ADHD in girls and boys – gender differences in co-existing symptoms and executive function measures

Skogli, Erik Winther; Teicher, Martin H.; Andersen, P.; Hovik, Kjell Tore; Øie, Merete Glenne · 2013 · OpenAlex-citations

DOI: 10.1186/1471-244x-13-298

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Summary

This study investigates gender differences in Attention-Deficit/Hyperactivity Disorder (ADHD) among medication-naïve children and adolescents, aiming to address the underidentification of females with the disorder. The research was motivated by evidence that girls often present with fewer hyperactive symptoms and more internalizing comorbidities, which may lead to missed diagnoses. The authors sought to determine if there were significant gender-by-diagnosis interactions in co-existing symptom severity and executive function (EF) impairment, and to identify which specific measures best distinguish ADHD patients from healthy controls (HC) within each gender. The study included 130 participants aged 8–17 years: 43 boys and 37 girls with ADHD, and 32 boys and 18 girls as healthy controls. Participants underwent comprehensive clinical assessments, including semi-structured interviews and rating scales. Co-existing symptoms were measured using self-report instruments (RCMAS-2, STAIC, SMFQ) and parent-rated scales (CBCL). Executive function was assessed via neuropsychological tests (e.g., Letter-Number Sequencing, Color-Word Interference, Trail Making Test) and parent-rated everyday executive skills using the Behavior Rating Inventory of Executive Function (BRIEF). Data were analyzed using Analysis of Variance (ANOVA) to detect group interactions and Random Forest classification to determine the predictive accuracy and variable importance for distinguishing ADHD from HC within each gender. Results indicated that ANOVAs revealed only one significant diagnosis-by-gender interaction: females with ADHD reported significantly higher levels of physiological anxiety than their male counterparts. However, Random Forest classification showed distinct patterns in diagnostic accuracy. Co-existing symptom ratings were more effective at distinguishing females with ADHD from HC (93% accuracy) than males (86% accuracy), with self-reported anxiety being the most critical variable for females. Conversely, parent-rated EF skills (BRIEF) were more accurate for males (96% accuracy) than females (92% accuracy), with parent ratings of rule-breaking behavior being the primary distinguishing factor for boys. Neuropsychological EF tests demonstrated modest predictive ability for both genders (73% for males, 79% for females). The findings suggest that gender-specific profiles exist in the expression of ADHD, particularly regarding comorbid symptoms. The study concludes that combining self-report and parent-rating scales is essential for accurate identification, as self-reports may uncover internalizing problems prevalent in females that are often overlooked. This approach could help mitigate referral bias and improve diagnostic rates for girls with ADHD, who are frequently underidentified due to less disruptive behavioral presentations.

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