Prospective Follow-Up of Girls With Attention-Deficit/Hyperactivity Disorder Into Early Adulthood: Continuing Impairment Includes Elevated Risk for Suicide Attempts and Self-Injury

• Published in: Journal of consulting and clinical psychology 2012-12, Vol.80 (6), p.1041-1051
• Main Authors: Hinshaw, Stephen P., Owens, Elizabeth B., Zalecki, Christine, Huggins, Suzanne Perrigue, Montenegro-Nevado, Adriana J., Schrodek, Emily, Swanson, Erika N.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult and adolescent clinical studies; Adults; Attempted Suicide; Attention Deficit Disorder with Hyperactivity; Attention Deficit Disorder with Hyperactivity - psychology; Attention deficit disorders. Hyperactivity; Attention Deficit Hyperactivity Disorder; Beck Depression Inventory; Behavior Problems; Biological and medical sciences; Child; Child clinical studies; Child development; Children; Clinical Diagnosis; Comorbidity; Diagnostic Interview Schedule for Children; Effect Size; Externalization; Externalizing behaviour; Female; Females; Follow-Up Studies; Girls; Human; Human Females; Humans; Injuries; Internalization; Longitudinal Studies; Measures (Individuals); Medical diagnosis; Medical sciences; Motor Vehicles; Multivariate Analysis; Nonsuicidal Self-Injury; Pathology; Pediatrics; Perceptions; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk; Risk Factors; Self Concept; Self Destructive Behavior; Self esteem; Self-Injurious Behavior - psychology; Selfinjury; Socioeconomic Status; Substance Abuse; Suicidal behaviour; Suicide; Suicide, Attempted - psychology; Suicides & suicide attempts; Symptoms; Symptoms (Individual Disorders); Wechsler Individual Achievement Test; Young Adult
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/a0029451

Objective: We performed a 10-year prospective follow-up of a childhood-ascertained (6-12 years), ethnically and socioeconomically diverse sample of girls with attention-deficit/hyperactivity disorder (ADHD; N = 140: combined type [ADHD-C] n = 93; inattentive type [ADHD-I] n = 47) plus a matched comparison group (N = 88). Girls were recruited from schools, mental health centers, pediatric practices, and via advertisements; extensive evaluations confirmed ADHD versus comparison status. Method: Ten-year outcomes (age range 17-24 years; retention rate = 95%) included symptoms (ADHD, externalizing, internalizing), substance use, eating pathology, self-perceptions, functional impairment (global, academic, service utilization), self-harm (suicide attempts, self-injury), and driving behavior. Results: Participants with childhood-diagnosed ADHD continued to display higher rates of ADHD and comorbid symptoms, showed more serious impairment (both global and specific), and had higher rates of suicide attempts and self-injury than the comparison sample, with effect sizes from medium to very large; yet the groups did not differ significantly in terms of eating pathology, substance use, or driving behavior. ADHD-C and ADHD-I types rarely differed significantly, except for suicide attempts and self-injury, which were highly concentrated in ADHD-C. Domains of externalizing behavior, global impairment, service utilization, and self-harm (self-injury and suicide attempts) survived stringent control of crucial childhood covariates (age, demographics, comorbidities, IQ). Conclusions: Girls with childhood ADHD maintain marked impairment by early adulthood, spreading from symptoms to risk for serious self-harm. Our future research addresses the viability of different diagnostic conceptions of adult ADHD and their linkages with core life impairments.