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Greetings:
A preview of the new issue of ADHD RESEARCH UPDATE can be found
below. The preview contains the contents of the current issue
along with complete text of one of the articles.
The article in this month's preview reviews the results of
the largest study ever conducted on ADHD in girls - a badly
under researched area. The study was published recently in
the Journal of the American Academy of Child and Adolescent
Psychiatry. I hope that it is of interest to you.
If you would prefer to read this on the web, it is posted for
you at http://www.helpforadd.com/preview.htm
For more extensive coverage of new research on ADHD, please
consider becoming a regular subscriber to ADHD RESEARCH
UPDATE. You'll find information about subscribing at the
end of this message if you are interested.
Feel free to share this information with others you know who
may be interested in it.
Sincerely,
David Rabiner, PhD
Licensed Psychologist
*******************************************************
ADHD RESEARCH UPDATE - Vol. 24 PREVIEW
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IN THIS ISSUE...
* ADHD in girls - REPRINTED IN FULL BELOW
Other studies summarized for subscribers in this month's issue
were...
* New data on the possible overdiagnosis of ADHD
* New information on the relationship between medication treatment
for ADHD and substance abuse
* ADHD as a public health problem: Report on recent meeting
sponsored by the Centers for Disease Control (CDC)
___________________________________________________________
* ADHD IN GIRLS *
One of the important shortcomings of most of the research based
information on ADHD is that the vast majority of studies have been
conducted solely on boys, or, have included very few girls in the
sample. As a result, the scientific literature on ADHD is almost
exclusively based on male subjects.
Recently, a study funded by the National Institute of Mental
Health on a large group of girls both with and without ADHD was
published in the Journal of the American Academy of Child and
Adolescent Psychiatry (Biederman, J. et al., (1999). Clinical
correlates of ADHD in females: Findings from a large group of
girls ascertained from pediatric and psychiatric referral sources.
Journal of the American Academy of Child and Adolescent Psychiatry,
38, 966-975. In this study, the authors examined the clinical
correlates of ADHD in girls so that similarities and differences
with what has been found among boys with ADHD could be ascertained.
This study represents the largest and most comprehensive study of
girls with ADHD that has been published to date.
Participants in this study were girls between the ages of 6 and
18. There were 140 girls who had been diagnosed with ADHD based
on structured psychiatric interviews conducted with the child's
parent(s). In addition, 122 girls of similar ages and other
backgrounds who did not have ADHD were included as comparison
subjects. These two groups of girls were compared on a wide
variety of characteristics so that the researchers
could learn about the problems associated with ADHD in females
specifically. The major findings are summarized below.
* Among the girls who were diagnosed with ADHD, 59% had the
combined type (i.e. both inattentive and hyperactive/impulsive
symptoms), 27% had the Predominantly Inattentive type, and
only 7% had the Predominantly Hyperactive/Impulsive type.
Overall, a significantly greater proportion of symptoms of
inattention were present according to parents relative to either
hyperactive/impulsive symptoms.
* Girls with ADHD were significantly more likely to be diagnosed
with other disorders as well.
Compared to girls without ADHD, girls with ADHD were more likely
to be diagnosed with co-morbid conduct disorder, oppositional
defiant disorder, mood disorders, anxiety disorders, and substance
use disorders. Tic disorders and enuresis (i.e. bed wetting or
day-time wetting) were also more common in the girls with ADHD.
Overall, 45% of the girls with ADHD were diagnosed with at least
one other condition. Only 4% of the girls with ADHD had more than
2 co-morbid disorders, however.
Although the rate of co-morbid behavior disorders in girls with
ADHD was high, it was still no more than half of the rate that has
been previously reported for boys. Because disruptive behavior
disorders are one of the main reason that children get identified
and referred for treatment, the authors speculate that the lower
incidence of these problems in girls with ADHD may partially
explain the marked gender differences that are often found in
children with ADHD who are receiving clinical treatment.
The rate of mood and anxiety disorders in girls with ADHD was quite
similar to what has been previously found in boys. Contrary to what
some have suggested, there was thus no evidence in this sample of
children that girls with ADHD are more likely than boys to have
problems in these areas. There was, however, an indication that
problems with substance use were more common among girls with ADHD
than has been previously found to be true for boys. For example,
girls with ADHD were about 4 times as likely to be smokers.
* Cognitive, school, and family functioning
Girls with ADHD had scores on measures of intellectual functioning
and academic achievement that were modestly lower than what was
found in the non-ADHD girls. They were also about 2.5 more likely
to be diagnosed with a learning disability, more than 16 times more
likely to have repeated a grade in school, and almost 10 times as
likely to have been placed in a special class at school.
It is perplexing why girls with ADHD were so much more likely to
have repeated a grade given that the difference in the academic
achievement test scores were, although lower, not so dramatically
different from other girls. I think this may reflect that fact that
achievement testing - which is done on an individual basis - tends
to reflect the highest level of work that children are capable of.
In many instances, this is quite a bit higher than the level that
a child with ADHD actually performs at on a day to day basis. So,
these data may reflect the debilitating effect that ADHD has on a
child's typical school performance, which can result in grade
retention and special class placement even for children who are
quite bright and capable.
Whatever the explanation, these data underscore how important it
is for parents to insure that their daughter's educational needs
are being carefully and adequately addressed. Children with
ADHD are often legally entitled to special educational services
to help address the unique needs that they have. You can
learn about the educational rights for children with ADHD at
http://www.helpforadd.com/rights.htm
The parents of girls with ADHD also described their family life
as less cohesive and reported greater amounts of conflict with
their daughters.
CLINICAL IMPLICATIONS
The results of this study make clear that ADHD in girls is as
serious a condition and has a comparably large negative impact
on children's functioning and adjustment as it does in boys.
Overall, the correlates of ADHD in girls were remarkably similar
to what is known to be true for boys. Among the few differences
found were that girls were less likely to be diagnosed with a
co-morbid behavior disorder than boys (i.e. oppositional defiant
disorder or conduct disorder) and perhaps more likely to have
problems related to substance use. Rates of mood and anxiety
disorders, and impairment in academic functioning appeared to be
quite comparable.
The lower rates of disruptive behavior problems, along with the
preponderance of inattentive symptoms relative to hyperactive/
impulsive symptoms, may partially explain why ADHD in girls may
often not be recognized. Because rates of mood and anxiety
disorders were similar to what has been found in boys, the authors
speculate that in conjunction with the lower levels of disruptive
behavior and hyperactive/impulsive symptoms, this may lead
clinicians to diagnose girls with the former types of disorders
rather than ADHD. As you may recall from a study recently
reviewed in ADHD RESEARCH UPDATE, (see http://www.helpforadd.com/study.htm)
pediatricians were
significantly more likely to diagnose boys with ADHD than girls,
even when the problems described by parents were quite comparable.
The authors stress that clinicians need to be aware that, despite
their lower rates of disruptive disorders, ADHD in girls is a
serious condition associated with impairment in multiple areas
of children's functioning. Thus, there is no reason to assume that
the treatment of girls with ADHD should be any less aggressive
or comprehensive than that of boys.
Parents need to be aware that their daughter with ADHD is at
significantly increased risk for a variety of other conditions as
discussed above. In fact, in this study, almost 50% of girls
with ADHD had at least one other diagnosable disorder. It is
thus essential that evaluations of girls for ADHD take a broad
look at their emotional, behavioral, social, and academic
functioning so that a comprehensive treatment plan addressing
all areas of important difficulty can be developed and implemented.
In particular, given the indication of possible increased risk
of substance use in girls with ADHD, this may be an area that
is especially important for parents to monitor.
Too often, in my opinion, even if ADHD in females is identified,
necessary attention to areas of difficulty apart from core ADHD
symptoms may not be targeted in a child's treatment, or may not
be addressed in the most helpful way. This is especially likely to
be the case when a primary care physician is the sole treatment
provider, as physicians are typically less attentive to a child's
overall emotional and behavioral functioning in their evaluations,
and may tend to rely on medication treatment alone when other
interventions may also be needed.
There are several limitations to this study that the authors
acknowledge. First, the girls with ADHD were referred from both
psychiatric and pediatric facilities/practitioners, and the
degree to which they are representative of girls with ADHD in
the general community can not be determined with any certainty.
Thus, it is quite possible that the girls in this study were
more impaired than would be girls with ADHD from the general
population.
In addition, it is clear that research on treatment specifically
in girls with ADHD is sorely needed. Currently, most of the
data on both medical and non-medical treatment of ADHD is also
based predominantly on boys. To my knowledge, there is currently
no clear indication of any known differential effect for various
treatments that is specifically related to gender, but this may be
partially because the studies that are required to carefully look
at this issue have not really been done. As such studies are
published, I will certainly be sure to include them in the
newsletter.
*****************************************************************
** SUBSCRIPTION INFORMATION **
Dear Parent or Health Care Professional:
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If you have a child with ADHD, learning about the
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child's healthy development. Please take a moment to
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Hundreds of parents and professionals from around the world have
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I am confident that you will as well and encourage you to become
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Best wishes,
David Rabiner, PhD
Licensed Psychologist
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