Girls with attention deficit disorder: a silent minority? A report on behavioral and cognitive characteristics

A sample of girls and boys with attention deficit disorder (ADD) were examined for within-group sex differences and compared with control boys and girls on historical, behavioral, and cognitive characteristics. Profiles of essential and secondary features of ADD support the Diagnostic and Statistical Manual of Mental Disorders nosology for ADD with and without hyperactivity as clinically distinct subtypes of ADD, with the girls and boys with ADD with hyperactivity exhibiting attentional, behavioral, and cognitive impairments, and the children with ADD without hyperactivity exhibiting deficits along an attentional/cognitive axis. Management problems and antisocial behaviors were correlates of hyperactivity, and increased impulsivity was not associated with attentional deficits in the absence of hyperactivity. Within the ADD with hyperactivity group, the girls demonstrated more severe cognitive impairments, particularly in the area of language function, were younger at the time referral for medical attention, and tended to come from families of lower socioeconomic status. Disruptive, uncontrolled behaviors were more frequent among the boys with ADD with hyperactivity. The girls with ADD without hyperactivity demonstrated poorer self-esteem and were significantly older than the boys with ADD without hyperactivity at referral. Girls in both ADD with and without hyperactivity groups were more likely to suffer peer rejection than their male counterparts. The results of this study suggest that girls with ADD may be underidentified and that cognitive deficits have a more prominent role in the identification of girls, whereas behavioral disturbances increase the likelihood of identification for boys.