Impairment and Internalizing Comobidity in Adolescent ADHD: Gender Considerations, Risk Factors, and Response to Treatment

Abstract

The literature on attention-deficit/hyperactivity disorder (ADHD) has historically concentrated on externalizing symptoms in elementary-aged males. This paper investigates gender differences in ADHD-related impairment, relationships between ADHD and comorbid internalizing problems, and response to intervention for adolescents with ADHD. Participants are 325 ethnically diverse rising 6th and 9th graders randomized to a high intensity (412 hour) Summer Treatment Program for Adolescents (HI; n=109) vs. low intensity (24 hour) organizational skills intervention (LI; n=109) and an untreated comparison group (n=107). Multiple regression of baseline data was used to evaluate differences in patterns of impairment by gender and grade as well as the relationship between three common areas of ADHD-related impairment (social problems, academic impairment, and family conflict) and teen-reported depressive and anxious symptoms. Results showed few differences in parent- or teacher-reported impairment by gender or grade. Notably, participants identifying as female were found to have fewer parent-reported academic problems (b=-0.09, p=0.017). Rising 9th graders were found to have higher levels of family conflict (b=0.18; p<0.001) than rising 6th graders. A disordinal interaction was found in for teen-reported depressive symptoms (b=1.43; p=0.006) and parent-reported anxiety symptoms (b=-1.37; p=0.012) with lower symptoms reported for females compared to non-females in the 6th grade cohort but higher levels than non-females in the 9th grade cohort. In terms of the interaction between baseline ADHD-related impairment and internalizing problems, higher levels of family conflict was found to predict depressive symptoms (b=1.36; p=0.032). The HI intervention was found to be associated with a decrease in anxiety symptoms compared to the LI intervention one year following intervention (d =0.28). Grade was found to moderate treatment effects of the LI intervention compared to the untreated group with a greater reduction in symptoms for rising ninth graders (d=-0.48) than rising 6th graders (d=-0.01).