A life course approach to understanding ADHD among women

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For many years ADHD was thought of as a childhood disorder that mainly affected boys. However, we now know many adults have ADHD (about 2.5% of the population). Having ADHD in adulthood comes with higher risk for poor outcomes, including unemployment, substance abuse and even higher mortality. While in childhood more boys are diagnosed with ADHD than girls, in adulthood women make up 50% of the ADHD population. However, because of an outdated idea that ADHD only affects males, ADHD among adult women is largely ignored in research. This project seeks to address this neglect by investigating several important aspects of ADHD among women, including: (1) what features characterise girls who will later show ADHD in adulthood, (2) whether ADHD symptoms increase for some girls in adolescence, and (3) whether menstrual cycle hormonal changes make symptoms worse for women with ADHD. Why are some women diagnosed with ADHD in adulthood without having a childhood diagnosis? We will investigate childhood and adolescent characteristics of girls who later go on to develop ADHD in adulthood using data from two large UK studies. We will consider several areas that might characterise these girls, including a more 'female' ADHD presentation (e.g. talkativeness rather than physical hyperactivity); compensation for ADHD symptoms (e.g. with pro-social behaviours) or family 'scaffolding' (e.g. intense parental involvement); and adolescent stressors (e.g. greater demands of more challenging schooling). If we identify earlier predictors of late-identified ADHD, this could have several impacts: first, this could help build more sensitive measures of ADHD to better capture girls who may 'fly under the radar' of teachers, parents and clinicians. This could in turn lead to earlier identification of ADHD, and limit the number of years girls and women with ADHD experience misdiagnosis and poor functioning.Another reason women may be diagnosed with ADHD for the first time in adulthood could be that their ADHD got worse in adolescence. Adolescence is a key period of rapid brain development amidst increasing social and educational demands. Using data from a large study that follows adolescents from ages 9/10 to 12/13 and assesses ADHD symptoms each year, we will investigate whether some girls show a pattern of increasing ADHD symptoms in adolescence. We can also investigate what factors put some girls more at risk for increasing ADHD symptoms. Because this study also collected information on pubertal development and hormone levels, we can look specifically at whether the onset of puberty is associated with increasing ADHD symptoms. This is especially important as research shows that the age of pubertal onset is moving younger and younger among girls. Among women with ADHD, the effects of hormones on functioning are a big concern. Many women with ADHD report their ADHD gets worse, or their medication doesn't work as well, at certain times of their menstrual cycle. However this has never been investigated in a research study. To look into this issue, we will collect information from women for 3 months in two ways: first, we will give women daily questionnaires on their smartphones about their ADHD symptoms, ADHD medication, menstrual cycle, and related problems (like low mood and cognitive problems). Second we will use a 'smart ring' device that women wear on their finger to sense sleep patterns and physical activity, which may help us understand how hormonal changes and ADHD are related. This 'smart ring' can also measure body temperature, which is important because body temperature changes over the menstrual cycle, so this is an innovative and non-intrusive way to assess phases of the cycle. Findings from this study could have a major impact on ADHD treatment for women, as cycle tracking, adjustments of medication dosage during certain cycle phases and interventions to support sleep and physical activity may be beneficial.