Girls with ADHD: Higher Risk of Anxiety in Adolescence

Anxiety and ADHD are common in children and adolescents, and they often occur together. This study found that in girls, inattention can lead to anxiety over time, and anxiety can also increase inattention in adolescence. In boys, impulsivity in childhood can increase the risk of anxiety. These results show that symptoms are related differently in boys and girls, which may help improve treatments.

Anxiety disorders and attention deficit hyperactivity disorder (ADHD) are very common in children and adolescents worldwide. About 1 in 3 young people may have some form of anxiety, while almost 1 in 10 may have ADHD.

Both disorders can cause significant difficulties in life, such as problems learning in school, relating to others, and coping with everyday situations. In addition, it is common for anxiety and ADHD to appear together, something called comorbidity, which makes diagnosis and treatment even more challenging.

ADHD is characterized by two main groups of symptoms: inattention (such as difficulty concentrating or following directions) and hyperactivity-impulsivity (such as fidgeting or acting without thinking).

Research shows that these two dimensions of ADHD may relate differently to anxiety symptoms, but we still don’t know exactly how this happens, especially as a child grows and considering the differences between boys and girls.

Previous studies have suggested that ADHD and anxiety can influence each other over time. In other words, children with ADHD may develop anxiety later in life, and vice versa.

However, most of this research has failed to separate what changes within the same child over the years (individual changes) from what varies between different children (group differences). This is important because factors such as genetics or a stable family environment can affect these results.

Another challenge for studies in this area is the way data is collected.

Questionnaires and interviews do not always yield the same results, since assessment scales often do not consider all diagnostic criteria, such as how long the symptom lasts, how much it disrupts daily life, or the distress it causes. In addition, parents and children may have different perceptions of the same behaviors.

Parents, for example, tend to underestimate internal symptoms such as anxiety, while children often do not realize how much their impulsive or inattentive behaviors impact others.

This study sought to better understand how ADHD and anxiety symptoms influence each other over time, taking into account the two dimensions of ADHD separately, the differences between boys and girls, and also the stages of child development.

To do this, the researchers followed two large samples of children in Norway, from the ages of 4 to 16, with assessments carried out every two years. They used interviews with the parents to understand how the symptoms evolved over time.

The results showed different patterns for girls and boys. In girls, symptoms of inattention in childhood were linked to the emergence of anxiety in adolescence. Furthermore, when girls showed anxiety around the ages of 12 and 14, they also tended to develop more inattention later in life.

In boys, the relationship was different: symptoms of hyperactivity and impulsivity at ages 6 and 8 were associated with increased anxiety two years later. However, for boys, anxiety did not lead to more ADHD symptoms later in life.

These findings indicate that the two dimensions of ADHD (inattention and hyperactivity-impulsivity) influence anxiety differently depending on the child’s gender.

This suggests that treatment and prevention strategies also need to be tailored: girls with symptoms of inattention may benefit from early support to prevent the development of anxiety, while boys with high impulsivity may need help in this area to prevent the emergence of anxiety.

In addition, treating anxiety in girls may help reduce symptoms of inattention during adolescence.

READ MORE:

Reciprocal relations between dimensions of attention-deficit/hyperactivity and anxiety disorders from preschool age to adolescence: sex differences in a birth cohort sample

Mojtaba Habibi Asgarabad, Silje Steinsbekk, Cynthia M. Hartung, Lars Wichstrøm

Journal of Child Psychology and Psychiatry, Volume 66, Issue2

February 2025. Pages 154-166

https://doi.org/10.1111/jcpp.14038

Abstract:

Symptoms of anxiety and attention-deficit/hyperactivity disorder (ADHD) are prospectively related from childhood to adolescence. However, whether the two dimensions of ADHD—inattention and hyperactivity-impulsivity—are differentially related to anxiety and whether there are developmental and sex/gender differences in these relations are unknown. Two birth cohorts of Norwegian children were assessed biennially from ages 4 to 16 (N = 1,077; 49% girls) with diagnostic parent interviews used to assess symptoms of anxiety and ADHD. Data were analyzed using a random intercept cross-lagged panel model, adjusting for all unobserved time-invariant confounding effects. In girls, increased inattention, but not hyperactivity-impulsivity, predicted increased anxiety 2 years later across all time-points and increased anxiety at ages 12 and 14 predicted increased inattention but not hyperactivity-impulsivity. In boys, increased hyperactivity-impulsivity at ages 6 and 8, but not increased inattention, predicted increased anxiety 2 years later, whereas increased anxiety did not predict increased inattention or hyperactivity-impulsivity. The two ADHD dimensions were differentially related to anxiety, and the relations were sex-specific. In girls, inattention may be involved in the development of anxiety throughout childhood and adolescence and anxiety may contribute to girls developing more inattention beginning in early adolescence. In boys, hyperactivity-impulsivity may be involved in the development of anxiety during the early school years. Effective treatment of inattention symptoms in girls may reduce anxiety risk at all time-points, while addressing anxiety may decrease inattention during adolescence. Similarly, treating hyperactivity-impulsivity may reduce anxiety risk in boys during late childhood (at ages 8–10).