Sex and Pubertal Status Moderate the Association Between ADHD and Depression Symptoms: An Examination From Preadolescence Through Late Adolescence




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Objective: This study examines the effects of sex and pubertal status on the association between attention-deficit/hyperactivity disorder (ADHD) and depression symptoms in preadolescence through late adolescence.

Methods: Participants were 472 youth from the Multimodal Treatment Study of Children With ADHD. The study sample included 308 youth with DSM-IV ADHD, recruited from 1993 through 1996, and 164 comparison youth who were recruited approximately 2 years later. Self-reported depression symptoms from the Children’s Depression Inventory and pubertal status from the Tanner Self-Report Scale were collected, along with combined parent-teacher reports of ADHD. Regression analyses examined the impact of ADHD, sex, pubertal status, and their interactions on total depression symptoms and related subscales (ie, negative mood, interpersonal problems, ineffectiveness, anhedonia, and negative self-esteem) in preadolescence. Next, path models examined associations between ADHD, sex, and pubertal status on depression symptoms into middle and late adolescence.

Results: In preadolescence, significant ADHD × sex × puberty interactions emerged for total depression symptoms and anhedonia (P < .05). Higher levels of ADHD severity were associated with higher levels of depression in early maturing girls and later maturing boys. Effects appear to be driven by anhedonia. Longitudinal effects emerged showing that total depression symptoms and anhedonia in preadolescence predicted levels of each respective outcome into late adolescence.

Conclusions: Sex and pubertal status meaningfully impact the association between ADHD and depression symptoms in youth and should be considered in future work and treatment.

J Clin Psychiatry 2019;80(3):18m12548