(February 22, 2006) -- ADHD identification creates extra challenges when the patient is female.

Many researchers complain gender-based behavioral proclivities are not adequately addressed even in the handbook of standardized criteria for attention-deficit/hyperactivity disorder.

"There are three to five boys picked up with ADHD for every girl," said Robert Resnick. He is professor of psychology at Randolph-Macon College in Ashland, Va., and former president of the American Psychological Association. Resnick has a 35-year-old son diagnosed with the disorder.

"Girls present differently," he said. "They are less aggressive, more likely to be chatty, more depressed, more internalized than boys who are externalizing, pushing, shoving, running."

Girls with ADHD, he noted, tend to engage in early sexual behavior and face a higher than normal risk of pregnancy.

In the book "Understanding Girls With ADHD," Kathleen Nadeau stated that "there are many girls left undiagnosed because their symptoms look different (because) girls are less rebellious, less defiant, generally less 'difficult' than boys."

A study, reported in the Journal of the American Academy of Child and Adolescent Psychiatry, suggested the major symptoms of ADHD appear similar in both genders, but girls with the disorder are less likely to have accompanying disruptive behaviors. That may be one reason for their lower rate of diagnosis, theorized the research team led by child and adolescent psychiatrist Dr. Joseph Biederman of Massachusetts General Hospital.

In testing 140 girls with ADHD, with an average age of 11, the researchers observed all the typical symptoms, including inattentiveness, hyperactivity and impulsive behavior. The most frequent symptom was inattention, they found.

Consistent with previous studies, the girls scored relatively low on IQ and academic achievement tests and had high rates of impairment in social, school and family functioning.

Girls with ADHD also had high rates of other psychiatric disorders, such as behavioral, mood and anxiety problems as well as an increased risk for drug and alcohol abuse. The rates of mood disorders were similar in both genders, but girls had less of a tendency than boys to be affected by disruptive conditions, such as oppositional defiant disorder, the authors reported.

"The looks of the disorder are different across age and gender," said Donna Palumbo, who was not involved in the study. She is associate professor of neurology and pediatrics, director of the Strong Neurology ADHD Program and head of pediatric neuropsychology training at the University of Rochester School of Medicine and Dentistry in Rochester, N.Y.

"Girls are more cognitive in symptoms. They may never be restless, hyperactive, or impulsive," she said. "Boys tend to get more diagnosed than girls because they're disruptive in class, their behaviors get them in trouble, while the girls are quietly zoning out (and) not bothering anyone. They are less diagnosed and at older ages than boys."

Some studies estimate as many as half to three-fourths of all girls with the disorder go undiagnosed. Other researchers speculate that may be one reason more girls, and women, are diagnosed with depression than are men.

A survey of 5,718 children born in Olmsted County, Minn., between Jan. 1, 1976, and Dec. 31, 1982, showed boys were more than three times more likely to have an ADHD diagnosis than were girls. The results were published in the Mayo Clinic Proceedings.

Scientists are working to resolve whether the difference is a result of genetic predisposition, a reflection of diagnostic shortcomings or relevant to some other factors.

Their studies count among reams of research tackling the tough-and-tricky task of tracking problematic behavior to its core.

Their answers will be incorporated into the evolving modern-day story of ADHD, which begins, as far as most of its relaters can tell, more than a century ago.

Last updated: 02/06

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