Gender Differences in ADHD Essay Example

1. Introduction

Were I to ask you to picture a person with attention deficit hyperactivity disorder [ADHD], who would come to mind? It might be the fidgedy, hyperactive young boy who can not sit still and talks nonstop. Rarely do we associate an easily distracted, quiet, daydreaming girl with the neurodevelopmental disorder which, although usually recognized in childhood, may often last into adulthood. There are three presentations of ADHD: predominantly Inattentive, predominantly Hyperactive-Impulsive, and Combined (Epstein and Loren, 2013: 1). Boys and men tend to exhibit the Hyperactive-Impulsive type with externalising, more "obvious" and socially disruptive symptoms while girls and women frequently display the Inattentive type with symptoms including difficulty to focus, pay attention to detail, stay organised, listen and remember things - rather internalising behavioural patterns (Quinn and Madhoo, 2014). Although ADHD is the best-studied child and adolescent psychiatric disorder, the majority of study data is based on male patients or boys (Retz-Junginger et al, 2008: 815). 

Medicine is imbued with both a biologically determined notion of sex, and a predominatly socially constructed notion of gender. Although biological sex and gender identity do not necessarily overlap, which should be considered by medical systems, for the purposes of discussion in the following, the concept of sex is treated consistent with that of gender.

In 2019, Caroline Criado Perez’s Invisible Women generated a renewed and broadened discussion of the term "Gender Data Gap", which discusses widestretching gender biases in data acquisition. Medical systems are not exempt from "gender gaps", particulary evident in a lack of gender-specific data and the exclusion of women form medical research, resulting in a lack of data which forms the basis of the "Gender Health Gap".  

This paper aims to sketch out Medical Gender Bias by reference to ADHD diagnosis and treatment as a paramount example while also offering some strategies that have been suggested to close this gap. 

Introduction to the Gender Health Gap?

2. An examination of gender implications in ADHD

2.1. The Gender Diagnosis Gap of ADHD

In general, there are difficulties to diagnose ADHD as its assessment is based on the individual decision making process of a practitioner and its a clinical diagnostic based on a multitude of psychopathological symptoms in addition to the inclusion and exclusion criteria that have to be taken into account. However, ADHD is diagnosed more often in boys than in girls. This is due, among other things, to the numerical dominance of male patients in utilisation populations, but also to the fact that the diagnostic criteria on which the diagnosis is based have been evaluated in predominantly male cohorts  (Retz-Junginger et al, 2008: 815). 

There are a numeber of factors contributing to the underdiagnosis of ADHD in girls during childhood, of which a difference in predominant symptoms and ADHD subtype seems to be most implicable. Girls and women tend to exhibit internalising rather than externalising symptoms , less prominent overt, physical aggression than boys and are more likely to be diagnosed with predominantly Inattentive ADHD. Their symptom profile  causes an underrecognition of ADHD in girls and Ohan and Visser (2009) identify a decreased disruptiveness as a major factor for the gender gap in a referral for treatment of girls by others. A study conducted with vignettes which differed only in whether a female or male name was used showed that informants like family members, teachers or colleagues were more likely to overlook symptoms of ADHD in females, decreasing a likelihood for referring them for diagnosis or treatment ((Quinn and Madhoo, 2014). 

Furthermore, criteria for ADHD in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV], the standard work for the diagnostic of mental disorders, especially in the English-speaking world, more accurately describes boys’ symptom profiles than girls’ (Ohan and Johnston, 2005: 379f). As a result, girls are often underdiagnosed during childhood and while DSM-IV symptom domain thresholds are rather appropriate for the diagnosis of young children, they are not sufficiently transferrable for identifying ADHD impairments with adolescents and adults (Epstein and Loren, 2013:2). Similarly, the  current International Statistical Classification of Diseases and Related Health Problems [ICD-10] as the most important, globally recognised classification system for medical diagnoses also raises issues for the ADHD diagnosis. Though worthy of improvement, the DSM-IV is more appropritate for adult diagnosis as there is a differenciation between ADHD subtypes whereas the ICD-10 concepts do not correspont sufficiently and do not differenciate (Jungiger et al, 2008: 1). Therefor, diagnoses may differ significantly depending on which classification system is used by the practitioner and impacts potential missed diagnoses of girls and women. In general, both DSM-IV and ICD-10 diagnosis have considerable limitations, especially concerning adult diagnoses as their criteria are predominantly unspecific and often intersect with other comorbid psychiatric disorders like depression and anxiety (Retz-Junginger et al, 2008: 810). This highlights the cruciality of an accurate diagnosis in order to guide effective treatment and the consequences of misdiagnosis and an ensuing incorrect treatment .

"As a generality, females have fewer symptoms as measured by DSM-IV-TR criteria but are just as impaired as males by these symptoms. In addition, for some time, it has been known that women and girls with ADHD are more likely to internalize symptoms and become anxious and depressed and suffer emotional dysregulation than men and boys with the disorder." (Quinn and Madhoo, 2014)

All these factors maintain and aggravate the overall diagnosis gap of women with ADHD. Petre (2019) suggests, that the overdiagnosis of boys and underdiagnosis of girls can be attributed 

2.2. The Gender Treatment Gap of ADHD

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2.3. Strategies for Closing the Gender Health Gap of ADHD

3. Conclusion

ADHD presentation in women and girls is gender-specific and prevalent gender bias in medicine may promote misdiagnosis etc. ADHD underdiagnosed and undertreated in women and girls, often discounted in favour of other comorbid psychiatric disorders 

5. Works cited

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