Childhood Predictors of Lifetime Risk of Self-Harm: A Longitudinal Analysis of Women with and without ADHD

Introduction: Recent findings document that attention-deficit/hyperactivity disorder (ADHD) is associated with self-harm, during adolescence and young adulthood. Such findings appear particularly true for females with a psychiatric illness. Yet little is known about the early childhood predictors of self-harm in women with histories of childhood ADHD.

Methods: Utilizing data from the Berkeley Girls with ADHD Longitudinal Study (BGALS; N = 228), we characterized lifetime risk of self-harm, including non-suicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SA), in adolescent and young adult women, comparing those with (n = 140) and without (n = 88) childhood ADHD. At Wave 3 (M age = 19.6, range 17-24), self-harm was assessed via two self-reported measures and at Wave 4 (M age = 25.56, range 21-29), it was assessed via a clinician-administered structured interview. We examined childhood predictors of lifetime risk of self-harm by utilizing measures ascertained at baseline assessment in childhood (Wave 1; M= 9.6, range 6-12). We focused on six predictor domains of interest: early psychopathology (i.e., CBCL externalizing/internalizing, SNAP inattention and hyperactivity/impulsivity symptoms), childhood trauma, peer social preference, executive functioning, parenting, and self-esteem, each of which has been found to be both (a) impaired in samples with ADHD and (b) a risk factor for self-harm.

Results: Preliminary analysis using receiver-operating characteristics, indicate that parent rated hyperactivity/impulsivity symptoms predict NSSI, qualified by self-esteem measures, such that girls with more than 3.86 hyperactivity/impulsivity symptoms and low self-esteem, had a lifetime history of NSSI of 79.4%. For SI, self-esteem was a predictor, moderated by early childhood trauma, such that girls with low self-esteem and more than 2 childhood traumas had a 47% lifetime history of SI. Furthermore, the group with the highest lifetime history of SA (54.5%) had parents who reported higher externalizing and hyperactivity/impulsivity symptoms.

Conclusions: Understanding early childhood predictors of self-harm can inform both intervention strategies and help clinicians understand which domains to consider during risk assessment.