Clinical overlap between at-risk mental states and attention-deficit/hyperactivity symptoms in community adolescents: investigating the influence of sex
Abstract
Adolescence is a period of heightened vulnerability to mental disorders, including attention-deficit hyperactivity disorder (ADHD) and at-risk mental states for psychosis (ARMS). Although evidence suggests an association between these conditions, research in community adolescent samples is limited, and the moderating role of sex remains unclear. It is also unknown whether the sex-related symptom patterns typically observed in ADHD are preserved in adolescents with ADHD–ARMS. A cross-sectional study included 697 non-help-seeking adolescents aged 11–15 years from a community sample of school-attending youth. Validated instruments assessed ADHD symptoms, anxiety, depression, and attenuated psychotic symptoms. Participants were classified into control, low-risk, intermediate-risk, and ARMS groups. Generalized ordinal logistic regression and consistent partial least squares structural equation modeling (PLS-SEM) were used to examine the association between ADHD symptoms and ARMS and the potential moderating effect of sex. 2% of participants exceeded the cut-off for inattentive ADHD symptoms and 18.4% for the combined presentation, while 2.8% were classified as ARMS. A combined presentation of ADHD symptoms was substantially more prevalent in the ARMS group (68.4%) vs controls (6.6%). Hyperactivity–impulsivity predicted ARMS status, particularly in females. In girls, ARMS was associated with hyperactivity–impulsivity and emotional problems, whereas in boys it was associated with depressive symptoms and suicidal ideation. PLS-SEM indicated that sex did not moderate the association between ADHD symptoms and ARMS but had a direct effect on ARMS. ADHD symptoms meeting the threshold for the combined presentation are associated with ARMS in adolescents. Female sex was associated with higher ARMS scores linked to hyperactivity–impulsivity, while in males risk was related to depression and suicidal ideation. ARMS–symptom associations were stronger in females. These findings support sex-sensitive approaches for early prevention of psychosis risk in youth.