ADHD: Pigerne bliver overset pga uvidenhed og kønsbias

I mange år har megen forskning tydet på, at mellem 50-75% af piger med ADHD er udiagnosticerede, og at de piger som bliver diagnosticeret, bliver det 5 år senere end drengene. En mulig forklaring kan være, at pigernes symptomer overses, da de oftest er internaliseret, hvorimod drengenes er eksternaliseret. Nyt studie kan nu bekræfte, at dette rent faktisk er tilfældet, og tilføjer at ubehandlet ADHD hos pigerne har alvorlige konsekvenser på længere sigt. 

Her hos ADDspeaker møder vi hver eneste dag konsekvenserne af denne fejlslagne og groft diskriminerende forskelsbehandling der er på ADHD-området i Danmark. Vi møder de kvinder der kæmper en kamp uden lige for at få deres pigers lidelser anerkendt, så de kan blive mød forståelse og omsorg, fremfor fordømmelse, og det gælder både for mødrene selv og deres piger.

At 55% med Autisme også lider af komorbid ADHD er blot endnu et problem for pigerne, idet kombinationen af ADHD og Autisme gør, at pigernes autisme kan virke ‘overskyggende’ på deres hyperaktive/impulsive, og letafledelige adfærd, da piger i langt højere grad end drenge, bruger deres intellekt til social interaktion, og her kommer autismens symptom ‘maskering’ på banen og skaber en coping mekanisme for pigerne, hvor de ‘observerer, analyserer og kopierer’ de populære piger, og dermed bedre kan indgå i sociale relationer i de mindre klasser, end drengene kan.

Drengene spiller fodbold og andre fælleslege, hvor fokus er på de fysiske evner og kompetencer, og her kommer den nedsatte nonverbale hæmningskontrol tydeligt frem. Pigerne leger derimod små voksne, og skaber dramaer mellem grupper af piger, hvorefter de så ‘øver’ sig i at løse konflikter, være en god veninde, og naturligvis også … hvordan de kan stikke en kniv i ryggen på deres rivaler.

Så pigerne symptomer på nedsat hæmningskontrol kommer langt mere til udtryk som tankemylder og emotionel dysfunktion, begge ting som foregår internt i sindet, og for mange ender som kimen til angst, depression, og øget risiko for misbrug og promiskuøsitet i teenage-årerne, som konsekvens af den manglende anerkendelse af deres symptomer på ADHD.

Forskellen kan tydeligt ses i statistikkerne over forbrug af ADHD-medicin, hvor der er 3x flere drenge end piger der er i behandling, mellem 0 – 17 år, hvorefter tallene udlignes til nogenlunde 50/50% efter 18 års alderen, et sikkert tegn på at der er en signifikant underdiagnosticering blandt pigerne.

Hovedpunkter

• Drenge med ADHD udviser en mere hyperaktiv adfærd og mindre hæmningskontrol (primært nonverbalt) og kognitive fleksibilitetsproblemer end piger med ADHD gør.
• Drenge med ADHD viste større underskud i motorisk responshæmning (nonverbal adfærd) end piger med ADHD
• Piger har symptomer, der er mere subtile og følgeligt mindre (socialt) forstyrrende, hvilket kan undergrave deres chancer for at blive henvist klinisk.
• Lærere undervurderer muligvis også symptomer hos piger, da deres symptomer sammenlignet med drenge er mindre (socialt) forstyrrende.
• Piger er mindre (nonverbalt) hyperaktive og manifesterer mindre motorisk responshæmning (nonverbal adfærd).
• Med hensyn til de Eksekutive funktioner viser resultaterne en kønsmæssig forskel i hæmning, hvor drenge viser større underskud end piger gør.
• Drenge med ADHD har mere kognitive fleksibilitetsproblemer end piger har.
• De langsigtede virkninger af ubehandlet ADHD inkluderer problemer med hensyn til selvværd, selvmordsadfærd, psykotropisk stofmisbrug, social funktion, jobmuligheder og antisocial opførsel.

/ADDspeaker

Reference

Meta-Analysis of Sex Differences in ADHD Symptoms and Associated Cognitive Deficits

Loyer Carbonneau, M., Demers, M., Bigras, M., & Guay, M. C. (2020). Meta-Analysis of Sex Differences in ADHD Symptoms and Associated Cognitive Deficits. Journal of Attention Disorders. https://doi.org/10.1177/1087054720923736

Study Shows Gender Disparities in ADHD Symptoms of Hyperactivity and Poor Response Inhibition

Abstract

Objective: A meta-analysis was carried out to determine whether there are sex differences among children and adolescents with ADHD on the primary symptoms of ADHD and on executive and attentional functioning. 

Method: Studies published from 1997 to 2017 comparing boys and girls with a valid ADHD diagnosis were retained. 

Results: The meta-analysis found boys with ADHD to be more hyperactive than girls with ADHD and boys to have more difficulties in terms of motor response inhibition and cognitive flexibility. Results also confirm that youths with ADHD have more executive deficits than non-ADHD peers have, but there is no sex difference in this regard. 

Conclusion: Results show that there are sex differences in the behavioral expression of the difficulties related to ADHD. This highlights the importance of pursuing research to refine the profile of girls with ADHD and to develop diagnostic criteria adapted to each sex. 

Key findings

• Boys with ADHD manifest more hyperactive behaviors and bigger inhibition and cognitive flexibility problems than girls with ADHD do.
• Boys with ADHD demonstrated greater deficits in motor response inhibition than did girls with ADHD
• Girls have symptoms that are more subtle and, consequently, less disruptive, which may undermine their chances of being referred clinically.
• Teachers might also underestimate symptoms in girls, given that, compared with boys, their symptoms are less disruptive.
• Girls are less hyperactive and manifest less motor response inhibition difficulties.
• Regarding executive functions, results show a sex difference in inhibition, with boys demonstrating greater deficits than girls do.
• Boys with ADHD have more cognitive flexibility problems than girls do.
• The long-term effects of untreated ADHD include problems regarding self-esteem, suicidal behaviors, psychotropic drug addiction, social functioning, job performance, and antisocial behaviors.

Conclusion

In sum, our results suggest on the whole that the behavioral expression of ADHD symptoms differs by sex: Girls are less hyperactive and manifest less motor response inhibition difficulties. However, like boys, they are inattentive and have interference control problems. These results are important in that, on one hand, they underscore the fact that girls have symptoms that are more subtle and, consequently, less disruptive, which may undermine their chances of being referred clinically. In light of these results, it seems that most of these criteria refer to behaviors more commonly manifested by and more easily noted in boys. This points to a serious limitation of the DSM-5, namely, that symptoms are not modulated according to sex. This constitutes a major obstacle when it comes to recognizing and diagnosing girls with ADHD, as it might be harder for girls to meet the hyperactivity–impulsivity diagnostic criteria. This could lead to a wrong diagnosis or to late diagnosis and, over time, to a worsening of symptoms and to associated problems, such as academic, social, and psychological difficulties. Our study also shows that boys with ADHD have more cognitive flexibility problems than girls do. This could be explained by a later brain development in boys than in girls, especially for later developing skills such as cognitive flexibility. However, working memory, planning, and attention deficits are just as common in boys as in girls. In other words, our results show that girls with ADHD have difficulties regarding executive and attentional functioning. In sum, girls with ADHD do not differ from boys with ADHD in many domains of cognitive functioning and they have significantly more severe difficulties across the executive and attentional functions measured relative to girls without ADHD. This meta-analysis is the first to examine sex differences on cognitive flexibility, working memory, and planning.