ADHD in girls and boys – gender differences in co-existing symptoms and executive function measures

Abstract

BackgroundADHD is diagnosed and treated more often in males than in females. Research on gender differences suggests that girls may be consistently underidentified and underdiagnosed because of differences in the expression of the disorder among boys and girls. One aim of the present study was to assess in a clinical sample of medication naïve boys and girls with ADHD, whether there were significant gender x diagnosis interactions in co-existing symptom severity and executive function (EF) impairment. The second aim was to delineate specific symptom ratings and measures of EF that were most important in distinguishing ADHD from healthy controls (HC) of the same gender.MethodsThirty-seven females with ADHD, 43 males with ADHD, 18 HC females and 32 HC males between 8 and 17 years were included. Co-existing symptoms were assessed with self-report scales and parent ratings. EF was assessed with parent ratings of executive skills in everyday situations (BRIEF), and neuropsychological tests. The three measurement domains (co-existing symptoms, BRIEF, neuropsychological EF tests) were investigated using analysis of variance (ANOVA) and random forest classification.ResultsANOVAs revealed only one significant diagnosis x gender interaction, with higher rates of self-reported anxiety symptoms in females with ADHD. Random forest classification indicated that co-existing symptom ratings was substantially better in distinguishing subjects with ADHD from HC in females (93% accuracy) than in males (86% accuracy). The most important distinguishing variable was self-reported anxiety in females, and parent ratings of rule breaking in males. Parent ratings of EF skills were better in distinguishing subjects with ADHD from HC in males (96% accuracy) than in females (92% accuracy). Neuropsychological EF tests had only a modest ability to categorize subjects as ADHD or HC in males (73% accuracy) and females (79% accuracy).ConclusionsOur findings emphasize the combination of self-report and parent rating scales for the identification of different comorbid symptom expression in boys and girls already diagnosed with ADHD. Self-report scales may increase awareness of internalizing problems particularly salient in females with ADHD.

Patterns of Comorbidity Among Girls With ADHD: A Meta-analysis

“…27 Such treatment practices assume that ADHD in girls confers more risk for internalizing than externalizing symptoms. Importantly, results from previous studies of girls with versus without ADHD are mixed, with evidence that ADHD may be particularly predictive of anxiety and depression in girls 28,29 ; alternatively, other studies suggest that ADHD poses a higher risk for externalizing disorders and that girls with ADHD have higher rates of internalizing symptoms than boys simply due to the main effect of gender. 30 Similar to ADHD symptoms, externalizing behaviors in girls may reflect the gender paradox: despite its lower prevalence in girls compared with boys, externalizing symptoms are more impairing and produce worse outcomes for girls, underscoring the clinical significance of comorbid externalizing symptoms.…”

“…29,71 Some studies suggest that ADHD may be underdiagnosed in girls, 27,72 whereas others suggest that ADHD is overdiagnosed in boys. 73 The assumption of underdiagnosis of ADHD in girls may suggest that the comorbidity estimates derived in this study are inflated, because they are based on girls with particularly severe (ie, impairing) ADHD symptoms.…”

Children Schooling Achievements in the Course of Early Education and Their Cognitive Development

“…Citing literature usually boys characterized better level of shifting, and girls better level of working memory and inhibition [32]. Further [33] also administered significant differences between boys and girls in EF and mathematical achievements.…”

Percepção de mães brasileiras e espanholas sobre os problemas de comportamento dos filhos com tdah

“…Não há um consenso na literatura sobre este achado, inclusive são limitadas as investigações utilizando o CBCL com amostra similar ao presente estudo. A despeito das controvérsias em torno deste tema, alguns autores sinalizam maior prevalência dos comportamentos internalizantes nas meninas e dos comportamentos externalizantes nos meninos Rivera et al, 2005;Skogli, Teicher, Andersen, Hovik, & Øie, 2013). Estudos realizados com amostra de escolares sem transtornos psicológicos apontaram resultados divergentes (Borsa & Nunes, 2011b;Borsa et al, 2011;Emerich, Da Rocha, Silvares, & Gonçalves, 2012).…”