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ADHD in girls linked to mood, eating disorders.

BOSTON -- Girls with attention deficit/hyperactivity disorder are significantly more likely than are girls without the condition to be diagnosed with major depression, according to research presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry

In addition, girls with ADHD have a significantly increased risk of developing an eating disorder than do their counterparts, the data show.

The numbers on depression come from a longitudinal case-control study that included 140 girls with ADHD and 122 controls enrolled by community psychiatrists or pediatricians at an academic medical center. The study participants, aged 6-18 years at the time of enrollment, were followed prospectively for 5 years, including assessment of psychiatric, cognitive, interpersonal, family, and educational functioning, reported Dr. Joseph Biederman of Massachusetts General Hospital, Boston. Psychiatric disorders were assessed using blinded structured diagnostic interviews.

The investigators analyzed demographic factors using logistic and linear regression for binary and dimensional variables, respectively, and they used Cox proportional hazard survival models to estimate the incidence of major depression. Environmental and familial factors and personal characteristics were examined in the survival models as risk factors for the onset of major depression.

According to the analysis, at follow-up, the girls with ADHD were at significantly higher risk than were controls to manifest disruptive behavior, mood and anxiety disorders, and substance dependence, said Dr. Biederman, noting that the magnitude of increased risk was greatest for major depression. Specifically, "the risk of major depression in girls with ADHD was 5.4 times that seen in the control girls."

Additionally, compared with the control group, major depression in girls with ADHD had an earlier onset, lasted more than twice as long (3 years vs. 1.3 years), was associated with greater impairment, such as suicidality, and was more likely to require intensive treatment, including psychiatric hospitalization, he explained.

Independent of other predictors, parental major depression and proband mania predicted major depression in girls with ADHD, Dr. Biederman noted.

The Findings "indicate that major depression emerging in the context of ADHD is an impairing and severe comorbidity with a unique set of correlates and outcomes worthy of further scientific and therapeutic considerations," Dr. Biederman said. The high morbidity associated with ADHD in girls supports the importance of early recognition to implement prevention and early intervention strategies.

With respect to eating disorders, Dr. Craig B.H. Surman, also from Massachusetts General Hospital, reported the results of a prospective study of 125 adolescent girls with ADHD and 100 adolescent girls without it. During 5 years of follow-up, 20 girls with ADHD and 5 girls without the condition developed an eating disorder (either anorexia nervosa or bulimia nervosa). The investigators estimated the incidence of lifetime anorexia or bulimia nervosa using Cox proportional hazard survival models and compared measures of comorbidity, course of ADHD, growth, and puberty in ADHD girls with and without eating disorders.

The analysis showed that girls with ADHD were 3.6 times more likely to meet criteria for an eating disorder throughout the follow-up period than were girls in the control group. Specifically, the girls with ADHD were 5.6 times more likely to develop bulimia nervosa and 2.7 times more likely to develop anorexia nervosa, Dr. Surman said.

Also, girls with ADHD and eating disorders had significantly higher rates of major depression, anxiety disorders, and disruptive behavior disorder, compared with ADHD girls without eating disorders.

"Almost all of the available research on ADHD has been based on underpowered, cross-sectional studies of preteen and teenage males," Dr. Biederman said. "A better understanding of the course and outcome of ADHD in girls has important clinical and public health implications."


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Title Annotation:Behavioral Pediatrics
Author:Mahoney, Diana
Publication:Pediatric News
Article Type:Clinical report
Date:Jan 1, 2008
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