Katherine Wilkinson
Image source: https://bhsregister.com/5081/opinion/yes-i-can-sit-still-yes-i-am-a-girl-and-yes-i-have-adhd/
Countless thoughts tripping over one another always at the most inconvenient of times, too many to fit in your head but they do anyway. Gaze drifts during conversations, school, fun activities, and everywhere else, but you never realize it until it’s too late. Fidgeting takes place at the most inconvenient times because you don’t feel quite right existing in your own body. At other times, your body feels like a stubborn child, refusing to do what you want it to do even if it’s important. You hear someone say something thought-provoking, and the insatiable urge to blurt out whatever thought happens to be loudest takes over. Although off-putting to your peers, that doesn’t stop you from doing it. Emotions are not something you feel; they are something you become. It’s all day, every day. You wish you could handle it like everyone else is, but little do you know, most people don’t have to.
Attention-deficit hyperactivity disorder (ADHD) is a neurological disorder affecting children and adults that is categorized by difficulty managing attention, issues with controlling impulses, and/or overwhelming hyperactivity and causes problems in school, work, relationships, friendships, or caring for oneself. There are three subtypes: hyperactive, inattentive, and combined (American Psychiatric Association, 2022). While ADHD is one of the more well-known neurological disorders, there are still many children who fly under the radar and struggle through life without being evaluated for it. The majority of these children are female.
In recent years, an average of 12.5% of U.S. households had at least one male child with an ADHD diagnosis, while only 6.7% of U.S. households had at least one female child with an ADHD diagnosis (Centers for Disease Control and Prevention, 2019-2022). The current male-to-female diagnosis ratio is 2:1 in children and 1.6:1 in adults (American Psychiatric Association, 2022). However, in prior years, the male-to-female ADHD diagnosis ratio was estimated to be 10:1 (American Psychiatric Association, 1980). While these data may imply that there are simply more males than females with ADHD, that is likely not the case. On average, females receive their diagnoses four years later than their male counterparts despite having higher rates of psychiatric comorbid disorders (Skoglund et al., 2023). These differences are present due to a lack of inclusion of females in ADHD research, which is still present today but not to the same degree as previously. This has led to a deficiency in information about how ADHD presents in females and fueled biases in evaluation, treatment, and public perception of this disorder. Teachers and the general public have reported believing in the increased prevalence of ADHD in boys compared to girls, and teachers had a more difficult time identifying ADHD in girls than boys (Quinn & Wigal, 2004).
` Although females are still capable of presenting the symptoms most common in males, the most common type of ADHD diagnosed in females is inattentive (Biederman et al., 1999; Gershon, 2002) which is associated with symptoms like lack of attention to detail, making careless mistakes, difficulty in organizing and planning activities, losing items frequently, and reluctance to begin tasks which require sustained mental effort. These differences in symptom presentation and overall disorder experience are influenced by social and biological factors (American Psychiatric Association, 2022). In females, inattentive symptoms are often associated with laziness and personal flaws rather than ADHD, and these perceptions have impacted the frequency of diagnosis within this population. Females are more likely to receive a diagnosis and pharmacological treatment if they display more outwardly noticeable symptoms of ADHD such as issues with conduct or hyperactivity (Mowlem et al., 2018), which are not as common in the inattentive subtype compared to hyperactive. Even when ADHD is diagnosed in childhood, these children and adolescents still struggle with creating and maintaining friendships (Blachman & Hinshaw, 2002; Young et al., 2004), self-harm (Rucklidge & Tannock, 2001), and self-esteem (Mazzone et al., 2013). Even though females tend to develop more coping strategies to mask their symptoms and attempt to fit into society, this does not mean that they are not struggling. Throughout their lifetimes, females with ADHD are at increased risk for mood disorders, substance abuse, attempting suicide, frequently utilizing emotion-based coping mechanisms, teen pregnancy, and borderline personality disorder (Beauchaine et al., 2019; Biederman et al., 2006; Chronis-Tuscano et al., 2010; Rucklidge & Kaplan, 1997; Skoglund et al., 2019).
ADHD going undiagnosed and untreated in females can have detrimental consequences. Without access to treatment and accommodations, late-diagnosed females will struggle more than their non-ADHD female counterparts in the areas previously mentioned. Because inattentive ADHD is more likely to last throughout the lifetime (Döpfner et al., 2015; Larsson et al., 2011) and is the most significant predictor of academic success as opposed to hyperactivity (Pingault et al., 2011), it is even more important that interventions are made during childhood to reduce negative impacts caused by ADHD-related struggles. Across males and females, later diagnosis is associated with increased mortality (Dalsgaard et al., 2015). Although there is limited research about the age of diagnosis and treatment and its effects on outcomes on ADHD symptom severity, receiving help in those areas, whether it is through psychotherapy, pharmacological treatment, or another form of intervention, would most certainly help improve quality of life.
Receiving an ADHD diagnosis can have positive effects such as reducing self-blame and hatred for the existence of ADHD symptoms, developing a more thorough understanding of oneself, appreciating positive qualities associated with ADHD, and aiding peers in understanding how one’s thinking or behavior is associated with their ADHD (Halleröd et al., 2015; Morgan, 2023). Next, having an official diagnosis provides access to treatments of many forms. For example, prescribed stimulant medication can alleviate symptoms soon after taking it, unlike other non-stimulant depression and anxiety medications, which can take weeks to take effect. Different forms of treatment like ADHD coaching, cognitive-behavioral therapy, meta-cognitive therapy, and neurofeedback training have been shown to positively affect and improve symptom management in children and adults with ADHD (Arns et al., 2009; Kubik, 2010; Miranda & Presentación, 2000; Moreno-García et al., 2019; Solanto et al., 2010; Young et al., 2020). The absence of ADHD treatment can contribute to worse outcomes compared to those without ADHD, and the majority of those with ADHD who received treatment significantly benefited from it when compared to those with untreated ADHD (Shaw et al., 2012). Identifying and understanding the ways ADHD affects oneself through adequate diagnosis and treatment can help reduce negative outcomes and potentially save lives.
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