Understanding Girls with Attention-Deficit/hyperactivity Disorder (ADHD): Applying Research to Clinical Practice

By Soffer, Stephen L.; Mautone, Jennifer A. et al. | The International Journal of Behavioral Consultation and Therapy, Spring 2008 | Go to article overview

Understanding Girls with Attention-Deficit/hyperactivity Disorder (ADHD): Applying Research to Clinical Practice


Soffer, Stephen L., Mautone, Jennifer A., Power, Thomas J., The International Journal of Behavioral Consultation and Therapy


Attention-deficit/hyperactivity disorder (ADHD) is a chronic and relatively common psychiatric condition characterized by a wide range of deficits in behavior control and attention (American Psychiatric Association, 2000). There are three subtypes of ADHD described by the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision (DSM-IV, TR; American Psychiatric Press, 2000): ADHD, Combined Type (ADHD/COM) is characterized by high levels of hyperactive/impulsive and attention problem symptoms; ADHD, Predominantly Inattentive Type (ADHD/I) refers to individuals with significant attention problem symptoms in the absence of clinically significant hyperactivity/impulsivity; and ADHD, Predominantly Hyperactive/Impulsive Type (ADHD/HI) refers to the least common subtype for individuals with substantial hyperactive/impulsive symptoms without attention problem symptoms. Children with ADHD typically experience problems related to academic performance, interactions with other family members, and peer relationships (Barkley, 2006; DuPaul & Stoner, 2003). Prevalence estimates of ADHD in school-age child samples in the United States range from 4-10% (Pliszka & AACAP Work Group on Quality Issues, 2007). Survey research has consistently indicated that ADHD is more frequently identified in boys than girls, with estimates ranging from three times more likely in community samples to upwards of nine times more frequent in clinical samples (Barkley, 2006; Biederman & Faraone, 2004).

The majority of research related to ADHD has been completed with boys as the predominate members of study samples. However, over the past decade there have been increased efforts dedicated to learning about the characteristics of girls with ADHD, both in comparison to girls without this condition and in relation to boys with ADHD. Such research is essential in developing a more thorough understanding of the specific characteristics presented by girls with ADHD to help inform assessment and intervention efforts on behalf of this under-studied population. This is particularly important in the context of recent research findings establishing that, just as boys with ADHD, girls with this disorder compared with non-affected girls experience significant symptoms, comorbidity, and impairment across home, school, and social settings (Gaub & Carlson, 1997; Gershon, 2002; Hinshaw, 2002; Hinshaw and Blachman, 2005). Additionally, similar to boys with ADHD, a majority of girls diagnosed with ADHD continue to demonstrate significant symptoms and impairment due to their symptoms as they grow into adolescence (Hinshaw, Owen, Sami, Fargeon, 2006). There is a growing research base to support the conclusion that girls, much like boys, with ADHD and their families are coping with a serious, chronic condition that generally has a negative impact on multip le areas of functioning and development.

Girls with ADHD Compared with Non-ADHD Girls

Although it has been known for some time that girls are diagnosed with ADHD at lower rates than boys, only a few studies have focused on examining the differences between ADHD and non-ADHD samples for girls compared to boys. Such research is important to building an understanding of the symptom profiles and comorbidity patterns, as well as types and quality of impairment of girls with ADHD when compared to girls without this disorder.

Symptoms, Comorbidity, and Impairment

Several descriptive studies have demonstrated that girls with ADHD, compared with non-ADHD girls, exhibit a range of characteristic symptoms of this condition, comorbid disorders, and other associated problems. One of the initial studies specifically examining ADHD in a large sample of female participants was completed by Biederman and colleagues (1999). These researchers examined a sample of 140 girls with ADHD and 122 girls without ADHD, who were between ages 6 and 18 years and recruited from pediatric and psychiatric care facilities. …

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