Research needed into how ADHD manifests itself in girls

for more research into how Attention Deficit Hyperactive Disorder manifests itself in girls.

Galway woman Rose Kavanagh, who is the local co-ordinator of the Irish National Council of Attention Deficit Disorder Support groups (INCADDS ), explains that ADHD presents itself differently in females.

Due to the lack of awareness and understanding surrounding the gender element of the condition many girls remain undiagnosed or misdiagnosed, she says. They may face a range of challenges as they grow older because of this.

Ms Kavanagh, who lives in Claregalway and is a board member of ADHD Europe, was commenting earlier this week in the wake of the launch of a document by ADHD Europe in Brussels which called for a spotlight to be shone on young girls and women with the disorder. October is ADHD month.

With recognition of their condition and support they can become active members of their communities and and fulfil their potential, she believes.

“An emergent body of research and practice insights tells us that trying to assess and diagnose ADHD in girls is more complicated than it is in males. In part, this is because they may have a later onset, as ADHD presents in a very different way in females.

“Apart from that, the inattentive type ADHD is thought to be more common in girls and women than it is in boys and men, and inattentive ADHD symptoms are still largely misunderstood by medical professionals; those with this type are the least likely to be diagnosed and professionals often mistake them for mood disorders, anxiety, or other related conditions.

“Indeed, in females, ADHD may present as more subtle or internal problems (eg, anxiety, inattention ), and less external problems (eg, aggression, challenging behaviour ).”

While girls may not appear to be externally impulsive or hyperactive in the classroom, they tend to internalise their behaviours and their thoughts may cause them huge distraction and internal restlessness, she outlined.

This can sometimes be seen in the child who is constantly fiddling with her hair, doodling, deep in thought, daydreaming, and missing important social cues.

“Inattention and internalising problems are difficult for the sufferer, but less of a problem for others, such as teachers, and so these girls fall through the cracks and struggle alone, often in silence.

“ADHD in females also has links with emotional dysregulation and mental health problems. This may have a biological basis, because research has also shown that changes of estrogen levels in the brain can greatly affect girls with ADHD symptoms during puberty and beyond, making them more susceptible to severe premenstrual mood swings, depression and/or anxiety.”

Ms Kavanagh says that during adolescence, girls with ADHD may lack the necessary coping strategies - the ones they used during childhood may no longer work for them. As a result, they are liable to have greater impairment in social, school and family functioning than girls without ADHD.

Their ability to maintain friendships in adolescence is hindered by their forgetfulness, their tendency to miss dates with friends, their apparent lack of interest in what their friends have to say, and appearing to be self-centered, she maintains.

“If a girl with ADHD is left undiagnosed or untreated as she enters adolescence and young adulthood, she will almost inevitably encounter a range of adjustment problems that can lead to additional disorders, such as an eating disorder (bulimia, anorexia ), or personality disorder.

“In addition, other behaviours typical of these girls include early sexual activity driven by a need to feel good, a misguided sense of wanting to be liked and to be popular – a type of self-treatment for chronic low self esteem. This sometimes impulsive behaviour leads to unprotected sex, a higher ratio of teenage pregnancies and sexually transmitted infections, and an early smoking habit developed during their school years.”

Ms Kavanagh, a former member of the ADHD Awareness Action Committee, outlines that adults with undiagnosed ADHD are more likely to experience divorce, be a single parent, be under-educated, be under-employed or unemployed. They are also more likely to suffer from insomnia, constant stress due to difficulty in managing the demands of daily life, and a lower life expectancy due to accidents than those treated for ADHD. Girls with undiagnosed or untreated ADHD are also more likely to take their own lives than their neurotypical peers.

“Clearly, therefore, when undiagnosed and unsupported, the issue of women with ADHD is a heavy burden for the individual and for society, and so the importance of early identification and treatment cannot be emphasised enough.

“In order to achieve this goal, the indicators (symptoms ) of ADHD in women and girls needs to be better understood by parents, teachers, healthcare professionals, and society at large. An assessment for ADHD diagnosis in girls and women should take into account the symptom history based on how ADHD presents in girls and women. Above all, satisfactory academic achievement should not rule out a diagnosis, as ADHD also occurs in highly intelligent women.”

ADHD Europe is calling for more research on how ADHD presents in girls, gender specific checklists to identify and diagnose girls and women with ADHD, a screening system to be in place which assesses ADHD in girls and women who present with eating disorders, anxiety, depression, sleep problems, personality disorders as well as alcohol and substance abuse.

More training is needed for parents, teachers, school staff, paediatricians, psychiatrists and psychologists on the indicators for ADHD in girls and women and the additional disorders that frequently accompany ADHD in this group, according to Ms Kavanagh.

Additional research and training is also required on the way estrogen affects mood swings in girls with ADHD when they reach puberty and the prevalence of eating disorders, anxiety and depression in this category.

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