Teen Girls Are Not Alright. ADHD Magnifies the Crisis.
Rates of sexual violence, suicidality, and sadness have hit a record high among teen girls, according to an alarming new CDC report. Those risks are further elevated for girls with ADHD. Here, ADDitude experts explore the findings and explain how parents can help girls in crisis.
February 21, 2023
Teen girls in the U.S. are “engulfed in a growing wave of sadness, violence and trauma,” according to a report released last week by the Centers for Disease Control and Prevention (CDC) that found alarming increases in rates of rape, depression, suicidality, and cyberbullying among adolescents.1 “The numbers are unprecedented,” said Kathleen Ethier, director of the CDC’s Division of Adolescent and School Health. “Our young people are in crisis.”
The CDC report echoes findings from a 2022 ADDitude survey of 1,187 caregivers, which found that an astounding 75% of adolescent girls with ADHD also have anxiety, 54% suffer from depression, more than 14% have a sleep disorder, and nearly 12% report an eating disorder — more than three times the national average for neurotypical women.
“The kids are not alright. Not at all,” wrote one ADDitude reader who works as a youth therapist.
The CDC report, based on the most recent Youth Risk Behavior Survey, included a nationally representative sample of students in public and private high schools, and it found that adolescent health risks have ballooned to levels never seen before—especially for girls. Its findings include the following:
- Nearly 60% of teen girls reported persistent feelings of sadness and hopelessness during the past year, double the rate reported 10 years ago, and twice the rate in boys. For LGBTQ+ teens, this number jumped to a startling 70%.
- 1 in 3 of girls seriously considered attempting suicide during the past year, up nearly 60% from a decade ago.
- At least 1 in 10 girls attempted suicide in the past year. Among LGBTQ+ youth, the number was more than 1 in 5.
Girls with combined type ADHD are 3 to 4 times more likely to attempt suicide than are their neurotypical peers, and they are 2.5 times more likely to engage in non-suicidal self-injuring behavior, said Stephen Hinshaw, Ph.D., in an ADDitude webinar titled, “Girls and Women with ADHD.” The 2022 ADDitude survey found that 18% of girls with ADHD had engaged in self-harm in the past two or three years, as opposed to 9% of boys; it did not specifically ask about suicidality, however anecdotal reports from caregivers are both frequent and frightening.
“A few years ago, I would have been shocked by these numbers,” said one mom of a teen daughter recently diagnosed with ADHD. “But in 2021 my girl was admitted to a clinic for suicidal ideation. She is still here and working on her mental health daily.”
Only 6% of caregivers rated their adolescents’ mental health as “very good” in the ADDitude mental health survey. Contributing to elevated rates of depression, self-harm, and suicidality among teen girls with ADHD are poor response inhibition and peer victimization, as well as a history of maltreatment, such as physical abuse, sexual abuse, or neglect, Hinshaw said.
“I can’t tell you how many mums are holding their girls tight as they self-harm their way through adolescence,” wrote one ADDitude reader in Canada.
“We are gaslighted, misdiagnosed, or expected to suck it up,” wrote an ADDitude reader on Instagram. “The wait times for help are not OK, and once you finally do get ‘help,’ they barely listen or dismiss your concerns.”
Sexual Violence at an All-Time High
Among the CDC report’s more distressing findings was a stark increase in sexual violence among teen girls. It found the following:
- 1 in 5 girls recently experienced sexual violence
- 14% have been forced to have sex, an increase of 27% over the past 2 years
- For American Indian or Alaska Native girls, that number jumped to 18%, and for LGBTQ+ teens, it was 20%
“For every 10 teenage girls you know, at least one of them, and probably more, has been raped,” Ethier said during a press briefing.
The prevalence of sexual violence causes significant and understandable anxiety. According to the ADDitude survey, 20% of girls expressed anxiety about physical or sexual assault, as opposed to 7% of boys.
The CDC’s study reflects this anxiety, reporting that:
- 10% of girls did not go to school in the past 30 days because of safety concerns, nearly double the rate from 10 years ago; the same was true for 7% of boys.
- School avoidance rates were higher among LGBTQ+ students, at 14%; American Indian and Alaska students, at 13%; and Black students at 12%.
The prefrontal cortex in a developing brain is especially sensitive to the effects of stress and “children with ADHD may be even more sensitive to the effects of traumatic stress,” said Cheryl Chase, Ph.D., in her ADDitude webinar, “How Stress and Trauma Affect Brain Development.” In other words, the trauma of sexual violence leaves lasting scars.
The mother of a girl with ADHD explained the long-term implications of a sexual assault on her daughter’s health and well-being four year after the attack: “When she was a freshman in college this past year, she was re-triggered while in public talking to a boy who touched her inappropriately without her consent.”
Cyberbullying Twice as Likely for Girls
Whether in school or online, girls are more likely to be victims of bullying, according to the CDC report.
- 1 in 5 girls said they were bullied through texting and social media, almost double the percentage of boys who were cyberbullied
- In school, 17% of girls and 13% of boys reported experiencing bullying in school over the past year
Among teens with ADHD, the rates of bullying are much higher. According to ADDitude survey respondents, 60% of girls with ADHD have been bullied at school, 58% on social media and 44% in text messages.
“We know that kids who are neurodiverse are often seen as peculiar and different,” explained Sharon Saline, Ph.D. “You miss social clues, you blurt things out, and chances are you’re more likely to experience bullying and be socially excluded.”
This was the case for the daughter of an ADDitude reader in Wisconsin: “Bullying has been around my daughter’s lack of age-appropriate social insight and her emotional reactivity. Girls exclude her from group texts. Friends screenshot the negative posts others create about her, and she then ruminates until her mood totally plunges.”
Bullying is a widespread problem, and so is the response (or lack thereof) from most schools; 72% of ADDitude survey respondents who reported that their kids were the victims of bullying also said they were dissatisfied with the school’s response.
“The lack of help in the public school system is so disappointing,” wrote an ADDitude reader on Instagram. “They claim to not be tolerant of bullying, yet anytime you seek help you’re met with nothing but rotating doors and promises of help that go undone.”
Substance Use Higher in Girls
Teen girls are more likely to use alcohol, marijuana, vaping, and illicit drugs, according to the CDC.
- Alcohol: 27% of teen girls reported drinking in the last month vs 19% of boys
- Vaping: 21% of girls reported vaping in the last month vs 15% of boys
- Illicit drugs: 15% of girls reported ever using illicit drugs vs 12% of boys
- Misuse of prescription opioids: 15% of girls reporting ever misusing opioids vs 10% of boys
“ADHD affects substance abuse in both children and adults,” explained Walt Karniski, M.D., in a recent ADDitude webinar on ADHD medication. “Children with ADHD are more likely to smoke and to begin smoking at younger ages. They’re more likely to use alcohol at younger ages and more likely to abuse alcohol as adults.”
“A Level of Distress that Calls on Us to Act”
In the introduction to its 89-page report, the CDC authors clearly state its takeaway: “Young people in the U.S. are collectively experiencing a level of distress that calls on us to act.” The CDC urges schools to act swiftly and thoughtfully for maximum impact.
“Schools play an integral role in promoting wellness and connectedness, and facilitating protective factors among students,” said Anna King, president of the National PTA. Specifically, the report highlights the importance of implementing quality health education, connecting young people to needed services, and making school environments safer and more supportive.
“It’s about time someone noticed, besides all the struggling parents and kids,” wrote one ADDitude reader in New York.
How Can Parents Protect Their Kids?
Keep lines of communication open
“As girls reach the teen years, they naturally want to emancipate from adult control,” Chase says. “But teens’ brains have more ‘accelerators’ than ‘brakes,’ so they need a loving, interested adult to guide them.” This is doubly true for teens with ADHD, whose executive function weaknesses may exacerbate impulse control. So, how do you stay connected with a teen who seems intent on pushing you away?
- Prioritize a positive relationship
Sources for conflict between adolescents and parents abound, but Saline advises that parents pick their battles. “Your Number One agenda item as the parent of a teen is maintaining a positive connection,” Saline says. “So that they will come and talk to you if they need help.”
To build that connection, Chase emphasizes the importance of unstructured time together. “Going for walks, grabbing a smoothie together, playing a game,” she suggests. “Time just to ‘be’ and if they want to talk, they can.” Don’t wait for your teen to reach out to you. Be proactive, and invite them to do something low-key and stress-free every week or two.
- Make communication routine
When teens push back against their parents, seeking autonomy and space, anxious parents often ask a lot of questions, which can make teens feel hounded, Saline says. Keep communication open without putting teens in the hot seat by making conversations routine. Saline suggests instituting a family-wide practice of sharing one “happy” and one “crappy” thing that happened during the day — at dinner or in the car ride home. If it’s a daily practice in which everyone participates, your daughter won’t feel singled out.
- Actively listen, rather than offer unsolicited advice
When your child share experiences with you, practice active listening to ensure the communication continues. Allow your child tell their story, uninterrupted, and follow up with reflective statements, like “I think I’m hearing you say…” Avoid swooping in with unsolicited advice — that’s the fastest way to get a teen to shut down, according to Chase and Saline.
Help your daughter find treatment
Depression, anxiety, trauma, and self-harm are all treatable, and a mental health professional can help you figure out what avenue of treatment to pursue. If you sense something’s persistently troubling your teen, Chase urges you not to wait to find them a therapist. “It’s like going to the dentist with a toothache,” she explains. “It doesn’t mean they are broken.”
Cognitive behavioral therapy, dialectical behavior therapy, and medication are among the most common interventions. If trauma is involved, consider somatic therapy, which increases awareness of the sensations in the body as a form of healing.
If your child has ADHD, consider that ADHD treatment may decrease their risk for other challenges. Hinshaw says that treating ADHD can decrease rates of suicidality in teens. “Treatment is a huge antidote to internalization, self-stigma, and the belief that there’s something wrong with you,” he explains. In addition, multiple research studies have indicated that children and adults with ADHD who are taking stimulant medication are less likely to engage in substance use than are their untreated peers.
Suicide &Crisis Lifeline: Call or Text 988
National Sexual Assault Helpline: 1-800-656-HOPE
National Substance Abuse Helpline: 1-800-662-HELP
Mental Health in Teens: Next Steps
- Read: Special 2022 Mental Health Report from ADDitude
- Read: Compare & Despair: Social Media & Mental Health Concerns in Teens with ADHD
- Self-Test: Signs of Depression in Teens
- Learn: Nearly One in Four Women with ADHD Has Attempted Suicide
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1Centers for Disease Control and Prevention (2023). U.S. Teen Girls Experiencing Increased Sadness and Violence. Youth Risk Behavior Survey cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf