Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence.

Authors

Ashley G. Eng, University of KentuckyFollow
Urveesha Nirjar, University of KentuckyFollow
Anjeli Elkins, University of KentuckyFollow
Yancey J. Sizemore, University of Kentucky
Krystina N. Monticello, University of Kentucky
Madeline K. Petersen, University of Kentucky
Sarah A. Miller, University of Kentucky
Jordan Barone, University of Illinois at Chicago
Tory A. Eisenlohr-Moul, University of Illinois at Chicago
Michelle M. Martel, University of KentuckyFollow

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that exhibits striking sex differences in symptoms, prevalence, and associated problems across development. Etiological factors and mechanisms underlying these sex differences remain one of the most understudied aspects of this disorder. The current paper seeks to provide a novel theoretical framework for understanding this phenomenon by reviewing evidence that females with ADHD may experience a "double whammy" of organizational and activational pubertal hormonal effects. We propose a novel theory of activational effects of cyclical circulating ovarian hormones on ADHD with increasing risk at times of rapid declines in estrogen. These declines may decrease executive function and trait control at two points of the cycle characterized by biphasic affective risk: (1) increases in approach/risk-taking behaviors at mid-cycle (periovulatory) and (2) increases in avoidance/negative affect perimenstrually. Low estrogen and control may then interact with increases in positive and negative affect, respectively, to increase hyperactivity-impulsivity symptoms post-ovulation and inattention symptoms perimenstrually. These interactions may be exacerbated by organizational pubertal effects on relatively overdeveloped limbic circuitry and adolescent-specific social pressures magnified in females with ADHD.

Document Type

Article

Publication Date

2-1-2024

Notes/Citation Information

0018-506X/© 2023 Elsevier Inc. All rights reserved.

Digital Object Identifier (DOI)

https://doi.org/10.1016/j.yhbeh.2023.105466

Funding Information

This research was supported by the National Institute on Alcohol Abuse and Alcoholism training grant T32 AA027488, the National Institute of Mental Health (R01-MH119119; RF1-MH120843; T32MH067631), and by a fellowship from the American Psychological Foundation. NIAAA, NIH, and APF had no role in the writing of the manuscript or the decision to submit the paper for publication.

Repository Citation

Eng, Ashley G.; Nirjar, Urveesha; Elkins, Anjeli; Sizemore, Yancey J.; Monticello, Krystina N.; Petersen, Madeline K.; Miller, Sarah A.; Barone, Jordan; Eisenlohr-Moul, Tory A.; and Martel, Michelle M., "Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence." (2024). Psychology Faculty Publications. 216.
https://uknowledge.uky.edu/psychology_facpub/216