Written by Gouri Ajith and Edited by Lauren Cho
ADHD, or attention deficit hyperactivity disorder, is a common childhood issue, affecting between 5 and 11 percent of children under the age of 17 [1]. A highly heritable disease, ADHD is caused by the differences in the chemistry, structure, and communication signals within the brain [2]. These differences often affect working memory and impulse control, manifesting as either hyperactive ADHD or inattentive ADHD [3]. The hyperactive form of the disorder is characterized by externalized symptoms like physical aggression, excessive talking, and an inability to sit still [3]. This form of ADHD, which is only one of many forms that people are aware of, tends to affect boys more than it does girls. The inattentive form of the disorder, which often affects girls, is expressed as anxiety, cripplingly low self-esteem, verbal aggression, and depression [4].
Why do girls with ADHD display such different symptoms than that of boys? This variation may be due to differences in prenatal hormone exposure, which may change how ADHD affects brain development and functioning. Experts like Dr. Kathleen Nadeau, Director of the Chesapeake ADHD Center, suggest that the less overt symptoms displayed by girls with ADHD may due in part to differences in socialization [5]. The symptoms they express, like inattentiveness and extreme talkativeness, are often attributed to gender stereotypes and can be overlooked. As a result, impaired achievement and mood disorders often affect these girls’ functioning in school and family environments [4].
But there is a large discrepancy in the numbers of boys and girls with ADHD who are diagnosed. In medical evaluations, the ratio of boys to girls with ADHD is about 9:1; amongst community samples, the ratio is between 1:1 and 3:1 [6]. This difference suggests that girls with ADHD are being referred to and diagnosed by medical practitioners at lower rates than boys with ADHD. Part of the issue is in the initial referrals; many teachers and parents are unaware of the symptoms of inattentive ADHD and may write them off as moodiness or laziness. At the root of this issue may be in the studies that ADHD diagnostic methods are based upon; historically, research into the disorder has predominantly used data from young male patients [5].
When girls with ADHD are left untreated, their symptoms persist into adulthood, manifesting as underachievement, substance abuse, eating disorders, and financial crises [7]. It is crucial to not only to diversify research samples and improve our current diagnostic criteria, but to also increase awareness amongst the public about what it means to have ADHD, in any form.
References:
[1] “Attention-Deficit / Hyperactivity Disorder (ADHD).” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. 24 Jan. 2018. www.cdc.gov/ncbddd/adhd/data.html.
[2] “ADHD: The Facts.” ADDA – Attention Deficit Disorder Association, add.org/adhd-facts/.
[3] Joseph Biederman, Michael C. Monuteaux, Alysa E. Doyle, Larry J. Seidman, Timothy E. Wilens, Frances Ferrero, Christie L. Morgan, Stephen V. Faraon. 2004. “Impact of Executive Function Deficits and Attention-Deficit/Hyperactivity Disorder (ADHD) on Academic Outcomes in Children.” Journal of Consulting and Clinical Psychology. 72: 757–766.
[4] Biederman J, Faraone SV, Mick E, Williamson S, Wilens TE, Spencer TJ, Weber W, Jetton J, Kraus I, Pert J, Zallen B. 1999. “Clinical correlates of ADHD in females: findings from a large group of girls ascertained from pediatric and psychiatric referral sources.” Journal of the American Academy of Child & Adolescent Psychiatry. 38: 966-975.
[5] Nadeau, K.G., & Quinn, P.O. (Eds.) 2002. Gender issues and AD/HD: Research, diagnosis, and treatment. Silver Spring, MD: Advantage Books.
[6] Skounti M, Philalithis A, Galanakis E. 2007. Variations in prevalence of attention deficit hyperactivity disorder worldwide. Eur J Pediatr. 166: 117-123.
[7] Adelizzi, J.U. 1998. Shades of trauma. Plymouth, MA: Jones River Press.