ADHD in girls and boys – gender differences in co-existing symptoms and executive function measuresReport as inadecuate

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BMC Psychiatry

, 13:298

Child, adolescent and developmental psychiatry


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.

KeywordsADHD Gender Comorbidity Executive functions BRIEF Electronic supplementary materialThe online version of this article doi:10.1186-1471-244X-13-298 contains supplementary material, which is available to authorized users.

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Author: Erik Winther Skogli - Martin H Teicher - Per Normann Andersen - Kjell Tore Hovik - Merete Øie


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