ADHD: Not Just a “Boy’s Disorder”

By: Cayley Fleischman, BSc. Neuroscience & Psychology Student, University of Lethbridge

 In this week’s blog post, we explore the neurodevelopmental condition attention-deficit hyperactivity disorder (ADHD) and how it impacts males and females differently.

 If I asked you to imagine someone with ADHD, it’s likely you’d think of a young, rowdy, restless boy. While that’s not incorrect, though a little stereotypical, you might be surprised to know that a large number of people with ADHD don’t fit this profile.

 As of 2021, an estimated 5.9% of youth and 2.5% of adults globally have ADHD (Faraone et al.). Though rates of ADHD are typically much higher in males, recent evidence suggests that a lack of awareness on how symptoms differ between sexes has resulted in an underdiagnosis of the condition in females.

 According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), there are three types of ADHD: primarily hyperactive, primarily inattentive, and combined type. These types are diagnosed based on how severe symptoms of inattention and/or hyperactivity are prior to age 12.

Signs of inattention often include:

·         not giving enough attention to detail

·         difficulty staying on task

·         being easily distracted

·         forgetfulness

·         difficulty following instructions

·         issues organizing tasks and activities

Signs of hyperactivity often include:

·         fidgeting

·         excessive talking

·         trouble waiting for turns

·         blurting out answers or phrases

·         interrupting others

·         acting without thinking

These symptoms are due to changes in how the brain controls executive function (EF), which are mental abilities that allow us to effectively control our attention, memory, inhibition, and emotions. Research has found that those with ADHD have physical changes in the brain. Differences in the size and structure of areas such as the caudate nucleus, partial lobes, temporal lobes, and the prefrontal cortices, which are largely responsible for EF, have been shown.

While many of the physical changes in brain structure are similar between males and females, behavioural symptoms that accompany ADHD can be vastly different. In males, symptoms of hyperactivity are quite common whereas females tend to have more symptoms of inattention. This difference has caused a significant issue with females being properly assessed with the condition. ADHD has long been stereotyped as a “boy’s disorder”, which has caused diagnostic criteria to only focus on symptoms of hyperactivity since that’s how males with the disorder typically present. This leaves many females, who tend not to show these symptoms, at a disadvantage for being diagnosed compared to their male counterparts.

Because symptoms of inattention are usually more internal and less disruptive, it can be difficult for educators, parents, and healthcare professionals to notice them. However, there are many visible behaviours that are indicative of ADHD in females:

·         Emotional Reactivity and Dysregulation

(Frank, 2019)

o   This refers to our ability to control our response to situations by inhibiting our initial reactions and instead choosing a more appropriate response.

o   Females with ADHD often have problems with this task and tend to feel their emotions strongly and have difficulty controlling them. This can include symptoms like excessive sadness, irritability, an overly elevated mood, sensitivity with accepting feedback, and extreme fear of rejection.

o   These symptoms are often mislabeled as other conditions such as anxiety or depression.

·         Low Self-Esteem and Poor Social Relationships

o   Females with ADHD tend to experience lower self-esteem, have a poorer self-image, and feel ashamed of their diagnosis and symptoms.

o   Females with ADHD also tend to have fewer friends, unstable relationships, and more difficulty in maintaining relationships compared to females without ADHD.

 ·         Other Common Behaviours

o   over-spending and over-eating

o   disorganization

o   lack of sleep

o   often feeling overwhelmed and stressed

o   forgetful or “spacey”

 With these differences in symptoms and the notion that ADHD only affects males, it can be difficult for females to receive proper care. In response to this issue, emphasis has been placed on educating healthcare professionals and teachers on how ADHD affects females so that they are better able recognize the condition. Additionally, diagnostic criteria for the disorder have also been updated to include more symptoms of inattention as well as symptoms that may be unique to females. As caregivers, it’s important to be aware of the sex differences with ADHD as knowing the symptoms can help with addressing concerns and seeking care!

 So, if I ask you again to think about someone with ADHD, can you now imagine more than just a young, rowdy, restless boy?

Resources:

My Health Alberta: https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=hw166083

Canadian Mental Health Association: https://cmha.bc.ca/documents/attention-deficithyperactivity-disorder-in-adults-2/

References:

Akyurek, G. (2018). Executive functions and neurology in children and adolescents. Occupational Therapy - Therapeutic and Creative Use of Activity. https://doi.org/10.5772/intechopen.78312  

American Psychiatric Association. (2013). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425787

Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022

Frank, M. (2019, October 20). Myth: Only boys have ADHD. ADHD Awareness Month. Retrieved May 25, 2022, from https://www.adhdawarenessmonth.org/myth-only-boys-have-adhd/ 

Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. The primary care companion for CNS disorders, 16(3), PCC.13r01596. https://doi.org/10.4088/PCC.13r01596