ADHD Is Different for Women (2013) | Hacker News Reader

ADHD Is Different for Women (2013)

theatlantic.com

44 pointschaosmachine26 comments

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.

I come from a similar position. I wasn't tested or diagnosed until age 24, solely because I was never hyperactive.

My brother was diagnosed in primary school due to his behavior, while I was always 'the good kid who never paid attention'.

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...

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?

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.)

> 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).

This was a little unclear to me until I looked into the wikipedia page you linked a bit more[1]. To try to clarify in case others are in the same spot, ADHD has 3 primary "sub-types:"

* Predominantly inattentive, which is the form discussed in the original article.

* Predominantly hyperactive-impulsive, which most diagnosed boys exhibit.

* Combined (AKA both inattentive and hyperactive-impulsive)

I'm not sure if the most common case for young boys is only hyperactive or if it's combined. Either way, the symptoms of hyperactivity are most disruptive, so they are what causes most people to seek medical help.

[1]: https://en.wikipedia.org/wiki/Attention_deficit_hyperactivit...

It sounds like you're taking this as an attack or something on your personal experience.

She made her case pretty well. There is a stereotype about how ADHD manifests. This stereotype is based on how boys with ADHD generally manifest their symptoms. However, because women often manifest different symptoms from this stereotype, they go undiagnosed.

Yes, these lack of recognition of symptoms can also happen to boys that don't manifest in this "typical boy fashion".

I dunno I'm typing out a bunch of words to try to convey to you how silly and defensive you sound without breaking "HN decorum."

Sadly a pattern not unique to (child) psychology.

Some years back i heard about a guy that died from heart attack, in hospital, because he didn't manifest the symptoms the staff was trained to look for.

And more recently quite a number of core literature is found to be based around men in their 30s and not much else. When different age groups and gender gets investigated they find that symptoms differ.

> I am a young male suffering from ADHD. I've never exhibited hyperactive symptoms

Coloquially known as ADD. The condition presents in different ways:

* Inactive: "ADD." Symptoms of innatention.

* Hyperactive-Impulse: Hyperactivity and implusiveness, but no innatention.

* Combined: "ADHD." Hyperactivity, impulsiveness and innatention.

The hyperactive variants are easier to diagnose, the first is often misdiagnosed as "your kid is lazy/stupid." It's possible that females have a lower chance to present with one of the hyperactivity variants.

I have occasionally wondered if "often misdiagnosed as "your kid is lazy/stupid."" combined with "Confused and ashamed by their struggles, girls will internalize their inability to meet social expectations" results in schoolgirls doing statistically worse than schoolboys in (insert STEM field class that requires deep concentration). And not just failure when attempted, but also results in signing up for fashion textiles class instead of calculus knowing that calculus is "for boys" when in reality its pragmatically "for people without untreated ADD" which may at this time boil down to "for boys".

If (as a physics style thought experiment) the disease happens at the same rate in two populations, but is only diagnosed and treated in one population, then you'd naturally expect the untreated population to be, on average, somewhat less successful in attention-mandatory academics; math, sciences, computer programming... This would seem to be internally consistent, like a conspiracy theory, which is a heck of a long way from being proven in reality of course.

I'm not sure ADHD, as commonly diagnosed, usually presents as anything other than "being a boy in elementary school". I am sure that there are lots of people that actually have ADHD, but there are huge numbers of little boys that get labeled as ADHD because you're trying to make them sit in a chair and pay attention to quite boring material for 8 hours a day, with maybe a 15 minute break to get outside and run around - except they can't wrestle, play tackle football, or often do anything very strenuous that would burn off the excess energy.

I've known quite a few people who would snort adderall and other amphetamines-based analogs as a study drug - they reported being able to remember things better, and to get into a single-minded, grinding mindset that sounds a lot like what we programmers strive to achieve as flow. Various mathematicians (notably Erdos) have used amphetamines as a nootropic.

As a counter thought experiment, what if we are giving amphetamines to one subset of the population at a much higher rate than the other, and these drugs act as a force-multiplier for effort directed towards flow-dependent activities, like programming, science, and mathematics?

I don't doubt that ADHD exists so much as I suspect that it is wildly overdiagnosed in the U.S. Every other developed country has much, much lower rates of diagnosis than the U.S., but even in countries like France where there is a cultural inclination to find diagnoses or interventions other than an ADHD diagnosis, there are still ADHD diagnoses (at a rate that is a few percentage points of the US diagnosis rate).

The main treatment for ADHD is of course lifelong amphetamine prescriptions, and the US has a private pharmaceuticals industry very happy to market to insecure parents. And a general American insecurity about education that results in an astonishingly high proportion of elementary schoolers who get no or minimal recess at all.

The single biggest risk factors for an ADHD diagnosis are being male and being in the youngest quartile of your classroom. This is something we have managed to pathologize.

There used to be two distinct diagnoses, ADD and ADHD. Then they rolled the former into the latter (dunno why, less paperwork perhaps). It should really be read as AD(H)D, as the hyperactive part is not a required trait.

Same here, but I think she’s discussing how much more of an issue these types of non overt symptoms are for females than they are for males, not denying its significant presence in males.

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.

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.

In general I agree, but in the case of a medical problem it's probably relevant. She's trying to point out not all subpopulations have been studied extensively.

> What about ADHD in populations where there are few whites, say Asia, Africa, what has been observed there?

This is a great question. ADHD diagnosis rates vary pretty significantly between the US and Europe (due to diagnostic and cultural differences), and Japan would be a great datapoint. It seems like ADHD prevalence is relatively understudied in Japan, different symptomatic behaviors are viewed as troubling, and there is a much more dim view of stimulant medication.

But we don't need to inject race and gender into everything. It already came that way ;)

>“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.

Disruptive behaviour in nonwhite kids is much more likely to be interpreted as criminal tendency rather than an unfortunate medical condition.

It basically just tips the liberal reader's "oh no, that's bad, that's outdated, white male, bad, 1950s, modernism, bad"

Hyperactive black boys were taken to prison instead, I suspect.

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.

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

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.

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.

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