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ADHD-related sex differences in emotional symptoms across development

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Abstract

To investigate developmental changes in emotion dysregulation (ED) and associated symptoms of emotional lability, irritability, anxiety, and depression, among girls and boys with and without ADHD from childhood through adolescence. Data were collected from a sample of 8–18-year-old children with (n = 264; 76 girls) and without (n = 153; 56 girls) ADHD, with multiple time-points from a subsample of participants (n = 121). Parents and youth completed rating scales assessing child ED, emotional lability, irritability, anxiety, and depression. Mixed effects models were employed to examine effects and interactions of diagnosis, sex [biological sex assigned at birth], age among boys and girls with and without ADHD. Mixed effects analyses showed sexually dimorphic developmental patterns between boys and girls, such that boys with ADHD showed a greater reduction in ED, irritability, and anxiety with age compared to girls with ADHD, whose symptom levels remained elevated relative to TD girls. Depressive symptoms were persistently elevated among girls with ADHD compared to boys with ADHD, whose symptoms decreased with age, relative to same-sex TD peers. While both boys and girls with ADHD showed higher levels of ED during childhood (compared to their sex-matched TD peers), mixed effects analyses revealed substantial sexually dimorphic patterns of emotional symptom change during adolescence: Boys with ADHD showed robust improvements in emotional symptoms from childhood to adolescence while girls with ADHD continued to show high and/or increased levels of ED, emotional lability, irritability, anxiety and depression.

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Funding

This research was supported by the National Institutes of Health (SM: R01MH078160 and R01MH085328; KR: K23MH101322 and R03MH119457; KES: K23MH107734 and the Brain and Behavior Foundation NARSAD Young Investigator’s Award awarded to Dr. Seymour).

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Authors and Affiliations

  1. Department of Biostatistics, Indiana University School of Medicine, 410 West 10th Street, Indianapolis, IN, 46202, USA

    Yi Zhao

  2. Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA

    Alyssa C. De Ronda, Laura Rice, Keri S. Rosch, Stewart H. Mostofsky & Karen E. Seymour

  3. Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA

    Keri S. Rosch

  4. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 716 North Broadway, Baltimore, MD, 21205, USA

    Keri S. Rosch, Stewart H. Mostofsky & Karen E. Seymour

  5. Department of Neurology, Johns Hopkins University School of Medicine , 716 North Broadway, Baltimore, MD, 21205, USA

    Stewart H. Mostofsky

  6. Department of Mental Health, Johns Hopkins University School of Public Health, 6701 Rockledge Drive, Bethesda, MD, 20892, USA

    Karen E. Seymour

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  1. Alyssa C. De Ronda
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  2. Laura Rice
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  3. Yi Zhao
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  4. Keri S. Rosch
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  5. Stewart H. Mostofsky
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  6. Karen E. Seymour
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Contributions

KSR, SHM, KSR conceptualized the study, analyzed and interpreted the data, and wrote the manuscript. ACD, LR, and YZ analyzed and interpreted the data and wrote the manuscript.

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Correspondence to Karen E. Seymour.

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The authors declare no competing interests.

Additional information

This work was prepared while Dr. Karen Seymour was employed at Johns Hopkins University and Kennedy Krieger Institute. She is currently employed at the National Institutes of Health, Center for Scientific Review. The opinions expressed in this article are the author's own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government.

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De Ronda, A.C., Rice, L., Zhao, Y. et al. ADHD-related sex differences in emotional symptoms across development. Eur Child Adolesc Psychiatry (2023). https://doi.org/10.1007/s00787-023-02251-3

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