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Executive Functions in Young Adult Females with and without ADHD: Longitudinal Development and Associations with Impairment

  • Author(s): Miller, Meghan
  • Advisor(s): Hinshaw, Stephen P
  • et al.

Attention-deficit/hyperactivity disorder (ADHD) is a male predominant neurodevelopmental disorder, with the unfortunate consequence that boys and men constitute the focus of the bulk of the extant research (Gaub & Carlson, 1997; Hinshaw & Blachman, 2005). Many studies include entirely male samples; others include too few females to conduct meaningful analyses within all-female subsamples. Thus, very little research has focused specifically on girls with this disorder, particularly with respect to neuropsychological variables. It is important to understand these topics in females, including specific neuropsychological mechanisms underlying both typical and atypical development, in order to determine core underlying mechanisms as well as to guide diagnostic and treatment-development efforts. In the present study, I utilized data from a longitudinal study of girls with and without ADHD. This investigation of a large, well-characterized, and diverse female sample currently consists of data from three time points, the first collected in childhood (ages 6-12); the second collected during adolescence (ages 12-18); and the third collected during late adolescence/young adulthood (ages 17-25). This investigation had three main aims: (1) to determine whether girls with and without childhood-defined ADHD show improvements in neuropsychological functioning over time (from childhood to adolescence to young adulthood) and whether the developmental trajectory is different for girls with ADHD versus comparison girls; (2) to assess differences in neuropsychological functioning in those whose ADHD symptoms have persisted into young adulthood versus those whose ADHD symptoms have remitted; and (3) to determine whether neuropsychological performance in adolescence mediates associations between childhood ADHD symptoms and young adult functional outcomes. Results indicated that individuals with childhood-diagnosed ADHD - who had the greatest EF impairments in childhood - showed the greatest improvement from childhood to adolescence to young adulthood relative to comparisons on some measures of EF, but similar or slower rates of development on others, controlling for key baseline comorbidities. The ability of ADHD persistent-remitted status to predict change in EF abilities was lacking, and there was no evidence of any association between improvement in EF abilities and remitted ADHD status. Mediation analyses indicated that adolescent EF mediated associations between ADHD symptoms and young adult academic achievement abilities, but no other outcomes. Such findings suggest the potential importance of EF abilities as a treatment target in ADHD in order to prevent academic difficulties.

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