Gender differences in self- and investigator-rated psychopathology in adult attention-deficit/hyperactivity disorder

Complex network of eye movements during rapid automatized naming

Introduction

Although the method of visualizing eye-tracking data as a time-series might enhance performance in the understanding of gaze behavior, it has not yet been thoroughly examined in the context of rapid automated naming (RAN).

Methods

This study attempted, for the first time, to measure gaze behavior during RAN from the perspective of network-domain, which constructed a complex network [referred to as gaze-time-series-based complex network (GCN)] from gaze time-series. Hence, without designating regions of interest, the features of gaze behavior during RAN were extracted by computing topological parameters of GCN. A sample of 98 children (52 males, aged 11.50 ± 0.28 years) was studied. Nine topological parameters (i.e., average degree, network diameter, characteristic path length, clustering coefficient, global efficiency, assortativity coefficient, modularity, community number, and small-worldness) were computed.

Results

Findings showed that GCN in each RAN task was assortative and possessed “small-world” and community architecture. Additionally, observations regarding the influence of RAN task types included that: (i) five topological parameters (i.e., average degree, clustering coefficient, assortativity coefficient, modularity, and community number) could reflect the difference between tasks N-num (i.e., naming of numbers) and N-cha (i.e., naming of Chinese characters); (ii) there was only one topological parameter (i.e., network diameter) which could reflect the difference between tasks N-obj (i.e., naming of objects) and N-col (i.e., naming of colors); and (iii) when compared to GCN in alphanumeric RAN, GCN in non-alphanumeric RAN may have higher average degree, global efficiency, and small-worldness, but lower network diameter, characteristic path length, clustering coefficient, and modularity. Findings also illustrated that most of these topological parameters were largely independent of traditional eye-movement metrics.

Discussion

This article revealed the architecture and topological parameters of GCN as well as the influence of task types on them, and thus brought some new insights into the understanding of RAN from the perspective of complex network.

Establishing Normative Data for the Number Cancelation Test Among Children in Kindergartens and Primary Schools in China

This study aimed to suggest an attention assessment tool using a Digital Pen for measuring the temporal-spatial parameters during the Number Cancelation Test (NCT), and then to establish the normative data for the NCT among children in kindergartens and primary schools in China by recruiting a total of 989 children (496 males). Four measures, i.e., selective attention (SA), speed of cognitive processing (SpC), averaged time of circlings (ATC), and averaged circumference of circled curves (ACCC), were proposed to evaluate the NCT performance. They basically have a development trend with fast speed in the beginning before Grade 1 or 2 of primary schools, and then enter an extremely slow development period (with ceiling or floor effect). SA and SpC have gender and grade main effects, while ATC and ACCC have the grade main effect, only. In particular, females have higher SA scores than males in middle class of kindergarten, and Grade 2-Grade 5 of primary school, but no gender differences in other grades; females have higher SpC scores than males in middle class of kindergarten, and Grade 3-4 of primary school, but no gender differences in other grades. More importantly, in clinical practice, if SA or SpC measure of a child is below than the 5th centile (i.e., p5 level) of his/her grade-specific normative data, then this child may be predicted to have a high-risk of learning disabilities. Findings suggest that the proposed method can be used for early screening of learning disabilities by setting appropriate cut-off values.

Gender differences in adult ADHD: Cognitive function assessed by the test of attentional performance

Introduction

The aim of this study was to assess cognitive differences between male and female adults with Attention Deficit Hyperactivity Disorder (ADHD).

Methods

Patients with an ADHD diagnosis according to the DSM-IV guidelines were included in a cross-sectional study evaluating cognitive measures. 28 women and 41 men from ages 19 to 56 completed self-report questionnaires and performed a computer-based test of attentional performance (TAP). The TAP assesses cognitive functions highly affected in ADHD patients, including working memory, alertness and attention as well as behavioral control and response inhibition.

Results

There were no measurable differences in self-report scales assessing current symptomology between the sexes, however men scored higher on the scale for childhood symptoms. Performance measures for general wakefulness were comparable between men and women, while working memory and behavioral control test results differed. Females reacted significantly slower and more unstable for both the TAP Go/NoGo paradigm and working memory subtest, while also making more errors in the latter.

Conclusions

We found gender-specific effects regarding working memory and behavioral control in this sample of adult patients with ADHD. Further studies are warranted, examining whether these differences relate to differences in clinical presentation and comorbidity patterns between men and women.

Weekly Calendar Planning Activity for University Students: Comparison of Individuals With and Without ADHD by Gender

OBJECTIVE

To introduce a revised version of the Weekly Calendar Planning Activity (WCPA) adapted for university students (Weekly Calendar Performance Activity for students [WCPA-S]) and compare the performance of this activity between students with and without ADHD and across gender groups.

METHOD

Participants included a total of 157 students, ages 20 to 30, enrolled in universities/colleges and divided into two groups: students with ADHD (male = 23, female = 38) and without ADHD (male = 33, female = 63). A two-way ANOVA was used for data analyses. The WCPA-S was administered to each student individually.

RESULTS

Significant differences were found between students with and without ADHD and across genders in performance, duration of performance, and in the number of strategies used.

CONCLUSION

The WCPA-S proved to be an effective performance-based diagnostic tool for the utilization of executive functions in the daily life of university students. This instrument can be used to predict success in higher education and to support learning among university students with ADHD.

Screening for Adult Attention-Deficit/Hyperactivity Disorder in a Psychiatric Outpatient Population with Specific Focus on Sex Differences

BACKGROUND/AIMS

Attention-deficit/hyperactivity disorder (ADHD) is often overlooked in adults; moreover, the problem seems to be even more critical in women. In the present, observational screening study, a clinical, particularly adult outpatient population was examined regarding frequency and severity of a likely ADHD, whereby sex differences were of particular interest.

METHODS

224 participants, 146 men and 78 women, were included. Based on data recorded with the self-rating WHO screening instrument Adult ADHD Self-Report Scale (ASRS-v1.1), it was examined how many participants were conspicuous for adult ADHD by exceeding a predefined cutoff value (COV) (COV ≥ 4 for ASRS-6, and ≥12 for ASRS-18). To examine frequency distributions, χ² tests were conducted. For the inferential statistical comparison of means, t-tests for independent samples or Mann-Whitney U tests were calculated.

RESULTS

34.4% of the sample was screened positive in the ASRS-v1.1 screener short version, ASRS-6, while 17.4% were conspicuous in the symptom checklist, ASRS-18. There were indeed more men screened positive, but the difference in the frequency between the sexes was not statistically significant, indicating a balanced sex ratio. Further, severity of ADHD core symptoms inattention and hyperactivity/impulsivity was examined by comparing ASRS-18 symptom subscale scores. In concordance with the hypothesis, men and women did not differ in severity of symptoms.

CONCLUSION

Results indicate that women might be affected by ADHD in a comparable manner as men; this emphasizes the importance for the awareness of ADHD in both sexes in clinical practice.

Sex- and Subtype-Related Differences of Personality Disorders (Axis II) and Personality Traits in Persistent ADHD

OBJECTIVE

Despite growing awareness of adult ADHD and its comorbidity with personality disorders (PDs), little is known about sex- and subtype-related differences.

METHOD

In all, 910 patients (452 females, 458 males) affected with persistent adult ADHD were assessed for comorbid PDs with the Structured Clinical Interview of DSM-IV and for personality traits with the revised NEO personality inventory, and the Tridimensional Personality Questionnaire.

RESULTS

The most prevalent PDs were narcissistic PD in males and histrionic PD in females. Affected females showed higher Neuroticism, Openness to Experience, and Agreeableness scores as well as Harm Avoidance and Reward Dependence scores. Narcissistic PD and antisocial PD have the highest prevalence in the H-type, while Borderline PD is more frequent in the C-type.

CONCLUSION

Sex- and subtype-related differences in Axis II disorder comorbidity as well as impairment-modifying personality traits have to be taken into account in epidemiological studies of persistent ADHD.

Häufigkeiten von adulten ADHS-assoziierten Symptomen in der Normalbevölkerung – Referenzwerte der ADHS-Selbstbeurteilungsskala und des Wender-Reimherr-Interviews

Zusammenfassung. Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) ist eine Erkrankung, welche sich im Kindesalter erstmalig manifestiert und bei bis zu 60 % der Betroffenen in Teil- oder Vollausprägung in das Erwachsenenalter persistiert. Dabei charakterisieren sich ADHS-Syndrome nicht als qualitativ auftretende Merkmale, sondern entsprechen Beeinträchtigungen, welche auch in einem gesunden Kollektiv auftreten können, und lediglich in Abhängigkeit ihres Schweregrads eine krankheitswertige Valenz innehaben. Mit Blick auf die Dimensionalität der ADHS-Symptomatik und unter Berücksichtigung epidemiologischer Daten, welche bereits im subklinischen Bereich ADHS-assoziierter Symptome Beeinträchtigungen in der Alltagsfunktionalität Erwachsener berichten, erscheinen daher Referenzwerte, welche eine Einschätzung ADHS-assoziierter Symptome in Bezug auf eine nicht-klinische Stichprobe ermöglichen, wünschenswert. Diese Lücke soll mit der vorliegenden Arbeit geschlossen werden. Es werden altersabhängige Referenzwerte für die Selbstbeurteilungsskala ADHS-SB und die deutsche Übersetzung des halbstandardisierten Wender-Reimherr-Interviews zur Einschätzung ADHS-assoziierter Symptome in einer nicht-klinischen Stichprobe vorgelegt. Ferner unterstützen unsere Ergebnisse bisherige Befunde, dass bereits unterhalb der diagnostischen Schwelle der Klassifikationssysteme psychopathologische Phänomene aus dem ADHS-Spektrum einen negativen Einfluss auf den Lebensalltags der Betroffenen haben können.

A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis

OBJECTIVE

To describe the clinical presentation of attention-deficit/hyperactivity disorder (ADHD) in women and girls and factors influencing proper diagnosis and treatment.

DATA SOURCES

A PubMed search was conducted in April 9, 2012 for English-language publications from the previous 10 years. Search terms included attention deficit hyperactivity disorder, attention deficit/hyperactivity disorder, ADHD, and AD/HD combined with gender, girls, females, women, continuity, discontinuity, gap, treatment, untreated, and lack of treatment.

STUDY SELECTION/DATA EXTRACTION

A total of 41 articles were reviewed for relevance. Reference lists from relevant articles were reviewed for additional publications; sources known to the authors were also included.

RESULTS

Attitudes about ADHD among individuals with ADHD and knowledgeable informants (families, teachers, colleagues) vary on the basis of the diagnosed individual's gender. The ADHD prevalence rates are higher among boys than girls. A low index of clinical suspicion exists for girls; their presentation is considered "subthreshold" because inattentiveness is more prominent than hyperactivity/impulsivity. Females with ADHD may develop better coping strategies than males to mask their symptoms. Lastly, anxiety and depression, common comorbidities in female patients with ADHD, can lead to missed or misdiagnosis. If not properly diagnosed and treated, girls with ADHD experience the same negative consequences as boys, including poor academic performance and behavioral problems. Unique issues related to hormonal effects on ADHD expression and treatment response are also experienced by women and girls.

CONCLUSIONS

Accurate ADHD diagnosis in women and girls requires establishing a symptom history and an understanding of its gender-specific presentation. Coexisting anxiety and depression are prominent in female patients with ADHD; satisfactory academic achievement should not rule out an ADHD diagnosis.

Sex differences and the interaction of age and sleep issues in neuropsychological testing performance across the lifespan in an ADD/ADHD sample from the years 1989 to 2009

Chart review of population (9 to 80 years) neuropsychological test battery for ADHD diagnosis, questionnaires with multiple responders were evaluated in outpatient setting from 1989-2009. The focus was gender differences across age, diagnostic group (ADHD-Inattentive/ADHD plus), neuropsychological test performance, and reported sleep symptoms over the lifespan. Individuals were assigned to ADHD-I group or ADHD plus group (based upon secondary diagnosis of sleep, behavioral, emotional disturbance); ADHD not primary was excluded (brain insult, psychosis). Among these were 1,828 children (ages 9 to 14), adolescents (ages 15 to 17), and adults (ages 18 and above); 446 children (312 diagnosed ADHD-I), 218 adolescents (163 diagnosed ADHD-I), and 1,163 adults (877 ADHD-I). Sleep was problematic regardless of age, ADHD subtype, and gender. The type and number of sleep problems and fatigue were age dependent. ADHD subtype, gender, fatigue, age, and sleep (sleep onset, unrefreshing sleep, sleep maintenance) were significant variables affecting neuropsychological test performance (sequencing, cognitive flexibility, slow- and fast-paced input, divided attention, whole brain functioning). Findings suggest that ADHD involves numerous factors and symptoms beyond attention, such as sleep which interacts differently dependent upon age.