The four chapters in this section share common themes and raise pertinent questions: What does epidemiology teach? How can it be urgently translated ino service? And where should future research be headed?

Manassis highlights the critical point that anxiety symptoms may not be pathological at subclinical level while depression, even at a subsyndromal level, raises the risk for depression by threefold. It is important to translate these findings to real-life practice. The Virginia twin study, for instance, highlights the need to intervene early with depressed girls. Cross-cultural studies show a consistency of gender difference in depression/anxiety in Asia but not in Africa. Understanding of these differences needs to be linked with gender role orientation and cultural context. The results of biologic research in depression/anxiety should be taken as spring boards for future effortsóthe final word on effectiveness and safety of SSRIs in children and adolescents, for instance, is not yet in (1). With respect to interpersonal psychotherapy, it is particularly effective in girls, who tend more than boys to internalize conflicts (2).

Bradley and Zucker have reviewed gender identity disorder (GID) from a clinical and research standpoint, highlighting Canadian and Dutch studies. Both these cultures being western, where unisex style of dressing and “tomboyish” behavior is accepted, it is plausible that girls get referred later than boys while this may not be so in other cultures. Most of the conclusions are based on maternal information and show a need for stronger support for mothers and daughters alike. Studies on rhesus monkeys give new insights into the timing of hormonal manipulation in utero that results in masculinization (3). Similarly, preliminary results indicate 5 alpha reductase deficiency leading to GID in girls (4). No systematic data exist in developing countries where GID may be hidden. Levy introduces the multiple obstacles in identifying behavior disorder such as referral bias, rater bias and fundamental differences in subtypes of attention deficit hyperactivity disorder (ADHD). It would be safe to say that a cross culturally uniform over-representation of the inattentive subtype of ADHD is noted in girls. Data from available studies do not resolve the question of whether neurocognitive profiles are gender specific or linked to the inattention subtype of ADHD. An important point to highlight is that boys outnumber girls even among those with the inattention subtype Higher heritability and a possible polygenic multiple threshold model has been proposed in females but replication is needed. New data point to gender based differences in neuroanatomy of the brain with smaller amygdalae in female brains compared to male (5). Future studies will determine the relevance of this finding.