Sex Differences in the Meaning of Parent and Teacher Ratings of ADHD Behaviors: An Observational Study.

OBJECTIVE: To test explanations for the underrecognition of female ADHD by examining differences in adult ratings of boys and girls matched for levels of directly observed ADHD behaviors.

METHOD: In a secondary analysis of a population-based sample, 3- to 4-year-olds ( n = 153, 79 male) and 8- to 9-year-olds ( n = 144, 75 male) were grouped according to levels of directly observed ADHD behaviors (low/moderate/high). Groups were then compared with parent/teacher ADHD ratings.

RESULTS: There were no sex differences in levels of directly observed ADHD behaviors within groups. For preschoolers, parents' ratings of males, but not females, significantly increased across groups-mirroring levels of observed behaviors. For older children, both parent and teacher mean ratings were significantly higher for males than females across groups.

CONCLUSION: Identified differences in adult ratings of males and females matched for directly observed behaviors may contribute to understanding the substantial ADHD underrecognition in females.