Eng: Ovarian Hormone Effects on ADHD Symptoms and Impairment Across the Menstrual Cycle in Adolescents

Females with Attention-Deficit/Hyperactivity Disorder (ADHD) become particularly impaired during adolescence, experiencing increased comorbidity and important public and personal health outcomes like increased suicide attempts, risky sexual behavior, and substance use. However, female-specific risk factors for ADHD have been vastly understudied despite this increased impairment and comorbidity. One particularly understudied risk factor is the dramatically rising and fluctuating levels of ovarian hormones during late puberty that begin cycling on a monthly basis. In adult women, rapid decreases in estrogen levels increase risk for ADHD symptoms across the menstrual cycle. However, little work has been done exploring timing of developmental onset and possible environmental moderators of these effects. Therefore, a critical next step is empirical examination of when hormonal effects on ADHD symptoms and impairment in adolescent females become apparent. Such work will advance personalized assessment and intervention efforts in adolescent females, a particularly understudied group, in line with NIMH initiatives to advance the study of women’s health. Given the above, the proposed project aims to (1) evaluate the effects of day-to-day changes in estrogen on ADHD symptoms and impairment across the menstrual cycle in adolescents and (2) determine if specific traits and environmental stressors are associated with increased sensitivity to hormonal effects. These aims will be explored using a quasi- experimental longitudinal design across the menstrual cycle. Participants will be a clinical sample of 40 adolescents ages 11 to 17 who have begun menstruating, over-recruiting for ADHD. Examination of within-person effects across one month using multilevel modeling allows sufficient statistical power.