A life course approach to understanding ADHD among women

多年来，多动症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多动症（约占人口的2.5%）。成年后患有注意力缺陷多动症会带来更高的不良后果，包括失业、药物滥用，甚至更高的死亡率。在儿童时期，被诊断患有多动症的男孩比女孩多，而在成年期，女性占多动症人群的50%。然而，由于一种过时的观点认为ADHD只影响男性，成年女性的ADHD在研究中基本上被忽视了。该项目试图通过调查女性ADHD的几个重要方面来解决这种忽视问题，包括：(1)成年后出现ADHD的女孩有哪些特征，(2)一些女孩在青春期是否会出现ADHD症状增加，(3)月经周期荷尔蒙的变化是否会使患有ADHD的女性症状加重。为什么有些女性在成年后被诊断为多动症，而在童年时却没有诊断？我们将利用英国两项大型研究的数据，调查成年后患上多动症的女孩的童年和青春期特征。我们将考虑几个可能表征这些女孩的方面，包括更“女性化”的ADHD表现（例如，健谈而不是身体多动）；对ADHD症状的补偿（如亲社会行为）或家庭“支架”（如父母强烈参与）；以及青少年压力源（例如，对更具挑战性的学校教育的更高要求）。如果我们能识别出晚期发现的多动症的早期预测因素，这可能会产生几个影响：首先，这可以帮助建立更敏感的多动症测量方法，以更好地捕捉那些可能在老师、父母和临床医生的雷达下“飞”的女孩。这反过来可能导致ADHD的早期识别，并限制患有ADHD的女孩和妇女经历误诊和功能不良的年数。女性在成年后第一次被诊断为多动症的另一个原因可能是她们的多动症在青春期变得更严重。随着社会和教育需求的增加，青春期是大脑快速发育的关键时期。利用一项大型研究的数据，该研究跟踪了9/10岁至12/13岁的青少年，并每年评估ADHD症状，我们将调查是否有些女孩在青春期表现出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出现多动症症状。因为这项研究还收集了青春期发育和激素水平的信息，我们可以专门研究青春期的开始是否与多动症症状的增加有关。这一点尤其重要，因为研究表明，女孩的青春期开始年龄越来越小。在患有多动症的女性中，激素对功能的影响是一个大问题。许多患有注意力缺陷多动障碍的女性报告说，她们的注意力缺陷多动障碍在月经周期的某些时候变得更糟，或者她们的药物不起作用。然而，这从未在一项研究中进行过调查。为了研究这个问题，我们将在3个月的时间里通过两种方式收集女性的信息：首先，我们将每天在女性的智能手机上给她们提供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）的问卷。其次，我们将使用女性戴在手指上的“智能戒指”设备来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多动症之间的关系。这种“智能环”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，所以这是一种创新的、非侵入性的评估月经周期阶段的方法。这项研究的发现可能会对女性多动症的治疗产生重大影响，因为周期跟踪、在特定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 However, because of an outdated idea that ADHD only affects males, ADHD among adult women is largely ignored in research.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.