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In addition to raising awareness about girls and women with AD/HD, The Center will attempt to provide our readers with access to some of the latest research and published findings on females with AD/HD.

Here, we provide results from original research and reviews from students, as well as experts in the field. Please assist us in this endeavor by forwarding any articles you think we could add to this list. You can send them to Dr. Quinn at DrQuinn@ncgiadd.org


Impact of gender and age on executive functioning:
Do girls and boys with and without attention deficit hyperactivity disorder differ neuropsychologically in preteen and teenage years?

Dev Neuropsychol. 2005; 27(1):79-105 (ISSN: 8756-5641)

Seidman LJ; Biederman J; Monuteaux MC; Valera E; Doyle AE; Faraone SV
Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts General Hospital, Boston, MA 02114, USA. larry_seidman@hms.harvard.edu

ADHD is known to have neuropsychological correlates, characterized mainly by executive function (EF) deficits. However, most available data are based on studies of boys through age 12. Our goal was to assess whether girls with ADHD express neuropsychological features similar to those found in boys, and whether these impairments are found in both preteen and teen samples. Participants were 101 girls and 103 boys with DSM-III-R ADHD, and 109 comparison girls and 70 boys without ADHD, ages 9 to 17 years. Information on neuropsychological performance was obtained in a standardized manner blind to clinical status. Primary regression analyses controlled for age, socioeconomic status, learning disability, and psychiatric comorbidity. Girls and boys with ADHD were significantly more impaired on some measures of EFs than healthy comparisons but did not differ significantly from each other. With the exception of 1 test score there were no significant Sex x Diagnosis interactions. Moreover, there were no more significant interactions among age, gender, and diagnosis than would be expected by chance. Neuropsychological measures of EFs were comparably impaired in girls compared to boys with ADHD, and these impairments are found at ages 9 to 12 and ages 13 to 17. These findings suggest that executive dysfunctions are correlates of ADHD regardless of gender and age, at least through the late teen years.


Perceptions of Girls and ADHD: Results from a National Survey

Medscape General Medicine 6(2), 2004. © 2004 Medscape Posted 05/04/2004

Quinn, P. and Sharon Wigal.


The purpose of this survey is to explore perceived gender differences in attention-deficit/hyperactivity disorder (ADHD).

Methods: Online Harris Interactive interviews were conducted with 1797 adults (general public), 541 parents of children with ADHD, 550 teachers, and 346 children aged 12 to 17 years with ADHD. Responses were examined to determine perceptions of ADHD.

Results: Most of the general public (58%) and teachers (82%) think ADHD is more prevalent in boys. The general public and teachers think boys with ADHD are more likely than girls to have behavioral problems (public: 52% vs 26%; teachers: 36% vs 18%, respectively), while girls with ADHD are thought to have less noticeable problems than boys, such as being inattentive (public: 19% vs 11%; teachers: 29% vs 10%, respectively) or feeling depressed (public: 16% vs 1%; teachers: 12% vs 0.0%, respectively). Four out of 10 teachers report more difficulty in recognizing ADHD symptoms in girls. An overwhelming majority of teachers (85%) and more than half of the public (57%) and parents (54%) think girls with ADHD are more likely to remain undiagnosed. ADHD was reported to have a negative effect on self-esteem, more so in girls. Girls who were taking medication for their ADHD were nearly 3 times more likely to report antidepressant treatment prior to their ADHD diagnosis. Girls were more likely to feel it was "very difficult" to focus on schoolwork and get along with parents.

Conclusions: Survey responses suggest that gender has important implications in the diagnosis and treatment of ADHD. Responses by ADHD patients demonstrate gender-specific differences in the personal experience of the condition. Future prospective clinical trials are warranted to clarify the unique needs and characteristics of girls with ADHD.


Polymorphism of the serotonin-2A receptor gene (HTR2A) associated with childhood attention deficit hyperactivity disorder (ADHD) in adult women with seasonal affective disorder.

J Affect Disord. 2002; 71(1-3):229-33 (ISSN: 0165-0327)

Levitan RD; Masellis M; Basile VS; Lam RW; Jain U; Kaplan AS; Kennedy SH; Siegel G; Walker ML; Vaccarino FJ; Kennedy JL
Centre for Addiction and Mental Health, University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada. robin_levitan@camh.net

INTRODUCTION: Several lines of research point to a possible overlap between seasonal affective disorder (SAD) and attention deficit hyperactivity disorder (ADHD), particularly in females. There is also emerging evidence that variation of the 5-HT2A receptor gene (HTR2A) contributes to both SAD and ADHD. The current study investigated whether variation in HTR2A was associated with symptoms of childhood ADHD in adult women with SAD.

METHOD: Sixty-six women with SAD were administered the Wender-Utah Rating Scale (WURS), which retrospectively assesses childhood ADHD, as part of an ongoing genetic study of SAD. WURS scores were compared across the three genotypic groups defined by the T102C polymorphism of HT2RA.

RESULTS: Analysis of variance indicated a significant difference in mean 25-item WURS scores across the three genotypic groups (p = 0.035). Post-hoc tests revealed that the C/C genotypic group had a significantly higher mean score than both the T/T group and T/C group. Based on previously established WURS criteria, 38% of subjects with the C/C genotype, and none with the T/T genotype, had scores consistent with childhood ADHD.

LIMITATIONS: The current sample size is small, and childhood ADHD diagnoses were based on retrospective recall.

CONCLUSION: These preliminary results suggest a possible association between variation in HTR2A, childhood ADHD, and the later development of SAD in women.

• PreMedline Identifier: 12167522

Symptoms of attention deficit hyperactivity disorder in severely obese women.

Eat Weight Disord. 2005; 10(1):e10-3 (ISSN: 1124-4909)

Fleming JP; Levy LD; Levitan RD
University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada. flemingjp@rogers.com

OBJECTIVE: Past and current symptoms of Attention Deficit Hyperactivity Disorder (ADHD) were assessed in a clinical sample of severely obese females.

METHOD: Core symptoms of ADHD were examined in 75 consecutive, severely obese (BMI > or = 35) women referred to a medical specialist for the non-surgical treatment of obesity. Subjects completed both a retrospective report of childhood symptoms of ADHD (Wender Utah Scale) and two standardized adult ADHD symptom scales.

RESULTS: The frequency of clinically suggestive elevations in ADHD scores was substantially and significantly higher than the normative samples in 9 out of 11 symptom subscales. Inattentive symptoms, but not hyperactive symptoms of ADHD, were frequently reported. Overall, 26.7% of the sample reported significant symptoms of ADHD in both childhood and adulthood.

CONCLUSIONS: This preliminary study suggests that severely obese women report significant symptomatology related to both childhood and adult ADHD.

• PreMedline Identifier: 16682849


Cognitive functioning moderates the relation between Attention Deficit Hyperactivity Disorder symptoms and alcohol use in women.

Addict Behav. 2004; 29(8):1605-13 (ISSN: 0306-4603)

Span SA; Earleywine M
Psychology Department, California State University Long Beach, 1250 Bellflower Boulevard, 90840-0901, USA. sspan@csulb.edu

Previous work revealed that cognitive functioning moderated the relation between Attention Deficit Hyperactivity Disorder (ADHD) Symptoms and alcohol use [Alcohol., Clin. Exp. Res. 23 (1999) 224]. ADHD Symptoms correlated significantly with alcohol use for individuals with a poorer performance on tasks assessing prefrontal area functioning but not for individuals with higher scores on these tasks. The current study proposes to replicate this previous work and extend it in three ways. These include using a sample consisting solely of women, including the current DSM-IV [American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed., revised). Washington, DC: Author] criteria for ADHD, and increasing the number of measures to assess cognitive functioning and drinking habits. Eighty-two female undergraduates completed four measures of alcohol use, three measures of ADHD, and six measures of cognitive functioning. Stacked two-group analyses replicated the previous moderator effect. Alcohol use and ADHD symptoms correlated .31 (ns) for the individuals who scored higher on the neuropsychological tasks. However, these constructs correlated .53 (P < .05) for individuals with lower scores on these tasks. Better performance on tasks assessing prefrontal area functioning may protect individuals from drinking in accordance with their ADHD symptoms.

• PreMedline Identifier: 15451127


Validity of self-report and informant rating scales of adult ADHD symptoms in comparison with a semistructured diagnostic interview.

J Atten Disord. 2006; 9(3):494-503 (ISSN: 1087-0547)

Magn??sson P; Sm??ri J; Sigurdard??ttir D; Baldursson G; Sigmundsson J; Kristj??nsson K; Sigurdard??ttir S; Hreidarsson S; Sigurbj??rnsd??ttir S; Gudmundsson OO

Department of Child and Adolescent Psychiatry, Landsp??tali University Hospital, Reykjav??k, Iceland. pama@landspitali.is

In a study of ADHD symptoms in the relatives of probands diagnosed with ADHD, the validity of self-reported and informant-reported symptoms in childhood and adulthood was investigated with a semistructured diagnostic interview, the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) adapted for adults, as a criterion. The participating relatives were 80 women and 46 men aged 17 to 77. Rating scales based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) were completed by participants and informants. Internal consistency of the scales and interrater reliabilities of the diagnostic interview were satisfactory. Correlations between ratings across sources of information supported convergent and divergent validity. Self-report scales and informant scales predicted interview-based diagnoses in childhood and adulthood with adequate sensitivities and specificities. It was concluded that the rating scales have good psychometric properties, at least in at-risk populations.

• PreMedline Identifier: 16481666


Sex differences in dopamine receptors and their relevance to ADHD.

Neurosci Biobehav Rev. 2000; 24(1):137-41 (ISSN: 0149-7634)

Andersen SL; Teicher MH
The Consolidated Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA 02178, USA. andersen@mclean.org

Gender differences in ADHD may be attributable to gender differences in dopamine receptor density. Striatal male D2 receptor density increases 144+/-26% between 25 and 40 days (the onset of puberty), while female D2 receptor density increases only 31+/-7%. Male receptor density is then sharply eliminated by 55% by adulthood. Periadolescent females show little overproduction and pruning of striatal D1 and D2 receptors, though adult density is similar to males. The rise of male, but not female, striatal dopamine receptors parallels the early developmental appearance of motor symptoms of ADHD and may explain why prevalence rates are 2-4 fold higher in men than women. Pruning of striatal dopamine receptors coincides with the estimated 50-70% remission rate by adulthood. Transient lateralized D2, dopamine receptors (left > right) in male striatum may increase vulnerability to ADHD. More persistent attentional problems may be associated with the overproduction and delayed pruning of dopamine receptors in prefrontal cortex. Differences in D1 receptor density in nucleus accumbens may have implications for increased substance abuse in males.

• PreMedline Identifier: 10654670


Association between attention-deficit/hyperactivity disorder and bulimia nervosa: analysis of 4 case-control studies.

J Clin Psychiatry. 2006; 67(3):351-4 (ISSN: 0160-6689)

Surman CB; Randall ET; Biederman J
Clinical and Research Program in Pediatric Psychopharmacology at Massachusetts General Hospital and Harvard Medical School, Boston, Mass, USA.

BACKGROUND: Impulsivity is a common feature of attention-deficit/hyperactivity disorder (ADHD), and evidence suggests that impulsivity traits may be an indicator of poor prognosis for individuals with bulimia nervosa. To identify whether there is an association between ADHD and bulimia nervosa, the authors systematically examined data from children and adults with and without ADHD. METHOD: We systematically identified rates of bulimia nervosa in individuals with and without ADHD (DSM-III-R criteria) in our 2 large pediatric and 2 large adult samples (N = 522 children, 742 adults). Subjects were assessed from the late 1980s to February 1999. RESULTS: In the 2 samples of adults with and without ADHD, significantly greater rates of bulimia nervosa were identified in women with versus without ADHD (12% vs. 3%, p < .05 for 1 sample and 11% vs. 1%, p < .05 for the other sample). No significant differences in rates of bulimia nervosa were identified in men or children with ADHD when compared to sex-matched control subjects. CONCLUSION: Although preliminary and requiring further confirmation, these findings suggest that ADHD may be associated with bulimia nervosa in some women. If confirmed, this association between bulimia nervosa and ADHD could have important clinical and therapeutic implications.

• PreMedline Identifier: 16649819


Associations among overeating, overweight, and attention deficit/hyperactivity disorder: a structural equation modelling approach.

Eat Behav. 2006; 7(3):266-74 (ISSN: 1471-0153)

Davis C; Levitan RD; Smith M; Tweed S; Curtis C
Departments of Kinesiology and Health Science and Psychology, Bethune College, York University, 4700 Keele Street, Toronto, Ontario, Canada M3J 1P3. cdavis@yorku.ca

BACKGROUND: Some recent studies have reported strong links between obesity and ADHD in adults; however, to date, little work has focussed on possible behavioural mechanisms that could account for this association.

METHOD: This study used structural equation modelling (SEM) in a sample of healthy adult women to test the predictions that ADHD symptoms predict aspects of overeating, including binge eating and emotionally-induced eating, which in turn are positively correlated with Body Mass Index.

RESULTS: The SEM produced a non-significant chi-square and both the measurement model and the structural model fit the data very well.

CONCLUSIONS: Plausible mechanisms are discussed to help explain how the symptomatology of ADHD could foster different forms of overeating.

• PreMedline Identifier: 16843230


Lack of gender effects on subtype outcomes in adults with attention-deficit/hyperactivity disorder : Support for the validity of subtypes.

Eur Arch Psychiatry Clin Neurosci. 2006; 256(5):311-9 (ISSN: 0940-1334)

Grevet EH; Bau CH; Salgado CA; Fischer AG; Kalil K; Victor MM; Garcia ChR; Sousa NO; Rohde LA; Belmonte-de-Abreu P
Adult ADHD Outpatient Clinic, Clinical Hospital of Porto Alegre, Av. Taquara 586/606, 90460-210, Porto Alegre, RS, Brazil, grevet@terra.com.br.

The aim of the present study is to verify if gender modifies the clinical, adaptative and psychological outcomes of adult attention-deficit/hyperactivity disorder (ADHD) subtypes. We evaluated 219 clinically referred adult patients. The interviews followed the DSM-IV criteria,using the K-SADS-E for ADHD and oppositional defiant disorder and SCID-IV for comorbidities. Regression models were used to analyze gender and subtype main effects and interactions in psychiatric outcomes. In the initial sample, 117 patients (53.5%) were of the combined subtype, 88 (40%) were inattentives and 14 (6.5%) hyperactives. There were no significant interactions between gender and subtype in any variable assessed. Men and women did not differ in the relative frequency of each subtype. Patients of the combined subtype in both genders presented a higher severity and increased rates of conduct and ODD disorders than inattentives. The main effects of gender and subtype in this sample are similar to those previously reported in other countries, suggesting the cross-cultural equivalence of the phenotype. The absence of significant interactions between gender and subtype suggests that, at least in clinical-based samples, DSM-IV adult ADHD subtypes present cross-gender validity.

• PreMedline Identifier: 16685602


Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder.

J Clin Psychiatry. 2002; 63 Suppl 12:10-5 (ISSN: 0160-6689)

Barkley RA
Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave. N., Worcester, MA 01655, USA. barkleyr@ummhc.org

People with attention-deficit/hyperactivity disorder (ADHD) are affected by the disorder throughout their lifetimes. Children with ADHD often have comorbid oppositional defiant disorder and conduct disorder in addition to having developmental and social problems. The persistence of ADHD into adolescence and young adulthood varies according to who is being interviewed and the criteria used to define the disorder. For those adolescents and adults in whom ADHD does persist, educational difficulties continue, and problems in the areas of employment, driving, and sexual relationships emerge. ADHD is also associated with increased health care costs even when controlled for psychiatric treatment. Because most ADHD research has been conducted with male children and adolescents with ADHD, combined type, most outcomes for ADHD should be thought of as male outcomes for this subtype. In the future, ADHD researchers should study outcomes for girls and women and for people with ADHD, predominately inattentive type.

• PreMedline Identifier: 12562056


ADHD in girls: clinical comparability of a research sample.

J Am Acad Child Adolesc Psychiatry. 1999; 38(1):40-7 (ISSN: 0890-8567)

Sharp WS; Walter JM; Marsh WL; Ritchie GF; Hamburger SD; Castellanos FX
Child Psychiatry Branch, NIMH, Bethesda, MD, USA.

OBJECTIVE: The investigation of attention-deficit/hyperactivity disorder (ADHD) in girls raises complex questions of referral bias and selection criteria. The authors sought to determine whether they could recruit a research sample of comparably affected girls using a combination of sex-independent diagnostic criteria and sex-normed cutoffs on teacher ratings. They also report on the largest placebo-controlled crossover comparison of methylphenidate and dextroamphetamine in girls with ADHD.

METHOD: Subjects were 42 girls with DSM-III-R/DSM-IV ADHD (combined type) contrasted to 56 previously studied boys with ADHD on comorbid diagnoses, behavioral ratings, psychological measures, psychiatric family history, and stimulant drug response.

RESULTS: Girls with ADHD were statistically indistinguishable from comparison boys on nearly all measures. Girls exhibited robust beneficial effects on both stimulants, with nearly all (95%) responding favorably to one or both drugs in this short-term trial. Dextroamphetamine produced significantly greater weight loss than methylphenidate.

CONCLUSIONS: This highly selected group of ADHD girls was strikingly comparable with comparison boys on a wide range of measures. The results confirm that girls with ADHD do not differ from boys in response to methylphenidate and dextroamphetamine and that both stimulants should be tried when response to the first is not optimal.

• PreMedline Identifier: 9893415


Gender differences in ADHD?

J Dev Behav Pediatr. 1998; 19(2):77-83 (ISSN: 0196-206X)

Arcia E; Conners CK
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA. earcia@aol.com

This study examined possible gender differences in children and adults with attention-deficit/hyperactivity disorder. Results indicated that adult self-ratings differed significantly by gender. Adult women reported fewer assets and more problems than did male counterparts, but there was no gender difference with respect to age at referral, intelligence quotient, indicators of neuropsychological performance, or parent or teacher ratings of behavior. Referral bias against girls is a possible reason for previously reported gender differences, so we interpreted our results in light of the participants' referral patterns. There was a nonsignificant trend for girls with relatively more severe ratings of hyperactivity, conduct disorder, or inattention to be referred earlier than were boys. Overall, our results suggest no evidence of cognitive or neuropsychological differences by gender in samples that are sensitive to behavioral deviance in girls (as evidenced by early referral), but adult women's self-perception is comparatively poorer than that of adult men.

• PreMedline Identifier: 9584935


Sex differences in ADHD: conference summary.

J Abnorm Child Psychol. 1996; 24(5):555-69 (ISSN: 0091-0627)

Arnold LE
Child & Adolescent Disorders Research Branch, National Institute of Mental Health, Rockville, Maryland 20906, USA.

Clinical samples of attention deficit hyperactivity disorder (ADHD) have been dominated by males. Consequently, female manifestations and sex differences have been relatively neglected in the extensive ADHD research. Because ADHD is so common (3% to 5% of school children) and chronic (lifelong in many cases), even a small proportion of females multiplied by such a large base means hundreds of thousands of girls and women with ADHD, a significant public health problem. An NIMH conference concluded that research is needed not only on sex differences related to ADHD, but also on manifestations of ADHD in females as such. Areas of focus should include differences in life course (sex-differential age effects); effects of hormones; effects of ADHD parenting (in utero and postnatal) on the next generation; response to and implications for design of psychosocial treatment; effects of differential comorbidity; normative "background" sex differences that influence the manifestation of ADHD; differences in development of verbal fluency and social behavior; possible interactions of sex and ethnicity; a prospective study of both sex offspring of ADHD adults; and such methodological issues as appropriate instruments and diagnostic thresholds, power to prevent false negatives, valid impairment measures, validity and reliability of child self-reports, and more inclusive samples (all three subtypes: inattentive, hyperactive-impulsive, and combined).

• PreMedline Identifier: 8956084


Psychometric characteristics of the Wender Utah Rating Scale (WURS): reliability and factor structure for men and women.

Psychopharmacol Bull. 1995; 31(2):425-33 (ISSN: 0048-5764)

Stein MA; Sandoval R; Szumowski E; Roizen N; Reinecke MA; Blondis TA; Klein Z
University of Chicago, Department of Psychiatry, IL 60637-1470, USA.

The goals of this study were to examine the factor structure of the Wender Utah Rating Scale (WURS), to evaluate potential gender differences in factor composition, and to assess the reliability of the scale. The WURS was completed by 310 fathers and 305 mothers of children referred for evaluation of Attention-Deficit Hyperactivity Disorder (ADHD). For males, a five-factor solution (Conduct Problems, Learning Problems, Stress Intolerance, Attention Problems, Poor Social Skills/Awkward) accounted for 72 percent of the variance. There was also a five-factor solution for females (Dysphoria, Impulsive/Conduct, Learning Problems, Attention and Organizational Problems, Unpopular) which accounted for 71 percent of the variance. Symptoms of inattention and impulsivity loaded on separate factors for both men and for women. Test-retest reliability was examined with a different sample of 57 adults who completed the WURS on two separate occasions, 1 month apart. The WURS demonstrated satisfactory internal consistency and temporal stability, and it may be a useful tool for the study of ADHD in adults.

• PreMedline Identifier: 7491401


Gender differences in a sample of adults with attention deficit hyperactivity disorder.

Psychiatry Res. 1994; 53(1):13-29 (ISSN: 0165-1781)

Biederman J; Faraone SV; Spencer T; Wilens T; Mick E; Lapey KA
Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114.

Although originally conceptualized as a childhood disorder, attention deficit hyperactivity disorder (ADHD) may also be an adult disorder. However, despite increasing media attention to adult ADHD, its validity has only recently been studied in a systematic fashion. The overrepresentation of females in adult samples in comparison to pediatric samples of ADHD raises additional questions about the validity of this disorder in adults. The goal of this article is to explore whether ADHD is a valid clinical entity in female subjects and whether it is expressed differently in male and female adults. To this end, we examined the clinical, cognitive, and functional characteristics of 128 referred adult ADHD cases of both sexes. Each subject had a clinical diagnosis of childhood-onset ADHD confirmed by structured interview. The male and female ADHD adults were similar to one another but more disturbed and impaired than non-ADHD adult control subjects. Compared with normal control females, ADHD women had higher rates of major depression, anxiety disorders, and conduct disorder; and more evidence of school failure and cognitive impairment. The consistency of these findings in both genders further supports the validity of the diagnosis of ADHD in adults. Our results stress the viability and importance of identification of female subjects with ADHD. The underidentification and undertreatment of females with ADHD may have substantial mental health and educational implications, suggesting that research is needed to develop a better understanding of clinical indicators of ADHD in females.

• PreMedline Identifier: 7991729


Bibliography of Research on Women and Girls with ADHD

An extensive listing of research studies and books on ADHD in girls and women all in one place.

To learn more about TheCenter click here.

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