Primary Care Companion J Clin Psychiatry 2002;4(4):164-168
© Copyright 2014 Physicians Postgraduate Press, Inc.
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The effect of gender in mediating the association between
environmental adversity and risk of attention-deficit hyperactivity
disorder (ADHD) and associated impairments was
examined in this study. Method:
280 probands with ADHD and
242 healthy comparison probands of both sexes aged 6 to 17
years were studied. The association between Rutter’s indicators
of adversity (e.g., family conflict, social class, family size, maternal
psychopathology, and paternal criminality) and ADHD,
comorbidity, and functioning was tested. Results:
In both genders,
higher levels of environmental adversity were associated
with a greater risk for ADHD and other comorbidity in a dosedependent
manner (i.e., the risk for ADHD increased as the
number of risk factors increased). Gender did, however, modify
learning disability and global functioning, as more detrimental
effects were observed in boys than in girls. Low social class,
maternal psychopathology, and family conflict were significantly
associated with functional impairment and psychopathology
in the probands, with control for maternal smoking during
pregnancy, proband ADHD status, parental ADHD, and gender.
Risk for ADHD and associated morbidity was increased
by psychosocial adversity in general and by low social
class, maternal psychopathology, and family conflict in particular
independent of gender and other risk factors. However, gender
did modify the risk for adverse cognitive and interpersonal
outcomes in that boys were more vulnerable to ADHD than
girls. Separating the effects of genetics from those of the environment
is difficult; thus, these results must be seen as provisional
until they are confirmed by twin and adoption studies.