Research into attention deficit/hyperactivity disorder (ADHD) has traditionally focused mainly on boys, but researchers are beginning to more closely examine this disorder and its effects on girls and women. Two recent studies offer an interesting view on the ways in which hyperactivity may put girls at risk for future troubles.
In a study appearing in this month's issue of the Archives of General Psychiatry, a team of researchers from the Université de Montréal and the University College London set out to examine the combination of hyperactivity and physical aggression in a large sample of girls. They followed their 881 subjects from the age of 6 until the age of 21, periodically assessing the girls for hyperactive behaviors, like restlessness or fidgeting, and aggressive behaviors, like hitting and kicking, throughout the study's 15 year run. About a third of the subjects had scored high on tests of disruptiveness during kindergarten and thus were at risk for developing ADHD or conduct disorder. The researchers intentionally altered their sample to include subjects likely to display hyperactivity or aggressiveness, but because of this their results cannot be generalized to the general public.
They found that 10.4% of the subjects scored high on assessments of hyperactivity, while 8.5% were both highly hyperactive and highly aggressive. Girls identified as hyperactive and aggressive between the ages of 6 and 12 were at increased risk for adjustment problems by the time they reached 21 and experienced more problems on average than the other subjects. They were more likely to smoke, be in a physically or psychologically abusive relationship (either as the victim or the abuser), have poor academic outcomes, become pregnant before the age of 18, and be on welfare. Few girls, 0.4%, scored high on measures of physical aggression alone, an indication that for some girls who are physically aggressive, hyperactivity is likely to be a coexisting problem. The researchers suggest that schools focus on hyperactivity rather than physical aggression, as this may be a more effective strategy for identifying girls at risk for future problems. By stressing physical aggression alone as a risk factor, they argue, schools leave out many girls in need of intervention.
Emotional problems may also affect women with hyperactivity, an unrelated study from the University of Utah, published in the February issue of the Journal of Clinical Psychiatry, points out. The researchers investigated the gender differences evident in a group of 515 adults with ADHD, 34% of whom were female. The female subjects often presented with a greater range of symptoms, with 75% falling into the combined subgroup of ADHD, which encompasses symptoms of hyperactivity/impulsivity as well as inattentiveness. Only 62% of male subjects fell into this category. The women also experienced more accompanying psychological symptoms, scoring higher on tests of depression, anxiety, and sleep disorders. These researchers stress that with symptoms of depression and anxiety accompanying ADHD, these women could be misdiagnosed. Assessments of ADHD in girls and women should take into account the emotional elements of the disorder that may be present.
While boys are more likely to be diagnosed with ADHD, these studies illustrate that ADHD also has a large influence on the well-being of girls and can signify continued problems for them. Programs addressing these problems when girls are still young may be beneficial for them, helping them to avoid the problems for which they may have an elevated risk. As research continues to investigate the issues of gender and age in ADHD, we will likely learn more about how different group are affected, and treatments can be better tailored to more successfully meet their specific needs.
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