Education

Our Understanding Of ADHD Is Changing. Here’s Why That Matters For Girls and Women.

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Attention deficit hyperactivity disorder, or ADHD, has long been stereotyped as a disorder for little boys who can’t sit in their seats, but diagnoses for girls have risen 55 percent from 2003 to 2011, according to a study in the Journal of Clinical Psychiatry. This is good news — because it means girls with ADHD are finally being diagnosed properly.

“Many of the studies on ADHD have been done on boys, which leaves us less sure about the symptoms’ presentation of girls. That we have more data on girls is very helpful,” said Schuyler Cunningham, director of the DC Center for Neurocognitive Excellence, in an email to ThinkProgress. “It makes sense that as our knowledge base grows, diagnoses also increase.”

A significant percentage of American children — 11 percent — have ADHD, according to the Centers for Disease Control’s 2009-10 data on children aged 4 to 17. These 6.4 million children’s parents spend a substantial amount of money on treatment, with the annual average direct cost for each ADHD patient coming to $1,574.

There are sub-types of ADHD, such as Inattentive Sub-type ADHD, but Hyperactive-Impulsive ADHD is what people usually think of when they think of children with ADHD, and that sub-type is most often associated with boys. Inattentive ADHD, which girls are more likely to have, show symptoms like being easily distracted, forgetful, and disorganized, as well as not finishing assigned homework. Even signs of hyperactivity may manifest itself differently in girls for several reasons, including social and cultural influences. Girls often feel pressured to mask their symptoms because of societal expectations about how they should behave.

This makes life particularly difficult for women with ADHD, who aren’t sure why they face the same obstacles over and over again, but who would never consider that they may have ADHD, especially as an adult. More women appear to be getting help, however. For women between the ages of 26 and 34, prescriptions for ADHD increased 85 percent between 2008 and 2012, according to a 2014 report by Express Scripts, a prescription management company.

Because it often takes longer to recognize ADHD in girls, it didn’t help that until a couple years ago, the Diagnostic and Statistical Manual of Mental Disorders stated that the age of onset criteria was seven. The DSM was recently revised to show symptoms can cause impairment before age 12, and it also added more examples of how symptoms could look in adolescence and adulthood, but some experts think the age should be higher.

Dr. Thomas E. Brown, a clinical psychologist who received his Ph.D. from Yale University, wrote in a 2009 paper on the subject, “This later age at onset for some patients makes sense because the cognitive functions impaired in ADHD are among the slowest brain functions to fully mature. Brain functions that provide infrastructure for [executive functions] do not fully come on line until the late teens or early 20s.”

“ADHD is still not that old in terms of being in the DSM and our understanding of it is very much evolving. We went from ADD versus ADHD, to one diagnosis of ADHD with multiple subtypes and varying degrees of severity,” Cunningham said. “That we are doing more studies that further illuminate the ADHD landscape across different demographics is a big step forward. But they are a moving target in as much as the criteria of the diagnosis changes over time.”

One of the challenges for parents trying to figure out how whether or not their daughter has ADHD is a misunderstanding of how diagnosis works. A 2014 survey of 1,883 people conducted by Edelman Berland and fielded by Harris Interactive shed light on this problem, showing 36 percent of the mothers surveyed thought that children had to have hyperactive-impulsive symptoms in order to be diagnosed. Half of those mothers also thought their child’s behavior was typical for their age and that they would grow out of it before the parents eventually decided to seek help.

It’s important that girls and women who are concerned they may have symptoms get screened for ADHD, especially if they also have anxiety and depression. Up to 50 percent of people with ADHD can have anxiety, and 30 percent can have major depression. Girls are often misdiagnosed or other diagnoses can mask their ADHD, and because of this, sometimes female patients are treated with drugs that make symptoms worse.