Why does adhd affect boys more

Around 8. Doctors diagnose ADHD more commonly in boys than girls. In fact, around three times as many boys receive an ADHD diagnosis as girls. School-age children often receive a diagnosis when they become disruptive in the classroom. ADHD affects the way a person thinks, feels, and behaves. The condition can make it difficult to focus on tasks for extended periods of time or keep track of things such as homework assignments.

Boys with an ADHD diagnosis may be more restless, impulsive, and hyperactive than their peers. They may also have difficulty concentrating, find it hard to remain seated in school, or have learning delays. Keep reading to learn more about ADHD in boys and how it differs from the condition in girls. This article will also look at the treatment options available and how parents and caregivers can help manage the condition.

Doctors diagnose and treat ADHD more frequently in boys than in girls because the symptoms in boys can be more noticeable and distracting for others. Externalizing behaviors related to ADHD are generally more common in school-age boys than internalizing behaviors, which are more commonly present in girls.

Practitioners are, therefore, more likely to label classroom hyperactive behaviors as ADHD in boys. This is a sort of natural bias in diagnosis. In fact, the number of boys with an ADHD diagnosis compared with the number of girls is , and it may be as high as in some populations. Girls with ADHD typically have fewer hyperactive and impulsive symptoms and more inattentive symptoms.

Because of this, girls with ADHD, while distracted, are less disruptive. This is especially apparent during school hours, where ADHD is easier to notice. Some research also suggests that since ADHD is not as externally obvious in girls, they often go without an ADHD diagnosis despite having the condition. Adults and school-age peers may sometimes view girls with hyperactive-impulsive symptoms as overemotional, pushy, or overly talkative.

Girls may also work hard to hide their symptoms. Learn more about ADHD in girls here. Learn more about untreated ADHD in adults here. ADHD is one of the most common childhood neuropsychiatric conditions. All these behaviors are signs of ADHD. But people react to them in different ways, for lots of reasons. Teachers and families may be more accepting of or less likely to notice the signs girls often show. This helps explain why boys are three times more likely to be diagnosed with ADHD than girls are — and why boys tend to get diagnosed at younger ages than girls.

Girls are diagnosed with ADHD on average five years later than boys — boys at age 7 and girls at age There are also many girls who never get diagnosed. They are more likely to have experienced early physical or sexual abuse, and may manifest symptoms related to PTSD.

Any combination of these comorbid issues creates a complex diagnostic picture. Distracted from their own self-care, women with ADHD postpone checkups and procedures, and function with serious sleep deficits. Inconsistent eating patterns, shaped by inattention and impulsivity, can result in complications. Chronically stressed, they may depend on prescription medications to manage anxiety, mood disorders, sleep, or pain, or they may self-medicate with alcohol or drugs.

As women mature, they learn to appear less symptomatic, yet their suffering continues as their well-guarded secret. They may distance themselves from friends, and hide their despair from partners. Believing in their unworthiness, they may endure relationships involving emotional and physical abuse.

Such hopelessness, combined with impulsivity, contributes to significantly more self-harm compared to men. Even more concerning is their much greater likelihood of suicidal thoughts and attempts. Recent population studies suggest that women with ADHD are more likely to die earlier of unnatural causes, especially due to accidents.

These starkly elevated risk factors merit attention as a public health crisis. But these outcomes are avoidable. Healing begins with a safe connection to one person who becomes a lifeline to acceptance and support. It is critical that research explore why ADHD exacts a far greater toll on women.

Perhaps the perfect storm of internalized symptoms, hormonal fluctuations, and the pressure of societal expectations combine to create a context of stressors unique to females. Attributing their difficulties to their own character failures feeds the shame and demoralization that can undermine them. Because women with ADHD are more reactive than proactive, they gradually lose confidence in their own judgment since it often betrays them. Compared to men, women with ADHD perceive themselves as more impaired, and their experience of negative events as more painful.

They are more likely to blame themselves for their difficulties, and feel lucky if things turn out well. They are more likely to struggle with low self-esteem and shame. It appears that women with ADHD are more vulnerable to their perceived failures in self-regulation than men. But what if the experience of men is not considered the standard? We cannot direct the wind, but we can adjust our sails. Women with ADHD cannot change their brain wiring, but they can reframe their experiences through a different lens.

They can learn to embrace their unique strengths and aptitudes, celebrate the creativity of non-linear thinking, establish new priorities based on self-acceptance, and find ADHD-friendly environments in which they can thrive. Ideally, an ADHD diagnosis is the first step toward reversing their destructive belief system: It offers a neurological explanation for why things are so hard, and offers validation that allows them to own their successes.

To improve diagnostic accuracy, explore these evidence-based issues in your evaluations. Beware of gender bias:. Women with ADHD have been ignored for a long time even though it was and has been there. Gawd darn they treat m e like a criminal when I take meds. Well Nik79, what really do you expect? Is your anxiety based on real fear of something or would you consider it unexplained. If unexplained it may be hyperactivity. For me hyperactivity was everything I thought anxiety was. Hang in there.

To be honest and accurate you would have to say men are diagnosed more often than women. When hard studies are done with accurate diagnosis women have the same rate as men.

As per the norm women will have different display of symptoms and much more commonly have their concerns dismissed. Boys tend to have the classic symptoms that have been adopted as diagnosis criteria. There is no longer a diagnosis of just ADD because there is always a hyperactive component.

I cannot say for sure how girls and women would diagnose differently, but I can describe how ADHD affected me as testosterone normally drops with age. When gender differences were assessed in a sample of non-referred children Biederman et al. Girls also showed similar levels of cognitive, school, and family functioning.

The authors concluded that the clinical correlates of ADHD are not influenced by gender and that gender differences observed in clinical settings may be caused by referral biases. The vulnerability of these methods to clinicians and informant biases Rousseau et al.

Given the limited validity of subjective measures of ADHD, there has long been an interest in using objective, laboratory-based tools that could provide a norm-referenced measure of ADHD.

Some studies had shown girls to have fewer CPT errors, superior signal detection, and less inattention with longer interstimulus intervals Arnold, Other studies, however, failed to identify the gender difference in CPT performance Yang et al. A meta-analysis of gender differences in CPT among clinic-referred children indicated that consistent with rating scale studies Gaub and Carlson, ; Gershon, , boys with ADHD committed significantly more commission errors than girls with ADHD.

However, no gender differences were found in the rate of omission errors. These findings suggest that inhibitory control, but not attention deficit may be mediated by gender. Alternatively, the lack of gender differences in inattention may be attributed to methodological limitations of the included studies, mainly the inclusion of a low number of studies, which were based on predominantly male samples Hasson and Fine, The gender gap in clinical populations of children with ADHD continues to hinder the correct diagnosis and treatment of girls with the disorder Skogli et al.

Thus, understanding how gender influences ADHD manifestations may have important clinical, ethical, and public implications. Prior studies have shown that girls with ADHD are under-identified due to sex-specific biases and expectations Waschbusch and King, ; Meyer et al.

While these studies were able to identify gender differences on standardized rating scales, differences in gender performances on direct CPT measures have received less attention Hasson and Fine, The current study sought to assess gender differences in rating and objective measurements of ADHD as well as in co-occurring problems in a clinic-referred sample of children with ADHD. Based on a relatively balanced female-to-male ratio In addition, we examined gender differences in the level of distractibility and in time-on-task effects during CPT performance.

Although increased distractibility is considered one of the core symptoms of ADHD within the inattention domain American Psychiatric Association, , direct and systematic research on this deficit and how it is differently patterned in males and females is currently very limited. Furthermore, using different types of measures would increase our understanding of ADHD underdiagnosis in females and whether certain symptoms are more predictive of ADHD referral and diagnosis in males than in females or vice versa.

Israel has a socialized healthcare system in which all citizens are free to choose between four health maintenance organizations HMOs. Patient fees are equivalent across all four HMOs, and all HMOs provide equivalent medical services that are based on national health regulations. The diagnosis of ADHD in Israel is usually given by a psychiatrist or a neurologist and includes the use of the Diagnostic and Statistical Manual of Mental Disorders DSM criteria and a formal diagnostic questionnaire for parents and teachers Hezi, Participating children and their families were all of Jewish background, lived in rural and urban areas in Northern Israel, and had medium-high or high socioeconomic status, based on a social scale that divides geographic locations into different socioeconomic categories Israeli Central Bureau of Statistics, Inclusion criteria were children between 6—17 years, diagnosed with ADHD.

Exclusion criteria were an intellectual disability, chronic neurological levels e. The protocol for the research project conforms to the provisions of the Declaration of Helsinki, approved by the Institutional Review of Board of Maccabi health services. The Conners 3 is a multi-informant assessment of children between 6 and 18 years of age that takes into account home, social, and school settings and is considered to be a reliable instrument for detecting ADHD problems in children aged 6—18 years.

However, as detailed below, it differs from other CPTs in its ability to differentiate between different types of disinhibited responses and between problems in RT and inattention. Importantly, the test incorporates external interfering stimuli auditory and visual serving as measurable distractors, a feature that is unique to the MOXO-CPT. The test included eight levels stages ; each consisted of 53 trials 33 target and 20 non-target stimuli and lasted The total duration of the test was On each trial, a stimulus target or non-target was presented in the middle of the screen for 0.

Each stimulus remained on the screen for the full presentation time, regardless of whether a response was provided or not. This practice allows the measuring of RT as well as its accuracy.

The child was instructed to respond to the target stimulus as quickly as possible by pressing the space bar once and only once. In addition, the child was instructed not to respond to any other stimuli but the target, and not to press any other key but the space bar.

Target and non-target stimuli were cartoon pictures. Given that ADHD often co-occurs with specific learning disabilities that may be confounded with CPT performance, all stimuli were free of letters or numbers Seidman et al. Non-target stimuli included five different images of animals. Overall, six different distractors were presented, each of them could appear as pure visual e. Distractor presentation time varied between 3. There were six various visual distractors: a bowling ball presented for 3.

Auditory distractors included the six corresponding sounds of the visual distractors. The test included eight levels, each included different distractors set: Levels 1 and 8 did not include any distractors.

Levels 2 and 3 included pure visual stimuli, levels 4 and 5 included pure auditory stimuli, and levels 6 and 7 included a combination of visual and auditory stimuli. During levels 2, 4, and 6, only one distractor was presented at a time. During levels 3, 5 and 7, two distractors were presented simultaneously.

The number of omission errors were also calculated i. The score in the Attention index was calculated as the average of correct responses throughout the eight test levels. This index excluded responses that were performed during the void period after the stimulus has disappeared. This method allowed the test to differentiate between the overall rate of correct responses measured by the Attention index and the rate of correct responses that were given only on the right timing measured by the Timing index.

These two aspects of RT correspond to two different deficits typical to ADHD: difficulty to provide an accurate response and difficulty to respond on time National Institute of Mental Health, The score in this index was calculated as the average of correct responses while the target stimulus was still presented on the screen throughout the eight test levels.

Other types of non-inhibited responses e. Score in this index was calculated as the average of impulsive responses throughout the eight test levels. Differentiating between commission errors that were conducted due to impulsive behavior and commission errors that were conducted due to motor hyper-responsivity allowed the identification of multiple sources of response disinhibition.

The score in this index was calculated as the average of hyperactive responses in the eight test levels. Second, eight different distractors were used instead of six. Third, all distractors were presented for 8 s, with a fixed interval of 0. Finally, each level consisted of 59 trials 34 targets and 25 non-targets and lasted These effects may provide evidence that gender differences in ADHD symptoms vary as a function of symptom type, informant role or both.

Gender differences in the agreement rates between teacher and parents rating of ADHD-related symptoms were examined with chi-square tests. In addition, we examined gender effects on the difference between the first and the last test levels for each CPT index in order to explore whether boys and girls are differently affected by time on the task.

Finally, to examine gender differences in distractibility levels during CPT performance, we first calculated the difference between the mean score in the no-distractor level base-line and the mean score in each distractor type pure visual, pure auditory, and a combination of visual and auditory distractors.

This calculation was conducted separately for each CPT index. The outcome of this calculation is considered a measure of the distractibility level. Distractor type visual, auditory, or combined and distractibility load low or high distractibility was the within-subject factors, and gender was the between-subject factor.

Such interactions would provide evidence for differential patterns of sensitivity to environmental distractors between boys and girls. All multivariate analyses were followed by posthoc analyses with Bonferroni correction for multiple comparisons.

Age served as a covariate variable. The results of the analyses are presented in Table 1. Because inattention and hyperactivity are included in the same subscale of the TRF, it was impossible to identify whether teachers perceived girls as more inattentive or more hyperactive than boys. Post hoc analysis of the interaction effect yielded a mean difference of 2. In order to examine whether gender differences exist in the agreement rates between teacher and parents rating of ADHD-related symptoms, we conducted a chi-square test.

The eight test levels served as the within-subject factor and gender as the between-subject factor. The results are shown in Table 2. Table 2. Gender differences in the four continuous performance test CPT performance indices. Similar patterns were identified in the Timing and Hyperactivity indices. The effect of the test level that was observed in all CPT indices reflects the variation between levels in the presence, type, or load of distractors.

These effects will be described in the next section. Finally, we wished to examine whether boys and girls were differently affected by time on the task. Therefore, we compared boys and girls on the difference between the first and the last level of every CPT index, using two-way repeated-measures ANOVA. For these analyses, test level first and last and CPT index Attention, Timing, Hyperactivity, and Impulsivity were the within-subject factors and gender was the between-subject factor.

For these analyses, distractor type visual, auditory, or combined and distractibility load low or high distractibility was the within-subject factors, and gender was the between-subject factor.

The results are shown in Table 3. Post hoc analysis of the effect of distractibility load did not reveal significant differences. To the best of our knowledge, this is the first study that focused on gender differences in distractibility in children with ADHD. Examination of gender differences in parent and teacher reports on ADHD-related symptoms, according to the Conners rating scales, showed that the level of inattention symptoms was higher among referred girls.

However, boys and girls were equally impaired in terms of impulsivity and hyperactivity. A similar pattern emerged in the TRF, where teachers reported more inattention problems for girls, but higher levels of depression, anxiety, and rule-breaking behaviors for boys.