Study: Hospitalized Girls with ADHD at Higher Risk for Non-Suicidal Self-Injury
The majority of psychiatric hospital in-patients with ADHD and non-suicidal self-injury (NSSI) were girls in a recent study that reiterates the importance of identifying and diagnosing ADHD and its comorbidities in girls at a young age.
September 24, 2020
Hospitalized adolescent girls with attention deficit hyperactivity disorder (ADHD or ADD) are more likely to experience non-suicidal self-injury (NSSI)1 than are boys with ADHD, according to a study recently presented at the virtual congress of the European College of Neuropsychopharmacology. This study, which found NSSI correlated most strongly with ADHD comorbidities like affective and psychotic disorders, follows an ongoing body of research analyzing the link between ADHD in girls and an elevated risk for self-injury.2
Findings came from a cross-sectional study of 202 adolescent inpatients (51% female) at the Vadaskert Child and Adolescent Psychiatry Hospital in Budapest. Researchers used the structured diagnostic Mini International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) and the self-rated Deliberate Self-Harm Inventory, to determine that 52 of the adolescents (23 boys and 29 girls) met full diagnostic criteria for ADHD and another 77 exhibited more than five sub-threshold ADHD symptoms.
Thirty-five of the 52 teens diagnosed with ADHD had current NSSI — 10 of these patients were boys and 25, or 71% of all patients with NSSI and ADHD, were girls. High rates of psychiatric comorbidities among these teen patients with ADHD plus NSSI were common:
- 94% had a history of suicidal behavior
- 66% had been diagnosed with oppositional defiant disorder (ODD)
- 63% had been diagnosed with generalized anxiety disorder
- 60% had a psychotic disorder
- 46% had been diagnosed with obsessive compulsive disorder (OCD)
A regression analysis revealed that the relationship between ADHD and NSSI was mediated fully by the symptoms of the ADHD comorbidities. Significant risk factors for NSSI in patients with ADHD in both sexes were affective disorders, suicidality, and psychotic disorders. Comorbid alcohol abuse was a risk factor for girls only. Researchers found no evidence of a direct causal relationship between ADHD and NSSI.
The study was limited by sample size and by the incidence of comorbidities and additional research with larger sample sizes is necessary. However, these findings reiterate the importance of diagnosing ADHD in girls early to better recognize and treat comorbidities, and implement interventions with life-long benefits.
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1Balazs J et al. ECNP 2020, Abstract EDU.02.
2Hinshaw, Stephen P., Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: Continuing impairment includes elevated risk for suicide attempts and self-injury. APA PsycNet (2012). https://content.apa.org/record/2012-21629-001