Menarche and ADHD : associations between puberty, ADHD traits and mental health in female adolescents

BACKGROUND: Adolescents with attention-deficit/hyperactivity disorder (ADHD) may be more vulnerable to cooccurring mental health challenges during puberty, and some evidence suggests that puberty impacts ADHD traits. However, pubertal influences on psychological outcomes in female adolescents with ADHD are poorly understood. We investigated how menarche relates to ADHD traits and its potential moderation of associations between ADHD status or traits and mental health. METHODS: Study data from baseline to wave 3 (N = 5,318; 100% female; baseline age M = 9.9, SD = 0.6; 52.3% non-Hispanic White). ADHD traits, internalising difficulties and externalising difficulties were measured using the Child Behavior Checklist. Bayesian generalised linear mixed models examined cross-sectional and longitudinal associations between menarche status and ADHD traits. Interactions between menarche status and ADHD status or traits as predictors of mental health outcomes were also investigated. In comparative analyses, breast development replaced menarche status. RESULTS: ADHD traits did not differ between pre- and post-menarche adolescents in cross-sectional analyses, but post-menarche adolescents had higher ADHD traits the following year. Complete breast development (vs. not started) also predicted higher ADHD traits the next year. Interactions between menarche and ADHD status were not associated with mental health outcomes cross-sectionally or longitudinally. Positive associations between ADHD traits and mental health difficulties were marginally stronger in post-menarche adolescents. The association between higher wave 2 ADHD traits and greater wave 3 externalising difficulties was substantially stronger with more advanced breast development at wave 2. CONCLUSIONS: Longitudinal findings provide preliminary evidence that more advanced gonadarche in early adolescence is prospectively associated with elevated ADHD trait expression in females when controlling for individual differences in ADHD trait levels. More advanced breast development may reflect physiological and psychosocial changes that could contribute to a stronger relationship between higher ADHD traits and greater subsequent externalising difficulties.