A life course approach to understanding ADHD among women

多年来，ADHD被认为是一种主要影响男孩的儿童疾病。然而，我们现在知道许多成年人患有ADHD（约占人口的2.5%）。成年后患有ADHD会带来更高的不良后果风险，包括失业，药物滥用甚至更高的死亡率。虽然在儿童时期，更多的男孩被诊断患有ADHD，但在成年期，女性占ADHD人口的50%。然而，由于ADHD只影响男性的过时观念，成年女性的ADHD在研究中基本上被忽视了。该项目旨在通过调查女性ADHD的几个重要方面来解决这一忽视问题，包括：（1）成年后会表现出ADHD的女性的特征，（2）青春期的一些女孩ADHD症状是否会增加，以及（3）月经周期激素变化是否会使ADHD女性的症状恶化。为什么有些女性在成年后被诊断患有ADHD，而没有儿童诊断？我们将使用两项大型英国研究的数据，调查女孩的童年和青少年特征，这些女孩后来在成年后发展为ADHD。我们将考虑几个可能影响这些女孩的领域，包括更多的“女性”ADHD表现（例如，健谈而不是身体多动）; ADHD症状的补偿（例如，亲社会行为）或家庭“脚手架”（例如，父母的强烈参与）;和青少年压力源（例如，更大的需求更具挑战性的学校教育）。如果我们确定了后期发现的ADHD的早期预测因素，这可能会产生几个影响：首先，这可能有助于建立更敏感的ADHD指标，以更好地捕捉可能在教师，家长和临床医生的雷达下飞行的女孩。这可能反过来导致更早地识别ADHD，并限制患有ADHD的女孩和女性经历误诊和功能低下的年数。女性可能在成年后首次被诊断患有ADHD的另一个原因可能是他们的ADHD在青春期变得更糟。青少年时期是大脑快速发育的关键时期，社会和教育需求不断增加。使用一项大型研究的数据，该研究跟踪了9/10至12/13岁的青少年，并每年评估ADHD症状，我们将调查一些女孩是否在青春期表现出ADHD症状增加的模式。我们还可以调查哪些因素使一些女孩更容易增加ADHD症状。由于这项研究还收集了青春期发育和激素水平的信息，我们可以具体研究青春期的开始是否与ADHD症状的增加有关。这一点尤其重要，因为研究表明，女孩进入青春期的年龄越来越小。在患有ADHD的女性中，激素对功能的影响是一个很大的问题。许多患有ADHD的女性报告说，在月经周期的某些时候，她们的ADHD变得更糟，或者她们的药物不起作用。然而，这从未在研究中进行过调查。为了研究这个问题，我们将通过两种方式从女性那里收集3个月的信息：首先，我们将在智能手机上向女性提供关于ADHD症状，ADHD药物，月经周期和相关问题（如情绪低落和认知问题）的日常问卷。其次，我们将使用一种“智能戒指”设备，女性戴在手指上可以感知睡眠模式和身体活动，这可能有助于我们了解荷尔蒙变化和ADHD之间的关系。这种“智能戒指”还可以测量体温，这一点很重要，因为体温在月经周期中会发生变化，因此这是一种评估周期阶段的创新和非侵入性方式。这项研究的结果可能对女性ADHD治疗产生重大影响，因为周期跟踪，在某些周期阶段调整药物剂量以及支持睡眠和身体活动的干预措施可能是有益的。

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 However, because of an outdated idea that ADHD only affects males, ADHD among adult women is largely ignored in research.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.