Hormonal effects on ADHD symptoms in adolescents across the menstrual cycle

Female-specific risk factors for ADHD in adolescence have been vastly understudied despite increased impairment and comorbidity during this period. In adults, the premenstrual phase and rapid decreases in estradiol levels are associated with increased risk for ADHD symptoms. The current project aims to evaluate the effects of day-to-day changes in estradiol and progesterone on ADHD symptoms across the menstrual cycle in adolescents. Participants were 13 adolescents aged 12 to 17 years over-recruited for ADHD. Participants collected saliva samples and completed measures of ADHD symptoms daily. Generalized additive mixed models were used to explore symptom trajectories across the menstrual cycle and examine the relationships between hormones and ADHD symptoms. Inattention and hyperactivity severity exhibited significant menstrual cycle-related variation, but average symptom trajectories across the cycle were largely flat. Significant person-specific cycle effects and individual differences in estradiol-symptom associations suggest substantial heterogeneity in menstrual cycle influence on ADHD symptoms. These findings suggest that menstrual cycle-related changes in ADHD symptoms are not characterized by a uniform pattern across adolescents and instead may reflect individual differences in hormone sensitivity. Future research should prioritize identifying distinct hormone-symptom response profiles and determine their clinical relevance for personalized ADHD management.