A meta-analytic review of gender differences in ADHD

Overt and relational aggression in girls with attention deficit hyperactivity disorder

We employed a multi-informant approach to examine attention deficit hyperactivity disorder (ADHD) subtype differences, as well as ADHD versus comparison group differences, in overt aggression, relational aggression, and peer regard related to such aggression. Participants included 228 girls (ages 6 to 12 years) diagnosed with either ADHD-Combined (ADHD-C; n = 93), ADHD-Inattentive (ADHD-I; n = 47), or nondiagnosed comparisons (n = 88) who attended research-based summer camp programs. Girls with ADHD-C exhibited higher rates of overt and relational aggression than did girls with ADHD-I, who in turn exhibited higher rates than comparison girls. For the ADHD-C subgroup, aggressive behavior was associated with both negative peer regard and lack of positive peer regard; for the ADHD-I subgroup, aggressive behavior was related to negative peer regard but not to positive peer regard. Controlling for subtype, relational aggression contributed incremental variance in peer regard over and above overt aggression, but effects for the latter were stronger. We discuss the importance of overt versus relational aggression for girls with ADHD as well as disparities in findings according to informant sources.

No evidence of attentional deficits in stabilized bipolar youth relative to unipolar and control comparators

OBJECTIVE

The purpose of this study was to determine the presence or absence of attentional problems and prior diagnosis of ADHD in a cohort of stabilized bipolar I relative to unipolar and normal control.

METHOD

Indices of attention were obtained from bipolar (n = 44), unipolar (n = 30), and normal controls (n = 45). Measures included: Freedom from Distractibility (FD) Composite Index of the WISC III, Conners' Continuous Performance Test (CPT), Wisconsin Card Sorting Test (WCST), and a checklist measure of subjective cognitive/attentional problems (SIP-AV).

RESULTS

Bipolar (6.8%), unipolar (10%), and no control youth report a prior diagnosis of ADHD. No significant group or sex differences were observed on FD Composite Index, various CPT indices, or the WCST. Despite normative attentional function by objective testing, subjectively experienced cognitive problems in the clinical probands were reported.

CONCLUSIONS

This cohort of well-functioning bipolar youth diagnosed on average 3-4 years prior to assessment do not possess attentional deficits based on a variety of objective tests compared to unipolar or control youth, but self report subjective difficulties in attentional/problem solving ability. In contrast to other authors, we do not find that bipolar youth have high rates of comorbid ADHD.

Buffers of peer rejection among girls with and without ADHD: the role of popularity with adults and goal-directed solitary play

We investigated a risk-resilience model in 91 girls with ADHD and 58 age- and ethnicity-equated comparison girls, who participated in all-female naturalistic summer research camps. The hypothesized risk factor was peer rejection (assessed via sociometric nominations), with criterion measures including multiinformant composites of aggressive behavior and anxious/depressed symptoms. The two hypothesized protective factors were the girls' popularity with adult staff (assessed via staff ratings) and objective observations of goal-directed solitary play. Peer rejection was related to higher levels of aggressive behavior and depressed/anxious behavior, confirming its status as a risk factor. Next, for all girls, popularity with adults predicted lower levels of aggression and goal-directed solitary play predicted lower levels of anxiety/depression. Whereas popularity with adults was most protective among the peer-accepted subgroup, solitary play was most protective among the peer-rejected subgroup. Diagnostic status (ADHD versus comparison) moderated the findings such that engaging in meaningful solitary play was a stronger predictor of lower levels of anxious/depressed behavior in girls with ADHD than in comparison girls. We discuss the need for replication in prospective research and implications for research and intervention regarding the social functioning of peer-rejected children, particularly those with behavior disorders.

Seeing the unexpected: how sex differences in stress responses may provide a new perspective on the manifestation of psychiatric disorders

In this report, the authors propose that underlying sex differences in the biobehavioral response to stress may contribute to the variance in prevalence of some psychiatric disorders based on sex. The authors begin with a discussion of stress physiology and review a new theory on sex differences in stress responses (ie, the "tend-and-befriend" response), which may provide a recent framework for considering sex differences in the manifestation of some psychiatric illnesses. The authors then move to a discussion of major depression and attention deficit hyperactivity disorder as examples of how sex differences in stress responses may influence the behavioral symptoms of psychiatric disorders that are more often diagnosed in one sex compared with another. The authors conclude with a brief discussion of the implications of this new perspective on treatment approaches and encourage further inquiry into the importance of sex-based differences in the behavioral manifestation of some psychiatric illnesses.