ADHD is diagnosed more commonly in boys than girls, but that doesn't mean that less attention should be paid to the disorder's affects on women. In this group, one of ADHD's most unfortunate comorbidities appears to be major depressive disorder, and new longitudinal studies further illuminate the depth of the relationship between these two conditions. The nature of this link should bring more attention for early interventions and greater sensitivity to the ways in which ADHD affects girls.
Estimated rates of depression have consistently run as much as 300% higher among young people with ADHD (approximately 25-30% for affected subjects compared to 10% for controls in multiple studies). In a very general statement of their conclusions, researchers in a longitudinal study at UC Berkely noted that girls may have "a wider range of negative outcomes than boys" and that they're even more likely to fall into the three most common side-effects of chronic ADHD: behavioral delinquency, academic failure and substance abuse. As we've previously reported, girls with ADHD are considerably more likely to suffer from eating disorders as well.
New research on ADHD and major depression goes even further. In the most recent study, researchers at the Massachusetts General Hospital followed the progress of 262 girls, slightly more than half of whom were attention-deficit challenged, for five years as they entered adolescence and young adulthood. They found that depression is not only more common but that it generally begins earlier, lasts longer and creates more severe symptoms among ADHD girls. Females with the disorder, their results state, are at least 2.5 times as likely to develop major depression by the time they're finishing high school. The average age of onset was lower for the ADHD girls; the duration of their depressive periods was twice as long; their rates of suicidality and psychiatric hospital stays were higher. And since major depression may also begin in early adulthood, statistics will most likely rise as the study's subjects age.
Because the loud, disruptive behaviors so common to attention-challenged boys are more subtle in most girls, the condition very often goes undiagnosed. The ratio of ADHD diagnosis for boys vs. girls is 10 to 1, but the author of this most recent study estimates the real-world ratio to be less than 2 to 1. The gender difference lies not so much in the severity of symptoms as in the way they present. Many young girls who spend their school days dreaming or staring out the window do, in fact, suffer from ADHD. But because they don't act out and disturb the class, parents and teachers may remain confused about the nature of their academic difficulties. And depression, being easier to recognize, may be diagnosed before the attention deficit problems that preceded it. Still, girls can also experience the aggressive, disruptive behavior more common to boys, and another, more thorough 15-year study of more than 800 Canadian girls found that, by the time they turned 21, those defined as disruptive were more likely to have relationship problems, early pregnancies and a reliance on government welfare programs.
The source of depression in ADHD school girls is complex, but major factors seem to be academic troubles and, more importantly, the fractured social lives of severely affected adolescents. ADHD teens, due largely to problems with self-expression, often find it harder to make and keep friends and may end up saddled with "antisocial" or "outsider" tags. Researchers advocate giving greater attention and funding to early prevention programs so that affected girls can be identified and assigned to a proper course of treatment including behavioral interventions, special classes and, if necessary, non-stimulant medications. The earlier we can detect these disorders, the greater power we have over their eventual influence.
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