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.
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.”
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."
> 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.
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.
> 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 ;)
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.
>“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.
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.
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.
[+] [-] api_or_ipa|10 years ago|reply
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|10 years ago|reply
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...
[+] [-] mattdeboard|10 years ago|reply
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."
[+] [-] zamalek|10 years ago|reply
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.
[+] [-] shermanyo|10 years ago|reply
My brother was diagnosed in primary school due to his behavior, while I was always 'the good kid who never paid attention'.
[+] [-] digi_owl|10 years ago|reply
[+] [-] r-w|10 years ago|reply
[+] [-] unknown|10 years ago|reply
[deleted]
[+] [-] mc32|10 years ago|reply
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|10 years ago|reply
I counted "white" once in the article, and repeated in the abstract/intro. The author was quoting someone who was interviewed.
[+] [-] panglott|10 years ago|reply
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 ;)
[+] [-] tsotha|10 years ago|reply
[+] [-] mkinitcpio|10 years ago|reply
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|10 years ago|reply
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.
[+] [-] pjc50|10 years ago|reply
[+] [-] panglott|10 years ago|reply
[+] [-] bru_|10 years ago|reply
[+] [-] Simulacra|10 years ago|reply
[+] [-] pascalmahe|10 years ago|reply
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.
[+] [-] unknown|10 years ago|reply
[deleted]
[+] [-] bru_|10 years ago|reply
My sister on the other hand is pretty quiet and just sometimes procrastinates too much and doesn't clean her apartment.