Girls with ADHD show other mental health risks

NEW YORK (Reuters Health) - Girls with attention-deficit hyperactivity disorder are more likely than their peers to develop depression, anxiety, eating disorders or other psychiatric problems by the time they reach adulthood, a new study suggests.

The study, reported in the American Journal of Psychiatry, followed 187 6- to 18-year-old girls with and without ADHD for 11 years. Over that time, girls with the disorder were more likely to at some point have symptoms of depression, anxiety, eating disorders, substance abuse or antisocial disorders than girls without ADHD.

The researchers say the study is the first to follow girls with ADHD into adulthood, and the findings mirror what they had previously seen in boys.

However, one psychiatrist not involved in the study stressed that the findings do not mean that girls with ADHD should necessarily be placed on the stimulant drugs commonly used for the disorder, including Ritalin, Concerta, and Adderall.

“Some people might become alarmed by the findings,” said Dr. Daniel Carlat, an associate clinical professor of psychiatry at Tufts University School of Medicine in Newburyport, Massachusetts.

“My concern is that they might think this means you need to treat these girls aggressively with stimulant medication starting at an early age,” said Carlat -- who also publishes a newsletter, The Carlat Psychiatry Report, billed as an alternative to “existing journals and newsletters that receive pharmaceutical industry funding.”

Right now, he told Reuters Health in an interview, there is little evidence that treating ADHD -- with drugs or otherwise -- can prevent other psychiatric disorders from arising.

For the study, researchers led by Dr. Joseph Biederman of Massachusetts General Hospital in Boston followed 96 girls with ADHD and 91 without the disorder. At the outset and again five and 11 years later, the girls completed standard diagnostic interviews for psychiatric disorders.

The researchers found that by the age of 30, more than three-quarters of the ADHD group had suffered depression at some point in their lives, versus less than one-quarter of the comparison group.

Similar differences emerged for other types of disorders. By age 30, more than three-quarters of girls with ADHD had had anxiety disorder symptoms at some point in their lives, compared with just over half of girls without ADHD. And close to two-thirds had problems with drugs or alcohol at some point, versus less than one-quarter of girls without ADHD.

The findings underscore the importance of evaluating girls for potential symptoms of ADHD and the disorders that may accompany it, Biederman told Reuters Health, noting that ADHD is often still seen as largely a boys’ disorder.

Exactly why ADHD is associated with a range of other psychiatric disorders is unknown, Biederman said. He speculated that some children may have an underlying genetic susceptibility to these conditions, and one or more may emerge when environmental stressors enter the picture.

Whether ADHD treatment can lower the odds of other problems remains in question.

Biederman, who has had financial ties to various drug companies, including makers of ADHD drugs, pointed to a 2009 study he and his colleagues published in the journal Pediatrics. They found that of 112 children with ADHD, those treated with stimulants were less likely to develop depression or anxiety disorders over the next 10 years.

However, that type of observational study does not prove cause-and-effect.

Carlat pointed out that, of girls with ADHD in the current study, 93 percent had received some form of treatment at some point -- most commonly, medication plus counseling. He added, however, that this was not a treatment study, and therefore not designed to show whether ADHD treatment can or cannot prevent other psychiatric problems.

What the findings do suggest, according to Carlat, is that parents of girls with ADHD should be aware that their daughters could have or could develop some of these other disorders. And if they have concerns about any symptoms their daughters have, they should bring it up with their doctors.

“Parents should also realize,” Carlat said, “that there are alternative therapies to (ADHD) medication.”

Besides behavioral therapy for children, Carlat noted, there is also parenting-skills training, which may be available through a social worker or psychologist. The training aims to teach parents ways of dealing with their children’s behavioral problems, helping them with homework and addressing other issues of day-to-day life.

SOURCE: American Journal of Psychiatry, online January 15, 2010.