Lau Tsz Wing Ivy, Lim Choon Guan, Acharryya Sanchalika, Lim-Ashworth Nikki, Tan Yi Ren, Fung Shuen Sheng Daniel
The Institute of Mental Health, Buangkok Green Medical Park 10 Buangkok View, Singapore, 539747, Singapore.
Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
Child Adolesc Psychiatry Ment Health. 2021 Jan 22;15(1):3. doi: 10.1186/s13034-021-00356-8.
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.
A total of 773 participants (aged 6 to 18, 88% males) newly diagnosed with ADHD were recruited from the largest 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.
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. Gender remained a significant predictor of externalizing problem after controlling for other factors. Lower socioeconomic status and parental use of physical punishment were significant predictors of both internalizing and externalizing problems.
Gender differences in ADHD comorbidities do exist in the Asian clinical population. The lack of externalizing symptoms in females with ADHD has made timely referral and diagnosis challenging. More research is needed in understanding the gender differences in ADHD and the biopsychosocial mechanism underlying the differences in order to improve the detection of ADHD in females.
关于亚洲人群注意力缺陷多动障碍（ADHD）共病的性别差异研究有限，且先前的研究结果尚无定论。新加坡是东南亚的一个城邦国家，人口570万。本研究调查了新加坡患有ADHD的儿童和青少年在内化问题和外化问题上的性别差异。并讨论了这些性别差异背后可能的社会因素。
从新加坡最大的公立儿童和青少年精神病中心招募了773名新诊断为ADHD的参与者（年龄6至18岁，88%为男性）。分别通过父母和教师使用儿童行为检查表和教师报告表来评估他们的内化问题和外化问题。使用家长问卷收集人口统计学和相关社会因素。
据报告，患有ADHD的女性比男性有更少的违法和攻击性行为，但有更多的抑郁症状，这与西方文献中的研究结果相似。在控制其他因素后，性别仍然是外化问题的一个重要预测因素。较低的社会经济地位和父母使用体罚是内化问题和外化问题的重要预测因素。
在亚洲临床人群中，ADHD共病确实存在性别差异。患有ADHD的女性缺乏外化症状使得及时转诊和诊断具有挑战性。需要更多的研究来了解ADHD中的性别差异以及这些差异背后的生物心理社会机制，以便改善对女性ADHD的检测。
