Long-term outcomes of females with attention-deficit hyperactivity disorder: increased risk for self-harm

O’Grady, Sinclaire M.; Hinshaw, Stephen P.

doi:10.1192/bjp.2020.153

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…Associated psychopathology (internalizing and/or externalizing), executive dysfunction, maltreatment or other early adverse experiences, negative father–daughter interactions, low self‐worth, and peer victimization/rejection are implicated. Such process‐oriented findings may aid with intervention (see O'Grady & Hinshaw, 2021, for commentary).…”

Section: Developmental Progressions Mediators and Heterotypic Continu...mentioning

confidence: 99%

Annual Research Review: Attention‐deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions

Hinshaw

Nguyen

O’Grady

et al. 2021

Child Psychology Psychiatry

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115

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Attention‐deficit/hyperactivity disorder (ADHD) – and its underlying behavioral dimensions of inattention and hyperactivity–impulsivity – have been understudied in females. We first cover the conceptual issues of prevalence, diagnostic practices, diversity, comorbidity, and causal factors, plus forces limiting awareness of ADHD in females. After a narrative review of cross‐sectional and longitudinal findings, we conclude the following. (a) Girls meet diagnostic criteria for ADHD at just under half the rates of boys, a ratio that becomes much closer to equal by adulthood. (b) Girls and women with ADHD show a predominance of inattention and associated internalizing problems; boys and men display greater levels of hyperactive–impulsive symptoms and associated externalizing problems. (c) Sex differences in ADHD symptoms and related outcomes depend heavily on the clinical versus nonreferred nature of the samples under investigation. (d) Females with ADHD experience, on average, serious impairments, with a particularly heightened risk for problems in close relationships and engagement in self‐harm. (e) Clinicians may overlook symptoms and impairments in females because of less overt (but still impairing) symptom manifestations in girls and women and their frequent adoption of compensatory strategies. Our review of predictors and mediators of adult outcomes highlights (a) the potential for heterotypically continuous pathways in females with childhood ADHD and (b) developmental progressions to self‐harm, intimate partner violence, unplanned pregnancy, and comorbid psychopathology. Focusing on ADHD in females is necessary to characterize causal and maintaining mechanisms with accuracy and to foster responsive interventions, as highlighted in our closing list of clinical implications and research priorities.

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Section: Developmental Progressions Mediators and Heterotypic Continu...mentioning

confidence: 99%

Annual Research Review: Attention‐deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions

Hinshaw

Nguyen

O’Grady

et al. 2021

Child Psychology Psychiatry

Self Cite

115

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“…ADHD hyperactivity-impulsivity presentation occurs more than twice as frequently in boys as in girls, while girls diagnosed with ADHD are more likely to have the inattentive type ( 70 ). However, many girls with ADHD, particularly those with high impulsivity in their childhood, follow a heterotypical continuous developmental pathway, that puts them at a strikingly high risk of engaging in DSH ( 71 ). We found that 17.9% of the studied population at the age of 18 years reported that they had performed DSH at least once in their life which is roughly similar to what is found in other studies ( 72 ).…”

Section: Discussionmentioning

confidence: 99%

Before the damage is done: Early childhood hyperactivity difficulties in adolescents with deliberate self-harm – findings from the DALSC cohort

Evald¹,

Møhl

2020

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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Background: Deliberate self-harm (DSH) is a growing issue among Danish adolescents, and a dramatic increase in the incidence of DSH has been observed since the turn of the millennium. The importance of early childhood factors on later development has been established, but research on the trajectories of DSH is still scarce, and longitudinal studies are much needed. Method: Participants were 3,291 children and their mothers from The Danish Longitudinal Survey of Children (DALSC), a Danish population-based birth cohort from 1995. Logistic regression and mediation analyses were used to examine significant early childhood determinants of self-harming behavior in adolescence. Results: The study found that 17.9% of the children had a history with DSH at the age of 18 years. A significant relationship was found between the likelihood of DSH at the age of 18 years and hyperactivity difficulties assessed through the Strengths and Difficulties Questionnaire (SDQ) at 3 and 7 years of age. Using a mediation model, it is documented that difficulties in peer relationships at the age of 11 years is a partial mediator explaining 19% of the variation. Limitations: i) a vague definition of self-harm in the questionnaires; ii) lack of sample representation as children of lower socio-economic groups have lower participation rates, and only Danish-ethnicity children have been sampled; iii) possibility of omitted variable bias. Conclusion: The adolescents engaging in DSH are experiencing a more complex range of psychosocial problems than those who do not have experience with DSH. The main finding of the study is that hyperactivity as a risk factor for the development of DSH in adolescence can be identified as early as 3–7 years of age. This relationship between the very early occurring hyperactivity and later DSH, to the best of our knowledge, has not previously been described.

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“…Recent publications point out factors relating to childhood and adolescence that are relevant to the risk of selfharm in women with ADHD. These factors include: combined type ADHD, childhood abuse and/or neglect, high severity of ADHD symptoms, low self-esteem, presence of comorbidities, negative father-child interactions and executive impairment [25,26].…”

Section: Factors Contributing To Suicidality and Nonsuicidal Self-injurymentioning

confidence: 99%

“…Additionally, women with a persistent ADHD diagnosis faced a greater risk of suicide attempt and NSSI than females with transient diagnosis and control. NSSI present in adolescence are a risk factor for suicide attempts later in life [26], so it is important to implement therapeutic interventions as early as possible.…”

Section: Factors Contributing To Suicidality and Nonsuicidal Self-injurymentioning

confidence: 99%

Suicidality and nonsuicidal self-injury in females diagnosed with attention-deficit hyperactivity disorder - a narrative review

Todzia-Kornaś,

Szczegielniak,

Gondek

2023

Current Opinion in Psychiatry

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Purpose of review Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder and is associated with an increased risk of suicidal behavior, especially in females. The differences in the presentation of ADHD in females, factors contributing to suicidality and the effects of therapeutic interventions are presented in this review to highlight the relationship between ADHD and suicidality and self-harm behavior. Recent findings Impulsivity, an inherent symptom of ADHD, commonly acts as a risk factor of suicidality and is associated with both suicidal behavior and nonsuicidal self-injury. The combined subtype of ADHD, which typically is characterized by significant impulsivity, is linked with the highest vulnerability to suicide attempts. Female gender, lower educational attainment, comorbid substance abuse, a history of depression, and experience of childhood maltreatment were singled out as distinct factors that were independently linked to lifetime suicide attempts. Summary The association of the ADHD and suicidality is gaining an increasing interest in recent years. Active suicide prevention is required in this population and it is crucial for clinicians and researchers to have access to the most current information in this field.

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Long-term outcomes of females with attention-deficit hyperactivity disorder: increased risk for self-harm

Cited by 4 publications

References 5 publications

Annual Research Review: Attention‐deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions

Annual Research Review: Attention‐deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions

Before the damage is done: Early childhood hyperactivity difficulties in adolescents with deliberate self-harm – findings from the DALSC cohort

Suicidality and nonsuicidal self-injury in females diagnosed with attention-deficit hyperactivity disorder - a narrative review

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