(PS1-77) Hormonal Influences on ADHD and Daily Functioning: Menstrual Cycle Effects in College Students

Abstract Text: Our understanding of Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms and impairment is based primarily on male participant-dominated studies. As a result, additional work is needed to understand ADHD in girls and women (Haimov-Kochman & Berger, 2014). A recently introduced transdiagnostic framework, the Dimensional Affective Sensitivity to Hormones across the Menstrual Cycle (DASH-MC), postulates that hormone fluctuations are associated with changes in psychological symptoms, including ADHD (Peters et al. 2024). The Multiple Hormone Sensitivity Theory builds upon this framework, and suggests that declines in estrogen may cause premenstrual decreases in executive and cognitive functioning, leading to greater difficulties with attention and emotion dysregulation (ED) (Eng et al. 2024). The present work aimed to expand upon previous work with a focus on the changes in executive functioning (EF) and ED across the menstrual cycle in young adults with ADHD.
Participants included 48 college students (Mage = 20.6, SD = 1.89) who met criteria for ADHD, regularly menstruated, and were not taking hormonal birth control. The sample primarily identified as White (N = 29, 60.4%), and 20.8% (N = 10) identified as Hispanic or Latine. During an online baseline visit, ADHD diagnosis was confirmed by a study clinician using the Diagnostic Interview for ADHD in adults 2.0 (DIVA-2.0; Fadeuilhe Grau et al., 2016), and participants completed measures of EF, ED, and premenstrual symptom severity (Garnefski & Kraaij, 2006; Karr, 2024; Steiner et al., 2003).
Participants then completed a set of questionnaires each evening over the course of 35 days, including measures of ADHD symptom severity, impairment, EF, mood, and ED, to test hypotheses regarding associations between the menstrual cycle, ADHD symptoms, EF, and ED. Menstrual cycle was assessed using daily temperature readings and ovulation tests. We hypothesized that (1) participants would experience more severe impairments in ED and EF during the luteal and menstruation phases when compared to the follicular and ovulation phases, and (2) participants who reported greater overall EF and ED difficulties, would also report more premenstrual symptoms suggesting a greater negative impact of menstrual cycle fluctuations on those who are most impaired.
Preliminary regression analyses were conducted with baseline data to examine the relationship between premenstrual symptom severity, ED and EF. Greater premenstrual symptom severity significantly predicted difficulties in EF across planning (B = -.23, t = -2.73, p = .009) and emotional control (B = -.33, t = -3.22, p = .003). Greater premenstrual symptom severity also significantly predicted greater use of maladaptive, but not adaptive, cognitive emotion regulation coping strategies (B = .73, t = 2.78, p = .008). Additional analyses examining EF, ED, and ADHD symptoms across the menstrual cycle will be conducted using multilevel modeling to further disentangle the impact of the menstrual cycle in women with ADHD. By developing a greater understanding of impacts of this relationship, future interventions can aim to include specific methods of reducing symptom severity during targeted timepoints.