Attention-Deficit/Hyperactivity Disorder 63
Gender-Related Diagnostic Issues
ADHD is more frequent in males than in fema les in the general population, with a ratio of
approximately 2:1 in children and 1.6:1 in ad ults. Females are more likely than males to
present primarily with inattentive features.
Functional Consequences of 
Attention-Deficit/Hy peractivity Disorder
ADHD is associated with reduced school performance and academic attainment, social re-
jection, and, in adults, poorer occupation al performance, attainment, attendance, and
higher probability of unemployment as well as elevated interpersonal conflict. Children
with ADHD are significantly more likely than  their peers without ADHD to develop con-
duct disorder in adolescence and antisocial  personality disorder in adulthood, conse-
quently increasing the likelihood for substance use disorders and incarceration. The risk of
subsequent substance use disorders is elevated, especially when conduct disorder or an-
tisocial personality disorder develops. Individuals with ADHD are more likely than peers
to be injured. Traffic accidents and violatio ns are more frequent in drivers with ADHD.
There may be an elevated likelihood of  obesity among individuals with ADHD.
Inadequate or variable self-app lication to tasks that require sustained effort is often in-
terpreted by others as laziness , irresponsibility, or failure to  cooperate. Family relation-
ships may be characterized by discord and ne gative interactions. Peer relationships are
often disrupted by peer rejection, neglect, or  teasing of the individual with ADHD. On av-
erage, individuals with ADHD obtain less schooling, have poorer vocational achievement,
and have reduced intellectual scores than their peers, although there is great variability. In
its severe form, the disorder is markedly impairing, affecting social, familial, and scholas-
tic/occupational adjustment.