ADHD conjures images of little boys bouncing around a classroom, making rubber-band slingshots, struggling to sit still. We think of minds wandering off the task at hand to "Look at the shiny!" For many of us, we stop thinking about children and shift to our own struggles to focus, in the world of apps, blogs, tweets and other shiny objects. But when we do think of children and ADHD, we most likely think of boys. And we're not wrong: according to the Centers for Disease Control, there are 5.4 million children in the United States with reported Attention-Deficit/Hyperactivity Disorder, with boys more than twice as likely to be diagnosed as girls. (http://www.cdc.gov/ncbddd/adhd/data.html.)
But ADHD may be taking a more treacherous and insidious toll on girls. New research out of UC Berkeley suggests that girls with ADHD are very much in need of our attention, particularly as they mature into adolescence and teen years. A 10-year follow-up on 140 girls, now aged 17-24, this study found that girls diagnosed in childhood with ADHD had higher rates of suicide attempts and self-injury (Hinshaw et. al., 2012). This trend was seen in girls with the combined subtype of ADHD, which has both inattentive and hyperactive features.
ADHD poses several risk factors for teen girls. First, earlier data from this research team showed that girls with ADHD were more likely to have academic and social struggles. While we commonly think about how ADHD impacts academic performance, children with ADHD are often rejected by peers as they struggle with social skills (Mikami, 2010). As social pressure increases during adolescence, children are more vulnerable to feeling outcast or bullied, perhaps even more so girls who have been battling ADHD since they were young. Second, adolescent girls with ADHD are susceptible to impulsivity, making them more likely to engage in cutting, burning or suicidal behavior, compared to their peers without ADHD. Essentially, the social and academic impact of ADHD can lead girls to feel pretty bad about themselves; poor impulse control will let them act dangerously on those bad feelings.
The study also affirmed that ADHD is not a stable diagnosis over time which can itself create a risk factor. If symptoms subside in adolescence, then we stop monitoring and treating girls with ADHD, missing that they're still vulnerable to impulsivity. As this study shows, impulsivity in adolescent girls with ADHD is far more serious than shooting rubber bands and doodling. The good news remains that ADHD is treatable, through medication therapy or behavior modification approaches. What this research suggests is that we need to continue to monitor girls with ADHD, even if the symptoms are gone.
By Lucy Rimalower, LMFT
Hinshaw, S.P., Owens, E.B., & Zalecki, C., Huggins, Z.P., Montenegro-Nevado, A.J., Schrodek, E., & Swanson, E.N. (2012). Follow-up of girls with Attention-Deficit/Hyperactivity Disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of Consulting and Clinical Psychology.
Mikami, A.Y. (2010). The importance of friendship for youth with attention-deﬁcit/hyperactivity disorder. Clinical Child & Family Psychology Review, 13, 181-198.