Sex Differences in Substance Use, Prevalence, Pharmacological Therapy: History
View Latest Version
Please note this is an old version of this entry, which may differ significantly from the current revision.
Contributor:
Francisca Castellano-García
,
Gonzalo Haro
,
Ana Benito
,
,
Alejandro Fuertes-Saiz

Sex differences are poorly studied within the field of mental health, even though there is evidence of disparities (with respect to brain anatomy, activation patterns, and neurochemistry, etc.) that can significantly influence the etiology and course of mental disorders. Girls with ADHD are more at risk of substance use than boys, although there was no consensus on the prevalence of dual disorders. Girls are less frequently treated because of underdiagnosis and because they are more often inattentive and thereby show less disruptive behavior. Together with increased impairment in cognitive and executive functioning in girls, the aforementioned could be related to greater substance use and poorer functioning, especially in terms of more self-injurious behavior; and early diagnosis and treatment of ADHD, especially in adolescent girls, is essential to prevent early substance use, the development of SUD, and suicidal behavior.

  • ADHD
  • sex differences
  • adolescence
  • substance use disorder

1. Introduction

Sex differences in patients with mental disorders have been little studied [1][2], with the few studies on the subject being limited to analyzing quantitative differences between the sexes [3]. These differences can significantly influence the etiology and course of mental disorders. The literature published in recent years in relation to sex differences indicates that these dichotomies begin to manifest in pre- and early postnatal development. The hypothalamic–pituitary–gonadal (HPG) axis is thought to be responsible for this differentiation through the production of high levels of gonadal steroid hormones. [4]. For example, testosterone produces masculinization and defeminization in neural circuits in males, and the absence of testosterone produces a female neural phenotype [5]. After the first year of postnatal life, the HPG axis remains inactive until the onset of puberty [4]. At around 9 years of age in girls and one year later in boys, the hypothalamic–pituitary–adrenal axis is activated. This causes the increased production of adrenal androgens, thus initiating the development of secondary sexual characteristics, including the growth of pubic or axillary hair [6].
During puberty, there is an increase in sex hormones which results in changes in the activation and organization of the brain, leading to significant changes in its structure [7]. One of the best known and most replicated sex differences in brain development studies relates to overall volume (brain and intracranial), which is increased throughout development in boys compared to girls [8]. Grey matter volumes (cortical and subcortical) also show an inverted U-shaped growth trajectory with a maximum peak in girls at 8.5 years of age and approximately two years later in boys [9]. These findings have led to growing interest and an increase in studies in adolescents [8]. In fact, the study of sex differences may provide relevant information to explain the etiology of several diseases with an onset before or during adolescence and significant differences in prevalence according to sex [10].
One of the most worrying issues during adolescence is substance use. Epidemiological studies indicate that early adolescent use of alcohol, marijuana, and cocaine increases the risk of substance use disorder (SUD) in adulthood [11]. Indeed, risk taking and subsequent substance use during this developmental period increases the likelihood of developing SUD more so in boys than in girls [12]. Predisposing risk factors, such as impulsiveness [13], novelty seeking [14], exposure to early adversity [15], and other pre-existing conditions including attention deficit hyperactivity disorder (ADHD) [16], can also lead to the early use of substances.
ADHD affects 5–10% of the child population [17][18][19]. Although the condition was initially thought to decline or disappear during adulthood, research over the last three decades has found that it persists into adolescence in 50–60% of cases [20][21][22] and may even last through the whole lifespan [23][24][25]. The main characteristic of ADHD is the presence of a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with the functioning or general development of people with the disorder [26]. ADHD is classified into three subtypes according to whether there is a predominance of (1) combined presentation; (2) predominantly inattentive presentation; or (3) predominantly hyperactive/impulsive presentation. The core symptoms occur in childhood and early adolescence (before the age of 12) although their expression changes during adolescence with the motor hyperactivity being mitigated but the impulsivity and attention deficit persisting [27].
ADHD frequently co-occurs with other psychiatric disorders, such as conduct disorder, obsessive–compulsive disorder, or SUD [26]. Childhood ADHD predicts greater initial exposure to substances from earlier ages and a more rapid progression of substance use during adolescence [28] and in young adults [29]. This means that the disorder itself is considered a risk factor for SUD [30][31]. Follow-up studies have highlighted a higher prevalence of substance use in the population of adolescents with ADHD relative to the general population [32][33][34]. Nonetheless, a review on sex differences in relation to the disorder has never been published. 

2. Development and Findings

Indeed, the body of research suggesting that girls with ADHD may be at increased risk for SUD is growing [29][32][34][35][36][37][38]. Two studies, by Biederman et al. (2002) [39] and Biederman and Faraone (2004) [40], indicated that ADHD in girls was a greater risk factor for SUD than ADHD in boys, noting that girls with the disorder were at particular risk in early adolescence. Along the same lines, Ottosen et al. (2019) [41] confirmed that girls with ADHD were at an increased risk of SUD, indicating that delayed diagnosis and the late initiation of treatment was a risk factor for the development of SUD. In contrast, other studies emphasized that the association between ADHD and SUD is greater in adolescent boys [42] and considered male sex to be a risk factor for this comorbidity [33][40][43].
Yildiz et al. (2020) [43] found that alcohol consumption in adolescents with ADHD was associated with a SUD comorbidity in boys and with hyperactivity–impulsivity in girls [44], with girls presenting greater SUD [45]. However, the two studies with participants with severe childhood ADHD, found no sex differences: both sexes started drinking alcohol earlier, and the consumption was more frequent than in individuals without the disorder [44][46]. This could be because the severity of ADHD in childhood is related to the risk of consumption or because sex does not modulate this relationship. This finding suggests that it is important to consider the severity of ADHD when evaluating sex differences.
Nevertheless, the results of the study by Madsen and Dalsgaard (2013) [47] were opposite to all the other work in the field, showing that the boys in the control group had a pattern of more intense and frequent alcohol consumption than those who followed pharmacological treatments for ADHD. However, the latter consumed more tobacco than the control group of boys. Moreover, they found no difference in alcohol and tobacco use between adolescent girls with and without ADHD. These results could be justified, on the one hand, precisely by the fact that diagnosis and pharmacological intervention tends to be earlier in boys than in girls, thus facilitating improvement of the symptoms of the disorder in boys rather than girls. On the other hand, published studies addressing drug therapy indicate that people with ADHD who receive prompt treatment show the same rates of SUD as age-matched community controls [16][48]. In other words, when started early, medication lowers the risk of substance use [49], and this lower risk is sustained in the long term among men [50]. This seems to indicate the importance of early diagnosis and treatment, especially in girls.
This would lead to an earlier diagnosis in boys than in girls [51][52][53], who are usually diagnosed later and have a significantly lower probability of receiving pharmacotherapy than boys [54][55]. Previous studies have already indicated that ADHD seems to affect more men than women, with the exact proportion differing between clinical and general population samples [56][57][58][59][60][61]. The lack of externalizing symptoms in girls and women with ADHD hampers both their referral and earlier diagnosis [61]. Furthermore, the inattentive-type ADHD, which usually involves less disruptive behaviors, is more often diagnosed in women, both in childhood and in adulthood [19]. This could perhaps contribute to the explanation of why girls with ADHD tend to be underdiagnosed [62][63], probably due to sex differences in the presentation of the symptoms and comorbidities of the disorder [39][58].
Indeed, the study of ADHD has long focused primarily on boys [64] despite the still relatively high percentage of girls with the disorder [65]. The samples in most published work comprised mainly men with only a few female participants. This situation has caused many girls to receive a late diagnosis, and even more worryingly, these patients often do not receive appropriate pharmacological treatment after their diagnosis [66][67]. Follow-up studies have further suggested that women with ADHD may have more serious problems than their male counterparts [41]. For example, they have a higher risk of substance use, admission to inpatient psychiatric units, and higher mortality rates than men [32][62][66]. These results support the idea that the current diagnostic criteria may not adequately detect girls with ADHD [68][69]. Most of these criteria refer to behaviors that are more easily manifested and observed in boys. Therefore, the DSM-5 continues to present a considerable limitation in this sense because the symptoms it lists for ADHD are not modulated by sex differences. This situation causes a significant obstacle when it comes to recognizing and diagnosing girls with ADHD, thus producing erroneous or late diagnoses, which can lead to a worsening of symptoms in this population over time [63].
Adolescent girls had higher levels of cognitive impulsiveness and motor impulsivity [70]; made more errors of omission (deficits in attentional control); had more deficits in design memory, general visual memory, verbal arithmetic skills, and working memory skills [71]; and had higher processing and encoding speed scores, greater inhibitory control, and lower vocabulary scores than adolescent boys with ADHD [72]. These findings are consistent with those obtained in two meta-analyses. The first, conducted by Hasson and Fine (2012) [73], found that boys with ADHD made more commission errors (inhibitory control) in the Conners’ Performance Test (CPT) than girls who, in turn, made more omission errors (attentional control). The second meta-analysis was carried out by Loyer Carbonneau et al. (2021) [64] and found significant differences between both sexes regarding inhibition capacity (motor response inhibition and interference control) and cognitive flexibility such that boys with ADHD presented more hyperactive behaviors and greater inhibition problems than girls with ADHD. Previous research has shown that girls with ADHD were more likely to have the inattentive subtype [19] and because of these problems in attentional control showed more difficulties in design memory, visual memory, perceptual and visuospatial reasoning, and working memory [39][58][71][74]. Consequently, it seems that neuropsychological functions are more affected in girls with ADHD compared to boys with the same disorder [75]. This finding coincides with previous studies indicating that ADHD affects neuropsychological functioning differently depending on sex [64][76][77]. The more deteriorated neuropsychological profile in girls might be related to the fact that girls tend to receive a later diagnosis and less frequently receive therapeutic interventions. In addition, cognitive and motor impulsiveness and deficits in cognitive and executive functioning may be related to the higher risk of substance use in girls. In turn, consumption could worsen these deficits and impulsiveness. Therefore, in the future, early diagnosis and intervention in girls with this disorder is of vital importance to help improve the symptoms of ADHD and prevent other problems associated with it (such as substance use) among women. However, a review conducted in children showed that ADHD was frequently associated with poorer academic performance and that they were more likely to need to repeat a grade or even drop out of school [78]. In a similar vein, other studies have indicated that one of the factors that increases the risk of SUD in ADHD is academic failure [79]. That is, ADHD associated with a negative academic trajectory can lead to early substance use [80]. This points to the importance of specific programs to prevent school failure as well as substance use in adolescents with ADHD regardless of sex.

This entry is adapted from the peer-reviewed paper 10.3390/brainsci12050590

References

  1. Chandra, P.S.; Satyanarayana, V.A. Gender disadvantage and common mental disorders in women. Int. Rev. Psychiatry 2010, 22, 513–524.
  2. Howard, L.M. Gender differences in mental health. Int. Rev. Psychiatry 2010, 22, 415–416.
  3. Torrens-Melich, M.; Orengo, T.; de Fonseca, F.R.; Almodóvar, I.; Baquero, A.; Benito, A. Gender Perspective in Dual Diagnosis. Brain Sci. 2021, 11, 1101.
  4. Herting, M.M.; Sowell, E.R. Puberty and structural brain development in humans. Front. Neuroendocrinol. 2017, 44, 122–137.
  5. Blakemore, S.J.; Burnett, S.; Dahl, R.E. The role of puberty in the developing adolescent brain. Hum. Brain Mapp. 2010, 31, 926–933.
  6. Vijayakumar, N.; Op de Macks, Z.; Shirtcliff, E.A.; Pfeifer, J.H. Puberty and the human brain: Insights into adolescent development. Neurosci. Biobehav. Rev. 2018, 92, 417–436.
  7. Kurth, F.; Gaser, C.; Luders, E. Development of sex differences in the human brain. Cogn. Neurosci. 2021, 12, 155–162.
  8. Goddings, A.L.; Beltz, A.; Peper, J.; Crone, E.A.; Braams, B.R. Understanding the Role of Puberty in Structural and Functional Development of the Adolescent Brain. J. Res. Adolesc. 2019, 29, 32–53.
  9. Lenroot, R.K.; Gogtay, N.; Greenstein, D.K.; Wells, E.M.; Wallace, G.L.; Clasen, L.S.; Blumenthal, J.D.; Lerch, J.; Zijdenbos, A.P.; Evans, A.C.; et al. Sexual dimorphism of brain developmental trajectories during childhood and adolescence. Neuroimage 2007, 36, 1065–1073.
  10. Peper, J.S.; Burke, S.M.; Wierenga, L.M. Sex differences and brain development during puberty and adolescence. Handb. Clin. Neurol. 2020, 175, 25–54.
  11. Wagner, F.A.; Anthony, J.C. From first drug use to drug dependence; developmental periods of risk for dependence upon marijuana, cocaine, and alcohol. Neuropsychopharmacology 2002, 26, 479–488.
  12. Jordan, C.J.; Andersen, S.L. Sensitive periods of substance abuse: Early risk for the transition to dependence. Dev. Cogn. Neurosci. 2017, 25, 29–44.
  13. Gruber, S.A.; Dahlgren, M.K.; Sagar, K.A.; Gönenç, A.; Lukas, S.E. Worth the wait: Effects of age of onset of marijuana use on white matter and impulsivity. Psychopharmacology 2014, 231, 1455–1465.
  14. Mitchell, M.R.; Weiss, V.G.; Beas, B.S.; Morgan, D.; Bizon, J.L.; Setlow, B. Adolescent risk taking, cocaine self-administration, and striatal dopamine signaling. Neuropsychopharmacology 2014, 39, 955–962.
  15. Enoch, M.A. The role of early life stress as a predictor for alcohol and drug dependence. Psychopharmacology 2011, 214, 17–31.
  16. Mannuzza, S.; Klein, R.G.; Truong, N.L.; Moulton, J.L.; Roizen, E.R.; Howell, K.H.; Castellanos, F.X. Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: Prospective follow-up into adulthood. Am. J. Psychiatry 2008, 165, 604–609.
  17. Polanczyk, G.; de Lima, M.S.; Horta, B.L.; Biederman, J.; Rohde, L.A. The worldwide prevalence of ADHD: A systematic review and metaregression analysis. Am. J. Psychiatry 2007, 164, 942–948.
  18. Rucklidge, J.J. Gender differences in ADHD: Implications for psychosocial treatments. Expert Rev. Neurother. 2008, 8, 643–655.
  19. Willcutt, E.G. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics 2012, 9, 490–499.
  20. Biederman, J.; Monuteaux, M.C.; Mick, E.; Spencer, T.; Wilens, T.E.; Silva, J.M.; Snyder, L.E.; Faraone, S.V. Young adult outcome of attention deficit hyperactivity disorder: A controlled 10-year follow-up study. Psychol. Med. 2006, 36, 167–179.
  21. Faraone, S.V.; Biederman, J. What is the prevalence of adult ADHD? Results of a population screen of 966 adults. J. Atten. Disord. 2005, 9, 384–391.
  22. Okie, S. ADHD in adults. N. Engl. J. Med. 2006, 354, 2637–2641.
  23. Barkley, R.A. Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder. J. Clin. Psychiatry 2002, 63 (Suppl. 12), 10–15.
  24. Sibley, M.H.; Kuriyan, A.B.; Evans, S.W.; Waxmonsky, J.G.; Smith, B.H. Pharmacological and psychosocial treatments for adolescents with ADHD: An updated systematic review of the literature. Clin. Psychol. Rev. 2014, 34, 218–232.
  25. Visser, S.N.; Danielson, M.L.; Bitsko, R.H.; Holbrook, J.R.; Kogan, M.D.; Ghandour, R.M.; Perou, R.; Blumberg, S.J. Trends in the parent-report of health care provider- diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. J. Am. Acad. Child Adolesc. Psychiatry 2014, 53, 34–46.
  26. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; American Psychiatric Association: Arlington, VA, USA, 2013.
  27. Faraone, S.V.; Biederman, J.; Mick, E. The age-dependent decline of attention deficit hyperactivity disorder: A meta-analysis of follow-up studies. Psychol. Med. 2006, 36, 159–165.
  28. Molina, B.S.G.; Howard, A.L.; Swanson, J.M.; Stehli, A.; Mitchell, J.T.; Kennedy, T.M.; Epstein, J.N.; Arnold, L.E.; Hechtman, L.; Vitiello, B.; et al. Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: Findings from the MTA longitudinal study. J. Child Psychol. Psychiatry 2018, 59, 692–702.
  29. Ottosen, C.; Petersen, L.; Larsen, J.T.; Dalsgaard, S. Gender Differences in Associations Between Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder. J. Am. Acad. Child Adolesc. Psychiatry 2015, 55, 227–234.e4.
  30. Zhang-James, Y.; Chen, Q.; Kuja-Halkola, R.; Lichtenstein, P.; Larsson, H.; Faraone, S.V. Machine-Learning prediction of comorbid substance use disorders in ADHD youth using Swedish registry data. J. Child Psychol. Psychiatry 2020, 61, 1370–1379.
  31. Howard, A.L.; Kennedy, T.M.; Mitchell, J.T.; Sibley, M.H.; Hinshaw, S.P.; Arnold, L.E.; Roy, A.; Stehli, A.; Swanson, J.M.; Molina, B.S.G. Early substance use in the pathway from childhood attention-deficit/hyperactivity disorder (ADHD) to young adult substance use: Evidence of statistical mediation and substance specificity. Psychol. Addict. Behav. 2020, 34, 281–292.
  32. Dalsgaard, S.; Mortensen, P.B.; Frydenberg, M.; Thomsen, P.H. ADHD, stimulant treatment in childhood and subsequent substance abuse in adulthood—A naturalistic long-term follow-up study. Addict. Behav. 2013, 39, 325–328.
  33. Galera, C.; Fombonne, E.; Chastang, J.F.; Bouvard, M. Childhood hyperactivity-inattention symptoms and smoking in adolescence. Drug Alcohol Depend. 2008, 78, 101–108.
  34. Osland, S.; Hirsch, L.; Pringsheim, T. Smoking, alcohol and drug use in youth and adults with attention-deficit hyperactivity disorder. BJPsych Open 2017, 3, 141–146.
  35. Elkins, I.J.; Saunders, G.R.B.; Malone, S.M.; Keyes, M.A.; Samek, D.R.; McGue, M.; Iacono, W.G. Increased risk of smoking in female adolescents who had childhood ADHD. Am. J. Psychiatry. 2017, 175, 63–70.
  36. Matthies, S.; Holzner, S.; Feige, B.; Scheel, C.; Perlov, E.; Ebert, D.; van Elst, L.T.; Philipsen, A. ADHD as a serious risk factor for early smoking and nicotine dependence in adulthood. J. Atten. Disord. 2013, 17, 176–186.
  37. Korsgaard, H.O.; Torgersen, S.; Wentzel-Larsen, T.; Ulberg, R. Substance abuse and personality disorder comorbidity in adolescent outpatients: Are girls more severely ill than boys? Child Adolesc. Psychiatry Ment. Health 2016, 10, 8.
  38. Yarmush, D.E.; Manchery, L.; Luehring-Jones, P.; Erblich, J. Gender and impulsivity: Effects on cue-induced alcohol craving. Alcohol. Clin. Exp. Res. 2016, 40, 1052–1057.
  39. Biederman, J.; Mick, E.; Faraone, S.V.; Braaten, E.; Doyle, A.; Spencer, T.; Wilens, T.E.; Frazier, E.; Johnson, M.A. Influence of Gender on Attention Deficit Hyperactivity Disorder in Children Referred to a Psychiatric Clinic. Am. J. Psychiatry 2002, 159, 36–42.
  40. Biederman, J.; Faraone, S.V. The Massachusetts General Hospital studies of gender influences on attention-deficit/hyperactivity disorder in youth and relatives. Psychiatr. Clin. N. Am. 2004, 27, 225–232.
  41. Ottosen, C.; Tidselbak, J.; Faraone, S.V.; Chen, Q.; Hartman, C.; Larsson, H.; Dalsgaard, S. Sex differences in comorbidity patterns of attention-deficit/hyperactivity disorder. J. Am. Child Adolesc. Psychiatry 2019, 58, 412–422.
  42. Latimer, W.W.; Stone, A.L.; Voight, A.; Winters, K.C.; August, G.J. Gender differences in psychiatric comorbidity among adolescents with substance use disorders. Exp. Clin. Psychopharmacol. 2002, 10, 310–315.
  43. Yildiz, D.; Ciftci, A.; Yalcin, O. Substance use patterns, psychosocial traumas, psychiatric comorbidities, and gender differences among adolescent inpatients at an addiction treatment center. Dusunen Adam 2020, 33, 190–202.
  44. Elkins, I.J.; Saunders, G.R.B.; Malone, S.M.; Keyes, M.A.; McGue, M.; Iacono, W.G. Associations between childhood ADHD, gender, and adolescents alcohol and marijuana involvement: A causally informative design. Drug Alcohol Depend. 2018, 184, 33–41.
  45. Regan, T.; Tubman, J. Attention Deficit Hyperactivity Disorder (ADHD) Subtypes, Co-Occurring Psychiatric Symptoms and Sexual Risk Behaviors among Adolescents Receiving Substance Abuse Treatment. Subst. Use Misuse 2020, 55, 119–132.
  46. Selinus, E.N.; Molero, Y.; Lichtenstein, P.; Anckarsäter, H.; Lundström, S.; Bottai, M.; Hellner Gumpert, C. Subthreshold and threshold attention deficit hyperactivity disorder symptoms in childhood: Psychosocial outcomes in adolescence in boys and girls. Acta Psychiatr. Scand. 2016, 134, 533–545.
  47. Madsen, A.G.; Dalsgaard, S. Prevalence of smoking, alcohol and substance use among adolescents with attention-deficit/hyperactivity disorder in Denmark compared with the general population. Nord. J. Psychiatry 2013, 68, 53–59.
  48. Steinhausen, H.C.; Bisgaard, C. Substance use disorders in association with attention-deficit/hyperactivity disorder, co-morbid mental disorders, and medication in a nationwide sample. Eur. Neuropsychopharmacol. 2014, 24, 232–241.
  49. Molina, B.S.; Hinshaw, S.P.; Arnold, L.E.; Swanson, J.M.; Pelham, J.W.E.; Hechtman, L.; Hoza, B.; Epstein, J.N.; Wigal, T.; Abikoff, H.B.; et al. Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication. J. Am. Acad. Child Adolesc. Psychiatry 2013, 52, 250–263.
  50. Quinn, P.D.; Chang, Z.; Hur, K.; Gibbons, R.D.; Lahey, B.B.; Rickert, M.E.; Sjölander, A.; Lichtenstein, P.; Larsson, H.; D’Onofrio, B.M. ADHD Medication and Substance-Related Problems. Am. J. Psychiatry 2017, 174, 877–885.
  51. Byrd, H.C.M.; Curtin, C.; Anderson, S.E. Attention-Deficit/Hyperactivity Disorder and obesity in US males and females, age 8–15 years: National Health and Nutrition Examination Survey 2001–2004. Pediatr. Obes. 2013, 8, 445–453.
  52. Kessler, R.C.; Adler, L.A.; Berglund, P.; Green, J.G.; McLaughlin, K.A.; Fayyad, J.; Russo, L.J.; Sampson, N.A.; Shahly, V.; Zaslavsky, A.M. The effects of temporally secondary co-morbid mental disorders on the associations of DSM-IV ADHD with adverse outcomes in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Psychol. Med. 2014, 44, 1779–1792.
  53. Pineda, D.; Ardila, A.; Rosselli, M.; Arias, B.E.; Henao, G.C.; Gomez, L.F.; Mejia, S.E.; Miranda, M.L. Prevalence of attention-deficit/hyperactivity disorder symptoms in 4- to 17-year-old children in the general population. J. Abnorm. Child Psychol. 1999, 27, 455–462.
  54. Barbaresi, W.J.; Katusic, S.K.; Colligan, R.C.; Weaver, A.L.; Leibson, C.L.; Jacobsen, S.J. Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: Results from a population-based study. J. Dev. Behav. Pediatr. 2006, 27, e0147601.
  55. Huss, M.; Hölling, H.; Kurth, B.M.; Schlack, R. How often are German children and adolescents diagnosed with ADHD? Prevalence based on the judgment of health care professionals: Results of the German health and examination survey (KiGGS). Eur. Child Adolesc. Psychiatry 2008, 1, 52–58.
  56. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed.; Tex Reviewed; American Psychiatric Association: Washington, DC, USA, 2000.
  57. Byun, H.; Yang, J.; Lee, M.; Jang, W.; Yang, J.; Kim, J.; Hong, S.D.; Joung, Y.S.; Yang, J.-W. Psychiatric comorbidity in Korean children and adolescents with attention-deficit hyperactivity disorder: Psychopathology according to subtype. Yonsei Med. J. 2006, 47, 113–121.
  58. Gaub, M.; Carlson, C.L. Gender differences in ADHD: A meta-analysis and critical review. J. Am. Acad. Child Adolesc. Psychiatry 1997, 36, 1036–1045.
  59. Nøvik, T.S.; Hervase, A.; Ralston, S.J.; Dalsgaard, S.; Pereira, R.R.; Lorenzo, M.J. Influence of gender on attention-deficit/hyperactivity disorder in Europe—ADORE. Eur. Child Adolesc. Psychiatry 2006, 15, 15–24.
  60. Yang, P.; Jong, Y.J.; Chung, L.C.; Chen, C.S. Gender differences in a clinic referred sample of Taiwanese attention-deficit/hyperactivity disorder children. Psychiatry Clin. Neurosci. 2004, 58, 619–623.
  61. Lau, T.W.I.; Lim, C.G.; Acharryya, S.; Lim-Ashworth, N.; Tan, Y.R.; Fung, S.S.D. Gender differences in externalizing and internalizing problems in Singaporean children and adolescents with attention-deficit/hyperactivity disorder. Child Adolesc. Psychiatry Ment. Health 2021, 15, 3.
  62. Vingilis, E.; Erickson, P.G.; Toplak, M.E.; Kolla, N.J.; Mann, R.E.; Seeley, J.; vander Maas, M.; Daigle, D.S. Attention Deficit Hyperactivity Disorder Symptoms, Comorbidities, Substance Use, and Social Outcomes among Men and Women in a Canadian Sample. Biomed. Res. Int. 2015, 2015, 982072.
  63. Dalsgaard, S.; Thorsteinsson, E.; Trabjerg, B.B.; Schullehner, J.; Plana-Ripoll Brikell, I.; Pedersen, C.B. Incidence rates and cumulative incidences of the full spectrum of diagnosed mental disorders in childhood and adolescence. JAMA Psychiatry 2019, 77, 155–164.
  64. Loyer Carbonneau, M.; Demers, M.; Bigras, M.; Guay, M.C. Meta-Analysis of Sex Differences in ADHD Symptoms and Associated Cognitive Deficits. J. Atten. Disord. 2021, 25, 1640–1656.
  65. Staller, J.; Faraone, S.V. Attention-deficit hyperactivity disorder in girls: Epidemiology and management. CNS Drugs 2006, 20, 107–123.
  66. Dalsgaard, S.; Østergaard, S.D.; Leckman, J.F.; Mortensen, P.B.; Pedersen, M.G. Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: A nationwide cohort study. Lancet 2015, 385, 2190–2196.
  67. Mahone, E.M. Why fewer females than males are diagnosed with attention-deficit-hyperactivity disorder: It might not be hormones. Dev. Med. Child Neurol. 2010, 52, 790–791.
  68. Nussbaum, N.L. ADHD and female specific concerns: A review of the literature and clinical implications. J. Attent. Disord. 2012, 16, 87–100.
  69. Roberts, W.; Milich, R.; Barkley, R.A. Primary symptoms, diagnostic criteria, subtyping, and prevalence of ADHD. In Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment; Barkley, R.A., Ed.; Guilford Press: New York, NY, USA, 2014; pp. 51–80.
  70. Gökçe, S.; Yusufoğlu, C.; Akin, E.; Ayaz, M. Effect of gender differences on impulsivity in adolescents with attention-deficit/hyperactivity disorder. Anadolu Psikiyatr. Derg. 2017, 18, 379–386.
  71. Rucklidge, J.J. Gender differences in neuropsychological functioning of New Zealand adolescents with and without attention deficit hyperactivity disorder. Int. J. Disabil. Dev. Educ. 2006, 53, 47–66.
  72. Rucklidge, J.J.; Tannock, R. Psychiatric, psychosocial, and cognitive functioning of female adolescents with ADHD. J. Am. Acad. Child Adolesc. Psychiatry 2001, 40, 530–540.
  73. Hasson, R.; Fine, J.G. Gender differences among children with ADHD on continuous performance tests: A meta-analytic review. J Atten. Disord. 2012, 16, 190–198.
  74. Rucklidge, J.J. Gender differences in attention-deficit/hyperactivity disorder. Psychiatr. Clin. N. Am. 2010, 33, 357–373.
  75. Seidman, L.J.; Biederman, J.; Monuteaux, M.C.; Valera, E.; Doyle, A.E.; Faraone, S.V. Impact 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? Dev. Neuropsychol. 2005, 27, 79–105.
  76. Biederman, J.; Petty, C.R.; Doyle, A.E.; Spencer, T.; Henderson, C.S.; Marion, B.; Fried, R.; Faraone, S.V. Stability of executive function deficits in girls with ADHD: A prospective longitudinal follow-up study into adolescence. Dev. Neuropsychol. 2008, 33, 44–61.
  77. Becker, S.P.; McBurnett, K.; Hinshaw, S.P.; Pfiffner, L.J. Negative social preference in relation to internalizing symptoms among children with ADHD predominantly inattentive type: Girls fare worse than boys. J. Clin. Child Adolesc. Psychol. 2013, 42, 784–795.
  78. DuPaul, G.J.; Gormley, M.; Laracy, S.D. Comorbidity of LD and ADHD: Implications of DSM-5 for assessment and treatment. J. Learn Disabil. 2013, 46, 43–51.
  79. Eme, R. Male adolescent substance use disorder and attention-deficit hyperactivity disorder: A review of the literature. ISRN Addict. 2012, 2013, 815096.
  80. Breslau, J.; Miller, E.; Joanie Chung, W.J.; Schweitzer, J.B. Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time. J. Psychiatr. Res. 2011, 45, 295–301.
More
© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license; additional terms may apply. By using this site, you agree to the Terms and Conditions and Privacy Policy.
This entry is offline, you can click here to edit this entry!
Video Production Service
Feedback