Attention-deficit/hyperactivity disorder (ADHD) is associated with self-harm during adolescence and young adulthood, especially among females. Yet little is known about the developmental trajectories or childhood predictors/moderators of self-harm in women with and without childhood histories of ADHD. We characterized lifetime risk for nonsuicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SA), comparing female participants with (n = 140) and without (n = 88) childhood ADHD. We examined theory-informed childhood predictors and moderators of lifetime risk via baseline measures from childhood. First, regarding developmental patterns, most females with positive histories of lifetime self-harm engaged in such behaviors in adolescence yet desisted by adulthood. Females with positive histories of self-harm by late adolescence emanated largely from the ADHD-C group. Second, we found that predictors of NSSI were early externalizing symptoms, overall executive functioning, and father's negative parenting; predictors of SI were adverse childhood experiences and low self-esteem; and predictors of SA were early externalizing symptoms, adverse childhood experiences, and low self-esteem. Third, receiver operating characteristics analyses helped to ascertain interactive sets of predictors. Findings indicate that pathways to self-harm are multifaceted for females with ADHD. Understanding early childhood predictors and moderators of self-harm can inform both risk assessment and intervention strategies.

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CONTEXT: Although children with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for comorbid psychopathology, the clinical correlates of ADHD in girls are far less understood relative to boys, despite ADHD being one of the most common childhood disorders in girls.OBJECTIVE: To meta-analytically summarize rates of comorbid internalizing (anxiety, depression) and externalizing (oppositional defiant disorder [ODD], conduct disorder [CD]) psychopathology among girls with and without ADHD.DATA SOURCES: Literature searches (PubMed, Google Scholar) identified published studies examining comorbid psychopathology in girls with and without ADHD. STUDY SELECTION:Eighteen studies (1997 participants) met inclusion criteria and had sufficient data for the meta-analysis. DATA EXTRACTION:Odds ratios for each comorbid disorder were calculated from available data. Demographic (eg, age, race/ethnicity) and study characteristics (eg, referral source, diagnostic method) were also coded. RESULTS:Compared with girls without ADHD, girls with ADHD were significantly more likely to meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for each comorbid disorder assessed. Relative odds were higher for externalizing (ODD: 5.6×; CD: 9.4×) relative to internalizing disorders (anxiety: 3.2×; depression: 4.2×). Meta-regression revealed larger effect sizes of ADHD on anxiety for studies using multiple diagnostic methods, featuring younger children, and including clinic-referred (versus communityreferred) girls; the effect of ADHD on ODD varied based on diagnostic informant. LIMITATIONS:Findings were derived from cross-sectional studies, precluding causal inferences.CONCLUSIONS: Girls with ADHD frequently exhibit comorbid externalizing and internalizing disorders. We discuss future research priorities and consider intervention implications for ADHD and comorbid psychopathology in girls. Ms Tung collected and coded studies for inclusion, supervised the acquisition of data, carried out the analyses, and drafted the initial manuscript; Dr Li conceptualized and designed the study, supervised the acquisition of data, assisted with interpretation of analyses, and critically reviewed and revised the manuscript; Ms Meza and Ms Jezior collected and coded the studies for inclusion, assisted with drafting the initial manuscript, and reviewed and revised the manuscript; Ms Kianmahd, Mr Hentschel, and Mr O'Neil collected and coded the studies for inclusion and reviewed and revised the manuscript; Dr Lee supervised the acquisition of data, assisted with interpretation of analyses, and critically reviewed and revised the manuscript; and all authors approved the fi nal manuscript as submitted.