Author ORCID Identifier

https://orcid.org/0000-0002-2396-7594

Date Available

6-27-2024

Year of Publication

2024

Document Type

Doctoral Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

Arts and Sciences

Department/School/Program

Psychology

Advisor

Dr. Michelle M. Martel

Abstract

Background: Females with attention-deficit/hyperactivity disorder (ADHD) become particularly impaired during adolescence, experiencing increased rates of depression and anxiety, as well as 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 monthly. In adult women, rapid decreases in estrogen levels increase risk for ADHD symptoms across the menstrual cycle, particularly for those with high trait impulsivity. Preliminary pilot work suggests increased ADHD-related comorbidity and impairment by later pubertal stages. The current project aims to (1) evaluate the effects of day-to-day changes in estrogen on ADHD symptoms across the menstrual cycle in adolescents and (2) determine if specific traits such as impulsivity and environmental stressors are associated with increased sensitivity to hormonal effects.

Methods: Participants were 19 adolescents aged 11 to 17 years who had begun menstruating, and over-recruited for ADHD. Participants collected saliva samples as a measure of estradiol and progesterone and completed measures of ADHD symptoms daily. At a laboratory visit, participants completed measures of pubertal development, trait impulsivity, family functioning, peer rumination, and perceived stress. Multilevel models with planned contrasts were used to detect differences in symptoms among menstrual cycle phases and test moderators.

Results: Analyses indicated inattention was positively associated with progesterone. Hyperactivity was negatively associated with estradiol, and these symptoms were more severe in the periovulatory phase. Impulsivity was highest in the midluteal phase, but analyses did not reveal any hormonal associations. Although pubertal stage was not found to moderate ADHD symptoms, results did indicate trait impulsivity, peer rumination, and perceived stress as moderators.

Discussion: Results demonstrating changes in ADHD symptoms across the menstrual cycle and several moderators of such effects highlight key factors in the symptom exacerbation and increased impairment seen during adolescence in females. These findings suggest that menstrual cycle timing, as well as trait and social factors are important details that should be integrated with traditional tools during the assessment of ADHD symptoms. This study replicates findings that ADHD symptoms change across the menstrual cycle and adds to the overall work in this field by providing direct links between several environmental factors, ADHD symptoms, and the menstrual cycle.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2024.286

Funding Information

This study was supported by an American Psychological Foundation Fellowship from 2023-2024.

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