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Our Research

Discover our ongoing projects and work streams

ADHD in Women and Girls 

Funded by the Medical Research Council (MRC)

Due to the outdated view that Attention-Deficit/Hyperactivity Disorder (ADHD) is a childhood disorder primarily affecting boys, ADHD among adult women is often overlooked in research.

 

Our lab seeks to address this neglect by investigating several important aspects of ADHD among women across the lifecourse, including:  (1) what features characterise girls who will later show ADHD in adulthood,  (2) whether ADHD symptoms increase for some girls in adolescence, and  (3) whether hormonal changes during the menstrual cycle make symptoms worse for women with ADHD.

 

Funded by the MRC, this overarching project "A life course approach to understanding ADHD in women", consists of three interrelated studies:

Study 1

Identifying child/adolescent risk factors for late-identified ADHD in adulthood

Why are some women diagnosed with ADHD in adulthood without having a childhood diagnosis? We will investigate childhood and adolescent characteristics of girls who later go on to develop ADHD in adulthood using data from two large UK studies. We will consider several areas that might characterise these girls, including a more 'female' ADHD presentation (e.g. talkativeness rather than physical hyperactivity); compensation for ADHD symptoms (e.g. with pro-social behaviours) or family 'scaffolding' (e.g. intense parental involvement); and adolescent stressors (e.g. greater demands of more challenging schooling). If we identify earlier predictors of late-identified ADHD, this could have several impacts: first, this could help build more sensitive measures of ADHD to better capture girls who may 'fly under the radar' of teachers, parents and clinicians. This could in turn lead to earlier identification of ADHD, and limit the number of years girls and women with ADHD experience misdiagnosis and poor functioning. 

Study 2

Examining longitudinal ADHD symptom change among adolescent girls

Why are some women diagnosed with ADHD in adulthood without having a childhood diagnosis? Adolescence is a key period of rapid brain development amidst increasing social and educational demands. Using data from a large study that follows adolescents from ages 9/10 to 12/13 and assesses ADHD symptoms each year, we will investigate whether some girls show a pattern of increasing ADHD symptoms in adolescence. We can also investigate what factors put some girls more at risk for increasing ADHD symptoms. Because this study also collected information on pubertal development and hormone levels, we can look specifically at whether the onset of puberty is associated with increasing ADHD symptoms. This is especially important as research shows that the age of pubertal onset is moving younger and younger among girls. 

Study 3

Investigating the association of menstrual cycle with symptoms among women with ADHD

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Among women with ADHD, the effects of hormones on functioning are a big concern. Many women with ADHD report their ADHD gets worse, or their medication doesn't work as well, at certain times of their menstrual cycle. To look into this, we will collect information from women for 3 months in two ways: first, we will give women daily questionnaires on their smartphones about their ADHD symptoms, ADHD medication, menstrual cycle, and related problems (like low mood and cognitive problems). Second, we will use an Oura 'smart ring' device to measure sleep patterns and physical activity, which may help us understand how hormonal changes and ADHD are related. This 'smart ring' can also measure body temperature, which changes over the menstrual cycle and gives us an innovative and non-intrusive way to assess phases of the cycle. Findings from this study could have a major impact on ADHD treatment for women, as cycle tracking, adjustments of medication dosage during certain cycle phases and interventions to support sleep and physical activity may be beneficial.

Other Projects

Using causally informed approaches to disentangle the association between disordered gambling and mental health disorders

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Investigating gender differences in parent-adolescent agreement on ADHD symptoms

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To-date, majority of previous studies have explored the associations between disordered gambling and mental health disorders using cross-sectional research designs. As a result, it is difficult to disentangle the relationship between gambling disorder and other psychopathology, more specifically the extent to which other mental health problems may lead to disordered gambling, and the extent to which disordered gambling may contribute to other mental health problems. 

Anna Paul's PhD project will disentangle the complex associations between disordered gambling and mental health disorders by triangulating evidence across different causally informed research designs. The role of shared genetics in the associations between disordered gambling and mental health disorders will be explored to understand the extent to which common genetic vulnerabilities confound these associations. This will include a systematic review of genetically informed studies (twin and molecular genetic studies) that examine the link between gambling disorder and other mental health problems. Secondly, longitudinal data will be used to investigate the reciprocal causal relationships between disordered gambling and mental health disorders both within and between persons from early adolescence into late adulthood. This research will have important implications for clinical treatments that aim to reduce disordered gambling prevalence by targeting co-morbid mental health disorders.

A common explanation for female underrepresentation in ADHD diagnostic rates is the presence of less salient female-specific disorder manifestations, which are less readily detectible by parents. Using data from a large and nationally representative community sample from the UK, we will (a) examine the effect of gender on parent-adolescent agreement on the hyperactivity-inattention subscale of the Strengths and Difficulties Questionnaire, on a subscale and an item level, and (b) establish the relative utility of adolescent and parent ADHD reports in predicting adverse psychological outcomes associated with this disorder. Examination of parent and adolescent reports of ADHD symptoms and establishing their relative utility in predicting psychological outcomes will together contribute to a better understanding of barriers that girls living with ADHD face in accessing services and treatment. 

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