Diferencias en el trastorno por déficit de atención e hiperactividad en la infancia y adolescencia desde la perspectiva de género

Zusammenfassung

The research that is presented here as a doctoral thesis has been possible thanks to the collaboration of users and clients from the Psychology practice "Spica", where I started my professional work more than twenty-three years ago. Also, it is due to the uncertainties and new questions that were raised when I studied for my master’s degree in Gender Studies and Professional Development at the University of Seville. I was interested in knowing the causes of the different responses of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in its prognosis, evolution, and treatment. From the beginning I was interested in the clinical speciality of ADHD because of the impact it has on the self-esteem of people who suffer from it and the high level of stress it generates in the family and educational system. When looking at the data disaggregated by sex, I noticed a new dimension. The prevalence of ADHD is nine times higher in boys than it is in girls in the clinical samples, and three times higher in the population samples. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013 already recognizes gender differences in relation to causes and psychopathological conditions, while warning that gender marks differences in the prevalence and incidence rates of ADHD. And this is where the general objective of the work I present is focused: to assess the differences in neuropsychological functions and different educational styles of boys and girls diagnosed with ADHD, and the therapeutic responses after sports treatment from a gender perspective. As this is a thesis by compendium, this general objective is broken down into three secondary objectives to which we respond in three published partial studies. In the first study, we focused on comparing the neuropsychological performance of boys and girls with ADHD in different cognitive domains: verbal comprehension, perceptual reasoning, working memory, processing speed and in general cognitive performance. A total of 240 children aged 6 to 17 were evaluated. We divided them into two groups: an experimental group; formed by 65 boys and 55 girls with ADHD diagnoses, and a control group; formed by 60 boys and 60 girls without any kind of neurodevelopmental disorder. Neuropsychological functioning was measured with the Wechsler Intelligence Scale (WISC-IV), which evaluates performance related to verbal comprehension, perceptual reasoning, working memory and processing speed. The sum of the scores gives a total score which indicates the intellectual coefficient or level of general cognitive performance. The results obtained show inferior performance in boys and girls with ADHD compared to the controls, in all the cognitive domains assessed. Significantly lower scores were found in perceptual reasoning; with an average effect size in girls with ADHD in relation to children diagnosed with ADHD. Subtypes of ADHD in boys were not significantly correlated with any performance measure, and no significant interaction effects were observed between age and sex of the participants. The common performance points found between boys and girls with ADHD outweighed the differences, highlighting the importance of further research on cognitive dysfunction in girls with ADHD, regardless of gender differences in ADHD prevalence. In the second study, the objective was to explore the differences between affect and educational styles of the children diagnosed with ADHD and to relate it to the opinions of mothers and fathers from a gender perspective. The sample was composed of parents of 81 boys and 33 girls from 6 to 17 years old. We evaluated parental affection and parental control. To evaluate affection, we used the Affection Scale for Parents (EA-P) and the Scale of Norms and Demands for Parents (END-P). The results show how mothers report a greater number of affection-communication responses and a greater use of inductive educational practices than fathers. The greater use of rigid practices by mothers was associated with daughters, regardless of their age, subtype, medication, and comorbidities. However, parental practices used with male children were affected by the age and subtype of the children. That is, our results are conclusive regarding the influence of gender on the levels of affection and educational styles employed by parents of children with ADHD. In the third study our aim was to assess physical activity in relation to cognitive function in school-aged children diagnosed with ADHD. This study involved 24 people, 5 girls and 19 boys. Two groups were constituted: intervention group and control group. In the first one, 13 people participated in a sports activity in which aerobic games were performed at an approximate intensity of 60-70% of maximum oxygen consumption. Eleven people participated in the control group, who continued with routine school activities. The directed sports physical activity was carried out during six weeks in two one-hour sessions. To evaluate activity, quality of attention, sustained attention and performance, the Magellan Scale of Visual Attention (VAS) was used before and after the sports intervention. The results show a significant improvement in the quality of attention in the participants of the intervention group, but not in those of the control group. The results therefore suggest a positive effect of physical exercise on the quality of attention. In conclusion, we can say that children with ADHD present alterations in cognitive functions with respect to their undiagnosed peers; that differences are observed in the domain of perceptual reasoning with girls scoring the least. That can be explained by the differences between crystallized intelligence and fluid intelligence. On the other hand, we observe that there is gender bias in the diagnosis of girls depending on the manual used for their evaluation, being excluded on many occasions, a situation that can cause negative consequences in their development. Similarly, we can conclude that the differences between parents in relation to affection-communication responses and the educational styles used with their children favour socialisation processes and stereotypes that will have consequences for later development. Finally, we insist on the effect of physical exercise on the quality of attention, although with this sample we cannot conclude whether or not there are differences with respect to sex, that is if we move towards the recommendation of using physical-sporting interventions as complementary therapies in the treatment of ADHD in children.