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Attention-Deficit/Hyperactivity Disorder (ADHD), is defined, as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V), does not discuss symptoms and how they could present differently between males and females. The diagnostic criteria per the DSM V, is derived mostly from male samples (Kok, F. M, 2016). That doesn’t mean that more males have ADHD than females, more adolescent boys are diagnosed with ADHD than adolescent girls, but the number of adult women is nearly equal to that of adult men diagnosed with the disorder. (Quinn, P. O., 2014). There is research to support that girls present unique symptoms that boys do not, that would explain why girls have been overlooked and referred less for diagnosis unless they presented more severe symptoms. There are a few reasons for those unique symptoms in girls: female gender role expectations, inattentiveness more than hyperactivity, the internalizing of symptoms, hormones, comorbidity of disorders, and lack of awareness by clinicians, teachers and parents. (Kok, F. M, 2016) (Littman, E., 2018).
Female gender role expectations are one possible explanation for the lack of referrals for diagnosis of young girls and the rise in diagnosis of adult women. Girls and women alike are expected to meet the social normal of “feminine” behavior, they should be empathetic, nice, accommodating, compliant, good mothers and home organizers (Glaser Holthe M. E., 2017). If girls deviate from what is socially normal, it is often viewed as more social unacceptable, than it would be for boys. This is a reason why girls with ADHD sometimes withdrawal from social interactions and activities. They will do whatever is necessary to hide their symptoms so they can keep from violating those social norms. Since most girls learn to mask their symptoms from an early age most teachers and even parents miss the early signs of ADHD (Quinn, P. O., 2014). For adult women as they enter the workforce, get married, and start having children, symptoms can become more increasingly difficult to mask. They start experiencing increased amounts of anxiety, depression, and lowered self-esteem, which leads them to seek clinical help, and this would explain why more adult women are diagnosed with ADHD than young girls (Canela C, 2017).
Since there have been more young boys diagnosed than young girls, the diagnosing criteria contained in the DSM V, have been taken from mostly male samples, this has unintentionally led to gender bias (Kok, F. M, 2016). The DSM V has two main categories/criteria for diagnosing ADHD, the first is inattentiveness and the second is hyperactivity/impulsivity. Girls are more likely to have problems with inattention, these symptoms are much less disruptive in a classroom or home setting, than hyperactivity and impulsivity which is more often displayed by males externally. This leads to teachers referring boys more often than girls for diagnosis. That doesn’t mean that girls are less hyper than boys when it comes having ADHD, girls tend to internalize their symptoms, more than boys do and because of the gender differences their hyperactivity isn’t always manifested in the same ways.
The most common symptoms of hyperactivity in females are: hyper-talkativeness, high arousal, fidgeting, flight of thoughts, internal restlessness, and emotional reactivity (Glaser Holthe M. E., 2017). The most common symptoms of inattention in females are: forgetfulness, internalizing symptoms, daydreaming, disorganization, low arousal, impulsivity by the way of interrupting others, they say may say whatever comes to mind, and suddenly change directions in life (Glaser Holthe M. E., 2017). These symptoms are usually thought to be signs of emotional difficulties, disciplinary problems, and learning or attention difficulties, rather than symptoms of ADHD (Glaser Holthe M. E., 2017) . It is not uncommon for females to be diagnosed with anxiety or depression and put on an antidepressants before they receive treatment for ADHD (Quinn, P. O., 2014). The reason for this is because of the ADHD symptoms that females present, and were discussed previously. An example of this would be a female patient diagnosed with a persistent depressive disorder, based on symptoms of low arousal, which is also a symptom that stems from inattention a characteristic ADHD. Females may also present to their clinician symptoms of impulsivity and having unusually high energy and be diagnosed as being bipolar instead of having ADHD. It’s this comorbidity along with the bias of gender that can keep girls and women from receiving the proper diagnosis of ADHD. In a nationwide survey it was reported that more young girls than young boys were treated with antidepressants before receiving ADHD treatment (14% vs 5%), this supports the idea that medication used for therapy in females tends to be targeted toward non-ADHD conditions (Quinn, P. O., 2014).

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