Observed classroom behavior of children with ADHD: relationship to gender and comorbidity |
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| Authors: | Abikoff Howard B Jensen Peter S Arnold L L Eugene Hoza Betsy Hechtman Lily Pollack Simcha Martin Diane Alvir Jose March John S Hinshaw Stephen Vitiello Benedetto Newcorn Jeffrey Greiner Andrew Cantwell Dennis P Conners C Keith Elliott Glen Greenhill Laurence L Kraemer Helena Pelham William E Severe Joanne B Swanson James M Wells Karen Wigal Tim |
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| Affiliation: | (1) New York University School of Medicine, New York, New York;(2) New York State Psychiatric Institute, Columbia University, New York, New York;(3) Ohio State University, Columbus, Ohio;(4) Purdue University, Lafayette, Indiana;(5) McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada;(6) St. Johns University, Queens, New York;(7) Nassau Community College, Garden City, New York;(8) Duke University Medical Center, Durham, North Carolina;(9) University of California, Berkeley, California;(10) National Institute of Mental Health, Rockville, Maryland;(11) Mount Sinai Medical Center, New York, New York;(12) University of Pittsburgh, Pittsburgh, Pennsylvania;(13) University of California, San, Francisco, California;(14) Stanford University, Palo Alto, California;(15) State University of New York, Buffalo, New York;(16) University of California, Irvine, California |
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| Abstract: | Examined hypothesized gender and comorbidity differences in the observed classroom behavior of children with attention deficit hyperactivity disorder (ADHD). The behavior of 403 boys and 99 girls with ADHD, ages 7–10, was compared (a) to observed, sex-specific classroom behavior norms, (b) by sex, and (c) by comorbid subgroups. Boys and girls with ADHD deviated significantly from classroom norms on 15/16 and 13/16 categories, respectively. Compared to comparison girls, girls with ADHD had relatively high rates of verbal aggression to children. Boys with ADHD engaged in more rule-breaking and externalizing behaviors than did girls with ADHD, but the sexes did not differ on more  neutral, unobtrusive behaviors. The sex differences are consistent with notions of why girls with ADHD are identified and referred later than boys. Contrary to hypothesis, the presence of comorbid anxiety disorder (ANX) was not associated with behavioral suppression; yet, as hypothesized, children with a comorbid disruptive behavior disorder (DBD) had higher rates of rule-breaking, and impulsive and aggressive behavior, than did children with ADHD alone and those with ADHD+ANX. Elevated rates of ADHD behaviors were also observed in children with comorbid DBD, indicating that these behaviors are truly present and suggesting that reports of higher ADHD ratings in this subgroup are not simply a consequence of negative halo effects and rater biases. |
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| Keywords: | ADHD classroom observations behavior sex differences comorbidity |
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