OVARIAN HORMONES, ADHD, RISK-TAKING, & IMPULSIVITY

Attention-Deficit/Hyperactivity Disorder (ADHD) is a highly impairing disorder of inattention, hyperactivity, and impulsivity that is more frequently diagnosed in males versus females at a ratio of 3:1. However, females with the disorder become highly impaired during adolescence, perhaps due to the onset of cycling ovarian hormones at puberty. The present study empirically assessed the role of the major female sex hormones, estrogen and progesterone, in the presentation of ADHD symptoms, impulsivity, and associated risk-taking behaviors (e.g., risky sex, substance use and abuse) in a non-clinical sample of young adult women. 32 healthy young adult women who were screened for hormonal conditions and medication use completed an initial laboratory visit during which measures of impulsivity and ADHD symptoms were collected. Each morning for 35 subsequent days, participants’ hormones were measured via passive drool saliva samples, and participants responded to a brief online survey regarding substance use and sexual behaviors for the last 24 hours. Each evening, participants completed online questionnaires regarding ADHD symptoms. Results showed that ADHD symptoms were most pronounced when estrogen was low; this association manifested (1) between women, with lower average estrogen across the entire cycle predicting higher ADHD symptoms, and (2) within women, with lower-than-average levels of estrogen during periods of higher-than-average progesterone predicting higher ADHD symptoms two days later, consistent with a post-ovulatory, luteal phase effect of estrogen. Moderation analyses revealed that these within-person effects of ovarian hormones were significant only among women with high negative or positive urgency (emotion-related impulsivity) or high sensation seeking. With regard to alcohol use, within-person results were somewhat different; higher-than-average within-person estrogen was associated with higher likelihood of drinking and binge drinking on the following day, and this was true only during periods of lower-than-average progesterone, consistent with a pre-ovulatory, follicular phase effect of estrogen. These results have implications for the conceptualization of ADHD and associated risk-taking behaviors such as drinking, including personalization of treatment approaches for women