Recently we highlighted a study that suggested that diagnosis rates of ADHD differed in children of different races. Today’s blog points out the differences in symptoms and diagnosis rates between genders.
Now, more than ever, researchers are uncovering tangible evidence to explain the differences in Attention Deficit Hyperactivity Disorder (ADHD) symptoms among boys and girls. With accumulating data, we are better equipped to understand the neurobiology of these developing boys and girls, refine assessment, and focus on treatment.
Q & A | Gender Differences in ADHD:
Q: Are boys, in fact, more likely to have ADHD?
A: The ratio of ADHD in boys to girls is relatively equal, with reliable reports ranging between 2:1 (CDC, 2011) and 1:1 (Froehlich, 2007). To no surprise, however, boys continue to be disproportionately diagnosed at higher rates than girls (Bruchmuller, Margraf, & Schneider, 2011), likely due to their tendency to display more disruptive behaviors.
Q: Why do symptoms differ among boys and girls?
A: It is evident that boys and girls often exhibit distinct symptom profiles, at least in the early school years. Recent developments suggest that this is best explained by age, not necessarily gender. Brain imaging has shown that the brain areas involved in hyperactivity develop at a faster rate for girls (Qiu et. al, 2009). Alternatively, these areas are slower to mature in boys and help to explain the higher incidence of hyperactive behaviors in the school-age years. While it is true that girls’ overt symptoms of hyperactivity tend to wane, functional impairment can still take its toll on daily functioning.
Q: Are the consequences of untreated ADHD the same for boys and girls?
A: The consequences of untreated ADHD are similar among the genders in terms of impact on academics, career success, relationships, and executive function, though girls are at higher risk of developing more internalized disorders, such as depression and eating disorders (Gershon, 2002, Biederman et al., 2007). Given the varying symptom presentation among genders in childhood, quiet, well-behaved but inattentive girls have a greater chance of going undiagnosed or to receive late diagnosis.
As awareness of the differences and reasons why ADHD can present differently among genders, parents and teachers can be more attuned to behaviors signaling the need for an evaluation, ensuring that no child goes unnoticed.
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Biederman, J., Ball, S.W., Monuteaux, M.C., Surman, C.B., Johnson, J.L., & Zeitlin, S. (2007). Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study. Journal of Developmental and Behavioral Pediatrics, 28(4).
Bruchmuller, K., Margraf, J., & Schneider, S. (2011). Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Journal of Consulting and Clinical Psychology, 80(1).
Bloom B, Cohen RA, Freeman G. (2011). Summary health statistics for U.S. children: National Health Interview Survey, 2010. Centers for Disease Control and Prevention. Vital Health Statistics, 10(250).
Froehlich, T.E., Lanphear, B.P., Epstein, J.N., Barbaresi, W.J., Katusic, S.K., & Kahn, R.S. (2007). Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Archives of Pediatric Adolescent Medicine, 161(9).
Gershon, J. (2002). A meta-analytic review of gender differences in ADHD. Journal of Attention Disorder, 5(3).
Qiu, A., Crocetti, D., Adler, M., Mahone, E.M., Denckla, M.B., Miller, M.I., & Mostofsky, S.H. (2009). Basal ganglia volume and shape in children with attention deficit hyperactivity disorder. American Journal of Psychiatry, 166(1).