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AD/HD and Gender Issues

The following are the dissertation results of Barbara Prupas, PsyD. (bprupas@aol.com) Alliant International University, California School of Professional Psychology. Dr Prupas surveyed psychology interns to determine their knowledge of AD/HD and Gender Issues. She hypothesized that psychology interns needed more current information on AD/HD and gender issues. An original survey (ADHD-BIAS) was developed to use for gathering data from psychology interns. The following five (5) questions reveal the survey results.

 

1. What is the current level of knowledge amongst psychology interns regarding ADHD and gender issues? Most respondents (63%) knew that ADHD symptoms develop at a later age in girls than in boys. The interns (79%) correctly reported girls with ADHD are often more distressed than boys. Participants (92%) verified boys with ADHD are more likely to be referred for an evaluation than girls. Most interns (72%) understood that less than half of the children with ADHD receive needed treatment.

 

Interns were least knowledgeable about the following aspects of ADHD and gender. The majority of interns (88%) did not know that girls with ADHD have a greater risk for substance abuse than boys. Interns (81%) did not know that girls are just as likely to repeat a grade as boys with ADHD. Interns (85%) were unaware that girls with ADHD suffer from perfectionistic behavior too. Respondents (59%) did not recognize that peer relationship problems are most prevalent in girls with ADHD. The study participants (53%) were unacquainted with the fact that boys and girls with ADHD respond equally well to treatment.

 

2. Do psychology interns have gender sensitive attitudes towards children with ADHD? The ADHD survey results indicate postdoctoral interns have fairly sensitive attitudes regarding gender issues and ADHD. Subjects agreed that boys with ADHD do not necessarily come from troubled families and that a lack of parental discipline does not cause ADHD. Interns agree that labeling a child with ADHD can be beneficial. Interns realize ADHD is under-diagnosed in girls and that ADHD is a lifetime disorder with repercussion in adulthood.

 

Interns did not exhibit gender sensitive attitudes on the following statements. Interns failed to understand that fluctuating hormones cause cognitive and behavioral changes in girls with ADHD. Interns reported they did not know self-report behavioral rating scales are recommended for evaluating girls for ADHD. Lastly, most interns were unaware that girls with academic, emotional or social problems should be evaluated for ADHD.

 

3. How do demographic factors affect psychology interns’ level of knowledge and attitudes towards ADHD and gender issues? The average number of correct responses on the knowledge scale for interns with no additional training was 7.93, whereas the interns that received more than 25 hours of training had a mean of 10.4. In addition, there was a significant difference on the knowledge scale (correct items) between interns with 1-15 hours of training (mean= 8.31) and interns reporting over 25 hours of additional training (mean= 10.4). The study results illustrate that supplementary training is effective for increasing predoctoral interns’ knowledge on ADHD and gender issues.

 

4. How prepared are psychology interns to diagnose ADHD and implement ADHD treatment programs that are gender specific? More than half (60%) of the interns participating in the study reported they are unprepared or only minimally prepared to diagnose ADHD and implement appropriate treatment programs. Thirty-one percent (31%) of the respondents felt they are somewhat prepared to diagnose and treat ADHD in children whereas, only seven-percent reported they are very prepared to do so. More than half (58%) of the interns stated their internship site included children diagnosed with ADHD and forty-one percent reported no internship experience with children diagnosed as ADHD.

 

5. What suggestions, if any, do psychology interns have for improving academic and professional training on ADHD and gender issues? Most predoctoral interns (61%) believe that additional information is needed to identify gender specific symptoms and comorbid conditions associated with ADHD. Many respondents recommended that psychology graduate programs offer training on implementing gender specific ADHD treatment programs. Fewer interns reported needing more information on diagnosing ADHD in boys and girls. Less than ten percent of the participants indicated their graduate training was sufficient and there was no need for additional training on ADHD and gender issues.

 

Eleven interns participating in the study gave suggestions for psychology graduate programs and internships sites (checked ‘other’ on question 25). Interns recommended more information on differential diagnosis (bipolar disorder) and ADHD. Respondents suggested graduate programs offer more information on:

 

a) Treating adults with ADHD
b) Psycho-social stressors associated with ADHD
c) The implications of culture on individuals with ADHD.

The research results from 129 psychology interns indicate the necessity for additional graduate training in order to prevent gender bias during the identification, diagnosis, and treatment of children with ADHD. Psychology interns’ demographics were addressed to determine their influence on interns’ knowledge and attitudes about ADHD and gender. The ADHD survey results denote interns were informed about the gender differences associated with the diagnosis and treatment of ADHD. However, participants were less informed about the symptoms and comorbid conditions associated with gender and ADHD. Most predoctoral interns reported gender sensitive attitudes towards boys and girls with ADHD. A multivariate analysis of variance and post hoc tests determined supplemental training (over 25 hours) had a significant main effect on ADHD-BIAS knowledge scales.

 

Limitations of the Study
The relatively small sample size (N=129) and poor response rate were the limitations of the study. The added step instructing Internship training directors to forward the online survey to interns (instead of interns receiving the survey directly) may have influenced the survey response rate. A known limitation of non-response bias in mailed or Internet surveys. Respondents are more likely to have interest or knowledge about the research subject than non-respondents thus biasing the study results. Generalizations of the study results (should be made cautiously) and limited to psychology interns assigned to APPIC pre-doctoral internship programs only.

 

A key limitation of the study is the unknown validity and responsiveness of the instrument (ADHD-BIAS). Newly constructed instruments are often used for gathering preliminary information and unknown validity is accepted.

 

Clinical Implications
The diagnosis, development and management of ADHD in boys and girls is a complex issue and not without controversy. As the recognition and prevalence of ADHD increases, so must evidence-based research. Attention Deficit/Hyperactivity is a chronic disorder with wide spread consequences in males and females. Few psychologists will be able to avoid the impact of ADHD. This study underscores the necessity for additional intern training on ADHD and comorbid conditions associated with gender differences. It is essential that mental health professionals examine personal biases and focus their attention on enhancing the competency of all individuals with ADHD. Psychologists are an integral part of the multi-modal treatment approach for individuals with ADHD. The process of continually updating and disseminating information about the disorder is vital.

UPDATES ON MEDICATIONS to TREAT AD/HD

Trends in Medication Treatment for ADHD

A study was recently conducted by Medco Health Solutions to examine the demographic trends in the use of medications to treat ADHD in adult and pediatric populations. Using pharmacy claims data for a large population of commercially insured Americans, the study measures ADHD treatment prevalence and drug use from 2000 to 2005. Results indicate that in 2005, 4.4% of children (ages 0 to 19) and 0.8% of adults (ages 20 and older) used ADHD medications. Treatment rates were higher in boys (6.1%) than in girls (2.6%), but the rates for men and women were approximately equal (0.8%). During the period of the study, treatment prevalence increased rapidly (11.8% per year) for the population as a whole. Treatment rates grew more rapidly for adults than for children, more rapidly for women than for men, and more rapidly for girls than for boys.

Conclusion: Improved identification of ADHD in adult and female patients has contributed to rapid growth in ADHD medication use. Full text of article can be found in the Journal of Attention Disorders 2007; 10(4) pages 335-342.

Monographs and Articles

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