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Surprising findings about ADHD may help girls who are struggling

Girls are particularly vulnerable to developing anxiety disorders, but researchers have recently discovered something that may help slow down or prevent the development.

Jente i et tre
Girls with the inattentive type of ADHD are often perceived as shy, introverted, absent-minded, and dreamy. As young children, they often fly under the radar because they rarely cause trouble or disturb others.
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Researchers at NTNU have found new correlations between ADHD and anxiety. Both are major health issues among adolescents. The two disorders often co-occur in the same person.

What's new now is that the relationship between them appears to be different in girls and boys.

Affect girls and boys differently

There are several types of ADHD. The researchers’ findings are related to one specific type called the inattentive type. A higher percentage of girls have this type of ADHD. 

Boys often have the other variant. It is called the hyperactive-impulsive type. Some can have both.

“First and foremost, we have identified a link between anxiety and inattentive type ADHD. And we find that this only applies to girls,” says Lars Wichstrøm.

He is a professor at NTNU's Department of Psychology.

ADHD inattentive type and girls:

  • The inattentive type of ADHD is characterised mainly by attention difficulties, without pronounced issues with impulse control or hyperactivity.
  • In girls and women, the condition is often identified later in life.
  • They may appear 'calm, kind, and well-behaved,' which makes it less likely that their difficulties are linked to ADHD.
  • Girls tend to hide their struggles more than boys.
  • They often have co-occurring conditions such as anxiety and depression, which can mask the symptoms of ADHD.
  • When the diagnosis is overlooked, opportunities for support, treatment, and insight into the causes are lost.
  • Evidence suggests that men and women have the same symptoms, but they express and experience them differently.

Source: ADHD Norge

Surprised by major differences

This is the first time researchers have investigated – and shown – that the relationship between ADHD and anxiety differs according to sex, and that this applies to inattentiveness.

“We assumed there were differences between the sexes, but we did not expect them to be so significant,” says Wichstrøm.

He emphasises that they have studied inattention as a symptom of ADHD, rather than ADHD as a disorder.

Reciprocal relationship

The two disorders seem to reinforce each other. In girls, the prevalence of inattention increases the likelihood of more severe symptoms of anxiety disorders during childhood and adolescence. 

And: Anxiety in adolescence increases the likelihood that inattentiveness will worsen.

The researchers found no such correlation between inattention and anxiety in boys. 

However, they found that increased hyperactivity-impulsivity in the first few years of school increased the likelihood of developing anxiety.

Earlier detection

Anxiety disorders increase significantly during adolescence, especially for girls. 

The study concludes that early detection and effective treatment of inattention symptoms in girls can reduce the risk of anxiety later on in life. 

Similarly, interventions or treatment for anxiety can reduce the likelihood that attention difficultiesin young girls will increase. 

Lars Wichstrøm.
Professor Lars Wichstrøm at the Department of Psychology.

It is well known that ADHD and anxiety often co-occur in individuals. Only a small part of this comorbidity can be explained by shared genetics between ADHD and anxiety, according to Professor Wichstrøm. 

He says that they also know that the intensity of ADHD symptoms and anxiety can vary over time.

Why this is the case, however, is not yet known. 

Under the radar

On average, five per cent of children and adolescents have ADHD. This is true both in Norway and in other countries where this has been studied.

Girls with the inattentive type are often perceived as shy, introverted, absent-minded, and dreamy – or even lazy. 

As young children, they often go under the radar because they rarely cause any trouble or disturb others. 

The only symptom they have is inattention. It can be difficult to distinguish this from simply being normally distracted, disorganised, or forgetful.

Missing out on help

This means that girls often receive the diagnosis later in life. As a result, they miss out on interventions that could help limit the development of anxiety later, according to Wichstrøm.

Hyperactive-impulsive type ADHD is most prevalent in boys. It is easier to see and hear those who struggle with restlessness and hyperactivity, who cannot sit still or wait their turn. 

As a result, they are detected earlier, diagnosed, and get help more quickly.

Struggle and exclusion

Children who struggle with basic skills may experience exclusion, bullying, and other burdens.

“Personal and social challenges can easily lead to rumination, worry, anxiety, and catastrophising. It seems that girls are more vulnerable when they're exposed to negative life events or bullying. They're more likely to respond with depression than boys,” says Wichstrøm

He has conducted extensive research on anxiety and depression among adolescents.

ADHD is detected through anxiety

Researchers still do not know if there are any common factors underlying and influencing why some individuals develop both anxiety and ADHD. 

What they do know is that the older a person is when the diagnosis is made, the more common it is for them to have the inattentive type.

“Generally, as young people approach puberty, the prevalence of anxiety increases significantly – especially among girls, and it's only at that point that their ADHD is also detected,” says Wichstrøm.

Look for signs at ages 8-10

The researchers hope their findings can show the importance of early detection of ADHD in children.

“Anxiety increases significantly in children as early as 12 years old. If we can identify inattention problems before that age, possibly as young as 8 years old, we may be able to reduce or prevent them from developing into anxiety,” says Wichstrøm.

The researchers emphasis that more knowledgeis needed about the intricate connections between sex, ADHD, and anxiety. 

An additional step could be to confirm the findings they have made in an even larger study. Wichstrøm would like to see further research on the very youngest girls.

Jente i tre
The researchers hope their findings can highlight the importance of detecting ADHD in children early.

Helping people with ADHD

Wichstrøm is fully aware of the debate about the overdiagnosis of ADHD. He says it is entirely possible that too many end up with a diagnosis.

“But we must still strive to actually detect ADHD where it exists and help those who have it,” he says.

About the study

The NTNU study is an observational study. It is based on information from 1,000 children born in 2003 and 2004 and their parents. The participants have been followed up every other year from the time the children were 4 until they turned 18. They are now young adults, turning 22 this coming autumn.

The study is part of Mojtaba Habibi Asgarabad’s doctoral work and is part of the Trondheim Early Secure Study (TESS).

Reference: 

Asgarabad et al. Reciprocal relations between dimensions of attention-deficit/hyperactivity and anxiety disorders from preschool age to adolescence: sex differences in a birth cohort sampleJournal of Child Psychology and Psychiatry, vol. 66, 2024. DOI: 10.1111/jcpp.14038

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Read the Norwegian version of this article on forskning.no

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