ADHD has always been seen as a disproportionately male disorder. Studies have estimated that boys with ADHD outnumber girls with ADHD anywhere from 2:1 to 9:1, and until the past couple decades it was believed that males were simply more susceptible. However, recent work has revealed that this may not be the case…
In her meta-analysis, Dr. Julia Rucklidge claims that the gender discrepancy is actually a matter of referral bias and not who is affected. In other words, boys are far more likely to be referred for treatment than girls. Rucklidge cites a study that found only 6% of girls with ADHD were prescribed medication and 8% received counseling, while 47% of boys with ADHD received medication and 38% received counseling. The difference is staggering. So why is it that male ADHD is so much more likely to be recognized?
One of the major reasons for the male bias in ADHD diagnosis is the presentation of symptoms in boys vs. girls. Many studies have found that while the hyperactivity symptom is more prevalent in males, inattention is far more prevalent in females. Hyperactivity is much easier for an outsider, like a teacher or parent, to identify, while inattention is often more internal and difficult to detect. Given the perception that ADHD is a predominantly male disorder, there is a belief that girls are not “supposed” to have ADHD, creating a stigma surrounding those affected and perpetuating the gender bias in diagnosis and treatment.
Another reason for the discrepancy is the diagnosis criteria. Dr. Ellen Littman, author of Understanding Girls with ADHD, claims that the misunderstanding of female ADHD stems from early research conducted in the 70’s: “These studies were based on really hyperactive young white boys who were taken to clinics,” Dr. Littman says. “The diagnostic criteria were developed based on those studies. As a result, those criteria over-represent the symptoms you see in young boys, making it difficult for girls to be diagnosed unless they behave like hyperactive boys.” Compounding this, ADHD is most commonly diagnosed during childhood. For boys, the timing fits because most boys experience a decrease in symptoms following puberty. For girls, however, ADHD symptoms intensify as estrogen increases, leaving a large portion of women undiagnosed until far later in life. In fact, many women are about 40 by the time that they are diagnosed with ADHD.
A new study released this past year found that almost 50% of mothers of daughters with ADHD reported that they initially attributed symptoms to normal adolescent struggles. About 60% reported that they initially hesitated seeking help from a doctor and that they wish they had taken action sooner. The regret is real. Despite the underrepresentation of females, girls with ADHD are more likely to develop an internalizing comorbid disorder like anxiety or depression than boys, and they display lower self-esteem, ineffectiveness and are more affected by negative life events. What’s even more astonishing is that women with ADHD are more likely than men to pass on the disorder to their children, 50% of whom are affected!
ADHD diagnosis in girls is critical, and we can no longer selectively intervene when the presentation is obvious. Detecting inattention symptoms is just as easy if parents and teachers know what to look for.
Does your daughter face stigmatization? Did you wait too long to seek professional health? Did any of this information change your perception of gender’s role in ADHD? Please share your stories and comments about girls with ADHD!