Gender Differences In Adhd A Meta-analysis And Critical Review Pdf

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The present study examines the level of agreement, and potential gender differences, between parents' and teachers' reports of ADHD symptoms and other mental health problems in Greek children aged between years. Results: The level of agreement between parents' and teachers' reports was low to moderate for the SDQ 0. Parents reported more hyperactivity, emotional, and conduct problems than teachers according to SDQ and more overactivity and attention-deficit with hyperactivity according to CAP.

Sex differences in ADHD: Conference summary

Complete data were available for subjects aged 7 to 29 years. Logistic regression was used to examine sex and age effects on specific ADHD diagnoses. Fractional polynomial graphs were used to examine ADHD symptom count variations across age. Lower male:female ratios than reported in some clinic-based studies suggest that females are under-diagnosed in the community.

As in children, prevalence estimates for adult ADHD are controversial. The authors emphasize the need for age-specific diagnostic criteria for ADHD subtypes. Males are generally more likely to be diagnosed with ADHD than females, with a male to female ratio of approximately in community samples.

Previous work thus supports the importance of large population-based studies to ascertain the prevalence of ADHD symptoms and diagnoses in the community, and to aid in the definition of possible age- and gender-specific diagnostic criteria.

The present study investigates the prevalence of ADHD symptoms and DSM-IV symptom-criterion-based diagnoses in a large, non-referred, community-based sample, taking age and gender into account. However, our large, community-based sample allows us to examine the relative prevalence of DSM-IV-like ADHD diagnoses for non-referred individuals within various sex and age groups.

The study protocol was approved by the Washington University Human Studies Committee, and all respondent parents provided informed consent. As a part of a molecular epidemiology study of inattentive ADHD, we ascertained a representative sample of families from Missouri birth records, each with four or more full siblings age seven years and older and at least two siblings aged seven to 17 years.

Assessment of the families consisted of a telephone screener interview where trained interviewers asked the best informant parent usually the mother about lifetime impairment at home and school from the 18 ADHD symptoms for each sibling in the family, followed by mailed questionnaires. A later stage of the study required collection of DNA samples from both parents. Thus, families were excluded if one of the biological parents was unavailable i.

Families were also excluded if the family was known to have twins or if neither parent understood enough English to complete the screener interview.

Individual children were excluded if adopted, not a full sibling, in prison, or deceased. Out of 11, families contacted, 3, families refused to participate, 2, families were ineligible and 5, families completed the screener. Demographic data and socioeconomic status variables based on the U. Parents who completed the telephone screening on their children were asked to complete the SWAN questionnaires by mail. Positive scores indicate parental report of worse than average ADHD symptoms, whereas negative scores indicate better than average behavior.

Of those, 9, subjects had complete age, screener and SWAN data. There was a time gap of only a few months between the screener interview and the SWAN, but because the exact age at time of assessment seems more critical for current than lifetime symptoms, SWAN age was used for the main analyses. The total sample included very few individuals under age 7 or over age 29, so we limited our main analyses to individuals aged seven to 29 years at the time of the SWAN.

For comparison purposes, we also analyzed the demographic characteristics and lifetime DSM-IV-like ADHD subtype prevalence for the 22, individuals with complete screener data who were aged seven to 29 years at the time of the screening interview.

Demographic characteristics of the larger sample with screener data and the final study sample with both SWAN and screener data are displayed in Supplement 2. The overall sample consists of an approximately equal number of males and females.

The final study sample was The sample was divided by age into three subgroups — children 7—12 years , adolescents 13—17 years and young adults 18—29 years. Given the biological changes that occur during puberty, it is sensible to examine adolescents separately from children and young adults. We also calculated average inattention items 1—9 and average hyperactive-impulsive items 10—18 scores.

This requires the use of a specific cut-off to determine whether a symptom is considered positive. Differences in the quantitative subscale scores were analyzed across sex and age group using one-way ANOVA. Within each of the three age groups, linear regression analyses were done to examine the effects of sex and age on each quantitative SWAN score, and logistic regressions were performed to examine the effects of sex and age on current and lifetime DSM-IV-like ADHD diagnoses.

For all regression analyses, we adjusted the standard errors for family clustering of data. Finally, we used fractional polynomial regression 28 graphs to examine how current mean ADHD symptom counts vary with age for males and females with various lifetime ADHD subtypes.

Statistical analyses were carried out using SAS version 9. DSM-IV-like predominantly inattentive ADHD emerged as the most prevalent current and lifetime diagnostic subtype for each age group, followed by combined type. The ratios of DSM-IV-like inattentive and combined type ADHD prevalences in males versus females fell approximately between and and were highest in adolescents. For the predominantly hyperactive-impulsive subtype, the male: female ratio was about in children, but was lower in adolescents and adults.

In children, adolescents and adults, linear regression analyses showed that the quantitative hyperactive-impulsive, inattentive, and total SWAN scores created by averaging the appropriate SWAN items were significantly higher in males compared to females, and tended to decrease with older age. The effect of age on mean total and hyperactive-impulsive SWAN scores was significant in children and adolescents but not in adults.

In contrast, the effect of age on the SWAN inattentive subscore was significant only in adults Supplement 5. Logistic regression analyses, controlling for age and familial clustering, indicate higher likelihood of current DSM-IV-like ADHD subtype diagnoses in males compared to females.

However, the gender effect was not statistically significant for the hyperactive-impulsive subtype in adolescents or adults. For example, older age was significantly associated with current inattentive subtype diagnosis in children, while younger age was associated with current inattentive subtype diagnosis in adults.

Also, younger age was associated with current combined subtype in adolescents. Of note, one might expect prevalence of parent-reported lifetime diagnosis to continue increasing with age since there is more chance of exhibiting a lifetime symptom the longer a subject has been alive. The above linear and logistic regression analyses illustrate how the effect of age on ADHD symptoms and subtypes is not identical within each of the three age groups in this sample.

This suggests the effect of age is not linear across development from childhood to young adulthood. Fractional polynomial regression allows us to fit a curve rather than a straight line, so this method is very appropriate when examining the variation in ADHD symptom counts across the entire age range.

Fractional polynomial regression graphs showing estimated current total, inattentive, and hyperactive-impulsive mean ADHD symptom counts by sex and across age for subjects with a lifetime DSM-IV-like ADHD diagnosis red line and for total male or female sample blue line. Current ADHD symptom counts are based on number of items rated 1 or higher on the parent-rated SWAN questionnaire, which asks about symptoms over the past month. Fractional polynomial graphs showing estimated inattentive purple line and hyperactive-impulsive green line mean current symptom counts by sex and across age for individuals with a lifetime DSM-IV-like diagnosis of combined, inattentive, or hyperactive-impulsive type ADHD.

The confidence interval for mean hyperactive-impulsive symptom count is not shown in the lower left panel because it interfered with scaling of the graph confidence interval went below zero at the upper age range. Strengths of this study include the wide age range and large sample size, which provide enough power to examine gender and age differences in great detail. Since our data were selected from the community, they overcome some important limitations of previous studies using clinical samples.

However, we cannot report the prevalence of meeting full DSM-IV criteria due to absence of age-of-onset and impairment data. Our prevalence estimates for male This decrease in prevalence with age is in agreement with many other studies and supports the hypothesis that ADHD symptoms decrease with brain maturation.

The findings, however, are also compatible with a lack of age-appropriate symptom criteria for adolescents and adults and with lack of age-adjusted concepts of illness. The ratio was highest for adolescents 2. Since we used a population-based sample, our results are not subject to clinical referral bias that can lead to under representation of females, and our male:female prevalence ratio is likely more accurate that those obtained from clinical samples.

The lower prevalence in females may thus be the result of higher liability toward ADHD in boys than girls, 20 the expression of different genes for ADHD in boys versus girls, 30 or the requirement of a higher threshold in girls for the level of liability to manifest ADHD as explained by the polygenic multiple threshold model.

In our sample, the inattentive subtype of DSM-IV-like ADHD was the most common subtype in both males and females, as found in recent community studies, 8 , 18 , 29 but not in some clinic-based studies, where the combined subtype is most common.

In addition to producing overestimates of the relative prevalence of combined versus inattentive type ADHD, such referral bias may result in biased estimates of gender differences in the proportion of children with a particular subtype of ADHD.

Similar to the DSM-IV field trials, 17 we found male:female ratios for children aged 7 to 12 were highest for the combined type, intermediate for the hyperactive-impulsive type, and lowest for the inattentive type. Quantitative SWAN subscale scores total, inattentive and hyperactive-impulsive were highest in children and lowest in adults and significantly different across age groups. This supports the consensus that symptoms improve with age.

Significantly higher mean subscale scores in males across all age groups suggest the presence of more severe symptoms in males than females. Such changes in symptom counts over time are also consistent with the temporal instability of ADHD subtype diagnoses as shown in longitudinal studies. However they continue to have significantly elevated symptom counts compared to the total sample. This study has some limitations.

However, the age-of-onset criterion has questionable validity. However, parent reports of current ADHD symptoms in their child are very reliable 36 and are less likely to be subject to treatment effects than teacher reports. Our most important limitation is that we did not require impairment in multiple settings when assigning current or lifetime diagnoses.

Thus, it is not surprising that our prevalence estimates are somewhat inflated compared to studies that follow strict DSM-IV impairment and age of onset criteria.

The cutoff we used to indicate symptom presence for individual SWAN items was based on the item score distributions at the 95 th percentile for the majority of items. In further support of our SWAN item cutoff, a recent study examining psychometrics of the SWAN used the same cutoff slightly below average to indicate symptom presence.

A cutoff of 2 may seem more consistent with those between 2. If a stricter cutoff of 2 is used in our sample, the resulting estimates are much lower than those reported in most studies of ADHD prevalence 2. In a supplementary analysis to further assess the effect of using a cutoff of 1 vs. Ideally, we would also have liked to determine if the cutoff of 1 for symptom presence on the SWAN identifies individuals with significant impairment. Thus, we conclude that individuals identified on the basis of SWAN scores of 1 or greater are likely to be substantially impaired by their symptoms.

We separated child and adolescent groups at age 13 partly because of differences in symptoms that may occur during puberty, but we did not include any direct measures of pubertal development, so we cannot determine whether changes in ADHD symptoms correspond to a particular stage of puberty. In the case of depression, 13 is the approximate age where depression becomes more common in females, and pubertal development has been hypothesized to account for this change in the sex ratio for depression.

Parents were not asked about medication use for ADHD, which may have resulted in misclassification of some affected subjects who had fewer symptoms due to medication treatment. The difference in these instructions for lifetime versus current ADHD symptoms may have contributed to poor agreement between the measures as described above. The response rate for the SWAN was lower than that of the screener instrument. However, whether we used all screener subjects, or screener plus SWAN subjects, lifetime prevalence rates based on the screener were similar.

The families in our study were comparatively larger than the current average family size in the United States, and families in which either parent would be unavailable to provide DNA i. Also, our sample was primarily Caucasian.

These issues may limit the generalizability of our results. The study protocol did not allow interviewers to ask whether the diagnoses of other psychiatric or major medical illnesses were present. Because we did not examine psychiatric comorbidity, the overlap of symptoms between ADHD and other diagnoses such as mood and anxiety disorders could lead to some diagnostic misclassification. Study subjects were not seen in-person or directly assessed by a clinician during the screening phase of this study, which further limits the ability to make clinical diagnoses.

However, detailed in-person assessment on a subset of this sample is underway. This study has some important implications for diagnostic nosology. Our findings suggest lower male:female ratios in ADHD diagnoses than previous clinic-based studies.

Sex differences in ADHD: Conference summary

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. This is a preview of subscription content, access via your institution. Rent this article via DeepDyve. Achenbach, T.

Attention deficit hyperactivity disorder ADHD , one of the most prevalent childhood disorders today, is generally more likely to be diagnosed and treated in boys than in girls. To further examine gender differences in ADHD and to address some of the shortcomings of previous studies, this study examined gender differences in subjective and objective measures of ADHD among clinic-referred children with ADHD. Participants were children aged 6—17 years-old with ADHD boys, 75 girls. A retrospective analysis was conducted using records of a clinical database. CPT data, however, revealed higher impulsivity among boys. We did not find gender differences in the level of distractibility during CPT performance.

Gender Differences in ADHD: A Meta-Analysis and Critical Review. MIRANDA GAUB, B.A., AND CARYN L. CARLSON, PH.D. ABSTRACT. Objective: To.

Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children

Refworks Account Login. Open Collections. What has not been as widely studied is whether gender is similarly associated with ADHD differences in adults. In this review, the relation between gender and adult ADHD prevalence, persistence, impairment, comorbidity, cognitive functioning, and treatment response was examined across 73 studies. Although gender was related to several characteristics and correlates of adult ADHD, it appeared that many of these gender differences may be at least be partially attributed to methodological artifacts or social and cultural influences, rather than fundamental differences in the expression of ADHD in men and women.

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Она судорожно ловила ртом воздух, извиваясь в руках Хейла. Он хотел было отпустить ее и броситься к лифту Стратмора, но это было бы чистым безумием: все равно он не знает кода.

Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children

Сьюзан отгородилась от царившего вокруг хаоса, снова и снова перечитывая послание Танкадо. PRIME DIFFERENCE BETWEEN ELEMENTS RESPONSIBLE FOR HIROSHIMA AND NAGASAKI ГЛАВНАЯ РАЗНИЦА МЕЖДУ ЭЛЕМЕНТАМИ, ОТВЕТСТВЕННЫМИ ЗА ХИРОСИМУ И НАГАСАКИ - Это даже не вопрос! - крикнул Бринкерхофф.  - Какой же может быть ответ. - Нам необходимо число, - напомнил Джабба.  - Шифр-убийца имеет цифровую структуру.

 Сэр, мы до сих пор не имеем понятия, что это за предмет. Нам нужны указания. ГЛАВА 114 - Обыщите их еще раз! - потребовал директор. В отчаянии он наблюдал за тем, как расплывчатые фигуры агентов обыскивают бездыханные тела в поисках листка бумаги с беспорядочным набором букв и цифр. - О мой Бог! - Лицо Джаббы мертвенно побледнело.  - Они ничего не найдут. Мы погибли.

В ней царила полная тишина. Прямо перед ним, откинувшись на груду старых подушек, лежал пожилой человек с ярко-белой гипсовой повязкой на правом запястье. ГЛАВА 21 Голос американца, звонившего Нуматаке по прямой линии, казался взволнованным: - Мистер Нуматака, в моем распоряжении не больше минуты. - Хорошо. Полагаю, вы получили обе копии ключа. - Вышла небольшая заминка, - сказал американец. - Это невозможно! - рявкнул Нуматака.

Gender Differences in ADHD: A Meta-Analysis and Critical Review. MIRANDA GAUB, B.A.. MIRANDA This paper is only available as a PDF. To read, Please​.

Скорее всего Северная Дакота попал в ловушку. Стратмор опустился на колени и повернул тяжелый винтовой замок. Теперь крышку не поднять изнутри. Подсобка компьютера надежно закрыта. Ни он, ни Сьюзан не услышали тихих шагов в направлении Третьего узла.

Сьюзан снова задумалась. - Может быть, для того, чтобы вы не заподозрили, что это приманка.

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3 Response
  1. Royce L.

    To quantitatively review and critically evaluate literature examining gender differences in attention-deficit hyperactivity disorder (ADHD). Method. A meta-​analysis.

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