Skip to main content

Aging and Pubertal Development Differentially Predict Symptoms of ADHD, Depression, and Impairment in Children and Adolescents: An Eight-Year Longitudinal Study


Activational effects of the reproductive neuroendocrine system may explain why some youths with ADHD are at greater risk for exacerbated ADHD symptoms (hyperactivity, inattention, impulsivity) during adolescence. For youths diagnosed with ADHD, first signs of ADHD symptoms become noticeable by multiple reporters (e.g., teachers, parents) when children enter schools, typically around kindergarten. The current study examined possible sex differences in ADHD, impairment, and comorbidity due to pubertal effects, as the role of pubertal development in ADHD is understudied. ADHD symptoms, depressive symptoms, impairment, and pubertal stage were assessed annually by multiple reporters in a well-characterized community sample of 849 children over-recruited for ADHD over eight years. Ages ranged from 7 to 13 years (38.16% female) at wave 1. Multilevel models indicated that males had higher levels of hyperactivity, impulsivity, and inattention than females, but that females had higher levels of impairment than males. Inattention symptoms did not show marked maturation changes. Hyperactivity and impulsivity declined as youth aged and impairment increased as youth aged. Lastly, depressive symptoms largely increased as youth aged and were higher amongst youth at later pubertal stages. Put together, aging and pubertal development are associated with improved ADHD symptoms but not for youth with high impairment. Findings from this study contributes to understanding the role that aging, pubertal status, and pubertal development plays in ADHD, impairment, and comorbidity in children and adolescents.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. For simplicity, we designate “males” as youth who were assigned male at birth and are presumed to have testicular maturation throughout puberty, whereas we designate “females” as youth who were assigned female at birth and are presumed to have ovarian maturation throughout puberty. Although, there are many instances in which this presumption is erroneous (e.g., intersex youth; trans* youth; youth with delayed or precocious puberty).


  • Banaschewski, T., Coghill, D., & Zuddas, A. (2018). Oxford Textbook of attention deficit hyperactivity disorder. Oxford University Press.

  • Biederman, J., Ball, S. W., Monuteaux, M. C., Mick, E., Spencer, T. J., McCreary, M., Cote, M., & Faraone, S. V. (2008). New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. Journal of the American Academy of Child & Adolescent Psychiatry, 47(4), 426–434.

    Article  Google Scholar 

  • Brunsvold, G. L., Oepen, G., Federman, E. J., & Akins, R. (2008). Comorbid depression and ADHD in children and adolescents: Consensus and controversy. Psychiatric Times, 25(10), 13–13.

    Google Scholar 

  • Chronis-Tuscano, A., Molina, B. S. G., Pelham, W. E., Applegate, B., Dahlke, A., Overmyer, M., & Lahey, B. B. (2010). Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 67(10), 1044–1051.

    Article  PubMed  PubMed Central  Google Scholar 

  • Clawson, A., Strang, J. F., Wallace, G. L., Gomez-Lobo, V., Jack, A., Webb, S. J., & Pelphrey, K. A. (2020). Parent-child concordance on the Pubertal Development Scale in typically developing and autistic youth. Research in Autism Spectrum Disorders, 77, 101610.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cole, K. M., Wei, S. M., Martinez, P. E., Nguyen, T. V., Gregory, M. D., Kippenhan, J. S., Kohn, P. D., Soldin, S. J., Nieman, L. K., Yanovski, J. A., Schmidt, P. J., & Berman, K. F. (2021). The NIMH Intramural Longitudinal Study of the endocrine and neurobiological events accompanying puberty: protocol and rationale for methods and measures. Neuroimage, 234, 117970.

    Article  PubMed  Google Scholar 

  • Craighead, W. E., Smucker, M. R., Craighead, L. W., & Ilardi, S. S. (1998). Factor analysis of the Children’s Depression Inventory in a community sample. Psychological Assessment, 10(2), 156.

    Article  Google Scholar 

  • Dubol, M., Epperson, C. N., Lanzenberger, R., Sundström-Poromaa, I., & Comasco, E. (2020). Neuroimaging premenstrual dysphoric disorder: a systematic and critical review. Frontiers in Neuroendocrinology, 57, 100838.

    Article  PubMed  Google Scholar 

  • Eckert-Lind, C., Busch, A. S., Petersen, J. H., Biro, F. M., Butler, G., Bräuner, E. V., & Juul, A. (2020). Worldwide secular trends in age at pubertal onset assessed by breast development among girls: a systematic review and meta-analysis. JAMA Pediatrics, 174(4), e195881.

  • Eisenlohr-Moul, T. (2019). Premenstrual disorders: a primer and research agenda for psychologists. The Clinical Psychologist, 72(1), 5–17.

    PubMed  PubMed Central  Google Scholar 

  • Endicott, J., Spitzer, R. L., Fleiss, J. L., & Cohen, J. (1976). The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33(6), 766–771.

    Article  PubMed  Google Scholar 

  • Faraone, S. V., Biederman, J., & Mick, E. (2006). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine, 36(2), 159–165.

    Article  PubMed  Google Scholar 

  • Ge, X., Conger, R. D., & Jr, G. H. E. (2001a). The relation between puberty and psychological distress in adolescent boys. Journal of Research on Adolescence, 11(1), 49–70.

  • Ge, X., Elder, G. H., Regnerus, M., & Cox, C. (2001b). Pubertal transitions, perceptions of being overweight, and adolescents’ psychological maladjustment: gender and ethnic differences. Social Psychology Quarterly, 64(4), 363–375.

    Article  Google Scholar 

  • Hartung, C. M., & Lefler, E. K. (2019). Sex and gender in psychopathology: DSM–5 and beyond. Psychological Bulletin, 145(4), 390.

    Article  PubMed  Google Scholar 

  • Haslam, N., Williams, B., Prior, M., Haslam, R., Graetz, B., & Sawyer, M. (2006). The latent structure of attention-deficit/hyperactivity disorder: a taxometric analysis. Australian & New Zealand Journal of Psychiatry, 40(8), 639–647.

    Article  Google Scholar 

  • Heidari, S., Babor, T. F., De Castro, P., Tort, S., & Curno, M. (2016). Sex and gender equity in research: rationale for the SAGER guidelines and recommended use. Research Integrity and Peer Review, 1(1), 1–9.

    Google Scholar 

  • Hilsenroth, M. J., Ackerman, S. J., Blagys, M. D., Baumann, B. D., Baity, M. R., Smith, S. R., Price, J. L., Smith, C. L., Heindselman, T. L., Mount, M. K., & Holdwick, D. J. Jr. (2000). Reliability and validity of DSM-IV axis V. American Journal of Psychiatry, 157(11), 1858–1863.

    Article  PubMed  Google Scholar 

  • Jans, T., Weyers, P., Schneider, M., Hohage, A., Werner, M., Pauli, P., & Warnke, A. (2009). The Kiddie-SADS allows a dimensional assessment of externalizing symptoms in ADHD children and adolescents. ADHD Attention Deficit and Hyperactivity Disorders, 1(2), 215–222.

    Article  PubMed  Google Scholar 

  • Karalunas, S. L., Gustafsson, H. C., Dieckmann, N. F., Tipsord, J., Mitchell, S. H., & Nigg, J. T. (2017). Heterogeneity in development of aspects of working memory predicts longitudinal ADHD symptom change. Journal of Abnormal Psychology, 126(6), 774–792.

    Article  PubMed  PubMed Central  Google Scholar 

  • Koopman-Verhoeff, M. E., Gredvig-Ardito, C., Barker, D. H., Saletin, J. M., & Carskadon, M. A. (2020). Classifying pubertal development using child and parent report: comparing the pubertal development scales to Tanner staging. Journal of Adolescent Health, 66(5), 597–602.

    Article  Google Scholar 

  • Kovacs, M. (1985). The children’s Depression, Inventory (CDI). Psychopharmacology Bulletin, 21(4), 995–998.

    PubMed  Google Scholar 

  • Kovacs, M. (1992). Children’s Depression Inventory (CDI): technical manual update. Multi-Health Systems.

  • Lahey, B. B., Pelham, W. E., Loney, J., Lee, S. S., & Willcutt, E. (2005). Instability of the DSM-IV subtypes of ADHD from preschool through elementary school. Archives of General Psychiatry, 62(8), 896–902.

    Article  PubMed  Google Scholar 

  • Levy, F., Hay, D. A., McStephen, M., Wood, C., & Waldman, I. (1997). Attention-deficit hyperactivity disorder: a category or a continuum? Genetic analysis of a large-scale twin study. Journal of the American Academy of Child & Adolescent Psychiatry, 36(6), 737–744.

    Article  Google Scholar 

  • Martel, M. M., Klump, K., Nigg, J. T., Breedlove, S. M., & Sisk, C. L. (2009). Potential hormonal mechanisms of attention-deficit/hyperactivity disorder and major depressive disorder: a new perspective. Hormones and Behavior, 55(4), 465–479.

    Article  PubMed  PubMed Central  Google Scholar 

  • Maas, C. J., & Hox, J. J. (2004). The influence of violations of assumptions on multilevel parameter estimates and their standard errors. Computational Statistics & Data Analysis, 46(3), 427–440.

    Article  Google Scholar 

  • Mowlem, F., Agnew-Blais, J., Taylor, E., & Asherson, P. (2019). Do different factors influence whether girls versus boys meet ADHD diagnostic criteria? Sex differences among children with high ADHD symptoms. Psychiatry Research, 272, 765–773.

    Article  PubMed  PubMed Central  Google Scholar 

  • Musser, E. D., Karalunas, S. L., Dieckmann, N., Peris, T. S., & Nigg, J. T. (2016). Attention-deficit/hyperactivity disorder developmental trajectories related to parental expressed emotion. Journal of Abnormal Psychology, 125(2), 182.

    Article  PubMed  PubMed Central  Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (1998–2015). Mplus User’s Guide. Seventh Edition. Los Angeles, CA: Muthén & Muthén.

  • National Survey on Drug Use and Health (2017). Results from the 2017 National Survey on Drug Use and Health: Detailed Tables, SAMHSA, CBHSQ.;8-56A

  • Nigg, J. (2013). Attention-Deficit/Hyperactivity disorder. Child and adolescent psychopathology (2nd ed., pp. 381–385). John Wiley & Sons.

  • Nigg, J. T., & Casey, B. J. (2005). An integrative theory of attention-deficit/ hyperactivity disorder based on the cognitive and affective neurosciences. Development and Psychopathology, 17(3), 785–806.

    Article  PubMed  Google Scholar 

  • Owens, S. A., & Eisenlohr-Moul, T. (2018). Suicide risk and the menstrual cycle: a review of candidate RDoC mechanisms. Current Psychiatry Reports, 20(11), 106.

    Article  PubMed  PubMed Central  Google Scholar 

  • Parke, E. M., Mayfield, A. R., Barchard, K. A., Thaler, N. S., Etcoff, L. M., & Allen, D. N. (2015). Factor structure of symptom dimensions in attention-deficit/hyperactivity disorder (ADHD). Psychological Assessment, 27(4), 1427.

    Article  PubMed  Google Scholar 

  • Petersen, A., Crockett, L., Richards, M., & Boxer, A. (1988). A self-report measure of pubertal status: reliability, validity, and initial norms. Journal of Youth and Adolescence, 17, 117–133.

    Article  PubMed  Google Scholar 

  • Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345–365.

    Article  PubMed  Google Scholar 

  • Puig-Antich, J., & Ryan, N. (1986). The schedule for affective disorders and schizophrenia for school-age children (Kiddie-SADS)-1986. Pittsburgh: Western Psychiatric Institute and Clinic.

    Google Scholar 

  • Roberts, B., Eisenlohr-Moul, T., & Martel, M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114.

    Article  PubMed  Google Scholar 

  • Roy, A., Oldehinkel, A. J., & Hartman, C. A. (2017). Cognitive functioning in adolescents with self-reported ADHD and depression: results from a population-based study. Journal of Abnormal Child Psychology, 45(1), 69–81.

    Article  PubMed  Google Scholar 

  • Saylor, C. F., Finch, A. J., Spirito, A., & Bennett, B. (1984). The Children’s Depression Inventory: a systematic evaluation of psychometric properties. Journal of Consulting and Clinical Psychology, 52(6), 955.

    Article  PubMed  Google Scholar 

  • Schulz, K. M., Molenda-Figueira, H. A., & Sisk, C. L. (2009). Back to the future: the organizational–activational hypothesis adapted to puberty and adolescence. Hormones and Behavior, 55(5), 597–604.

    Article  PubMed  PubMed Central  Google Scholar 

  • Seymour, K. E., Chronis-Tuscano, A., Iwamoto, D. K., Kurdziel, G., & MacPherson, L. (2014). Emotion regulation mediates the association between ADHD and depressive symptoms in a community sample of youth. Journal of Abnormal Child Psychology, 42(4), 611–621.

    Article  PubMed  PubMed Central  Google Scholar 

  • Seymour, K. E., & Miller, L. (2017). ADHD and depression: the role of poor frustration tolerance. Current Developmental Disorders Reports, 4(1), 14–18.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shirtcliff, E. A., Dahl, R. E., & Pollak, S. D. (2009). Pubertal development: correspondence between hormonal and physical development. Child Development, 80(2), 327–337.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sibley, M. H., Swanson, J. M., Arnold, L. E., Hechtman, L. T., Owens, E. B., Stehli, A., Abikoff, H., Hinshaw, S. P., Molina, B. S. G., Mitchell, J. T., Jensen, P. S., Howard, A. L., Lakes, K. D., Pelham, W. E., & the MTA Cooperative Group. (2017). Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. Journal of Child Psychology and Psychiatry, 58(6), 655–662.

    Article  PubMed  Google Scholar 

  • Spear, L. (2009). Heightened stress responsivity and emotional reactivity during pubertal maturation: implications for psychopathology. Development and Psychopathology, 21(1), 87–97.

    Article  PubMed  PubMed Central  Google Scholar 

Download references


The authors thank all participants for making this work possible. This study’s design, hypotheses, and analysis plan were preregistered; see The datasets generated and analyzed for the current study are not publicly available but are available from the corresponding author on reasonable request.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ashley G. Eng.

Ethics declarations

Ethical Standards and Informed Consent

The authors complied with APA ethical standards in the treatment of their participants and ethics approval was obtained from the Institutional Review Board at Oregon Health & Science University. A parent/legal guardian provided written informed consent and children provided written assent.

This research was supported by R01-MH119119, R01-MH122446, RF1-MH120843, T32 NIAAA AA027488, T32 NICHD HD007489, and T32 NINDS T32NS115656. Infrastructure support was provided by NICHD P50HD105353, P50HD105328-01, and U54HD090256. The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Eng, A.G., Phan, J.M., Shirtcliff, E.A. et al. Aging and Pubertal Development Differentially Predict Symptoms of ADHD, Depression, and Impairment in Children and Adolescents: An Eight-Year Longitudinal Study. Res Child Adolesc Psychopathol 51, 819–832 (2023).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: