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#21634
Gender and ADHD in Ugandan Children: Comparison of Symptoms, Factor Structure, Prevalence, and Executive Functioning
Matthew D. Burkey1, Sarah McIvor Murray2, Robert Opoka3, Michael Boivin4, Judith Bass2
1 Department of Psychiatry, Johns Hopkins University School of Medicine; 2 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health; 3 Department of Pediatrics, Makerere University Faculty of Medicine (Uganda);
4 Department of Psychiatry, Michigan State University School of Medicine
Introduction
Results
Conclusions
In a sample of rural Ugandan children at high risk for neurocognitive impairment tested with the ADHD-RS-IV, there were no gender differences in ADHD symptom rates, prevalence, factor structure, or correlation with measures of executive functioning.
Our results differ from previous studies [3,4] that showed differences in impulsivity and in the relationship between hyperactivity and cognitive function by gender
To the best of our knowledge, this is the first analysis of gender differences in ADHD in a low-income Sub-Saharan African country population to include detailed factor analysis and neurocognitive evaluation data.
Gender differences in ADHD symptom presentation are commonly observed [1,2] and may result in underidentification of girls with ADHD [3].
Child neurocognitive development is a salient public health issue in Africa given the large proportion of the population under age 18 and high rates of risk factors for cognitive delay and ADHD, including malnutrition, stunting, cerebral malaria, and HIV [4].
Few studies have systematically evaluated gender differences in ADHD in the Sub-Saharan African context.
178 children (54% female) were assessed for ADHD in 2013.
Eight girls (8.3%) and 4 boys (4.9%) met symptom criteria for any type of ADHD (t(176)=0.87, p=.38). There were no significant gender differences by ADHD subtype.
Symptom score distributions and factor structure did not differ between males and females.
Correlations between ADHD symptoms and measures of executive function, visual attention, and general cognitive ability were similar among males and females.
Objectives
Fig. 1 – Gender Differences in ADHD Prevalence & Types Using ADHD-Rating Scale-IV
*P-value for student’s t-test
To assess gender differences in symptomatology, factor structure, prevalence, and associations between ADHD symptoms and executive functioning measures.
Characteristic
Females
Mean (SD)
Males
P-value*
Age
7.7 (2.0)
8.1 (2.0)
0.25
ADHD-RS-IV Total Score
12.6 (8.5)
12.6 (8.8)
0.99
Total Symptoms
3.3 (3.2)
3.2 (3.4)
0.81
Inattention Symptoms
1.6 (1.9)
1.6 (2.0)
0.89
Hyperactive/Impulsive Symptoms
1.7 (1.8)
1.6 (1.7)
0.54
References
Methods
Gaub M & Carlson L. Gender differences in ADHD: a meta-analysis and critical review. JAACAP, 1997;36(8):
Gershon J. A meta-analytic review of gender differences in ADHD. J Attention Disorders, 2002;5(3):
Skogli E, et al. ADHD in girls and boys--gender differences in co-existing symptoms and executive function measures. BMC Psychiatry, 2013;13(1): 298
Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, et al. Developmental potential in the first 5 years for children in developing countries. The Lancet, 2007;369:60-70.
Neuropsychological and demographic data were collected in a non-clinical sample of perinatally HIV-exposed children in rural Uganda.
ADHD symptoms were assessed using the ADHD Rating Scale-IV.
We assessed differences in symptom rates, factor structure, prevalence by subtype (using DSM-IV-TR symptom cutoffs), and association with measures of executive functioning (including: Global Executive Composite, Working Memory scale, and Metacognitive Index scales on the BRIEF), visual attention performance (TOVA Visual ADHD Score), and cognitive ability (KABC-II Mental Processing Index (MPI)).