------------------------------------------------------------------- This mailing is being sent to over 15,700 parents and professionals interested in keeping up with new research on ADHD. If you are no longer wish to receive this information, just mailto:[EMAIL PROTECTED] and type unsubscribe preview in the body of your message. For information on becoming a regular subscriber to ADHD RESEARCH UPDATE, please visit https://www.helpforadd.com/subscribe.htm. SPECIAL OFFER Subscribe during May and save 25% off the regular price. You'll receive 12 new issues for only $14.95. Are you a health care professional? I have started a second list to better meet your needs. To switch to this new list, just mailto:[EMAIL PROTECTED] and I will make the change. ------------------------------------------------------------------ Greetings: Below is an article that appeared in a prior issue of ADHD RESEARCH UPDATE. The article summarizes an important study on ADHD in girls. As you may be aware, much of the research on ADHD has focused on boys, so studies like this are quite important and long overdue. If you have been finding the information you have been receiving about new research on ADHD to be helpful, I'd like to encourage you to become a regular subscriber to ADHD RESEARCH UPDATE. This is a great time to subscribe as I'm running a special 25% savings offer through the end of May. You can find information about subscribing at: https://www.helpforadd.com/subscribe.htm and at the end of the article below. Please feel free to forward this article to others you know who may be interested in it. Sincerely, David Rabiner, Ph.D. Duke University ================================================================== * ADHD IN GIRLS One of the important shortcomings of most of the research based information on ADHD is that the vast majority of studies have been conducted solely on boys, or, have included very few girls in the sample. As a result, the scientific literature on ADHD is almost exclusively based on male subjects. Recently, a study funded by the National Institute of Mental Health on a large group of girls both with and without ADHD was published in the Journal of the American Academy of Child and Adolescent Psychiatry (Biederman, J. et al., (1999). Clinical correlates of ADHD in females: Findings from a large group of girls ascertained from pediatric and psychiatric referral sources. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 966-975. In this study, the authors examined the clinical correlates of ADHD in girls so that similarities and differences with what has been found among boys with ADHD could be ascertained. This study represents the largest and most comprehensive study of girls with ADHD that has been published to date. Participants in this study were girls between the ages of 6 and 18. There were 140 girls who had been diagnosed with ADHD based on structured psychiatric interviews conducted with the child's parent(s). In addition, 122 girls of similar ages and other backgrounds who did not have ADHD were included as comparison subjects. These two groups of girls were compared on a wide variety of characteristics so that the researchers could learn about the problems associated with ADHD in females specifically. The major findings are summarized below. * Among the girls who were diagnosed with ADHD, 59% had the combined type (i.e. both inattentive and hyperactive/impulsive symptoms), 27% had the Predominantly Inattentive type, and only 7% had the Predominantly Hyperactive/Impulsive type. Overall, a significantly greater proportion of symptoms of inattention were present according to parents relative to either hyperactive/impulsive symptoms. * Girls with ADHD were significantly more likely to be diagnosed with other disorders as well. Compared to girls without ADHD, girls with ADHD were more likely to be diagnosed with co-morbid conduct disorder, oppositional defiant disorder, mood disorders, anxiety disorders, and substance use disorders. Tic disorders and enuresis (i.e. bed wetting or day-time wetting) were also more common in the girls with ADHD. Overall, 45% of the girls with ADHD were diagnosed with at least one other condition. Only 4% of the girls with ADHD had more than 2 co-morbid disorders, however. Although the rate of co-morbid behavior disorders in girls with ADHD was high, it was still no more than half of the rate that has been previously reported for boys. Because disruptive behavior disorders are one of the main reason that children get identified and referred for treatment, the authors speculate that the lower incidence of these problems in girls with ADHD may partially explain the marked gender differences that are often found in children with ADHD who are receiving clinical treatment. The rate of mood and anxiety disorders in girls with ADHD was quite similar to what has been previously found in boys. Contrary to what some have suggested, there was thus no evidence in this sample of children that girls with ADHD are more likely than boys to have problems in these areas. There was, however, an indication that problems with substance use were more common among girls with ADHD than has been previously found to be true for boys. For example, girls with ADHD were about 4 times as likely to be smokers. * Cognitive, school, and family functioning Girls with ADHD had scores on measures of intellectual functioning and academic achievement that were modestly lower than what was found in the non-ADHD girls. They were also about 2.5 more likely to be diagnosed with a learning disability, more than 16 times more likely to have repeated a grade in school, and almost 10 times as likely to have been placed in a special class at school. It is perplexing why girls with ADHD were so much more likely to have repeated a grade given that the difference in the academic achievement test scores were, although lower, not so dramatically different from other girls. I think this may reflect that fact that achievement testing - which is done on an individual basis - tends to reflect the highest level of work that children are capable of. In many instances, this is quite a bit higher than the level that a child with ADHD actually performs at on a day to day basis. So, these data may reflect the debilitating effect that ADHD has on a child's typical school performance, which can result in grade retention and special class placement even for children who are quite bright and capable. The parents of girls with ADHD also described their family life as less cohesive and reported greater amounts of conflict with their daughters. CLINICAL IMPLICATIONS The results of this study make clear that ADHD in girls is as serious a condition and has a comparably large negative impact on children's functioning and adjustment as it does in boys. Overall, the correlates of ADHD in girls were remarkably similar to what is known to be true for boys. Among the few differences found were that girls were less likely to be diagnosed with a co-morbid behavior disorder than boys (i.e. oppositional defiant disorder or conduct disorder) and perhaps more likely to have problems related to substance use. Rates of mood and anxiety disorders, and impairment in academic functioning appeared to be quite comparable. The lower rates of disruptive behavior problems, along with the preponderance of inattentive symptoms relative to hyperactive/ impulsive symptoms, may partially explain why ADHD in girls may often not be recognized. Because rates of mood and anxiety disorders were similar to what has been found in boys, the authors speculate that in conjunction with the lower levels of disruptive behavior and hyperactive/impulsive symptoms, this may lead clinicians to diagnose girls with the former types of disorders rather than ADHD. As you may recall from a study recently reviewed in ADHD RESEARCH UPDATE, pediatricians were significantly more likely to diagnose boys with ADHD than girls, even when the problems described by parents were quite comparable. The authors stress that clinicians need to be aware that, despite their lower rates of disruptive disorders, ADHD in girls is a serious condition associated with impairment in multiple areas of children's functioning. Thus, there is no reason to assume that the treatment of girls with ADHD should be any less aggressive or comprehensive than that of boys. Parents need to be aware that their daughter with ADHD is at significantly increased risk for a variety of other conditions as discussed above. In fact, in this study, almost 50% of girls with ADHD had at least one other diagnosable disorder. It is thus essential that as is true for boys, evaluation of girls for ADHD take a broad look at their emotional, behavioral, social, and academic functioning so that a comprehensive treatment plan addressing all areas of important difficulty can be developed and implemented. Too often, in my opinion, even if ADHD in females is identified, necessary attention to areas of difficulty apart from core ADHD symptoms may not be targeted in a child's treatment, or may not be addressed in the most helpful way. In particular, given the indication of possible increased risk of substance use in girls with ADHD, this may be an area that is especially important for parents to monitor. There are several limitations to this study that the authors acknowledge. First, the girls with ADHD were referred from both psychiatric and pediatric facilities/practitioners, and the degree to which they are representative of girls with ADHD in the general community can not be determined with any certainty. Thus, it is quite possible that the girls in this study were more impaired than would be girls with ADHD from the general population. In addition, it is clear that research on treatment specifically in girls with ADHD is sorely needed. Currently, most of the data on both medical and non-medical treatment of ADHD is also based predominantly on boys. To my knowledge, there is currently no clear indication of any known differential effect for various treatments that is specifically related to gender, but this may be partially because the studies that are required to carefully look at this issue have not really been done. As such studies are published, I will certainly be sure to include them in the newsletter. ______________________________________________________________________ "ADHD RESEARCH UPDATE WILL PROVIDE YOU WITH CONVENIENT, RELIABLE ACCESS TO THE LATEST RESEARCH BASED KNOWLEDGE FOR UNDERSTANDING AND HELPING CHILDREN WITH ADHD." (You can subscribe at https://www.helpforadd.com/subscribe.htm or review the benefits of subscribing outlined below. Take advantage of 25% savings by subscribing during May!) Dear Parent: I hope you enjoyed the article presented above. It is an example of the comprehensive and objective summaries of research on ADHD that you will receive by subscribing to ADHD RESEARCH UPDATE. By becoming a subscriber, however, the amount of information on important new studies that you receive will be far greater. "IF YOU CAN SPARE ABOUT AN HOUR A MONTH, ADHD RESEARCH UPDATE IS GUARANTEED TO MAKE AN IMPORTANT DIFFERENCE FOR YOU AND YOUR CHILD." By spending about 45-60 minutes each month reading the newsletter, you will gain access to information that can make an important difference for you and your child. The studies I review are published in the world's leading medical and psychology journals that are typically only available in university and medical school libraries. What you can expect from subscribing is to gain substantial knowledge about promoting your child's healthy development that you can put to immediate and meaningful use. You will not find this comprehensive discussion of new research information on ADHD anywhere else on the internet. "WHY NOT HAVE THE BENEFIT OF THE LATEST RESEARCH INFORMATION FOR UNDERSTANDING ADHD AND HELPING CHILDREN WITH ADHD TO SUCCEED?" The cost of a one year subscription - which will bring you 12 new issues is regularly $19.95 and your satisfaction is fully guaranteed. During May, however, you can sign up for a one year subscription for only $14.95. You can find complete details on subscribing at: https://www.helpforadd.com/subscribe.htm The more you know about ADHD the more confident and effective you can be in promoting your child's healthy development. By subscribing, you will be assuring yourself of receiving the knowledge and information you need to assist you in this important task. Sincerely, David Rabiner, Ph.D. Licensed Psychologist Duke University ----------------------------------------- To unsubscribe send an email to: [EMAIL PROTECTED] with UNSUBSCRIBE PREVIEW in the BODY of the message.
