Responses to Social Stressors Among Females with Childhood ADHD: Link to Self-Harm and Internalizing Symptoms

• In Event: Self-Injurious Thoughts and Behaviors in Understudied Samples Across the Lifespan: Implications for Transdiagnostic Interventions

Abstract

Introduction: Historically, ADHD research has focused on predominantly male samples. However, studies indicate that girls with ADHD are uniquely at risk for self-harm and internalizing problems (Hinshaw et al., 2012), though underlying mechanisms remain unclear. Cross-sectional studies demonstrate associations between (a) involuntary responses to social stressors (RSS) and (b) both internalizing symptoms (Sontag et al., 2008) and self-harm (Borrill et al., 2009). Yet little is known about how RSS relate to ADHD. Girls with ADHD may be vulnerable to developing involuntary RSS given their elevated risk for peer rejection/victimization (Murray-Close et al., 2010), which may disrupt normative adolescent development of adaptive/effortful stress responses (Troop-Gordon et al., 2015). Therefore, we hypothesize that (1) childhood ADHD symptoms will predict greater involuntary RSS in emerging adulthood, (2) adolescent peer victimization/rejection will partially mediate this relation, and (3) involuntary RSS will partially mediate the relations between childhood ADHD symptoms and adult internalizing symptoms, non-suicidal self-injury (NSSI), and suicide attempt (SA).

Method: A diverse sample of females with (n=112) and without (n=82) childhood-diagnosed ADHD were followed prospectively across 16 years. Childhood, hyperactive-impulsive (HI) and inattentive (IA) symptoms were measured by teacher- and parent-report. Adolescent social preference was assessed by teacher-report, and peer victimization by self-report. In emerging adulthood, participants self-reported involuntary RSS via Connor-Smith’s Responses to Stressors Questionnaire, utilizing involuntary engagement (IE; e.g., uncontrolled arousal/action, rumination) and involuntary disengagement (ID; e.g. emotional numbing, escape) subscale averages. In early adulthood, history of SA and NSSI were operationalized as separate dichotomous variables based on validated structured interview, and internalizing symptoms by parent- and self-report on the Achenbach scales. All models included socioeconomic status (SES), race/ethnicity, and age as covariates.

Results: Hierarchical linear regressions revealed that childhood HI, but not IA, predicted greater IE (β=0.38, p<0.01, ΔR2=0.05) and ID (β=0.26, p<0.05, ΔR2=0.02) RSS in emerging adulthood. Via bootstrapped mediations, adolescent peer victimization significantly mediated the relation between childhood HI and IE RSS (Indirect Effect [I.E.]=0.0278, CI95=[0.0010, 0.0627]), whereas both adolescent peer victimization (I.E.=0.0315, CI95=[0.0042, 0.0657]) and low social preference (I.E.=0.0497, CI95=[0.0008, 0.1147]) were significant partial mediators between childhood HI and ID RSS. Bootstrapped logistic mediations revealed that both IE (I.E.=0.4455, CI95=[0.0180, 0.9858]) and ID (I.E.=0.4616, CI95=[0.0349, 1.0294]) RSS in emerging adulthood partially mediated the relation between childhood HI and adult internalizing symptoms. Only ID RSS (I.E.=0.0856, CI95=[0.0027, 0.2353]) partially mediated the relation between childhood HI and NSSI. ID RSS predicted higher likelihood of lifetime SA (b=0.7163, CI95=[0.0181, 1.4145]) but did not significantly mediate the relation between childhood HI and SA.

Discussion: Findings suggest that childhood HI predicts involuntary RSS in emerging adulthood and that adolescent peer victimization plays a key role in this connection. Involuntary RSS help explain the relation between childhood HI and both adult internalizing problems and NSSI. This suggests that emotion dysregulation is an important component of ADHD, helping to explain the link between impulsivity, social problems, and later psychopathology. Findings also support the hypothesis that NSSI serves an emotion regulatory function, highlighting the need for childhood interventions targeting emotion dysregulation in girls with ADHD.

Authors

• Patricia A. Porter, University of California - Berkeley
  Presenting Author

• Sinclaire M. OGrady, University of California - Berkeley
  Non-Presenting Author

• Stephen P Hinshaw, UC Berkeley
  Non-Presenting Author