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
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?
2005; 27(1):79-105 (ISSN: 8756-5641)
LJ; Biederman J; Monuteaux MC; Valera E; Doyle AE; Faraone SV
Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts
General Hospital, Boston, MA 02114, USA. firstname.lastname@example.org
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.
of Girls and ADHD: Results from a National Survey
General Medicine 6(2), 2004. © 2004 Medscape Posted 05/04/2004
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
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.
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. email@example.com
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
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
of attention deficit hyperactivity disorder in severely obese women.
Eat Weight Disord. 2005; 10(1):e10-3 (ISSN:
Fleming JP; Levy LD; Levitan RD
University of Toronto, Department of Psychiatry, Toronto, Ontario,
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
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
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. firstname.lastname@example.org
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
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. email@example.com
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
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. firstname.lastname@example.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
• PreMedline Identifier: 10654670
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,
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
• PreMedline Identifier: 16649819
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. email@example.com
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
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:
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, firstname.lastname@example.org.
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
life activity and health outcomes associated with attention-deficit/hyperactivity
J Clin Psychiatry. 2002; 63 Suppl 12:10-5 (ISSN: 0160-6689)
Department of Psychiatry, University of Massachusetts Medical School,
55 Lake Ave. N., Worcester, MA 01655, USA. email@example.com
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
• PreMedline Identifier: 12562056
in girls: clinical comparability of a research sample.
J Am Acad Child Adolesc Psychiatry. 1999; 38(1):40-7 (ISSN:
Sharp WS; Walter JM; Marsh WL; Ritchie GF; Hamburger SD;
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
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. firstname.lastname@example.org
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
differences in ADHD: conference summary.
J Abnorm Child Psychol. 1996; 24(5):555-69 (ISSN: 0091-0627)
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,
• PreMedline Identifier: 8956084
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,
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
differences in a sample of adults with attention deficit hyperactivity
Psychiatry Res. 1994; 53(1):13-29 (ISSN: 0165-1781)
Biederman J; Faraone SV; Spencer T; Wilens T; Mick E; Lapey
Pediatric Psychopharmacology Unit, Massachusetts General Hospital,
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.