December 11, 2023

Sex Differences in ADHD Symptoms and Related Cognitive Deficits in Youths

To what extent does sex matter in the expression of ADHD symptoms and associated cognitive deficits among youths with ADHD?

A recently published meta-analysis of 54 studies by a Canadian team of researchers at the University of Quebec at Montreal suggests it makes little to no difference. A meta-analysis of 26 studies with over 5,900 youths found no significant difference in inattention symptoms, and a meta-analysis of 24 studies with over 5,500 youths likewise found no difference in hyperactivity-impulsivity symptoms. Separating out hyperactivity and impulsivity made no difference.

Given these results, it's no surprise that a meta-analysis of 15 studies with over 3,500 youths again found no significant divergence between the sexes for total ADHD symptoms. Parents and teachers differed, however, in their ratings of symptoms. Whereas parents observed no differences, teachers reported boys had slightly more inattention and hyperactive-impulsive behaviors than girls. Turning to cognitive functions, a series of meta-analyses found no significant sex differences for interference control, working memory, and planning scores. But boys performed slightly worse on inhibition and motor response inhibition. While the raw data also showed boys slightly under-performing girls on cognitive flexibility, strong evidence of publication bias made this unreliable.

The team also compared youths with ADHD and youths without ADHD. Both for females and for males, those differences in ADHD symptoms were - as would be expected - extremely large, whether for total symptoms, inattention, or hyperactivity-impulsivity. All cognitive function scores were moderately better for normally developing boys compared with boys with ADHD, and for normally developing girls compared with girls with ADHD. Yet once again, when comparing these effect sizes between girls and boys, there were no significant differences for any of the symptom and cognitive function effects.

"In other words," the authors wrote, "boys and girls with ADHD presented significantly more primary symptoms and executive and attention deficits than did their peers without ADHD, and effect sizes were not significantly different between the sexes." They concluded, "girls with ADHD do not differ from boys with ADHD in many domains of cognitive functioning, and they have significantly more severe difficulties across the executive and attentional functions measured relative to girls without ADHD. This meta-analysis is the first to examine sex differences in cognitive flexibility, working memory, and planning."

Maryanne LoyerCarbonneau, Martin Demers, Marc Bigras, and Marie-Claude Guay, "Meta-Analysis of Sex Differences in ADHD Symptoms and Associated Cognitive Deficits," Journal of Attention Disorders (2020), https://doi.org/10.1177/1087054720923736.

Related posts

No items found.

Patterns of Child and Adolescent Psychiatric Admissions During COVID-19: Key Insights from Clinical Data

A recent study from Istanbul sheds light on how psychiatric admissions and diagnoses changed during the first few months of the pandemic compared to previous periods, offering critical insights for parents, clinicians, and policymakers. 

This study, conducted by a team of researchers led by Ozalp Ekinci, examined psychiatric admissions among children and adolescents during 2019 and 2020. 

By looking at diagnosis rates for various psychiatric conditions, the researchers aimed to pinpoint shifts in the mental health landscape as a direct response to the pandemic.

Findings: A Closer Look at Diagnosis Patterns

The analysis revealed several notable trends in psychiatric diagnoses among children and adolescents:

  1. Autism Spectrum Disorder (ASD): ASD diagnoses were notably higher in the early pandemic phase (6.4% in Group A) compared to the same period in the previous year (3.6%). This increase could reflect heightened stress or changes in routines that may have exacerbated underlying symptoms, leading to more frequent clinical presentations.
  2. Obsessive-Compulsive Disorder (OCD) and Tic Disorders: OCD and tic disorder diagnoses also saw a rise, increasing from 1.7% in 2019 to 2.9% during the pandemic’s onset. It’s possible that pandemic-driven anxieties and hygiene concerns, as well as disruptions to typical routines, may have worsened symptoms in those predisposed to OCD and similar disorders.
  3. Intellectual Disability (ID): Diagnoses for ID rose from 2.1% (Group C) to 3.7% (Group A). This increase highlights the challenges faced by children with developmental and intellectual disabilities, who may have experienced heightened difficulty adapting to the many changes imposed by the pandemic.
  4. Attention-Deficit Hyperactivity Disorder (ADHD): ADHD diagnoses were significantly higher in the pandemic phase (59.8% for Group A vs. 49.7% for Group B). With altered school structures, remote learning, and restricted socialization, ADHD symptoms could have been amplified, making it harder for children to concentrate and adhere to routines.
  5. Depression: Depression diagnoses also saw a rise (4.1% in Group A vs. 2.2% in Group C). Isolation, disruption of daily activities, and reduced social interactions likely contributed to increased depressive symptoms, particularly in adolescents who rely heavily on peer support.
  6. Conduct Disorder (CD): Interestingly, CD diagnoses were lower during the pandemic phase compared to pre-pandemic levels (3.6% in Group A vs. 6.4% in Group B). The reduction in face-to-face interactions and less exposure to traditional school settings may have lessened some of the typical triggers associated with conduct-related issues.
Implications

This study’s findings highlight some key takeaways that can guide mental health support efforts for children and adolescents:

  1. Increased Need for Early Support in Neurodevelopmental Disorders: The rise in ASD and ADHD diagnoses points to the need for specialized support in times of crisis, particularly for children who depend on routine and structure. Families and educators should work to create consistent environments that help manage symptoms.
  2. Addressing Pandemic-Induced Anxiety: With heightened cases of OCD and tic disorders, it’s clear that the pandemic’s emphasis on cleanliness and health may have intensified anxiety-driven behaviors. Future mental health responses should include strategies to manage health-related fears and equip children with coping skills.
  3. Supporting Emotional Resilience in Adolescents: Depression was notably higher among young people during the pandemic onset, suggesting a critical need for access to counseling and peer support, especially in times of isolation. Developing robust virtual mental health resources and promoting mental well-being in schools can help support children and adolescents both in and out of school.
  4. Recognizing the Complexity of Behavioral Changes: The drop in conduct disorder diagnoses during the pandemic suggests a link between behavioral disorders and social settings. Understanding these dynamics could lead to more tailored interventions that account for environmental factors impacting behavior.
Conclusion: 

As we continue to see the effects of the COVID-19 pandemic on mental health, studies like this one serve as important reminders of the unique mental health needs of young people. Supporting children and adolescents through proactive and targeted mental health services—especially during times of crisis—will be crucial to fostering resilience and well-being in future generations.

November 19, 2024

New Global Estimate of Adult ADHD Prevalence: A Comprehensive Review

Adult ADHD has long been a subject of debate in the field of mental health, with previous estimates of its prevalence varying widely. To achieve a more precise understanding, an international team of researchers conducted a new umbrella review and meta-analysis, offering an updated estimate of adult ADHD rates worldwide.

A Comprehensive Approach: Reviewing 57 Studies

This large-scale analysis combined five systematic reviews and meta-analyses, incorporating data from 57 unique primary studies. Altogether, the research synthesized findings from a pooled total of over 21 million participants. This comprehensive approach provided a more accurate estimate of the global prevalence of ADHD in adults.

Key Findings: 3.1% Global Prevalence

The study concluded that the worldwide prevalence of adult ADHD is 3.1%, with a 95% confidence interval ranging from 2.6% to 3.6%. This estimate falls within the range of earlier reports but provides a more targeted understanding of the rate at which ADHD affects adults globally.

Putting the Numbers in Context

The researchers described this prevalence rate as “relatively high.” They noted that it is only slightly lower than the estimated prevalence of major mental health conditions like schizophrenia (4%) and major depressive disorder (5%)—disorders that have historically received significant attention and resources worldwide.

Moreover, the prevalence of adult ADHD is higher than that of several other well-known mental health conditions, including bipolar disorder (1%), as well as anxiety disorders such as PTSD (Post-Traumatic Stress Disorder), OCD (Obsessive-Compulsive Disorder), GAD (Generalized Anxiety Disorder), and panic disorders.

Implications for Awareness and Treatment

This updated estimate emphasizes that ADHD is a significant global mental health concern in adults, comparable to or exceeding the prevalence of other disorders that are often more widely recognized. These findings underscore the need for greater awareness, research, and treatment options for adult ADHD, which is still frequently misunderstood or overlooked in the broader discourse of mental health.

Conclusion

By providing a clearer picture of how prevalent ADHD is in adult populations around the world, this study contributes valuable data that could shape future research, policy, and clinical approaches.

November 8, 2024

Updated Analysis of ADHD Prevalence in the United States: 2018-2021

Attention-Deficit/Hyperactivity Disorder (ADHD) remains a prevalent condition among children and adolescents in the United States. A recent analysis based on the National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics at the CDC, provides an updated look at ADHD prevalence from 2018 to 2021. Here’s a closer look at what the data reveals.

How the Survey Works

The NHIS is an annual survey primarily conducted through face-to-face interviews in respondents’ homes. Telephone interviews are used as a substitute in cases where travel is impractical. For each family interviewed, one child aged 3-17 is randomly selected for the survey through a computer program. Over the four years studied (2018-2021), a total of 26,422 households with children or adolescents participated.

Overall ADHD Prevalence and Age-Related Trends

The analysis found that 9.5% of children and adolescents in the United States had been diagnosed with ADHD, based on reports from family members. However, the prevalence varied significantly with age:

  • Ages 3-5: 1.5%
  • Ages 6-11: 9.6%
  • Ages 12-17: 13.4%

The increase in ADHD diagnosis with age underscores the importance of monitoring children’s developmental needs as they progress through school and adolescence.

Gender Differences: Higher Rates Among Males

The survey revealed a notable difference in ADHD prevalence between genders, with 12.4% of males diagnosed compared to 6.6% of females—nearly a two-to-one gap. This aligns with previous research indicating that ADHD is more frequently diagnosed in boys than girls, though awareness of how ADHD presents differently across genders is growing.

Family Income and ADHD Rates

Family income played a significant role in ADHD prevalence, particularly among lower-income groups:

  • Below the poverty line: 12.7%
  • Above the poverty line but less than twice that level: 10.3%
  • Above twice the poverty level: 8.5%

This pattern suggests that socioeconomic factors might influence the diagnosis and management of ADHD, with lower-income families possibly experiencing greater barriers to early diagnosis or consistent treatment.

Regional Differences Across the U.S.

Geographic location also impacted ADHD rates. Prevalence was highest in the South (11.3%), followed by the Midwest (10%), the Northeast (9.1%), and significantly lower in the West (6.9%). These variations could reflect regional differences in healthcare access, diagnostic practices, or cultural attitudes towards ADHD.

Stability Over Time

Despite these variations in demographics, the overall prevalence of ADHD remained relatively stable across the study period from 2018 to 2021, showing no significant changes by year.

What This Means for Families and Healthcare Providers

The findings from this updated analysis provide a clearer picture of ADHD’s prevalence across different demographic groups in the United States. They highlight the need for tailored approaches to diagnosis and care, taking into account factors like age, gender, income, and geographic location. With ADHD being a common condition affecting nearly 1 in 10 children, ongoing research and support for families are crucial to ensure that those with ADHD receive the care and resources they need.

Conclusion: 

This study reinforces the importance of awareness and early intervention, especially for families in underserved regions or those facing economic challenges. As clinicians and educators continue to support children with ADHD, understanding these demographic trends can help in creating more equitable access to diagnosis and treatment.

October 29, 2024