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Loyer Carbonneau M, Demers M, Bigras M, Guay MC. Meta-Analysis of Sex Differences in ADHD Symptoms and Associated Cognitive Deficits. J Atten Disord 2021; 25:1640-1656. [PMID: 32495675 DOI: 10.1177/1087054720923736] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: A meta-analysis was carried out to determine whether there are sex differences among children and adolescents with ADHD on the primary symptoms of ADHD and on executive and attentional functioning. Method: Studies published from 1997 to 2017 comparing boys and girls with a valid ADHD diagnosis were retained. Results: The meta-analysis found boys with ADHD to be more hyperactive than girls with ADHD and boys to have more difficulties in terms of motor response inhibition and cognitive flexibility. Results also confirm that youths with ADHD have more executive deficits than non-ADHD peers have, but there is no sex difference in this regard. Conclusion: Results show that there are sex differences in the behavioral expression of the difficulties related to ADHD. This highlights the importance of pursuing research to refine the profile of girls with ADHD and to develop diagnostic criteria adapted to each sex.
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Ahmad SI, Meza JI, Posserud MB, Brevik EJ, Hinshaw SP, Lundervold AJ. Attention-Deficit/Hyperactivity Disorder Symptom Dimensions Differentially Predict Adolescent Peer Problems: Findings From Two Longitudinal Studies. Front Psychol 2021; 11:609789. [PMID: 33584444 PMCID: PMC7873893 DOI: 10.3389/fpsyg.2020.609789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/17/2020] [Indexed: 02/04/2023] Open
Abstract
Introduction: Previous findings that inattention (IA) and hyperactive/impulsive (HI) symptoms predict later peer problems have been mixed. Utilizing two culturally diverse samples with shared methodologies, we assessed the predictive power of dimensionally measured childhood IA and HI symptoms regarding adolescent peer relationships. Methods: A US-based, clinical sample of 228 girls with and without childhood diagnosed attention-deficit/hyperactivity disorder (ADHD; M age = 9.5) was assessed and followed 5 years later. A Norwegian, population-based sample of 3,467 children (53% girls; M age = 8.3) was assessed and followed approximately 4 years later. Both investigations used parent and teacher reports of ADHD symptoms and peer relations. Multivariate regression analyses examined the independent contributions of IA and HI symptoms to later peer problems, adjusting for baseline childhood peer problems. We also examined childhood sex as a potential moderator within the Norwegian sample. Results: Higher levels of childhood HI symptoms, but not IA symptoms, independently predicted adolescent peer problems in the all-female clinical sample. Conversely, higher levels of IA symptoms, but not HI symptoms, independently predicted preadolescent peer problems in the mixed-sex population sample. Results did not differ between informants (parent vs. teacher). Associations between ADHD symptom dimensions and peer problems within the Norwegian sample were not moderated by child sex. Discussion: Differential associations between childhood hyperactive/impulsive and inattention symptoms and adolescent peer problems were found across two diverse samples using a shared methodology. Potential explanations for different findings in the clinical vs. population samples include symptom severity as well as age, sex, and cultural factors. We discuss implications for future research, including the importance of dimensional measures of ADHD-related symptoms and the need for shared methodologies across clinical and normative samples.
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Affiliation(s)
- Shaikh I Ahmad
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jocelyn I Meza
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Maj-Britt Posserud
- Division of Psychiatry, Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.,Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Erlend J Brevik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Stephen P Hinshaw
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Astri J Lundervold
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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Abstract
OBJECTIVE To determine the prevalence and psychosocial correlates of ADHD among adolescents in Jos, Nigeria. METHOD A cross-sectional descriptive two-stage study of 487 randomly selected participants using Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL), Raven's Standard Progressive Matrix (SPM) and the Children's Global Assessment Score (CGAS). RESULTS The prevalence of ADHD was 8.8%. The subtypes found were inattentive (3.08%), hyperactive-impulsive (2.05%), and combined (3.08%); male:female ratio of 1.4:1. ADHD was significantly associated with use of substance by father (odds ratio [OR] = 0.35; 95% confidence interval [CI] = [0.154, 0.781]), use of substance by mother (OR = 0.2; 95% CI = [0.055, 0.711]), and lower education of mother (OR = 0.3 95% CI = [0.116, 0.693]). Poor quality of handwriting (χ2 = 8.120; p = .010) and impaired global functioning ( t test = 10.756; p < .001) were significantly associated with ADHD in the adolescents. CONCLUSION Given the burden of ADHD, efforts should be made to establish a system for the early identification and management.
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Affiliation(s)
- M U Umar
- 1 Bayero University, Kano, Nigeria
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Coles EK, Slavec J, Bernstein M, Baroni E. Exploring the gender gap in referrals for children with ADHD and other disruptive behavior disorders. J Atten Disord 2012; 16:101-8. [PMID: 20837979 DOI: 10.1177/1087054710381481] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The current study examined the impact of the gender of children with ADHD on teachers' perceptions toward inattentive, hyperactive, or oppositional behaviors, and how these perceptions relate to teachers' ratings of children's impairment and referral recommendations. METHOD Teachers read eight vignettes depicting boys and girls with different subtypes of ADHD, as well as one depicting comorbidity (ADHD + ODD). Teachers then completed measures of impairment, and responded to questions about what services they would likely refer for the child and why. RESULTS Teachers rated girls as being significantly more impaired and more in need of services than boys. Regardless of gender, teachers overwhelmingly reported preferring the use of behavior modification for the described child. Also, children who were described with symptoms of ADHD-predominately inattentive subtype were rated as being the least impaired, while girls described as hyperactive and impulsive were rated by teachers as being the most impaired. CONCLUSION The current study adds to previous literature on gender bias in ADHD referrals by providing evidence for the differential referral of ADHD boys and girls to treatment based on presentation of symptoms.
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Wehmeier PM, Schacht A, Escobar R, Hervas A, Dickson R. Health-related quality of life in ADHD: a pooled analysis of gender differences in five atomoxetine trials. ACTA ACUST UNITED AC 2012; 4:25-35. [DOI: 10.1007/s12402-011-0070-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 12/14/2011] [Indexed: 11/24/2022]
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Merikangas KR, He JP, Burstein M, Swendsen J, Avenevoli S, Case B, Georgiades K, Heaton L, Swanson S, Olfson M. Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 2011; 50:32-45. [PMID: 21156268 PMCID: PMC4408275 DOI: 10.1016/j.jaac.2010.10.006] [Citation(s) in RCA: 885] [Impact Index Per Article: 68.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 10/09/2010] [Accepted: 10/18/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Mental health policy for youth has been constrained by a paucity of nationally representative data concerning patterns and correlates of mental health service utilization in this segment of the population. The objectives of this investigation were to examine the rates and sociodemographic correlates of lifetime mental health service use by severity, type, and number of DSM-IV disorders in the National Comorbidity Survey-Adolescent Supplement. METHOD Face-to-face survey of mental disorders from 2002 to 2004 using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview in a nationally representative sample of 6,483 adolescents 13 to 18 years old for whom information on service use was available from an adolescent and a parent report. Total and sector-specific mental health service use was also assessed. RESULTS Approximately one third of adolescents with mental disorders received services for their illness (36.2%). Although disorder severity was significantly associated with an increased likelihood of receiving treatment, half of adolescents with severely impairing mental disorders had never received mental health treatment for their symptoms. Service rates were highest in those with attention-deficit/hyperactivity disorder (59.8%) and behavior disorders (45.4%), but fewer than one in five affected adolescents received services for anxiety, eating, or substance use disorders. Comorbidity and severe impairment were strongly associated with service utilization, particularly in youth with behavior disorders. Hispanic and non-Hispanic Black adolescents were less likely than their White counterparts to receive services for mood and anxiety disorders, even when such disorders were associated with severe impairment. CONCLUSIONS Despite advances in public awareness of mental disorders in youth, a substantial proportion of young people with severe mental disorders have never received specialty mental health care. Marked racial disparities in lifetime rates of mental health treatment highlight the urgent need to identify and combat barriers to the recognition and treatment of these conditions.
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Affiliation(s)
- Kathleen Ries Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, Bethesda, MD 20892, USA.
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Abstract
Attention-deficit hyperactivity disorder (ADHD) is recognized to exist in males and females although the literature supports a higher prevalence in males. However, when girls are diagnosed with ADHD, they are more often diagnosed as predominantly inattentive than boys with ADHD. This article provides a review of gender differences noted across the lifespan. Males and females with ADHD are more similar than different, and generally ADHD profiles are not sex specific. Small gender differences have been found: adolescent girls with ADHD have lower self-efficacy and poorer coping strategies than adolescent boys with ADHD; rates of depression and anxiety may be higher, and physical aggression and other externalizing behaviors lower in girls and women with ADHD. Men with ADHD seem to be incarcerated more often than women with ADHD. However, many studies suffer from small sample sizes, referral biases, differences in diagnostic procedures, and possible rater influences. Treatments are reviewed and discussed with reference to the reported gender differences in functioning and the global deficits noted in all samples. The data available so far suggest that treatments are likely to be equally effective in males and females. However, referral bias is a problem, in that females with ADHD are less likely to be referred for treatment than males with ADHD. Future research should include equal representation of both sexes in samples such that sex by treatment analyses can be routinely conducted.
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Affiliation(s)
- Julia J Rucklidge
- Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand.
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Wehmeier PM, Schacht A, Dittmann RW, Banaschewski T. Minor differences in ADHD-related difficulties between boys and girls treated with atomoxetine for attention-deficit/hyperactivity disorder. ACTA ACUST UNITED AC 2010; 2:73-85. [DOI: 10.1007/s12402-010-0022-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 03/12/2010] [Indexed: 11/28/2022]
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Or D, Cohen A, Tirosh E. The reliability and validity of the Aggregate Neurobehavioral Student Health and Educational Review parent's questionnaire (ANSER-PQ). J Child Neurol 2010; 25:157-64. [PMID: 19692708 DOI: 10.1177/0883073809334385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The internal reliability and validity of the Aggregate Neurobehavioral Student Health and Educational Review parent's questionnaire (ANSER-PQ) were evaluated. Three diagnostic groups participated: (1) attention-deficit hyperactivity disorder (ADHD; N = 100), (2) learning disability (N = 80), and (3) a combined group (N-100). The Conners' parent and teacher rating scales were completed. Seven clusters were derived as follows: conduct, anxiety, social, attention and activity, strengths, obsessive-compulsive, and distress and disruption. Internal reliability was found above 0.7 for 6 of the clusters. Concurrent validity was found highly significant for the clusters of conduct and attention and activity. Discriminant validity of these clusters was found acceptable for the attention and learning disability groups. The clusters of conduct, attention and activity, and distress and disruption were found to significantly correlate with the Conners' teacher scale. The ANSER-PQ may be employed for the assessment of children with attention or learning disabilities.
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Affiliation(s)
- Drorit Or
- The Hannah Khoushy Child Development Center, Bnai Zion Medical Center, POB 4940, Haifa, Israel
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Oliveira CG, Albuquerque PB. Diversidade de resultados no estudo do transtorno de déficit de atenção e hiperatividade. PSICOLOGIA: TEORIA E PESQUISA 2009. [DOI: 10.1590/s0102-37722009000100011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Com este artigo pretende-se abordar a problemática da diversidade de dados na investigação do Transtorno de Déficit de Atenção e Hiperatividade (TDAH). Apresenta-se uma revisão da literatura centrada na heterogeneidade de conclusões relativas à caracterização do transtorno, à distinção dos subtipos, aos contextos de informação, às diferenças de gênero e à comorbidade. Na tentativa de compreender a disparidade de conclusões, salientam-se potenciais fatores explicativos, nomeadamente a heterogeneidade das amostras, a diversidade de metodologias e de procedimentos de investigação, entre outros. A revisão efetuada baseou-se, majoritariamente, em publicações referenciadas pelas bases de dados PsycInfo e ERIC, e, pontualmente, PubMed e Elsevier Direct.
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Rucklidge JJ. Gender differences in ADHD: implications for psychosocial treatments. Expert Rev Neurother 2008; 8:643-55. [PMID: 18416665 DOI: 10.1586/14737175.8.4.643] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) has now been recognized to exist in both males and females, albeit the literature supports a higher prevalence in males. However, when girls are diagnosed with ADHD, they are more often diagnosed as predominantly inattentive than boys with ADHD. This paper provides a review of gender differences noted across the lifespan in terms of psychosocial functioning, cognitive abilities and psychiatric comorbidities. Males and females with ADHD are more similar than different, and generally symptoms of ADHD are not sex specific. Small gender differences have been found: adolescent girls with ADHD have lower self-efficacy and poorer coping strategies than adolescent boys with ADHD, but these differences tend to disappear by adulthood; rates of depression and anxiety may be higher (especially in adolescence) while physical aggression and other externalizing behaviors may be lower in girls and women with ADHD, although not all studies support these findings (e.g., non-referred samples show similar rates of coexisting psychiatric disorders between boys and girls with ADHD). However, many studies suffer from small sample sizes, referral biases, differences in diagnostic procedures and possible rater influences. Psychosocial treatments are reviewed and discussed with reference to the reported gender differences in functioning as well as the global deficits noted in all samples. Although the data available so far suggest that psychosocial treatments are likely to be equally effective in males and females, this conclusion is based more on the small number of gender differences noted in overall functioning and less on empirical research on treatment by sex effects and the moderating role of sex, an effect only investigated by the Multi-modal Treatment Study of ADHD group, to date. Future research should include equal representation of both sexes in samples such that treatment analyses by gender can be routinely conducted.
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Affiliation(s)
- Julia J Rucklidge
- Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand.
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Sørensen L, Hugdahl K, Lundervold AJ. Emotional symptoms in inattentive primary school children: a population-based study. J Atten Disord 2008; 11:580-7. [PMID: 17968027 DOI: 10.1177/1087054707308491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The present study investigates teacher and parent reports of inattention and emotional symptoms in 6,229 primary school children. METHOD The assessment included the Emotional Symptoms subscale and the Impact scale from the Strengths and Difficulties Questionnaire and the inattention items from the Swanson, Nolan, and Pelham IV Questionnaire. RESULTS Children defined as inattentive showed a high risk of being defined as high scorers on the Emotional Symptoms subscale. A high score on both the Inattention and Emotional Symptoms subscales was associated with a high impact score. Teachers but not parents reported a higher risk of such co-occurrence of symptoms in girls than in boys. CONCLUSION Inattentive children should be screened for emotional problems by use of the multi-informants method.
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