Patterns of Comorbidity Among Girls With ADHD: A Meta-analysis.
Although children with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for comorbid psychopathology, the clinical correlates of ADHD in girls are far less understood relative to boys, despite ADHD being one of the most common childhood disorders in girls.



To meta-analytically summarize rates of comorbid internalizing (anxiety, depression) and externalizing (oppositional defiant disorder [ODD], conduct disorder [CD]) psychopathology among girls with and without ADHD.



Literature searches (PubMed, Google Scholar) identified published studies examining comorbid psychopathology in girls with and without ADHD.



Eighteen studies (1997 participants) met inclusion criteria and had sufficient data for the meta-analysis.



Odds ratios for each comorbid disorder were calculated from available data. Demographic (eg, age, race/ethnicity) and study characteristics (eg, referral source, diagnostic method) were also coded.



Compared with girls without ADHD, girls with ADHD were significantly more likely to meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for each comorbid disorder assessed. Relative odds were higher for externalizing (ODD: 5.6×; CD: 9.4×) relative to internalizing disorders (anxiety: 3.2×; depression: 4.2×). Meta-regression revealed larger effect sizes of ADHD on anxiety for studies using multiple diagnostic methods, featuring younger children, and including clinic-referred (versus community-referred) girls; the effect of ADHD on ODD varied based on diagnostic informant.



Findings were derived from cross-sectional studies, precluding causal inferences.



Girls with ADHD frequently exhibit comorbid externalizing and internalizing disorders. We discuss future research priorities and consider intervention implications for ADHD and comorbid psychopathology in girls.
Department of Psychology, University of California, Los Angeles, Los Angeles, California.
Irene
I
Tung
Department of Psychology, University of Wisconsin, Madison, Wisconsin; and.
James J
JJ
Li
Department of Psychology, University of California, Berkeley, Berkeley, California.
Jocelyn I
JI
Meza
Department of Psychology, University of California, Los Angeles, Los Angeles, California.
Kristen L
KL
Jezior
Department of Psychology, University of California, Los Angeles, Los Angeles, California.
Jessica S V
JS
Kianmahd
Department of Psychology, University of California, Los Angeles, Los Angeles, California.
Patrick G
PG
Hentschel
Department of Psychology, University of California, Los Angeles, Los Angeles, California.
Paul M
PM
O'Neil
Department of Psychology, University of California, Los Angeles, Los Angeles, California; stevelee@psych.ucla.edu.
Steve S
SS
Lee
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000523:psychology*; D002648:Child; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology*; D011599:Psychopathology / Q000706:statistics & numerical data
Child Psychiatry Hum Dev. 2005 Summer;35(4):359-81
15886870
J Abnorm Child Psychol. 2010 Aug;38(6):721-36
20339912
Natl Health Stat Report. 2015 Sep 3;(81):1-7
26375578
J Consult Clin Psychol. 2012 Feb;80(1):128-38
22201328
J Abnorm Child Psychol. 2003 Jun;31(3):231-45
12774858
J Child Adolesc Psychopharmacol. 2008 Dec;18(6):565-71
19108661
Psychol Med. 2007 Dec;37(12):1731-41
17451627
Child Psychiatry Hum Dev. 2012 Apr;43(2):254-70
22038319
J Consult Clin Psychol. 2006 Jun;74(3):489-499
16822106
J Am Acad Child Adolesc Psychiatry. 1997 Jul;36(7):980-8
9204677
MedGenMed. 2004 May 04;6(2):2
15266229
Eur Child Adolesc Psychiatry. 2007 Sep;16(6):362-9
17401612
Am J Psychiatry. 2010 Apr;167(4):409-17
20080984
Psychiatry Res. 1994 Jul;53(1):13-29
7991729
J Neural Transm (Vienna). 2007;114(8):1097-104
17406960
World Psychiatry. 2007 Oct;6(3):168-76
18188442
Dev Med Child Neurol. 2003 Oct;45(10):693-9
14515941
J Am Acad Child Adolesc Psychiatry. 1999 Nov;38(11):1355-62
10560221
J Child Psychol Psychiatry. 1999 Jan;40(1):57-87
10102726
Am J Psychiatry. 2002 Jan;159(1):36-42
11772687
J Am Acad Child Adolesc Psychiatry. 2000 Jan;39(1):28-38
10638065
J Am Acad Child Adolesc Psychiatry. 2014 Jan;53(1):34-46.e2
24342384
J Clin Child Adolesc Psychol. 2009 Sep;38(5):650-60
20183650
Biometrics. 1994 Dec;50(4):1088-101
7786990
Annu Rev Clin Psychol. 2009;5:311-41
19152496
Child Adolesc Psychiatr Clin N Am. 2000 Jul;9(3):525-40, vii
10944655
Biometrics. 2000 Jun;56(2):455-63
10877304
J Am Acad Child Adolesc Psychiatry. 1997 Aug;36(8):1036-45
9256583
Psychiatry Res. 2008 Jan 15;157(1-3):201-9
18023880
J Abnorm Child Psychol. 1999 Jun;27(3):237-45
10438189
J Child Psychol Psychiatry. 2005 Mar;46(3):255-62
15755302
Eur Child Adolesc Psychiatry. 2006 Dec;15 Suppl 1:I15-24
17177011
J Consult Clin Psychol. 1992 Dec;60(6):881-92
1360990
J Am Acad Child Adolesc Psychiatry. 2003 Sep;42(9):1015-37
12960702
J Clin Child Adolesc Psychol. 2011;40(5):777-86
21916696
Acta Obstet Gynecol Scand. 2012 Nov;91(11):1319-25
22882123
J Am Acad Child Adolesc Psychiatry. 2008 Apr;47(4):426-434
18388760
Behav Ther. 2016 Sep;47(5):622-632
27816075
J Clin Child Adolesc Psychol. 2006 Dec;35(4):571-7
17007602
Psychiatr Clin North Am. 2009 Sep;32(3):483-524
19716988
BMJ. 1997 Sep 13;315(7109):629-34
9310563
Eur Child Adolesc Psychiatry. 2011 Mar;20(3):137-45
21290154
Eur Arch Psychiatry Clin Neurosci. 2006 Aug;256(5):311-9
16685602
J Child Psychol Psychiatry. 2014 Dec;55(12):1345-53
24813803
Child Adolesc Psychiatr Clin N Am. 2000 Jul;9(3):499-510, vi
10944653
J Atten Disord. 2019 Sep;23(11):1339-1345
26443719
J Abnorm Child Psychol. 2012 May;40(4):595-606
22113705
J Am Acad Child Adolesc Psychiatry. 2010 Jun;49(6):595-605
20494269
J Clin Psychiatry. 2016 Jan;77(1):52-9
26761486
J Am Acad Child Adolesc Psychiatry. 2003 Dec;42(12):1424-32
14627877
J Psychopathol Behav Assess. 2011;33(3):299-307
33132494
J Consult Clin Psychol. 2012 Dec;80(6):1041-1051
22889337
Lancet. 2005 Jul 16-22;366(9481):237-48
16023516
J Dev Behav Pediatr. 2012 Apr;33(3):221-8
22343479
J Consult Clin Psychol. 2002 Oct;70(5):1086-98
12362959
J Child Psychol Psychiatry. 2010 Apr;51(4):497-517
20158575
BMC Psychiatry. 2013 Nov 09;13:298
24206839
Child Adolesc Psychiatry Ment Health. 2008 Jul 03;2(1):15
18598351
J Am Acad Child Adolesc Psychiatry. 2005 Apr;44(4):368-76
15782084
NCHS Data Brief. 2015 May;(201):201
25974000
J Am Acad Child Adolesc Psychiatry. 2001 Feb;40(2):147-58
11211363
J Am Acad Child Adolesc Psychiatry. 2001 Feb;40(2):137-46
11214601
Am J Orthopsychiatry. 2013 Apr-Jul;83(2 Pt 3):165-75
23889009
Can Child Adolesc Psychiatr Rev. 2005 Feb;14(1):21-5
19030497
J Am Acad Child Adolesc Psychiatry. 2001 May;40(5):530-40
11349697
J Dev Behav Pediatr. 2008 Dec;29(6):501-7
19077845
BMJ. 2001 Jul 14;323(7304):101-5
11451790
J Abnorm Psychol. 2003 May;112(2):179-92
12784827
J Clin Child Adolesc Psychol. 2011;40(4):532-45
21722026
Prim Care Companion CNS Disord. 2014;16(3):
25317366
J Abnorm Child Psychol. 2011 Jan;39(1):1-10
20644990
J Clin Child Adolesc Psychol. 2002 Dec;31(4):443-52
12402564
J Consult Clin Psychol. 2013 Feb;81(1):100-12
22866680