Menarche as a Predictor of ADHD Traits and Moderator of Mental Health Outcomes by ADHD Status and Trait Levels

Background: Adolescents with attention-deficit/hyperactivity disorder (ADHD) may be more vulnerable to mental health challenges during puberty, and some evidence suggests that puberty impacts ADHD traits. However, pubertal influences on adolescents assigned female at birth (AFAB) with ADHD are poorly understood. We investigated how menarche relates to ADHD traits, along with its moderating effects on mental health outcomes based on ADHD status or ADHD traits. Methods: This study used Adolescent Brain and Cognitive DevelopmentSM Study data from baseline to wave 3 (N = 5677; 100% female; baseline age M = 9.9, SD = 0.6; 51% non-Hispanic white). ADHD traits, internalising difficulties, and externalising difficulties were operationalised using the Child Behavior Checklist. Bayesian generalised linear mixed models were conducted to examine cross-sectional and longitudinal associations between menarche status and ADHD traits, along with moderating effects of menarche status on mental health according to ADHD status or traits. Comparative analyses were run with breast development. Results: Menarche status had a null association with concurrent ADHD traits, but post-menarche (versus pre-menarche) adolescents had higher ADHD traits the following year. Complete breast development (versus not started) predicted higher ADHD traits the next year. Menarche status and breast development moderated internalising and externalising difficulties according to ADHD status: the non-ADHD group had modestly higher mental health challenges with more advanced pubertal status, whereas there was no change for the ADHD group. Positive associations between ADHD traits and mental health challenges were marginally stronger post-menarche. Conclusions: Longitudinal findings provide preliminary evidence that female-specific markers of gonadarche plays a role in elevated ADHD trait expression. Greater mental health challenges with more advanced gonadarche were only observed in non-ADHD adolescents, but future research should investigate potential for ADHD subgroups that are especially vulnerable to pubertal influences on mental health.