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AD/HD and Gender Disparity
Attention-Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder among children and is found more often in boys than girls. Symptoms regularly appear before a child turns 7 and diagnoses have usually occurred when the patient is still a child. However, the population of both children and adults with AD/HD has increased, and many adults have begun seeking help for the disorder. This is a fairly recent shift, and as the prevailing association the general public holds with AD/HD is a stereotypical young boy who can't sit still, awareness, research and diagnoses for people of different ages and genders is still developing. Though AD/HD is diagnosed three times as often in boys than girls, the ratio between the number of men and women with the disorder generally evens out by adulthood.

Females with AD/HD in particular have been neglected and overlooked by researchers, "Most of the few prior studies have focused on comparing girls to boys--using boys' ADHD symptoms as the marker against which girls should be measured" says psychologist Kathleen Nadeau, Phd, in reference to two studies published in 2003 by psychologist Stephen P. Hinshaw, Phd, on ADHD in girls. Hinshaw was among the first to study this specific relation. The delayed acknowledgement of girls and women is because current diagnostic criteria is more suitable for males than females and the referral patterns occurring between teachers and parents based of the stereotyped male ADHD symptoms.

Due to underdeveloped research, many girls go undiagnosed because the symptoms of ADHD do not always match those displayed in boys with the disorder. There are a number of reasons symptoms manifest differently in girls than boys. Ellen Littman, PhD, is one of the first psychologists to research gender differences in AD/HD and has theorized that the identification and help for girls with ADHD is delayed because the literature has been biased towards male ADHD behavioral patterns, "As with all diversity issues, the danger lies in assuming that these more typical patterns characterize all children with ADHD... Therefore, while there appears to be an abundance of information available on ADHD, we may have a false sense that we know more about the experience of girls with ADHD than we really do."

The symptoms of AD/HD between boys and girls can differ, which contributes to girls being diagnosed later in life. Girls with AD/HD "tend to show fewer aggressive and impulsive symptoms, and they have lower rates of conduct disorder" than boys, whose symptoms will generally involve "hyperactivity and behavioral problems which are more noticeable during childhood". Because of these generalized behavioral differences, girls are more commonly diagnosed with Attention-Deficit Disorder or ADD, the non-hyperactive version of ADHD whose symptoms extend to persistent daydreaming. It is also known as the Inattentive Type. Because girls and patients that fall into the Inattentive Type category typically draw less attention to themselves, as their symptoms are usually considerably less noticeable then those of the hyperactive type, their diagnoses and opportunities for receiving help for the disorder will often be delayed until later in life.

Julia J. Rucklidge, PhD, assistant psychology professor at the University of Canterbury in Christchurch, New Zealand believes "We can't make assumptions that what applies to males will apply to females--females have different hormonal influences to start with that can greatly affect their behavior. Also, females are socialized differently and therefore tend to express themselves in a different manner, and are more susceptible to such problems as depression or anxiety that again influence behavior. This suggests that ADHD will manifest and express itself differently in females, but only research can tell us this definitively. Until then, these are assumptions that we make."

Two possible reasons that would cause girls with AD/HD to behave differently than boys with AD/HD are biological makeup and social pressure It is known that hormones play a role in behavior, and teenage girls will find that the difficulties that come with AD/HD greatly intensify the emotional roller coaster typically experienced at that age. The general hyper-reactivity of AD/HD can grow more intense in adolescence as hormonal fluctuations will "complicate and escalate reactivity". Social pressure plays a significant role in the behavioral differences between male and female patients with AD/HD. Girls in elementary and high school often make a greater effort to hide any academic struggles and work harder to please the teacher and conform to his or her expectations. Girls who are bright and compensate for the disorder longer are more likely to be diagnosed later in life.

When diagnosis is delayed or misdiagnosis occurs, Nadeau says "Girls with untreated ADHD are at risk for chronic low self-esteem, underachievement, anxiety, depression, teen pregnancy, early smoking during middle school and high school. As adults, they're at risk for divorce, financial crises, single-parenting a child with ADHD, never completing college, underemployment, substance abuse, eating disorders and constant stress due to difficulty in managing the demands of daily life--which overflow into the difficulties of their own children, 50 percent of whom are likely to have ADHD as well." Researcher and educational therapist Jane Adelizzi, PhD, claims that "Girls with undiagnosed AD/HD will most likely carry their problems into adulthood, and left untreated, their lives often fall apart."

Even if diagnosed at an appropriate age, girls with AD/HD may struggle socially right from the start, experiencing it as early as preschool-age. Many women look back on their childhood and remember feeling "different" from other girls. Girls with AD/HD who feel different or rejected from their peers can develop low self-esteem in teenage years that may affect them for years after. Girls with AD/HD may struggle to meet social expectations, "girls are typically encouraged to be neat, "feminine" (controlled and passive), carefully groomed (in order to be attractive to the opposite sex), sensitive to the feelings of others, and compliant with adults. These very expectations are often in direct opposition to the AD/HD tendencies of many girls." Hormonal fluctuations may increase emotional reactivity during teenage years as well, and dramatic outbursts or a tendency towards impulsive remarks may be present. Depression is often misdiagnosed for AD/HD as girls may experience it because of the struggles that come with having AD/HD and mistakenly identify the effect of depression without realizing the cause behind it.

While the rate of occurrence in female and male AD/HD patients of major depression and anxiety disorders is roughly equal, women tend to endure more experiences of psychological distress and low self-esteem. Women are more likely to have other mood and behavioral disorders and psychological conditions on top of AD/HD, such as dysphoria, compulsive overeating, chronic sleep deprivation and alcohol abuse.

Author Nicole Crawford addresses in her article "ADHD: A Woman's Issue" that symptoms exhibited by women with attention deficit disorder are similar to symptoms typically found in patients with post-traumatic stress disorder (PTSD). "The coexisting panic and anxiety are a result of the classroom trauma the patients experienced during childhood from the undiagnosed attention deficit disorder. For example, if the woman dealt with low self-esteem from attention problems back in grade school, returning to school later in life may trigger those same emotions," Crawford argues.

Women are typically considered more likely to be diagnosed with attention deficit disorder as adults, around their late 30's and early 40's. This often occurs because a child will become diagnosed and his family will go through a process of understanding what AD/HD is and how they can help the child. The mother with undiagnosed AD/HD will typically learn about it and in turn seek help for herself. There are a number of problems that can arise when diagnosis is delayed to this point, including the patient "blaming herself for when things go wrong, or believing she cannot achieve higher goals, especially if her symptoms interfered in her school or work performance." It has been noted by Crawford that these women are also likely to undergo financial problems, underemployment, divorce or lack of education.

AD/HD has traditionally been associated with the character of a hyperactive young boy unable to sit still or focus for more than thirty seconds at a time. This construct has spread from the medical community into the public and has become an impression that many carry. People who don't fit this stereotype such as girls or adults of either gender have only just begun to find acceptance by researchers who are broadening their scope of understanding. However, because of the prevalence held in this constructed character and how closely researchers held to this particular identification, most initial findings and studies on AD/HD have been centered on young boys. As these studies constitute the majority of literature on the topic, they also constitute the diagnostic criteria. As females often display different symptoms than males, many patients have been overlooked and their opportunities to receive aid in life have been delayed or denied The gender bias in diagnostic criteria among other reasons for misdiagnosis has severely impacted the lives of many.