Why More Boys Than Girls With ADHD Receive Treatment: A Study of Dutch Twins
Open accessAbstract
More boys than girls with attention deficit hyperactivity disorder (ADHD) receive treatment. One explanation for this bias may be that boys score higher on disruptive behavior scales than girls. Although this was supported by findings in clinical samples, recent studies in nonreferred samples showed that boys and girls with ADHD are similar with respect to their levels of disruptive behavior as reported by their mother. In this report, we investigate whether the difference in treatment rate is associated with higher teacher problem scores in boys with ADHD than in girls with ADHD. Data were obtained from mothers and teachers in a nonreferred sample of 283 boys and 291 girls with and without ADHD. Children were selected when they scored either low (controls) or high (probands) on attention problems. Mothers completed DSM-IV interviews, Child Behavior Checklists (CBCL) and the Conners Rating Scale (CRS). Teachers filled in the Teacher Report Form (TRF), and the CRS. Boys and girls with ADHD had similar levels of psychiatric illness and school impairment (such as being held back, special class placement and learning problems) by mother report. Mothers reported similar levels of aggression and attention problems in boys and girls with ADHD. In contrast, teachers consistently rated boys with ADHD as having higher scores on reports of attention problems and aggression than girls with ADHD. Gender differences vary across settings: boys and girls with ADHD are rated as behaving differently at school, but not at home. The higher level of teacher reported problem behavior at school may explain the high male–female ratio for ADHD in clinical settings. These findings have implications for the results of genetic studies that rely on referred samples, as these studies may give a distorted view of sex differences in the population.
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Previously reported higher male-to-female ADHD ratios may have been a function of referral or treatment bias, as a higher proportion of boys than girls with ADHD receive treatment.
“This finding suggests that previously reported higher ratios may have been a function of referral or treatment bias, as it is known that a higher proportion of boys than girls with ADHD receive treatment”
From The descriptive epidemiology of DSM-IV adult ADHD in the world health organization world mental health surveys (2017) · cites this paper as Derks et al. 2007
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Sex Differences in Comorbidity Patterns of Attention-Deficit/Hyperactivity Disorder
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- Authors
- Derks, E. M., Hudziak, J. J., & Boomsma, D. I.
- Affiliations
- Vrije Universiteit Amsterdam (NL)
- University of Vermont (US)
- Corresponding author
- Derks, Eske M.
- Venue
- Twin Research and Human Genetics
- Publisher
- Cambridge University Press (CUP)
- Published
- 2007-10-01
- Volume
- 10
- Issue
- 5
- Pages
- 765-770
- ISSN
- 1832-4274 (ISSN-L)
- 1839-2628
- OpenAlex
- W2031008482
- Cited by
- 79
- References
- 4
- Citations by year
- 2026: 8 · 2025: 3 · 2024: 1 · 2023: 5 · 2022: 2 · 2021: 5 · 2020: 2 · 2019: 3 · 2018: 3 · 2017: 2 · 2016: 4 · 2015: 3 · 2014: 8 · 2013: 3 · 2012: 4
- FWCI
- 2.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Twin Research and Human Genetics (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- attention deficit hyperactivity disorder, sex differences, treatment seeking, gender bias in diagnosis, teacher ratings, disruptive behavior, aggression
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Diseases in Twins, Female, Humans, Male, Netherlands, Prejudice, Comorbidity, Sex Distribution
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