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Cited by 108Attention Deficit Hyperactivity DisorderChild and Adolescent Psychosocial and Emotional DevelopmentAutism Spectrum Disorder Research

Patterns of Comorbidity Among Girls With ADHD: A Meta-analysis

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Tung, Irene, Li, James J., Meza, Jocelyn I., Jezior, Kristen L., Kianmahd, Jessica S.V., Hentschel, Patrick G., O’Neil, Paul M., Lee, Steve S.·2016·Pediatrics
DOI 10.1542/peds.2016-0430PMC PMC9923580
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Abstract

CONTEXT: Although children with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for comorbid psychopathology, the clinical correlates of ADHD in girls are far less understood relative to boys, despite ADHD being one of the most common childhood disorders in girls. OBJECTIVE: To meta-analytically summarize rates of comorbid internalizing (anxiety, depression) and externalizing (oppositional defiant disorder [ODD], conduct disorder [CD]) psychopathology among girls with and without ADHD. DATA SOURCES: Literature searches (PubMed, Google Scholar) identified published studies examining comorbid psychopathology in girls with and without ADHD. STUDY SELECTION: Eighteen studies (1997 participants) met inclusion criteria and had sufficient data for the meta-analysis. DATA EXTRACTION: Odds ratios for each comorbid disorder were calculated from available data. Demographic (eg, age, race/ethnicity) and study characteristics (eg, referral source, diagnostic method) were also coded. RESULTS: Compared with girls without ADHD, girls with ADHD were significantly more likely to meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for each comorbid disorder assessed. Relative odds were higher for externalizing (ODD: 5.6×; CD: 9.4×) relative to internalizing disorders (anxiety: 3.2×; depression: 4.2×). Meta-regression revealed larger effect sizes of ADHD on anxiety for studies using multiple diagnostic methods, featuring younger children, and including clinic-referred (versus community-referred) girls; the effect of ADHD on ODD varied based on diagnostic informant. LIMITATIONS: Findings were derived from cross-sectional studies, precluding causal inferences. CONCLUSIONS: Girls with ADHD frequently exhibit comorbid externalizing and internalizing disorders. We discuss future research priorities and consider intervention implications for ADHD and comorbid psychopathology in girls.

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  • Girls with ADHD are more likely than boys to have a comorbid internalizing condition like anxiety or depression.

    “Recent research has established that girls with ADHD are more likely than boys to have a comorbid internalizing condition like anxiety or depression.21”

    From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [21]

    The Discussion (page unavailable) reports that girls with ADHD have higher rates of anxiety and depression diagnoses than girls without ADHD, and notes that girls generally have higher rates of internalizing psychopathology than boys. The paper does not establish that girls with ADHD are more likely than boys with ADHD to have a comorbid internalizing condition; its meta-analysis compares girls with and without ADHD. (LLM, conf=0.86)

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1 of the 85 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Biederman J, Faraone SV. Attention- defi cit hyperactivity disorder. Lancet. 2005;366(9481):237-248
  2. Angold A, Costello EJ, Erkanli A. Comorbidity. J Child Psychol Psychiatry. 1999;40(1):57-87

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Authors
Tung, I., Li, J. J., Meza, J. I., Jezior, K. L., Kianmahd, J. S. V., Hentschel, P. G., O’Neil, P. M., & Lee, S. S.
Affiliations
  • University of California, Los Angeles (US)
  • University of Wisconsin–Madison (US)
  • University of California, Berkeley (US)
  • Department of Psychology, University of California, Los Angeles, Los Angeles, California;
Corresponding author
Lee, Steve S.
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2016-10-01
Volume
138
Issue
4
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2016-0430
PMC
PMC9923580
OpenAlex
W2522647067
Cited by
108
References
85
Citations by year
2026: 8 · 2025: 12 · 2024: 10 · 2023: 16 · 2022: 5 · 2021: 13 · 2020: 15 · 2019: 12 · 2018: 9 · 2017: 4 · 2016: 1
FWCI
1.24
Type
journal article
Language
en
Open access
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
National Science Foundation
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Keywords
attention deficit hyperactivity disorder, girls, comorbidities, internalizing disorders, anxiety, depression, externalizing disorders, oppositional defiant disorder, conduct disorder, clinic-referred children
MeSH terms
Adolescent, Attention Deficit Disorder with Hyperactivity, Mental Disorders, Child, Female, Humans, Psychopathology, Comorbidity, Diagnostic and Statistical Manual of Mental Disorders

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