Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children.

Ortal Slobodin,Michael Davidovitch

doi:10.3389/fnhum.2019.00441

Abstract

Attention deficit hyperactivity disorder (ADHD), one of the most prevalent childhood disorders today, is generally more likely to be diagnosed and treated in boys than in girls. However, gender differences in ADHD are currently poorly understood, partly because previous research included only a limited proportion of girls and relied mainly on subjective measures of ADHD, which are highly vulnerable to reporter’s bias. To further examine gender differences in ADHD and to address some of the shortcomings of previous studies, this study examined gender differences in subjective and objective measures of ADHD among clinic-referred children with ADHD. Participants were 204 children aged 6–17 years-old with ADHD (129 boys, 75 girls). A retrospective analysis was conducted using records of a clinical database. Obtained data included parent and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist (CBCL), Teacher’s Report Form (TRF), and child’s continuous performance test (CPT) scores. Results showed that according to parents’ and teachers’ reports of ADHD-related symptoms (Conners ADHD rating scales), girls had more inattention problems than boys, but no differences were identified in the level of hyperactivity and impulsivity symptoms. CPT data, however, revealed higher impulsivity among boys. We did not find gender differences in the level of distractibility during CPT performance. Specifically, the effects of distractors type (visual environmental stimuli, auditory stimuli, or a combination of them) and distractors load (one or two distracting stimuli at a time) on CPT performance did not differ between boys and girls with ADHD. These findings suggest that gender effects on ADHD symptoms may differ between subjective and objective measures. Understanding gender differences in ADHD may lead to improved identification of girls with the disorder, helping to reduce the gender gap in diagnosis and treatment.

Highlights

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent childhood disorders today (Barkley, 2015), with an estimated worldwide prevalence of 7.2% in children under 18 years of age (Thomas et al, 2015)
Based on a relatively balanced female-to-male ratio (1:1.7), the current study examined the gender differences in parent and teacher ADHD rating scales, co-occurring symptoms, and continuous performance test (CPT) performance indices
multivariate analysis of variance with covariates (MANCOVA) results of the Child Behavior Checklist (CBCL) subscales indicated that the effect of gender was not significant, Wilks’ Lamda = 0.937, F(8,192) = 1.62, p = 0.12

Summary

Introduction

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent childhood disorders today (Barkley, 2015), with an estimated worldwide prevalence of 7.2% in children under 18 years of age (Thomas et al, 2015). Gender has been considered a significant factor in ADHD research for many years (Arnold, 1996), gender differences among children with ADHD are not well understood (Hasson and Fine, 2012). Boys are more likely to be referred, diagnosed, and treated for ADHD symptoms than girls. These findings were previously attributed to gender differences in the manifestation of ADHD (e.g., males having more disruptive symptoms; Gaub and Carlson, 1997; Gershon, 2002) as well as to referral bias (Rucklidge, 2008, 2010; Ohan and Visser, 2009). The aim of the current study was, to examine gender differences in ADHD-related symptoms, using subjective and objective measures, within a clinic-referred sample of 6–17-yearold children with ADHD

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Discussion

Conclusion