GRSJ224/Medicalization of ADHD in Women

The medicalization of ADHD in women refers to the process in which non-medical symptoms are identified, classified, and defined as a medical illness or disorder; in this case, the medicalization of symptoms exhibited by women resulting in an ADHD diagnosis. Attention Deficit-Hyperactivity Disorder (ADHD) is a neurological disorder resulting in symptoms such as inattention, hyperactivity, impulsivity, and emotional dysregulation. ADHD is often thought to be a disorder affecting only children, especially young boys, and this assumption is still widely prevalent today among the public and even among medical professionals. It is estimated that approximately 9% of children and 4.4% of adults have ADHD. However, though medical experts as well as the public have focused widely on the medicalization of ADHD in boys and men, especially debates surrounding medical over-diagnosis and treatment of ADHD in children, women and girls remain significantly under-diagnosed and unrepresented today. The odds of boys receiving an ADHD diagnosis are roughly 2.5 times greater than girls. This is most likely due to symptoms going unrecognized or misattributed to other disorders, as ADHD symptoms appear different in girls than boys. Unexplored further still are intersectional issues of women with ADHD, such as race, sexuality, class/income, education level, and nationality.

Symptoms, Diagnostic Criteria, and Treatment

Symptoms and Diagnostic Criteria

The diagnostic criteria for ADHD requires a consistent pattern of symptoms for more than six months, resulting in the interference of function and development in two or more settings (home, school, or work, for example). From the following two lists of symptoms, individuals must exhibit six or more symptoms for children, and five or more for adults, considered at age 17 and older. Symptoms should also be considered inappropriate for the developmental level of the individual.

Inattentive:

• difficulty paying close attention, making careless mistakes in schoolwork, work, etc.
• difficulty holding attention during tasks or activities
• does not seem to listen during direct conversation
• trouble following through/completing instructions and tasks such as schoolwork, work duties, chores, etc.
• trouble organizing or planning tasks
• often loses important items, such as homework assignments, supplies, keys, wallet, phones, etc.
• easily distracted, especially by things such as intrusive noise
• forgetful in daily life

Hyperactivity/Impulsivity:

• fidgeting, restlessness, squirming, etc.
• trouble remaining in seat when expected
• often moving at inappropriate times, running, climbing, etc.
• difficulty taking part or playing in activities in a quiet manner
• excessive talking, chatting, etc.
• difficulty waiting their turn (in line, blurting out answers, etc.)
• interrupting or intruding while others are speaking

Symptoms must also have been present before the age of 12 and must clearly interfere with or inhibit the functioning of social, school, or work life. Symptoms presented are classified into three occurring types of ADHD:

• Predominantly Inattentive: required number of inattention symptoms met, but not hyperactivity-impulsivity, for past six months or more
• Predominantly Hyperactive-Impulsive: required number of hyperactivity-impulsivity symptoms met, but not inattention, for past six months or more
• Combined: required number of both inattention and hyperactivity-impulsivity symptoms met, for past six months or more

Gender Bias in Diagnosis and Medicalization

In the past, research on ADHD has been centred primarily on young boys; though more recently researchers have begun to study ADHD in adults. According to experts, the current criteria is inappropriate for women with the disorder, resulting in recognition, research, and diagnoses for women "[lagging] even further behind."* Parents, teachers, and even medical professionals often fail to recognize symptoms as ADHD due to the internalization or outright lack of hyperactivity in many girls.* In addition, extensive research states that ADHD has a high rate of comorbidity, indicating that individuals often have one or more psychiatric disorders as well as ADHD - this may include depression, anxiety disorders, personality disorders, autism spectrum disorder, and learning disabilities.

Differences in Symptoms

The manifestation of ADHD symptoms varies greatly in men and women due to a variety of factors, including different socialization and expectations placed upon young women. Furthermore, women are more likely to exhibit inattentive symptoms than men; hyperactive symptoms are considered not only less acceptable but also unrecognized as ADHD due to their lack of similarity to male hyperactivity.

Manifestations of ADHD Symptoms in Women Compared to Men
	Men	Women
Hyperactivity	Excessive motor activity, fidgeting, movement at inappropriate times, disruptive, calling out answers or interrupting, inability to remain seated or in place,	Flightiness, restlessness, talkativeness or 'chatterboxes', impulsiveness, disciplinary or defiance issues, laziness, lacking a 'filter' or bossy, immaturity, difficulty fitting in with peers, difficulty keeping friendships
Inattention		Forgetfulness, daydreaming, shyness, anxious, unwilling to take risks,
Emotional Dysregulation	Conduct disorder, Oppositional Defiant Disorder, stress intolerance, anger or outbursts, poor social skills	Anxiety, Depression, low self-esteem, personality or mood disorders, substance abuse, risky behaviours

Complications of Untreated ADHD

more likely to divorce or single parent (quinn 7)

forgoing social interaction or daily tasks (meals, laundry) and personal health to compensate for lost time (Quinn 7*)

Bias and Stigma in Diagnosis

often misdiagnosed as personality disorders due to emotional dysregulation

once diagnosed, fear of disclosure due to judgement (Holthe)

doctors or other professionals may still be biased and refuse evaluation, resulting in frustration.

diagnosis remains structured to reflect the nature of the disorder as it affects male patients, not women. Furthermore, most evaluations rely in part on recognition thru the memories and opinions of the patient's parents or teachers of their experiences and behaviours, not their own. thus, relying on childhood memories and report cards may fail to accurately reflect what the patient is actually experiencing, as such information may be irrelevant, outdated, or unsuited to determining whether an individual has ADHD. * Many individuals report having difficulty with evaluation due to disagreement among their family members or teachers, to whom ADHD may seem implausible. A US study in 2002 reported that 14% of adolescent girls, prior to their ADHD diagnosis, had been previously treated with antidepressants, while only 5% of adolescent boys in the study reported the same.

Stenner narratives surrounding stigma/medicalization

Treatment

how do women experience treatment or medication? seen as 'addicts'? (holthe or stenner)

treatment plans follow standard plan for men. lack of knowledge of hormonal interactions with ADHD and ADHD stimulant medication (Quinn*) but cyclical variations in hormones during various points in the menstrual cycle may decrease stimulant effectiveness. (Quinn*)

estrogen/progesterone and amphetamines *

Implications for Intersectional and Critical Analysis

Stenner: despite increasing medicalization of adhd as a disorder affecting women, the nature of medicalization itself still allows women to go unseen and undiagnosed (school as vital factor in diagnosis/recognition, also medical treatment facilities). doctors or other professionals may still be biased.

Quinn: well-structured support systems may allow symptoms to go undiagnosed, but not all women experience this quality of support. How does race or class affect this?