ADHD in Females Essay Example

There are several hundred forms of mental illness that can affect how a person functions in daily life, and while there is often no cure, most disorders are maintainable with proper treatment. For example, Attention Deficit Hyperactive Disorder (ADHD), which is a neurodevelopmental disorder often characterized by hyperactive or impulsive/inattentive behavior, is maintainable with medication and/or therapy. Although little is known about the root cause of it, research suggests that genetics play an important role, and people with a family history of ADHD are at greater risk of developing the disorder. Additionally, ADHD is one of the most diagnosed mental disorders among children, more specifically, among young boys. In fact, according to the National Center for Health Statistics, out of the 6.4 million children who had received a diagnosis of ADHD, males were three times more likely to receive a diagnosis than females, with 12.9% of males receiving a diagnosis during their lifetime compared to only 4.9% of women (Gindi). However, recent studies have proven that ADHD manifests in females just as often as males, which suggests that girls face more barriers to treatment than their male peers (Ramtekkar). While more research surrounding ADHD in females is needed, currently, the largest barriers to treatment for females with ADHD are gender bias, masking behaviors, and misdiagnosis. 

Gender bias, which leads to stereotyping, is one of the more common, yet unrealized, barriers to treatment for girls with ADHD. Despite widespread belief, practitioners do not diagnose the disorder through testing, but through a series of steps that rely on gathering information from several sources. However, each step in the process opens a new door for gender biases, and for girls, this issue can often result is a misdiagnosis or no diagnosis at all. Several studies have highlighted and verified that gender bias exists at each level of the diagnostic chain. For example, one study found that how parents perceive ADHD behaviors changes drastically between genders, and even when both display the same symptoms, parents often rate the symptoms in male children as more severe than those in female children (Mowlem et al. 128). The next link in the diagnostic chain is teachers, and they play an even bigger role than parents because practitioners often rely heavily on a teacher’s report when assessing a child. However, many teachers are unaware of the most recent discoveries in how the disorder manifests in girls and are working on an outdated idea that ADHD presents more in hyperactive boys (Guerra and Brown). When Guerra and Brown asked a sample of teachers to fill out an assessment, 92% of teachers claimed they knew how to spot the symptoms of ADHD in children, but 82% of them also said the disorder is more common in boys, and 95% listed hyperactivity as a symptom (5). The final decision lies in the hands of practitioners and mental health professionals who decide to make a diagnosis. Unfortunately, the criteria a person must meet to get diagnosed is based on research that was done on all male participants. Additionally, a study, done in 2012, found that not only were professionals less likely to diagnose ADHD in girls, but it may be over diagnosed in boys (Bruchmuller et al. 128). The authors asked one-thousand professionals (including social workers, child psychologists and psychiatrists) to examine one of four case studies and give a diagnosis based on the case vignette. They found that when the patient was identified as a male, the professionals were twice as likely to make a diagnosis of ADHD. Furthermore, many of the professionals did not diagnose the case studies that listed the typical symptoms of ADHD in girls with the disorder (Bruchmuller et al. 128). The stereotypical idea that ADHD is a disorder commonly found in boys, and commonly characterized by hyperactivity is so deeply ingrained into society that for girls to be diagnosed, and receive treatment, they must present with severe symptoms, or symptoms that closely resemble those of their male peers. 

In addition to gender biases, girls often develop masking behaviors that hinder the diagnosis and treatment of ADHD. “Masking” is a survival strategy where a person purposely acts in a socially acceptable manner to hide a socially unaccepted behavior (Egeskov). Female children learn early in life that while boys will be boys, they are expected to act like young ladies. Parents reinforce these deep-rooted gender roles in both conscious and unconscious ways. For example, they dress their daughters in pretty clothes, send them out to play, and then get angry when they come home with grass stains. Eventually, young women learn that although splashing in the mud is fun, that is a boy activity, and not one she should take part in. Instead, even though she wants to jump in the puddle, she will pretend to enjoy a more socially accepted behavior. In addition to pleasing adults, girls work hard to remain in good social standing with their peers. However, females with ADHD struggle more in areas of social functioning than boys with ADHD. Girls are more likely to be seen as weird and bullied by their peers, and this is another reason they try desperately to mask their unaccepted behaviors (Kok et al.). Females find many creative ways to mask their behavior and, most of the time, they are so successful that the symptoms go unnoticed for years. For example, while a young boy might act on his impulse to get up and move around in ways that are seen as disruptive to the class, a girl might make frequent trips to the restroom to get up out of her seat. In fact, girls are often so good at masking behaviors that even when symptoms are noticeable, they are brushed off as quirky personality traits instead of taken seriously as symptoms. Ironically, the coping skills they teach themselves to hide what they believe is unacceptable behavior only drives them deeper into seclusion and self-loathing and creates a barrier that prevents diagnosis of the disorder, which in turn prevents them from receiving the treatment they so desperately need.  

Finally, one of the largest barriers to treatment is the poorly understood difference in how symptoms present themselves between genders. There are three types of ADHD: Hyperactive-Impulsive Type (HI), Inattentive Type (IA), and Combined Type (C). Each type is characterized and diagnosed by a certain set of symptoms and behaviors, and those symptoms vary between the types quite considerably. Hyperactive symptoms include squirming, fidgeting, restlessness, inability to stay sitting, and talking overtly (DSM-5). Inattentive symptoms include poor listening skills, forgetfulness, lack of attention and focus, difficulty following instructions, distraction, diminished attention span, and being easily sidetracked (DSM-5). Finally, inattentive symptoms include impatience, interrupting, and engaging in activity without thinking about the consequences of their actions (DSM-5). It is common for children diagnosed with ADHD to have the combined type, but boys typically show more of the hyperactive symptoms, while girls display more inattentive symptoms. Because the hyperactive symptoms are more external and disruptive, they are noticed and linked with ADHD quite easily. On the other hand, inattentive symptoms are more internal, and adults often perceive these behaviors as defiance or other behavioral problems instead of linking them to ADHD. Because of this, girls are often misdiagnosed and do not receive the proper treatment.   

Early diagnosis of ADHD leads to early intervention, and this leads to a more effective path of treatment. When undiagnosed, girls are left to deal with the harsh realities of a mental illness alone and without support. Additionally, when misdiagnosed, girls receive improper treatment, and when that treatment fails, it spurs a cycle of endless medication changes and mood swings. It is important for parents, teachers, and providers to understand what ADHD looks like in girls, and how girls often mask their symptoms, so we can overcome yet another gender bias and ensure girls who are struggling with ADHD get the support and treatment they need and deserve.