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Wednesday, January 19, 2022

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Slowly, ADHD Gender Gap Closes

Feb. 12, 2001 — Becky Stanford loved gymnastics, but she didn’t stick with it because she couldn’t wait her turn. She had difficulty following rigid formats like long division and essay outlines. She struggled in school and with friends. Even her Sunday school teachers dreaded having her in class.

“I was much louder, much more energetic than my peers. Sometimes it really overwhelmed people,” says Stanford, now 28 and living in Helena, Mont. “You had to really gear up to have me over for the weekend or overnight. At sleepovers, I was the one sent to another room because I was keeping people up.”

At 13, Stanford was diagnosed with attention deficit hyperactivity disorder (learning disabilities. “Girls can be charming or coy or ditzy, and it can still be kind of cute. The cultural way of looking at females has a lot to do with that.”

ADHD is the most commonly diagnosed behavioral disorder in childhood, with an estimated 3% to 5% of the general population suffering from it, according to the National Institute of Mental Health. Symptoms can include hyperactivity, a lack of attention span, and impulsive behavior. People with the disorder often are disorganized, cannot complete tasks, and have trouble following more than one instruction at a time. Symptoms can begin as early as age 3 and usually are noticeable by age 7.

Research conducted at Harvard University and Massachusetts General Hospital suggests that ADHD in girls, like boys, tends to run in families, but because girls are not as likely to act out, their symptoms may go unnoticed. Girls more often have attention problems than the disruptive behavior that boys can exhibit, says Joseph Biederman, MD, who led the study published in the July 2000 issue of the American Journal of Psychiatry. Girls in general are one-third less likely than boys to exhibit inattentive ADHD children are overlooked despite their gender, says Nadeau, co-editor of ADDvance Magazine, a publication for women and girls with ADD or ADHD. “An inattentive little boy will be more obvious. He’s just sitting there drawing airplanes or looking out the window,” she says. “A lot of girls will tell you they have learned to look at their teacher while daydreaming because that won’t get them into trouble. A lot of this teacher-compliant behavior masks the problem.”

Screening guidelines for ADHD are “based mostly on hyperactivity in young boys. These were the kids causing the most problems. They were the most disruptive. It’s a matter of the squeaky wheel,” says Jaksa.

Unlike boys whose symptoms decrease at puberty, girls’ symptoms often increase during this time of hormonal change, Nadeau says. The diagnosing criteria for ADHD, however, require that symptoms begin before age 7, according to the National Institute of Mental Health.

“We need better criteria,” Jaksa says. “We need more realistic diagnostic [measures] that address what is going on with girls.”

Not everyone agrees. Biederman believes that the diagnosing guidelines are appropriate. Better education on how to recognize inattentive ADHD, and get girls referred for diagnosing, would help resolve the gender gap, he says.

“The issue is more emphasis on clinicians and educators not to rely only on aggression to recognize ADHD,” Biederman says. “ADHD in girls may not be as commonly described.”

Consider, too, that the most common drug treatment for ADHD is brain and speculated that this would improve attention and decrease distractibility. They noted, however, that their tests were conducted in healthy adult men who were tested in “stress-free” conditions, and said further research was needed.

More studies are under way to further point out the similarities and differences in symptoms between boys and girls. Left untreated, ADHD can lead to depression, lack of self-esteem, and emotional and academic problems — including drug experimentation and earlier sexual relations for girls, according to Nadeau. Many children with the disorder are physically active and more prone to injury. Once they reach adulthood, undiagnosed ADHD women often struggle with organization and being consistent as parents, just like ADHD men, she says.

“There are a lot of things that happen and they don’t have an understanding of why,” says Nadeau, who has authored several books, including Understanding Girls with ADHD. “Everyone just blames them. There is tremendous psychological damage.”

Becky Stanford says she felt misunderstood most of her pubescent years. Had she been diagnosed earlier, she says she could have received treatment that would have made life easier for her and those around her.

“Not knowing why you learn differently, and not understanding why things are easier for other people — I think that does affect your self-esteem,” says Stanford, MSW, a social worker who along with her mother has produced a video on ADHD called Dismissed and Undiagnosed Dreamers. “If I had found out earlier, we could have brought in tutors and people to help me with coping skills to help me organize. It would have helped me to get a better sense of myself early on.”

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