
ADHD Is Different for Women (2013) - chaosmachine
http://www.theatlantic.com/health/archive/2013/04/adhd-is-different-for-women/381158/?single_page=true
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api_or_ipa
I think the author has not suitably made her point about the symptoms
expressed by female vs. male sufferers of ADHD.

I am a young male suffering from ADHD. I've never exhibited hyperactive
symptoms. By all measures, my symptoms are very similar to the authors. I too
had a very difficult time expressing my illness to my family and friends (I
did not tell my parents for years in fear of being ridiculed, or worse, cut
off from my medication). When I did come out, I found the same reactions the
author did.

My experience is just one of many, and it's impossible to tell how many other
sufferers there are out there that face the same challenges as I did. I think
the author crossed a bridge too far by characterizing it as a gender issue
when her arguments can apply equally to male sufferers of the passive
inattentive variant of ADHD.

~~~
mattlutze
ADHD is defined in the DSM-IV and now -5 as presenting with predominantly
hyperactive tendencies or with predominantly inattentive tendencies (or
combined, presenting both).

I didn't read it as the author saying that males don't present with
inattentive type. Rather, I thought she was saying that, since women don't as
often present with hyperactive type ADHD as males, the general message is
"girls have less ADHD." Which, then, can impair seeking a diagnosis for a
female that has the disorder, since there's a general bias to look for other
things first.

As far as I've ever understood the inattentive type goes under-diagnosed for
both sexes, as it's not as disruptive to classrooms, where most diagnoses are
started for children. The hyperactive type may be more often diagnosed based
on comparisons between US and European diagnostic criteria -- the European
model results in fewer diagnoses[1].

The author discusses this early in the piece:

 _[Dr. Ellen Littman attributes under-diagnosis in part] "to the early
clinical studies of ADHD in the 1970s. “These studies were based on really
hyperactive young white boys who were taken to clinics,” Littman says. “The
diagnostic criteria were developed based on those studies. As a result, those
criteria over-represent the symptoms you see in young boys, making it
difficult for girls to be diagnosed unless they behave like hyperactive
boys.”_

[1]:
[https://en.wikipedia.org/wiki/Attention_deficit_hyperactivit...](https://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder#cite_note-
Cowen2012-13)

~~~
belorn
People also used to believed in 1970 that AIDS had something to do with
peoples sexual preferences. Is there a reason to believe that diagnostic
criteria has not changed in the last 50 years?

~~~
mattlutze
I would read the criteria in DSM-III, -IV, and -5 to answer that, but I don't
have access.

More inattentive diagnoses occur now, certainly -- I'm one of them. Diagnosed
finally as an adult because I wasn't a disruption in my classes. At question
is more whether an understanding of initial indicators, and efficacy in
flagging both presentations, is equal in parents and teachers.

Obnoxious/hyperactive kids wear on us more than space-cadet/inattentive kids.
The hyperactive ones are the squeaky wheel in this case.

(And, interesting choices in your signposting, there.)

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mc32
I think it's great physicians are able to better diagnose disease and are able
to see it when it manifests itself in populations where observation was missed
or ignored for different reasons (bias, exposure, expectations, etc).

There needs to be better understanding so that boys don't get over diagnosed
and women don't get underdiagnosed.

I find it unfortunate the author found it necessary to mention "white boys"
throughout the article. What about ADHD in populations where there are few
whites, say Asia, Africa, what has been observed there?

Do we need to inject everything with race and gender? I know it's important to
lessen the effect of race and gender on things, but this over emphasis on race
and gender on everything seems frivolous. Here I don't think it adds to the
discussion.

~~~
prawn
_I find it unfortunate the author found it necessary to mention "white boys"
throughout the article._

I counted "white" once in the article, and repeated in the abstract/intro. The
author was quoting someone who was interviewed.

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mkinitcpio
>“These studies were based on really hyperactive young white boys who were
taken to clinics,” Littman says.

I don't really get what lines like this are supposed to be getting at. Why is
race mentioned here at all? I'm now left wondering if there is also some
effect of race on ADHD symptoms, in which case I feel like the quote was not
really used honestly (used partly out of context- how much of this is due to
gender and how much to race?) or whoever said the quote spoke incorrectly
because they felt that the young boys also being white would drive home their
point more.

~~~
mattlutze
Brain stuff is influenced by genetic makeup as much as any other health
condition. Many health conditions present with different effect or prevalence
in different racial sub-populations or between the sexes.

It's meaningful to include race if it was a factor, because she's saying it
was a predominant trait in the study populations on which the diagnostic
criteria were originally built.

If you don't study an effect in different populations to determine the
universality of your criteria, you could very well be under- or over-
diagnosing persons from those groups.

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Simulacra
I don't think it's different on a chemical level, but societal sure.

~~~
pascalmahe
Citing the article, "while a decrease in symptoms at puberty is common for
boys, the opposite is true for girls, whose symptoms intensify as estrogen
increases in their system". IANA doctor or chemist but if there is interaction
with hormones, it's probably different on a chemical level.

By which I mean that the brain chemistry is affected in the same way by ADHD
but interaction with sexual hormones changes behaviour in different ways.

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bru_
This makes a lot of sense. Every day, at 4am, I would spring out of my bed and
begin screaming as I jumped up and down on my parents bed to wake them up,
sometimes literally opening their eyelids for them, kept screaming, made
myself captain crunch and began watching my daily episode of dragon ball z
while eating capn crunch and acting out kung fu moves on the furniture.

My sister on the other hand is pretty quiet and just sometimes procrastinates
too much and doesn't clean her apartment.

