Pathways to self-harmful behaviors in young adult females with and without ADHD: A longitudinal examination of risk and mediating factors

Accumulating evidence suggests that rates of suicide attempt and non-suicidal self-injury ([NSSI]; e.g., cutting, burning) peak in adolescence and early adulthood. Females and those with psychiatric symptoms/diagnoses appear to be at particular risk. Recent findings reported by Hinshaw and colleagues (in press) revealed that young adult women with childhood ADHD diagnoses (n = 140) reported higher rates of suicide attempts and NSSI than non-diagnosed, comparison women (n = 88). The current study aimed to expand on these preliminary findings in order to more thoroughly understand the pattern of suicide attempts and NSSI in this all-female sample. ADHD subtype differences and effects of diagnostic persistence (versus transient and non-diagnosed classifications) on self-harmful behaviors were explored. Crucially, possible mediating effects of impulsivity and comorbid psychopathology, ascertained in early/mid-adolescence, were investigated. Results indicated that young adult women with a childhood diagnosis of ADHD-Combined type (ADHD-C) and those with a persistent ADHD diagnosis (e.g., in childhood and young adulthood) were at highest risk for suicide attempts as well as the most varied and severe forms of NSSI. Mechanism analyses indicated unique pathways from childhood ADHD status to self-harmful behaviors in young adulthood. First, a lab-based measure of impulsivity, along with comorbid externalizing symptoms, emerged as simultaneous, partial mediators of the ADHD-NSSI linkage. Second, internalizing symptoms emerged as a partial mediator of the ADHD-suicide attempt linkage. Results underscore the elevated risk for self-harmful behaviors among young women with ADHD. Limitations, future directions, and implications for prevention and intervention efforts are discussed