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Children with Attention-Deficit/Hyperactivity Disorder:
Are There Gender Differences in School Functioning?
George DuPaul, Asha Jitendra, Katy Tresco, Rosemary Vile Junod
Given that
more boys and than girls are identified with Attention-Deficit/Hyperactivity
Disorder (ADHD), the vast majority of participants in research studies of this
population have been male. Until recently, we knew very little about
the nature of this disorder in girls, especially in relation to how ADHD impacted
school functioning. Thus, the purpose of this study was to identify possible
gender differences in school functioning in a large sample of elementary school-aged
children meeting research diagnostic criteria for ADHD and reported by their
teachers to be underachieving academically. This study targeted 1st through
4th grade children because this is the age range when ADHD symptoms and academic
difficulties typically are first noted.
A sample
of 133 male and 42 female elementary school students who met research diagnostic
criteria for ADHD participated in this study. School functioning was
assessed using teacher ratings of behavior and academic competence, direct
observations of classroom behavior, and a standardized, norm-referenced achievement
test. Data were collected in the middle of the school year so that teachers
were familiar with student academic, behavioral, and social functioning.
In general, boys and girls with ADHD participating
in this study showed the same degree of impairment in school functioning. Specifically,
both genders were found to function below their same-sex peers (based on normative
data) in academic, behavioral, and social domains. Some relatively minor
differences between boys and girls were found, particularly with respect to
teacher perceptions of academic enablers and teacher report of emotional and
behavioral difficulties. Girls were rated by their teachers as higher in academic
motivation and study skills than boys. When raw scores on behavior ratings
were considered, teachers rated boys to exhibit more problems with inattention,
impulsivity, and hyperactivity than girls. However, when standard scores
were analyzed, girls were rated as more problematic in a number of areas including
ADHD symptoms, internalizing concerns, and disruptive behavior. These results
indicate that teachers perceive boys to exhibit more severe ADHD symptoms than
girls; however, girls with ADHD are perceived to be more deviant with respect
to inattention and other behavioral difficulties relative to other girls than
boys with ADHD are relative to other boys. This finding could be due, in part,
to differences in teacher expectations for child behavior as a function of
gender. Teachers’ views of ADHD-related behaviors may be affected
by sex role stereotypes wherein girls are not expected to display problems
with inattention, impulsivity, and/or overactivity and, thus, those girls who
exhibit such behaviors are perceived as very different from their same-sex
peers.
The results of this study have implications for the school-based assessment
of children with ADHD. First, it is evident that girls with ADHD suffer
from a similar degree of impairment as experienced by boys with ADHD. Clearly,
this disorder is not milder or less impairing in girls. Given that ADHD
symptoms in girls may go unrecognized, practitioners should not wait for teachers
to refer girls who might have this disorder, but rather should actively screen
for students who may require services for ADHD. Screening and early detection
may be critical for preventing or reducing impairment resulting from symptoms
of this disorder. Second, assessment instruments (e.g., behavior rating
scales) that have separate norms for each gender should be used as part of
the evaluation battery. Although girls may appear less impaired than
boys in an absolute sense, impairment may actually be more severe for girls
relative to same-sex peers. Thus, the use of gender-specific norms is particularly
critical when measuring the degree of impairment that students experience as
a result of ADHD. It is particularly critical to use standard scores within
gender in order to minimize the influence of sex role stereotypes and gender
expectations regarding ADHD-related behaviors on teacher ratings.
For a complete description of this article, the reader is referred to:
DuPaul, G. J., Jitendra, A. K., Tresco, K. E., & Vile Junod, R. E. (2006).
Children with
attention deficit hyperactivity disorder: Are there gender differences in school
functioning. School Psychology Review, 35, 292-308.