinical Psychology.

"ADHD can signal future psychological problems for girls as they are entering adulthood," said the study's lead author, Stephen Hinshaw, PhD, a psychology professor at the University of California, Berkeley. "Our findings reinforce the idea that ADHD in girls is particularly severe and can have serious public health implications."

The first wave of the study comprised 228 girls ages 6 to 12 in the San Francisco Bay area. A total of 53 percent were white, 27 percent were African-American, 11 percent were Latina and 9 percent were Asian-American. The girls were recruited from schools, mental health centers, pediatric practices and community advertisements. They went through extensive diagnostic assessments, after which 140 girls were diagnosed with ADHD, while the rest were part of a control group. Forty-seven girls were diagnosed with ADHD-inattentive, a subtype of ADHD that means the girls are less likely to act out and can sit quietly but have a hard time paying attention. Ninety three had ADHD-combined, a combination of hyperactive, impulsive and inattentive symptoms. ADHD-combined is the most common subtype of ADHD referred for treatment.

After the initial diagnostic tests, the researchers followed up at year five and at year 10 with a full day of clinical assessments of each girl. They also conducted telephone interviews or home visits if necessary. Of the original sample, 95 percent of the girls were retained at the 10-year follow-up, when the participants were between the ages of 17 and 24. They and their families were questioned about a range of life problems, including any substance use, suicide attempts, self-injury and depressive symptoms. The young women were also tested for academic achievement and neuropsychological functioning.

Of the participants diagnosed with ADHD-combined, 22 percent reported at least one suicide attempt at the 10-year follow-up, compared to 8 percent of those with ADHD-inattentive and 6 percent of the control group. Girls in the ADHD-combined group were significantly more likely to injure themselves, with 51 percent reporting actions such as scratching, cutting, burning or hitting themselves. That compared to 19 percent in the control group and 29 percent in the ADHD-inattentive group.

There were no significant differences in substance use across the groups; however, the girls diagnosed with ADHD as children were more likely to continue to have symptoms of ADHD, more psychiatric problems and far greater use of psychological services, the study found.

"ADHD in girls and women carries a particularly high risk of internalizing, even self-harmful behavior patterns," said Hinshaw. "We know that girls with ADHD-combined are more likely to be impulsive and have less control over their actions, which could help explain these distressing findings."