Children with Attention Deficit Hyperactivity Disorder: Are There Gender Differences in School Functioning?.

Abstract. Few studies have comprehensively examined possible gender differences in the school functioning of children with attention deficit hyperactivity disorder (ADHD). This study investigated differences in academic, social, and emotional and behavioral functioning between 133 male and 42 female elementary school students who met research diagnostic criteria for ADHD. School functioning was assessed using teacher ratings, direct observations of classroom behavior, and a standardized, norm-referenced achievement test. Results indicated that participants, regardless of gender, experienced impairment across all functioning domains. The few gender differences obtained varied across areas of functioning and were dependent, in part, on the type of score and comparison group used. Specifically, although girls were less likely to have ADHD than were boys, when they did exhibit this disorder, their impairments were as severe, or possibly more severe, than for boys relative to non-ADHD peers of the same gender. Implications of these findings for school-based practice and research are discussed. ********** Attention deficit hyperactivity disorder (ADHD) is a disorder of childhood onset that is characterized by developmentally inappropriate levels of inattention and/or hyperactivity-impulsivity (American Psychiatric Association, 2000). ADHD affects approximately 3-10% of the school-aged population in the United States (American Psychiatric Association, 2000) and is associated with significant deficits in behavioral, emotional, academic, and social functioning (Barkley, 2006; DuPaul & Stoner, 2003). More than 50% of children with ADHD also display clinically significant symptoms of oppositional defiant disorder (ODD) and conduct disorder (CD) (Barkley, 2006). In community samples, boys are 2-3 times as likely as girls to have ADHD (American Psychiatric Association, 2000; Arnold, 1996). Most of what is known about ADHD is based on studies using samples of boys. In the past decade, studies have indicated that girls with ADHD exhibit similar deficits and outcomes as do boys with this disorder. For example, Hinshaw and colleagues have conducted several studies comparing a large sample of girls with ADHD to an ethnicity-matched control group of girls without ADHD (Hinshaw, 2002; Hinshaw, Carte, Sami, Treuting, & Zupan, 2002; Thurber, Heller, & Hinshaw, 2002). In general, these studies have indicated significant deficits in behavioral, emotional, and social functioning of girls with ADHD relative to girls without this disorder. Several of the variables included in these studies reflect areas of functioning that are relevant for school performance. For example, girls with ADHD obtained significantly lower IQ and achievement test scores than their peers without ADHD, with effect sizes in the moderate to large range (Hinshaw, 2002; Hinshaw et al., 2002). Potential gender differences in the manifestation of ADHD and associated difficulties also have been examined. Biederman and colleagues (1999, 2002) found that although girls with ADHD exhibited similar symptomatology and associated deficits to those displayed by boys, girls were more likely to have the inattentive subtype of ADHD and to be less likely to display symptoms of depression, ODD, and CD. Further, girls were less likely to display school problems or have a learning disability (Biederman et al., 2002). Similar results were obtained by Hartung et al. (2002) wherein boys with ADHD were found to display more ADHD symptoms than girls with this disorder, particularly in the school setting. Abikoff et al. (2002) examined gender differences in classroom behavior in a large sample of children with ADHD. As has been found in other studies, children with ADHD were found to exhibit higher rates of gross motor activity and fidgeting, negative verbalizations, and various other off-task behaviors relative to students without ADHD. …