Attention-deficit hyperactivity disorder (ADHD) is a well known and common disorder.
In fact, PubMed Health reports that it is “the most commonly diagnosed behavioral disorder of childhood” and affects around 3 to 5 percent of children.
ADHD is more common in males, but many researchers are beginning to examine the presence of ADHD in girls and women more closely.
These researchers are attempting to understand how the disorder expresses itself differently in females, both in terms of initial symptoms and in terms of long-term results.
Symptom Switch
In an article written by Patricia O. Quinn, MD, and Kathleen G. Nadeau, PhD, and published by the National Centers for Gender Issues and AD/HD (NCGI), Drs. Quinn and Nadeau suggest that girls with ADHD are less likely to display symptoms of hyperactivity and impulsivity.
According to PubMed Health, hyperactive behaviors may include fidgeting, problems playing quietly, excessive talking and inappropriate active behavior. Symptoms of impulsivity can include problems waiting their turn, frequent interrupting others and a tendency to answer or interject before a question is finished.
For children with ADHD but without strong symptoms of hyperactivity or impulsivity, symptoms usually fall into the “inattentive” category. This category includes behaviors like not following instructions, avoiding schoolwork, difficulty paying attention, forgetfulness, losing belongings often, frequent careless mistakes and a tendency to not listen when spoken to.
Some patients may have a combination of symptoms from different categories.
The inattentive symptoms are often less obvious and more difficult to observe than their hyperactive or impulsive counterparts. According to Drs. Quinn and Nadeau, the checklists that doctors and schools often use to identify ADHD tend to highlight these more obvious behaviors.
“Because girls are more likely to be inattentive and forgetful than hyperactive, these checklists often lead parents and professionals to overlook girls with attention problems,” said Drs. Quinn and Nadeau.
This could possibly be leading to an under-diagnosis of the disorder in girls.
Drs. Quinn and Nadeau also report that the differences between ADHD in the genders continue even when inattentive-type symptoms are not at play.
“Even hyperactive girls may look very different than boys - tending toward being hyper-talkative, and emotionally hyper-reactive rather than demonstrating the rough and tumble behavior of boys,” they say.
Long-term Differences
Researchers are exploring how ADHD in girls may play out after the initial symptoms have been spotted and diagnoses made.
Results from a study published in August 2012 in the Journal of Consulting and Clinical Psychology suggested that young adult females with ADHD, specifically of a combined type, were more likely to self-injure or attempt suicide than their peers without the disorder.
Led by Stephen P. Hinshaw, PhD, of the University of California, Berkeley, the researchers followed 228 girls over 10 years. Of these girls, 140 had ADHD – 93 of whom had a combined type and 47 of whom had an inattentive form of the disorder. The remaining 88 girls did not have ADHD.
The first part of the study was completed when the girls ranged from age 6 to age 12. When the follow-up occurred after 10 years, the age range was 17 to 24.
The girls were measured for factors such as ADHD symptoms, substance abuse and instances of self-harm, including suicide attempts and self-injury activities like burning or cutting.
Results showed that 22 percent of the girls with combined ADHD reported at least one suicide attempt, while only 8 percent of the girls with inattentive ADHD and only 6 percent of the non-ADHD group did so.
Additionally, 51 percent of the combined ADHD group reported instances of self-injury, compared to 29 percent of the inattentive ADHD group and 19 percent of the non-ADHD group.
These results led the authors to conclude, “Our findings argue for the clinical impact of ADHD in female samples, the public health importance of this condition in girls and women, and the need for ongoing examination of underlying mechanisms, especially regarding the high risk of self-harm by young adulthood.”
Further research with larger samples of girls will further explore these findings and potential ways to minimize self-harm in these patients.
Moving Forward
It would seem that Drs. Quinn and Nadeau would agree with the conclusion of Dr. Hinshaw and team that the public health importance of ADHD in females should be highlighted moving forward.
Drs. Quinn and Nadeau note that girls and boys have a variety of other gender differences (like those related to societal expectations, biology, socialization, etc.) and based on these differences, “it would be very surprising if girls didn’t face different struggles and manifest different behaviors than do boys with ADHD.”
“Parents, teachers, pediatricians, psychologists, and all of the other adults who work with girls with ADHD need to become familiar with these differences in order to diagnose girls accurately and to provide treatment that is more appropriate to their special needs,” report Drs. Quinn and Nadeau.
As research continues into the case of female ADHD, more specific methods of treatment for these patients may be developed. With better understanding of how ADHD expresses itself in women and what additional issues may result, doctors, patients and parents can work to more effectively treat females with ADHD.
