ERIC EJ1066320: Gender Differences in Self-Reported Symptomatology and Working Memory in College Students with ADHD

2015·0.21 MB·English

by  ERIC

Journal of Postsecondary Education and Disability, 28(1), 41 - 56 41
Gender Differences in Self-Reported Symptomatology
and Working Memory in College Students with ADHD
Suneeta Kercood
Tara T. Lineweaver
Jennifer Kugler
Butler University
Abstract
The purpose of this study was to examine gender differences in self-reported symptomatology and working memory
(visuospatial and auditory) in college students with Attention Deficit Hyperactivity Disorder (ADHD). Forty-seven
college students with ADHD and 44 non-affected control participants completed two self-report questionnaires and
six tests of auditory and visuospatial working memory. For self-report measures, we found significantly larger dif-
ferences in self-reported inattention and internal restlessness between female participants with and without ADHD
than between male participants with and without ADHD. In working memory, regardless of diagnosis, women
significantly outperformed men on one test of visuospatial working memory. Women with ADHD had more dif-
ficulty than their non-affected peers on one test of auditory working memory but, surprisingly, men with ADHD
performed better than their comparison peers on this measure. Our results indicate that gender may interact with
an ADHD diagnosis to impact both subjective and objective symptomatology of the disorder.
Keywords: Attention Deficit Hyperactivity Disorder, college student, working memory, gender differences, self-reports
Attention Defi cit Hyperactivity Disorder (ADHD) equip both the students who are seeking a collegiate
is usually diagnosed in childhood but often persists education and the universities mandated by law to help
across the lifespan, with numerous implications for them (Americans With Disabilities Act Amendments
adulthood (Babinski, et al., 2011; Barkley, 1998; Bar- Act, 2008; Section 504 of the Rehabilitation Act, 1973)
kley, Murphy & Kwasnik, 1996; Cahill, et al., 2012; with the information they need for these students to
Reimer, Mehler, D’Ambrosio, & Fried, 2010; Shekim, fi nd success in the college classroom.
Asarnow, Hess, Zaucha & Wheeler, 1990; Waite, 2007; One area that has received less attention than
Yen, Yen, Chen, Tang & Ko, 2009). ADHD affects warranted in the literature is the examination of
between 2% and 11% of the college student population potential gender differences in symptomatology in
(DuPaul, Weyandt, O’Dell & Varejao, 2009; Weyandt college students with ADHD. Gender differences in
& DuPaul, 2008). College students who are diagnosed this population have possible implications for educa-
with ADHD are at increased risk of being placed on tional and social outcomes, especially for females with
academic probation, having a lower grade point aver- ADHD (Cahill, et al., 2012; Rucklidge & Tannock,
age, experiencing more academic problems, and failing 2001; Yen et al., 2009). Traditionally, most of the
repeatedly than students without this disorder (Blase diagnostic and interventional research on ADHD has
et al., 2009; Heiligenstein, Guenther, Levy, Savino & focused on young boys with the disorder (Gershon,
Fulwiler, 1999; Norvilitis, Sun & Zhang, 2010; Nor- 2002; Rucklidge, 2006; Rucklidge & Tannock, 2001;
walk, Norvilitis & MacLean, 2009). Because young Waite, 2007). The extent to which the fi ndings of
adults with ADHD are enrolling in postsecondary these studies generalize to older college students and
education in increasing numbers despite their academic to women with ADHD is, thus, an empirical question.
struggles (Dipeolu, 2011; DuPaul et al., 2009; Weyandt Past studies have revealed that adolescent females
& DuPaul, 2008), gaining a better understanding of with ADHD report more overall distress, anxiety, and
how ADHD affects young adult college students will depression; a more external locus of control; and more
42 Journal of Postsecondary Education and Disability, 28(1)
conduct, cognitive, and hyperactivity symptoms than Less research has focused on gender differences
their peers who do not have ADHD (Rucklidge & in the cognitive symptomatology associated with
Tannock, 2001). Additionally, parents and teachers ADHD. Some studies have revealed that girls with
describe girls with ADHD as having more diffi culties ADHD fare more poorly intellectually than boys with
in attention, hyperactivity, oppositional behaviors, ADHD (Gaub & Carlson, 1997; Gershon, 2002), but
conduct problems, social skills, anxiety, and depression others have not supported this contention (Rucklidge,
than controls (Rucklidge & Tannock, 2001). Similarly, 2006; Rucklidge & Tannock, 2001). Rucklidge and
when adult women with ADHD were asked about their Tannock (2001) administered the Wechsler Intelligence
childhood, they reported their childhood relationships Scale for Children-Third Edition, as well as academic
with others (teachers, parents, peers) more negatively achievement measures, to adolescent boys and girls
than controls, felt less in control when faced with with and without ADHD. Girls with ADHD performed
diffi culties, and tended to demonstrate a “learned more poorly than their non-affected female peers on
helplessness” attributional style (Rucklidge & Kaplan, tasks involving processing speed, reading, spelling,
2000). Thus, many of the symptoms documented in and arithmetic. They also displayed poorer vocabulary
males with ADHD appear to apply to females as well scores than boys with ADHD, although they outper-
and many of the internalizing symptoms, impairments formed boys with ADHD in processing speed. In a
in relationships, and tendencies to underachieve in later study, Rucklidge (2006) found that both male and
everyday contexts have been shown to persist beyond female adolescents with ADHD were impaired com-
adolescence into adulthood (Babinski, et al., 2011). pared to their non-affected peers in naming, processing
Although the overall symptoms may be similar abilities, and inhibitory processes. However, the two
across females and males with ADHD when compared gender groups did not differ from each other across a
to their non-affected peers, most past research has large battery of neuropsychological tests except that
documented different characteristics in females and boys with ADHD were more impaired than girls with
males with ADHD when they are compared to one ADHD on two measures involving response inhibition.
another. When examining the types of symptoms typi- These results supported an earlier study by the same
cally displayed by females versus males, past studies research group (Rucklidge & Tannock, 2002), which
have revealed that females with ADHD are often less also found that adolescents with ADHD showed defi -
hyperactive and demonstrate signifi canlty fewer exter- cits in processing speed, naming, behavioral inhibition
nalizing problems than their affected male peers (Gaub and response consistency relative to controls, but that
& Carlson, 1997; Gershon, 2002). At the same time, boys and girls with ADHD did not differ from each
females with ADHD tend to show more inattention and other in their cognitive abilities.
internalizing problems, such as depression and anxiety, One area of common diffi culty for young adults
than males with ADHD (Gershon, 2002; Rucklidge & with ADHD is working memory. Working memory is
Tannock, 2001; Waite, 2007), except when they are part the capacity to simultaneously store and manipulate in-
of nonreferred populations (Gaub & Carlson, 1997). formation (Baddeley, 2003). This ability is responsible
Most of these studies have focused on children with for the short-term storage and online manipulation of
ADHD. A study by DuPaul and colleagues (2001) did information necessary for higher cognitive functions
not fi nd gender differences in self-reported symptoms particularly in the presence of distractions (Baddeley,
of university students across three different countries, 1986, 2003; Berti & Schroger, 2003; Shallice, 1988;
although they focused on the general population of Swanson & Seigel, 2001) and is essential to learning
college students rather than those diagnosed with in a classroom environment (Alloway, 2006). Re-
ADHD. These researchers raise the possibility that searchers have examined two primary types of working
gender differences may be less prevalent in higher- memory: visuospatial working memory and auditory
achieving populations, although advancing age may working memory. Although results are mixed across
also reduce differences between males and females (Du studies, most agree that young adults with ADHD dem-
Paul, et al., 2001). Lee, Oakland, Jackson and Glut- onstrate impairments in visuospatial working memory
ting (2008) also examined prevalence rates of ADHD (Barkley, et al., 1996; Clark et al., 2007; Dowson et
symptomatology in the general population of college al., 2004; Karatekin & Asarnow, 1998; McLean et al.,
freshman. They found differences between male and 2004; Murphy, Barkley & Bush, 2001; Roberts, Milich
female college freshman, with male college freshmen & Fillmore, 2012; Young, Morris, Toone & Tyson,
reporting more inattention and combined symptoms 2007), with some, but not all, researchers also docu-
than female college freshmen, but the effect sizes were menting defi cits on auditory working memory tasks
considered small. (Barkley et al., 1996; Biederman et al., 2009; Karatekin
Kercood, Lineweaver, & Kugler; Gender Differences in Working Memory in ADHD 43
& Asarnow, 1998; Murphy et al., 2001; Schweitzer, Method
Hanford & Medoff, 2006; White, Hutchens & Lubar,
2005). A recent meta-analysis concluded that both au- Participants
ditory and visuospatial working memory is impaired in Recruitment of college student participants with
adults with ADHD and that methodological variability and without an ADHD diagnosis spanned several col-
accounts for the inconsistent results across past studies lege campuses. We placed advertisements in campus
(Alderson, Kasper, Hudec & Patros, 2013). newspapers and requested that Student Disability
Very few studies have examined gender differ- Services (SDS) Offi ces send emails informing their
ences in working memory in individuals with ADHD. registered students of the study. Fliers in doctor’s of-
Those that have directly addressed this issue have fi ces, at local college student gathering places, and on
focused on adolescents (Rucklidge, 2006; Rucklidge campus bulletin boards also informed potential partici-
& Tannock, 2001). Neither of these studies found pants about the research project, and we announced the
gender differences in either visuospatial or auditory study in psychology courses that offered extra credit
working memory, but the range of working memory for research study participation.
tests examined in these studies was limited (Digit Span, Students with ADHD who volunteered to par-
Arithmetic, Spatial Span) because working memory ticipate provided written documentation approved
was only one of many cognitive and psychosocial by the SDS offi ce. The documentation included a
areas assessed. Two other studies included gender in medical record review conducted by the SDS offi ce
analyses when comparing adults with ADHD to adults and a structured clinical interview form that included
without the disorder on several working memory mea- DSM-IV criteria for ADHD that had to be completed
sures (Murphy et al., 2001; Schweitzer et al., 2006). by a physician or a clinical psychologist. Those not
Across these studies, men in general (regardless of registered with the SDS offi ce provided a formal test-
diagnosis) outperformed women on some auditory ing report and/or a current prescription for an ADHD
working memory tests (Letter-Number Sequencing medication. Students who had inadequate documenta-
and the Paced Auditory Serial Addition Test (PASAT)), tion or reported only a past history of ADHD symp-
but women outperformed men in smell identifi cation tomatology without a current diagnosis were excluded
and information processing speed. The only gender from the study.
difference to interact with diagnosis was on the PASAT Forty-seven college students with ADHD (19
in the Schweitzer et al. (2006) study, where males with male and 28 female) volunteered to participate in the
ADHD performed more poorly than males without study. The majority of the ADHD group (97.9%) was
ADHD, but no gender difference emerged for females Caucasian and 57.4% (n = 27) were receiving academic
with and without the disorder. The researchers did not accommodations at the time of this study. Although
directly compare males with ADHD to females with students were not directly queried about their medica-
ADHD on this or any other tests, so gender differences tion regimen, the Student Disabilities Offi ce verifi ed
within the ADHD group were not reported. that at least 36% (n = 17) of these students had a
The current study attempts to better delineate gen- prescription for and reported taking medication at the
der differences in self-reported symptomatology and time that they registered their disability. An additional
working memory (visuospatial and auditory) in college 43% (n = 20) included a current prescription as proof
students with ADHD. We asked college students with of their diagnosis. Thus, the majority of the ADHD
ADHD and age-matched controls to complete two participants (at least 79%) likely had access to psycho-
self-report measures of their ADHD symptomatology stimulant medications at the time of the study. We did
to help clarify the somewhat inconsistent fi ndings not ask participants to alter their regular medication
of the DuPaul et al. (2001) and the Lee et al. (2008) schedule at the time of their participation.
studies. Additionally, we administered three tests of Forty-four (14 male and 30 female) college stu-
visuospatial working memory and three tests of audi- dents enrolled in either a four-year college or a graduate
tory working memory to determine whether male and program served as age- and education-matched con-
female college students with ADHD are impaired rela- trols. Students with a past or current diagnosis of either
tive to their non-affected peers and, more importantly, ADHD or a learning disability were excluded from
whether gender differences exist in the visuospatial or the control group. Similar to the ADHD group, the
auditory working memory abilities of college students majority (88.6%) of these participants were Caucasian.
with ADHD.
44 Journal of Postsecondary Education and Disability, 28(1)
Materials Letter-Number Sequencing (LNS). During the
LNS subtest from the Wechsler Memory Scale–Third
Self-Report Measures Edition (Wechsler, 1997), the examiner reads a series
Conners’ Adult ADHD Rating Scale (CAARS). of intermixed letters and single digits aloud at a rate of
The CAARS is a reliable and valid self-report measure one item per second. The participant verbally reports
of ADHD symptoms for use with adults. It requires the numbers in numerical order, followed by the let-
participants to respond to 66 items by rating themselves ters in alphabetical order. Sequences begin with three
on behaviors and characteristics commonly associated items (two letters and one number or two numbers
with ADHD (Conners, Ehrhard, & Sparrow, 1999). and one letter) and become increasingly longer until
Scores total onto several primary subscales, each of the participant fails all three trials of a given sequence
which is normed by gender. For the purposes of this length. Raw scores on the LNS test refl ect the number
study, we focused on four subscales that represent of sequences correctly reported.
areas of common diffi culty for adults with ADHD
(Inattention, Hyperactivity, Emotional Lability, and Tests of Visuospatial Working Memory
Self-Concept), Spatial Span (SS). Also from the Wechsler Mem-
Internal Restlessness Scale (IRS). The IRS (Wey- ory Scale-Third Edition (Wechsler, 1997) and a visual
andt et al., 2003) assesses the construct of “mental rest- analog of the DS test, during the SS subtest participants
lessness” frequently reported by adults with ADHD. watch the examiner tap increasingly longer sequences
A self-report measure, the IRS presents 24 statements of raised, blue blocks positioned arbitrarily on a white
such as “Thoughts race through my mind,” “I feel board. Participants tap the blocks in the same order
internally restless,” and “While listening to others my they witnessed (forward span) or in the reverse order
attention drifts to unrelated thoughts.” Participants rate (backward span). Correct responses across forward
each item on a 7-point Likert scale, ranging from 1 = span and backwards span trials are totaled to determine
“none of the time” to 7 = “all of the time.” A study by the Spatial Span raw score.
Weyandt et al. (2003) evaluated the reliability and va- N-Back. During the N-Back (Awh et al., 1996,
lidity of the IRS. The IRS correlates signifi cantly with Cohen et al., 1994, 1997; Smith & Jonides, 1997),
other rating scales such as the Adult Rating Scale and participants view a series of letters that appear seri-
demonstrates adequate test–retest reliability (r = .89). ally on a computer screen. Their task is to inform the
More importantly, the IRS successfully differentiates examiner whenever a letter is identical to the letter that
college students with ADHD from their non-affected came immediately before it (1-back). In subsequent
peers (η2 = .431; Weyandt et al., 2003). trials, the task becomes more diffi cult as the partici-
pant attempts to inform the examiner when the letter
Tests of Auditory Working Memory matches the one that came two before it (2-back) or
Digit Span (DS). On the DS subtest from the three before it (3-back). The total number of correct
Wechsler Memory Scale-Third Edition (Wechsler, target detections across 1-back, 2-back and 3-back
1997), participants hear increasingly longer sequences trials comprises the N-Back raw score.
of single digit numbers. For the fi rst portion of this Conners’ Continuous Performance Test (CPT).
test, participants repeat the sequence out loud in order During the CPT, participants watch a long sequence of
of presentation (forward span). For the second portion, letters appear individually on a computer screen. They
they recite the sequence in reverse order (backward hit the space bar as quickly as they can whenever a let-
span). Correct sequences across the two portions of the ter appears unless the letter is an X, in which case they
test are totaled to determine the Digit Span raw score. withhold their response. Across the 20-minute-long
Paced Auditory Serial Addition Test (PASAT). task, the computer varies the rate of presentation of
During the PASAT (Gronwall & Sampson, 1974), stimuli. Both omissions (failing to respond to a letter
participants hear a sequence of single digit numbers. other than an X) and commissions (responding to an
They add adjacent digits together and verbally report X) count as errors. The computer also records reaction
the sum. While calculating the sum, they must also times (Conners, 2000). All CPT scores represent T-
remember the last digit they heard in order to add it to scores normed based on a large standardization sample.
the next number presented. The digits occur three sec-
onds apart during the fi rst trial and two seconds apart Procedure
during the second trial. Correct responses across the As part of a larger study examining distractibility
two trials are totaled to determine the PASAT raw score. in college students with ADHD (Lineweaver, et al.,
2012), participants completed two individual testing
Kercood, Lineweaver, & Kugler; Gender Differences in Working Memory in ADHD 45
sessions two weeks apart. To encourage participation (see Figure 1). Follow-up simple main effect analyses
and prevent attrition, they received $30 in compensa- revealed that male control participants reported more
tion after they completed both testing sessions. The inattention and internal restlessness than female con-
fi rst testing session involved the two questionnaires trol participants, with both effects nearing statistical
evaluating symptoms of ADHD (the CAARS and the signifi cance, CAARS Inattention: t (35) = 1.95, p =
IRS) and four of the tests of working memory: two .059; Internal Restlessness: t (35) = 1.86, p = .072. For
auditory (DS and the PASAT), and two visuospatial participants with ADHD, women with ADHD reported
(SS and the N-back). During the second testing more inattention and internal restlessness than men with
session, participants completed the remaining two ADHD, but only the difference in self-reported inatten-
working memory tests: the auditory LNS test and the tion neared signifi cance, CAARS Inattention: t (35) =
visuospatial CPT. 1.81, p = .080; Internal Restlessness: t (35) < 1, ns.

Results Gender Differences in Auditory and Visuospatial
Working Memory
Demographic Comparisons Scores on the six tests of working memory are
Table 1 summarizes the demographic character- summarized in Table 2. We included total scores on
istics of the male and female participants with and Digit Span, PASAT, LNS, Spatial Span, and N-Back,
without an ADHD diagnosis. The ADHD group and as well as omission errors, commission errors and hit
control group were statistically equivalent in their reaction times from the CPT in a multivariate analysis
gender distribution, χ2 (n = 91) = 0.73, p = .39. The of variance (MANOVA). Similar to the analysis of
four groups were also statistically equivalent in age self-reported symptomatology, the MANOVA included
and education. Additionally, the racial composition two between-subjects factors: group (control versus
of the sample was similar across genders within each ADHD) and gender (male versus female). Scores on
diagnostic group, ADHD group: χ22 (n = 47) = 0.69, all of the working memory measures were available for
p = .41; control group: χ22 (n = 43) = 2.13, p = .55. 40 participants in the control group and 41 participants
in the ADHD group.
Gender Differences in Self-Reported Symptomatology Unlike for self-reported symptomatology, none of
Self-reported ADHD symptomatology on both the main or interaction effects reached signifi cance in
the CAARS and the IRS are also summarized in Table the multivariate analysis, group: F (8, 70) = 0.89, p =
1. We included scores on the four CAARS subscales .53, η 2 = 0.09; gender: F (8, 70) = 1.09, p = .38, η 2=
p p
and total scores on the IRS in a multivariate analysis 0.11; group x gender: F (8, 70) = 1.08, p = .39, η 2 =
p
of variance with two between-subjects factors: group 0.11. Univariate comparisons indicated that the control
(control versus ADHD) and gender (male versus fe- group and the ADHD group performed similarly on
male). Scores on all of these self-report measures were all working memory tests. Surprisingly, female par-
available for 37 participants from the control group and ticipants signifi cantly outperformed male participants
37 participants from the ADHD group. on the visuospatial Spatial Span test. Finally, group
Not surprisingly, the main effect associated with and gender interacted to affect scores on the LNS test.
group was highly signifi cant, F (5, 66) = 11.76, p < Specifi cally, women with ADHD had more diffi culty
001, η 2 = 0.47. Univariate analyses indicated that stu- on the LNS test than their non-affected peers, but
p
dents with ADHD reported signifi cantly greater ADHD men with ADHD outperformed men without ADHD
symptomatology across all four CAARS subscales as on this auditory working memory test (see Figure 2).
well as on the IRS. The main effect associated with Follow-up simple main effect analyses indicated that
gender neared signifi cance, F (5, 66) = 2.33, p = .052, male and female control participants performed simi-
η 2 = 0.15. Female participants described themselves larly on the LNS test (t unequal variances (35.59) =
p
as signifi cantly more emotionally labile on the CAARS 1.21, p = .23), but men with ADHD performed better
than male participants regardless of diagnosis. Finally, than women with ADHD on this measure, t unequal
although the group by gender interaction did not reach variances (22.31) = 2.03, p = .055.
signifi cance in the multivariate analysis (F (5, 66)
= 1.48, p = .21, η 2 = 0.10), univariate comparisons
p
demonstrated signifi cantly larger differences in self-
reported inattention and internal restlessness between
female participants with and without ADHD than
between male participants with and without ADHD
46 Journal of Postsecondary Education and Disability, 28(1)
*TN D T
p < .05, ** p < 0.01, ***est; LNS = Letter Numbote: CAARS = Conners Internal Restlessness Self-Concept Emotional Lability Hyperactivity Inattention CAARS Years of College Age emographic Characteris able 1
p < .001er Sequen’ Adult A tics and S
cD e
inH lf-
gD R
e
R p
a o
ting Scale; (4.88)80.64 (3.06)45.36 (2.52)43.73 (2.75)51.82 (2.34)52.27 (0.37)2.14 (0.43)20.0 Male Control G rted Sympto
Internal R (3.17)70.00 (1.99)45.77 (1.64)46.27 (1.79)47.46 (1.52)47.27 (0.25)1.90 (0.29)19.37 Female roup matology
e M
s
t e
lessness= (4.33)102.36 (2.72)52.21 (2.23)50.64 (2.43)58.50 (2.07)58.64 (0.31)2.32 (0.37)19.95 Male ADH ans (SEs
Inte D G ) of t
rnal Restle (3.38)107.78 (2.12)55.30 (1.74)58.26 (1.90)57.57 (1.62)63.74 (0.26)2.39 (0.30)20.14 Female roup he Male an
s d
sn F
e 1 1 1 1 1 1 1 e
ss S , 70 , 70 , 70 , 70 , 70 , 87 , 87 df mal
c e
al P
e a
; PASAT = P 4.03* 0.28 1.51** 0.58 6.95* 0.28 1.40 InteractionGender Group x T rticipants in
a e t
c s h
ed Auditory S 55.32*** 10.63** 20.90*** 13.92*** 35.57*** 1.22 1.07 EffectGroup Main (F Values)t of Hypothes e Control and
eri M es AD
al Additi 0.42 0.48 6.05 1.38 0.00 0.08 0.39 ain EffecGender HD Gro
o t u
n p
s
Kercood, Lineweaver, & Kugler; Gender Differences in Working Memory in ADHD 47
(a)
(b)
Figure 1. Signifi cant Group x Gender interaction on the CAARS Inattention subscale (a) and the Internal
Restlessness Scale (b). Participants with ADHD (black bars) reported more Inattention and Internal Restlessness
than controls (hashed bars). Additionally, females with and without ADHD differed more in their self-reported
inattention and internal restlessness (right side of both graphs) than males with and without ADHD (left side of
both graphs).
48 Journal of Postsecondary Education and Disability, 28(1)
N W T
ote: WM = Work CPT-Hit RT CPT-Commits CPT-Omits N Back Spatial Span Visuospatial WM LNS PASAT Digit Span Auditory WM orking Memory M able 2
i
n e
g a
M n
s
e (
m S
o E
ry; s) o
CPT = C 43.64 52.11 55.24 56.86 17.71 11.71 94.57 19.21 n =M f the Ma
onners’ Continuo (2.42)42.34 (1 (2.77)51.84 (2 (4.38)47.88 (3 (0.79)56.23 (0 (0.66)19.31 (0 (0.70)12.62 (0 (4.62)87.96 (3 (0.96)19.77 (0 14n = 2aleFema n = 40Control Group le and Female Pa
us Pe .77) .03) .21) .58) .48) .51) .39) .70) 6le rticip
r a
formance T 41.14 (2.2 52.92 (2.5 52.00 (4.0 55.81 (0.7 17.69 (0.6 13.38 (0.6 86.38 (4.3 18.56 (0.9 n = 16Male AD nts in the C
est; R 6) 9) 9) 4) 1) 5) 2) 0) n = 4HD G ontro
T = reac 43.16 (1 54.36 (2 56.79 (3 55.56 (0 18.52 (0 11.44 (0 82.00 (3 18.28 (0 n = 2Fema 1roup l and AD
tion ti .81) .07) .28) .59) .49) .52) .46) .72) 5le HD G
m
r
e I o
; *p < .0 0.64 0.13 2.60 0.08 0.45 5.60* 0.08 0.26 nteractionx Group Gender ups
5
. T
e
s
G t
r F o
0.16 0.49 0.57 1.60 0.52 0.16 3.16 1.68 Effecoup M (1, 7f Hyp
t 7o
ai )th
n e
s
e
G s
e
n
0.03 0.06 0.12 0.20 4.60* 0.74 1.90 0.03 Effecder M
t
a
i
n
Kercood, Lineweaver, & Kugler; Gender Differences in Working Memory in ADHD 49
Figure 2. Signifi cant Group x Gender interaction on the Letter Number Sequencing Test. Women with ADHD
performed more poorly than women without ADHD on this auditory working memory test (right side of graph),
whereas men with ADHD performed better on this test than their non-affected male counterparts (left side of graph).
Discussion dicated that our women with ADHD did report being
signifi cantly more emotionally labile than our women
The purpose of our study was to explore gender without ADHD (t (47) = 5.03, p < .001), consistent with
differences in self-reported symptomatology as well as prior research that has demonstrated that females with
in visuospatial and auditory working memory in col- ADHD tend to have elevated emotional lability such
lege students with ADHD. Not surprisingly, college as poor temper control, variable mood, and emotional
students with ADHD reported signifi cantly greater over-reactivity (Robison et al., 2008).
ADHD symptomatology across all four CAARS Perhaps more importantly, we found that diagnosis
subscales and the IRS than their non-affected peers, interacted with gender to impact some, but not all,
consistent with the purpose and design of these self- aspects of self-reported symptomatology. Female par-
report measures (Conners, et al., 1999; Weyandt, et ticipants with and without ADHD differed more from
al., 2003). Additionally, female participants described each other in their self-reported inattention and internal
themselves as more emotionally labile than male par- restlessness than male participants with and without the
ticipants, regardless of whether they were diagnosed disorder. This effect emerged because females without
with ADHD or not. Although the interaction of gen- ADHD reported lower levels of inattention and internal
der and diagnosis did not reach signifi cance for this restlessness than males without ADHD and because
subscale, an examination of the means suggests that females with ADHD reported more diffi culty with
women with ADHD (whose average T-score was nearly inattention and, to a lesser and non-signifi cant extent,
one standard deviation above the normed mean of 50) internal restlessness than their ADHD male counter-
had a bigger infl uence on this gender main effect than parts. In combination, this resulted in a larger divide
women without ADHD (who also outscored their male in the self-reported symptomatology for females than
counterparts on the emotional lability scale, but whose males based on the presence or absence of an ADHD
scores averaged only 46, which is below the normed diagnosis. Prior research has indicated that females
mean T-score of 50). In fact, a follow-up analysis in- with ADHD primarily have the inattentive subtype
50 Journal of Postsecondary Education and Disability, 28(1)
with less hyperactivity than males, leading them to be children completed the Corsi Block-Tapping Test,
under-identifi ed at young ages (Grskovic & Zentall, boys performed better than girls (Orsini, Schiappa,
2010). Thus, it is not surprising that inattention and Chiacchio & Grossi, 1982), but when the same test was
internal restlessness were the two areas where gender administered to young adults aged 20-29, no gender
differentially affected self-reports of college students differences were observed (Ruggiero, Sergi, & Iachini,
with and without ADHD. In contrast, males with 2008). In another study that utilized a test of both
ADHD tend to exhibit greater levels of hyperactivity the processing and the storage components of spatial
than females and are, thus, identifi ed more frequently working memory, males were found to have greater
(Abikoff, et al., 2002; Reid et al., 2000). However, visuospatial working memory spans than females,
even within the general population, males tend to be and the authors used this fi nding to explain males out-
more physically active and to derive greater self-worth numbering females in science courses and programs
from physical activities (Fairclough & Ridgers, 2010; (Geiger & Litwiller, 2005). In contrast, on a novel
Trew, Scully, Kremer, & Ogle, 2009). This gender dif- multi-trial test, female college students made signifi -
ference in the general population is taken into account cantly fewer visuospatial working memory errors and
with the gender norms applied to CAARS raw scores, took signifi cantly less time to reach criterion than males
reducing the hyperactivity scores of the ADHD males (Duff & Hampson, 2001). Thus, studies have reached
as a result. Thus, this factor was less vulnerable to the confl icting conclusions with regard to whether male or
interaction of gender and diagnosis. female college students demonstrate stronger visuospa-
Our results do not align with those of either tial working memory skills. We expect that because
DuPaul et al. (2001) or Lee et al. (2008). DuPaul our sample exclusively included college students, our
and colleagues did not identify gender differences in young adult females may have had ample opportunities
self-reported ADHD symptomatology in university to develop advanced visuospatial working memory skills
students. Although Lee and colleagues did fi nd some compared to the general population of young women
gender differences in ADHD symptomatology amongst the same age. We did not query our participants about
college freshmen, they found that males reported more their college major or future career plans but, because
inattention and combined symptoms than females. Our of our recruitment procedures, many of our non-ADHD
results instead suggest that women college students student participants were likely psychology majors with
with ADHD report more inattention than men college at least some interest and background in the sciences.
students with ADHD and that women with ADHD dif- Thus, our student sample may have included a large
fer more from their non-affected women peers in their number of women who utilize visuospatial working
internal restlessness than men college students with memory skills in their academic areas of study, thereby
ADHD differ from men without the disorder. One rea- contributing to our fi nding that women outperformed
son for the discrepancy between our results and those of men on the Spatial Span test.
the two previous studies may be due to the comparisons Beyond this gender difference, we found a group
being made. Both the DuPaul et al. (2001) and the Lee by gender interaction on the auditory working memory
et al. (2008) studies examined the prevalence rates of Letter Number Sequencing test. Women with ADHD
symptoms in the general population of college students had more diffi culty on the LNS test than their non-af-
instead of making specifi c comparisons between stu- fected peers. Although these results are not particularly
dents with and without ADHD. Our results identify surprising, previous studies have not documented this
gender differences in self-reported symptomatology difference in auditory working memory between women
and suggest that, like for children, ADHD may affect with and without ADHD (Schweitzer et al., 2006). What
young adult men and women differently. Thus, gender was even more unexpected and counterintuitive was that
differences that emerge in childhood ADHD (Gershon, the results were the opposite for men; men with ADHD
2002; Rucklidge & Tannock, 2001; Waite, 2007) may performed better than their comparison peers. Although
persist throughout adulthood. we did not anticipate this effect, similar to our study, the
In examining gender differences in auditory and limited existing research on auditory working memory
visuospatial working memory in college students with and ADHD has documented better performance by men
and without ADHD, we found that women signifi cantly with ADHD than women with the disorder, particularly
outperformed men in our sample on the visuospatial on the LNS test (Schweitzer et al., 2006). However, it
Spatial Span test regardless of the presence or absence is unclear as to why the male students with ADHD in
of an ADHD diagnosis. Existing literature has been our sample performed better than their non-affected
inconsistent in establishing gender specifi c strengths peers on this measure. Future studies will be necessary
in visuospatial working memory. When school-aged to further investigate this issue.