Gender Differences Among Children with Externalising Behaviour Disorders in a Clinic Population

The objective of this study was to compare the referral patterns for males and females with externalising disorders who were admitted for specialised psychiatric treatment. The study was based on the total population of children receiving specialised mental treatment in Norway in 2001. From the total patient population of 28,571 children and adolescents aged 0-17 years, a sample was drawn of boys and girls who were referred for externalising behaviour disorders. The sample comprised a total 9729 children, of whom 2218 were females and 7511 were males. Males and females were compared with regard to age at referral, referring agents, secondary reasons for referral as indicated by referring agency, and diagnostic status. The analyses revealed several gender differences in referral patterns. A statistically significant larger proportion of males than females were referred at ages between 6 and 12 years (67.3% and 57.1%, respectively; p < 0.001 ), whereas relatively more females than males were referred at ages above 12 years (32.4% and 21.7%, respectively; p < 0.001 ). Males were more frequently referred from the school sector than females (31.2% and 21.8%, respectively; p < 0.001 ), and exhibited more externalising symptoms than females as indicated by their secondary reason for referral (47.8% and 31.5%, respectively; p < 0.001 ). Co-occurring internalising symptoms were relatively more frequent in females than in males (21.9% and 16.9%, respectively; p < 0.001 ). Furthermore, results showed statistically significant differences in diagnostic status between males and females. Among males 37.7% was assigned an ICD-10 axis I diagnosis of hyperkinetic disorders or conduct disorders; the corresponding number for females was 24.0% ( p < 0.001 ). The results may reflect the true prevalence in the child and adolescent population, or alternatively indicate a gender-related bias in the referral process of children.