Original article| Volume 60, ISSUE 10, P1098-1105, November 15, 2006

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Psychopathology in Females with Attention-Deficit/Hyperactivity Disorder: A Controlled, Five-Year Prospective Study


      Despite the importance of understanding the long-term outcome of children with attention-deficit/hyperactivity disorder (ADHD), the available literature is predominantly based on male samples. This study estimated the lifetime burden of comorbid psychopathology in a large sample of girls with and without ADHD followed up over five years.


      We conducted a blind, five-year prospective longitudinal study of girls with (n=140) and without (n=122) ADHD, aged 6–18 years at baseline, consecutively ascertained from either community pediatricians or psychiatrists at an academic medical center. At the five-year follow-up, 123 (88%) and 112 (92%) of the ADHD and control children, respectively, were re-assessed at a mean age of 16.7 years. Psychiatric disorders were assessed using blinded structured diagnostic interviews.


      At follow-up, females with ADHD were at significantly higher risk than controls to manifest disruptive behavior, mood and anxiety disorders, and substance dependence. The magnitude of increased risk was greatest for major depression and oppositional-defiant disorder, followed by substance dependence and anxiety disorders.


      These prospective follow-up findings documenting high morbidity associated with ADHD extend to females previously reported findings in male samples and underscore the importance of early recognition and intervention efforts for youth with ADHD of both genders.

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        • Angold A.
        • Costello E.J.
        Depressive comorbidity in children and adolescents: Empirical, theoretical and methodological issues.
        Am J Psychiatry. 1993; 150: 1779-1791
        • Angold A.
        • Costello J.
        • Erkanli A.
        J Child Psychol Psychiatry. 1999; 40: 57-87
        • Arnold L.
        Sex differences in ADHD: Conference summary.
        J Abnorm Child Psychol. 1996; 24: 555-569
        • Biederman J.
        • Faraone S.
        • Milberger S.
        • Guite J.
        • Mick E.
        • Chen L.
        • et al.
        A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders.
        Arch Gen Psychiatry. 1996; 53: 437-446
        • Biederman J.
        • Faraone S.V.
        • Mick E.
        • Williamson S.
        • Wilens T.E.
        • Spencer T.J.
        • et al.
        Clinical correlates of ADHD in females: findings from a large group of girls ascertained from pediatric and psychiatric referral sources.
        J Am Acad Child Adolesc Psychiatry. 1999; 38: 966-975
        • Biederman J.
        • Faraone S.V.
        • Milberger S.
        • Curtis S.
        • Chen L.
        • Marrs A.
        • et al.
        Predictors of persistence and remission of ADHD: results from a four-year prospective follow-up study of ADHD children.
        J Am Acad Child Adolesc Psychiatry. 1996; 35: 343-351
        • Biederman J.
        • Faraone S.V.
        • Monuteaux M.C.
        • Spencer T.
        • Wilens T.
        • Bober M.
        • et al.
        Gender effects of attention deficit hyperactivity disorder in adults, revisited.
        Biol Psychiatry. 2004; 55: 692-700
        • Biederman J.
        • Faraone S.V.
        • Weber W.
        • Russell R.L.
        • Rater M.
        • Park K.
        Correspondence between DSM-III-R and DSM-IV Attention Deficit Hyperactivity Disorder (ADHD).
        J Am Acad Child Adolesc Psychiatry. 1997; 36: 1682-1687
        • Biederman J.
        • Newcorn J.
        • Sprich S.
        Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders.
        Am J Psychiatry. 1991; 148: 564-577
        • Busch B.
        • Biederman J.
        • Cohen L.
        • Faraone S.
        • Sayer J.
        • Monuteaux M.
        • et al.
        Similar Correlates of ADHD in Children from Pediatric and Psychiatric Clinics.
        Psychiatr Serv. 2002; 53: 1103-1111
        • Faraone S.
        • Biederman J.
        • Mick E.
        The age dependent decline of attention-deficit/hyperactivity disorder: a meta-analysis of follow-up studies.
        Psychol Med. 2006; 36: 159-165
        • Faraone S.V.
        • Biederman J.
        • Keenan K.
        • Tsuang M.T.
        A family-genetic study of girls with DSM-III attention deficit disorder.
        Am J Psychiatry. 1991; 148: 112-117
        • Faraone S.V.
        • Tsuang M.T.
        Methods in Psychiatric Genetics.
        in: Tohen M. Tsuang M.T. Zahner G.E.P. Textbook in Psychiatric Epidemiology. John Wiley, New York, NY1995: 81-134
        • Fischer M.
        • Barkley R.A.
        • Smallish L.
        • Fletcher K.
        Young adult follow-up of hyperactive children: self-reported psychiatric disorders, comorbidity, and the role of childhood conduct problems and teen CD.
        J Abnorm Child Psychol. 2002; 30: 463-475
        • Geller B.
        • Sun K.
        • Zimmerman B.
        • Luby J.
        • Frazier J.
        • Williams M.
        Complex and rapid-cycling in bipolar children and adolescents: A preliminary study.
        J Affect Disord. 1995; 34: 259-268
        • Gershon E.S.
        • Hamovit J.
        • Guroff J.J.
        • Dibble E.
        • Leckman J.F.
        • Sceery W.
        • et al.
        A family study of schizoaffective, bipolar I, bipolar II, unipolar, and normal control probands.
        Arch Gen Psychiatry. 1982; 39: 1157-1167
        • Gittelman R.
        • Mannuzza S.
        • Shenker R.
        • Bonagura N.
        Hyperactive boys almost grown up: I.
        Arch Gen Psychiatry. 1985; 42: 937-947
        • Hinshaw S.P.
        Preadolescent girls with attention-deficit/hyperactivity disorder: I.
        J Consult Clin Psychol. 2002; 70: 1086-1098
        • Hollingshead A.B.
        Four Factor Index of Social Status.
        Yale Press, New Haven1975
        • Holm S.
        A simple sequentially rejective multiple test procedure.
        Scand J Stat. 1979; 6: 65-70
        • Jensen P.S.
        • Hinshaw S.P.
        • Kraemer H.C.
        • Lenora N.
        • Newcorn J.H.
        • Abikoff H.B.
        • et al.
        ADHD comorbidity findings from the MTA study: comparing comorbid subgroups.
        J Am Acad Child Adolesc Psychiatry. 2001; 40: 147-158
        • Mannuzza S.
        • Gittelman R.
        The adolescent outcome of hyperactive girls.
        Psychiatry Res. 1984; 13: 19-29
        • March J.S.
        • Swanson J.M.
        • Arnold L.E.
        • Hoza B.
        • Conners C.K.
        • Hinshaw S.P.
        • et al.
        Anxiety as a predictor and outcome variable in the multimodal treatment study of children with ADHD (MTA).
        J Abnorm Child Psychol. 2000; 28: 527-541
        • Mennin D.
        • Biederman J.
        • Mick E.
        • Faraone S.V.
        Towards defining a meaningful anxiety phenotpye for research in ADHD children.
        J Attent Disord. 2000; 3: 192-199
        • Mikami A.Y.
        • Hinshaw S.P.
        Buffers of peer rejection among girls with and without ADHD: The role of popularity with adults and goal-directed solitary play.
        J Abnorm Child Psychol. 2003; 31: 381-397
        • Milberger S.
        • Biederman J.
        • Faraone S.
        • Chen L.
        • Jones J.
        Further evidence of an association between attention-deficit/hyperactivity disorder and cigarette smoking: Findings from a high-risk sample of siblings.
        Am J Addict. 1997; 6: 205-217
        • Milberger S.
        • Biederman J.
        • Faraone S.V.
        • Chen L.
        • Jones J.
        Attention deficit hyperactivity disorder is associated with early initiation of cigarette smoking in children and adolescents.
        J Am Acad Child Adolesc Psychiatry. 1997; 36: 37-44
        • Neuman R.J.
        • Heath A.
        • Reich W.
        • Bucholz K.K.
        • Madden P.A.F.
        • Sun L.
        • et al.
        Latent class analysis of ADHD and comorbid symptoms in a population sample of adolescent female twins.
        J Child Psychol Psychiatry. 2001; 42: 933-942
        • Orvaschel H.
        Schedule for Affective Disorder and Schizophrenia for School-Age Children Epidemiologic Version.
        5th Edition ed. Nova Southeastern University, Center for Psychological Studies, Ft. Lauderdale1994
        • Perlis R.H.
        • Miyahara S.
        • Marangell L.B.
        • Wisniewski S.R.
        • Ostacher M.
        • DelBello M.
        • et al.
        Long-term implications of early onset in bipolar disorder: Data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD).
        Biol Psychiatry. 2004; 55: 875-881
        • Spitzer R.L.
        • Williams J.B.
        • Gibbon M.
        • First M.B.
        Structured Clinical Interview for DSM-III-R: Non-Patient Edition (SCID-NP, Version 1.0).
        American Psychiatric Press, Washington, DC1990
        • Weiss G.
        • Hechtman L.
        • Milroy T.
        • Perlman T.
        Psychiatric status of hyperactives as adults: a controlled prospective 15-year follow-up of 63 hyperactive children.
        J Am Acad Child Adolesc Psychiatry. 1985; 24: 211-220
        • Weissman M.M.
        • Leckman J.F.
        • Merikangas K.R.
        • Gammon G.D.
        • Prusoff B.A.
        Depression and anxiety disorders in parents and children: Results from the Yale Family Study.
        Arch Gen Psychiatry. 1984; 41: 845-852
        • West S.
        • McElroy S.
        • Strakowski S.
        • Keck P.
        • McConville B.
        Attention deficit hyperactivity disorder in adolescent mania.
        Am J Psychiatry. 1995; 152: 271-274
        • Wozniak J.
        • Biederman J.
        • Kiely K.
        • Ablon S.
        • Faraone S.
        • Mundy E.
        • et al.
        Mania-like symptoms suggestive of childhood onset bipolar disorder in clinically referred children.
        J Am Acad Child Adolesc Psychiatry. 1995; 34: 867-876
        • Young S.
        • Heptinstall E.
        • Sonuga-Barke E.J.
        • Chadwick O.
        • Taylor E.
        The adolescent outcome of hyperactive girls: self-report of psychosocial status.
        J Child Psychol Psychiatry. 2005; 46: 255-262