Gender Differences in 2 Clinical Trials of Adults With Attention-Deficit/Hyperactivity Disorder: A Retrospective Data Analysis
J Clin Psychiatry 2008;69(2):213-221
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Introduction: Studies show that, in childhood
attention-deficit/hyperactivity disorder (ADHD), boys have the combined type
with externalizing behaviors more frequently, and girls have the inattentive
type with increased internalizing disorders more frequently.
Method: This study explored gender differences in adults with
ADHD in 2 large, placebo-controlled, multicenter studies conducted from 2000 to
2001. Information collected included 2 measures of ADHD, multiple psychological
measures, general physical symptoms, and treatment response.
Results: Thirty-four percent of the subjects were female.
Women were rated as more impaired on every measure of ADHD symptoms including
total Conners' Adult ADHD Rating Scale-Investigator Format (CAARS-INV), total
Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS), and most
subscales of both measures. More women (75%) had combined type compared with
men (62%). Women showed a more complex presentation, with higher scores on the
Hamilton Rating Scale for Anxiety (HAM-A) and the Hamilton Rating Scale for
Depression, 17-item version (HAM-D17), more sleep problems, and more
past DSM-IV Axis I diagnoses. Both sexes displayed substantial impairment on 3
Psychological General Well-Being Schedule factors: tension-anxiety, life
satisfaction, and vitality-drive. Women experienced significantly (p = .003)
greater rates of emotional dysregulation (37%) versus men (29%) as defined by a
cluster of symptoms on the WRAADDS. The emotional dysregulation factor is
derived by combining 3 symptoms--temper control, mood lability, and emotional
overreactivity--from the Utah Criteria for ADHD in adults. These symptoms are
considered associated symptoms in the DSM-IV description of ADHD. Women also
experienced greater improvement (p = .011) on this symptom factor.
Conclusion: In contrast to the results from childhood studies,
women were more impaired than men on ADHD scales in our study. The higher level
of emotional symptoms and more complicated presentation in women may obscure
the diagnosis of ADHD. Thus, the assessments of adults with ADHD should include
an exploration of the emotional dimensions of the illness.