Background : Studies on gender differences in attention-deficit/ hyperactivity disorder (ADHD) comorbidities in the Asian populations have been limited and previous studies have shown inconclusive findings. Singapore is a city-state country in Southeast Asia with a population of 5.7 million. This study examined gender differences in internalizing and externalizing problems in Singaporean children and adolescents with ADHD. The plausible social factors underlying the gender differences were discussed.
Methods : A total of 773 participants (aged 6 to 18, 88% males) newly diagnosed with ADHD were recruited from the only public child and adolescent psychiatric center in Singapore. Their internalizing and externalizing problems were assessed using the Child Behavioral Checklist and Teacher’s Report Form by parents and teachers respectively. Demographics and relevant social factors were collected using parent questionnaires.
Results : Females with ADHD were reported to have less delinquent and aggressive behavior but more depressive symptoms than their male counterparts, similar to findings in the Western literature. Older age, lower socioeconomic status and parental use of physical punishment were associated with higher internalizing and externalizing problems after controlling for other factors.
Conclusions: Gender differences in ADHD comorbidities do exist in the Asian clinical population. This suggests a need for gender-specific assessment of ADHD as females do not present with much externalizing problem which makes identification more difficult.