Post by Diane on Sept 15, 2004 10:55:09 GMT -5
Psychologists are fighting gender bias in research on attention-deficit hyperactivity disorder.
BY NICOLE CRAWFORD
Monitor staff
Print version: page 28
When psychologist Stephen P. Hinshaw, PhD, published two studies on attention-deficit hyperactivity disorder (ADHD) in girls last October, psychologist Kathleen Nadeau, PhD, was heartened that females with ADHD were finally beginning to receive long overdue attention from researchers.
"Hinshaw is one of the first to study girls themselves," says Nadeau of the lead author's work, published in the Journal of Consulting and Clinical Psychology (Vol. 70, No. 5). "Most of the few prior studies have focused on comparing girls to boys--using boys' ADHD symptoms as the marker against which girls should be measured."
For Nadeau, Hinshaw's research was vindication for what she had observed clinically for years: "that girls experience significant struggles that are often overlooked because their ADHD symptoms bear little resemblance to those of boys." It was also a signal for her to push even harder to raise the awareness of the needs of women with the disorder. Through advocacy and groundbreaking research and writing, Nadeau and a small group of psychologists are fighting to bring the issues of ADHD in women from the fringes of research to center stage.
"Historically, research on ADHD has focused almost exclusively on hyperactive little boys, and only in the past six or seven years has any research focused on adult ADHD," says Nadeau, an expert on the disorder in women and director of Chesapeake Psychological Services of Maryland in Silver Spring. "And the recognition of females [with the disorder] has lagged even further behind."
According to Nadeau, this lagging recognition of girls and women is due to current diagnostic criteria--which remain more appropriate for males than females--and to parent and teacher referral patterns, spurred by the more obvious and more problematic male ADHD behaviors. Some deny that the disorder exists in females--or in anyone at all.
Researcher and educational therapist Jane Adelizzi, PhD, theorizes that females with ADHD have been largely neglected by researchers because hyperactivity is usually missing in girls, who typically have attention deficit disorder (ADD), the inattentive type of ADHD. But for advocates, the bottom line is this: Girls with undiagnosed ADHD will most likely carry their problems into adulthood, and left untreated, their lives often fall apart.
"Girls with untreated ADHD are at risk for chronic low self-esteem, underachievement, anxiety, depression, teen pregnancy, early smoking during middle school and high school," says Nadeau.
As adults, they're at risk for "divorce, financial crises, single-parenting a child with ADHD, never completing college, underemployment, substance abuse, eating disorders and constant stress due to difficulty in managing the demands of daily life--which overflow into the difficulties of their children, 50 percent of whom are likely to have ADHD as well," Nadeau adds.
"Girls with ADHD remain an enigma--often overlooked, misunderstood and hotly debated," says Ellen Littman, PhD, one of the first psychologists and researchers to focus on gender differences in ADHD and to advocate for a re examination of how the disorder is defined.
Littman theorizes that girls with ADHD aren't identified and helped earlier in their lives because male ADHD patterns have been over-represented in the literature. "As with all diversity issues, the danger lies in assuming that these more typical patterns characterize all children with ADHD," says Littman, who runs a clinical practice in Mount Kisco, N.Y. "Therefore, while there appears to be an abundance of information available on ADHD, we may have a false sense that we know more about the experience of girls with ADHD than we really do."
More research on gender issues in ADHD is needed for several reasons, says Julia J. Rucklidge, PhD, assistant psychology professor at the University of Canterbury in Christchurch, New Zealand, who has studied ADHD in Canadian women. "We can't make assumptions that what applies to males will apply to females--females have different hormonal influences to start with that can greatly affect their behavior." Also, Rucklidge says, females are socialized differently and therefore tend to express themselves in a different manner, and are more susceptible to such problems as depression or anxiety that again influence behavior. This suggests that ADHD "will manifest and express itself differently in females," she says. "But only research can tell us this definitively. Until then, these are assumptions that we make."
The mommy factor
Many women are in their late 30s or early 40s before they are diagnosed with ADHD. "One of the most common pathways to a woman being diagnosed is that one of her children is diagnosed. She begins to educate herself and recognizes traits in herself," says Nadeau. "These women are [usually] going to be older," because children are typically diagnosed with ADHD in mid-to-late elementary school.
Women with ADHD typically present with tremendous time management challenges, chronic disorganization, longstanding feelings of stress and being overwhelmed, difficulties with money management, children or siblings with ADHD, and a history of anxiety and depression, says Nadeau, who didn't recognize her own ADHD until middle age and has a daughter and a brother with the condition.
The disorder is typically treated with a combination of stimulant medication and ADHD-focused psychotherapy, "which is very structured, goal-oriented, and uses many 'coaching' techniques, as well as standard psychotherapy techniques," says Nadeau. "Women more than men with ADHD struggle with low self-esteem, and this needs to be a major focus of therapy," she adds.
BY NICOLE CRAWFORD
Monitor staff
Print version: page 28
When psychologist Stephen P. Hinshaw, PhD, published two studies on attention-deficit hyperactivity disorder (ADHD) in girls last October, psychologist Kathleen Nadeau, PhD, was heartened that females with ADHD were finally beginning to receive long overdue attention from researchers.
"Hinshaw is one of the first to study girls themselves," says Nadeau of the lead author's work, published in the Journal of Consulting and Clinical Psychology (Vol. 70, No. 5). "Most of the few prior studies have focused on comparing girls to boys--using boys' ADHD symptoms as the marker against which girls should be measured."
For Nadeau, Hinshaw's research was vindication for what she had observed clinically for years: "that girls experience significant struggles that are often overlooked because their ADHD symptoms bear little resemblance to those of boys." It was also a signal for her to push even harder to raise the awareness of the needs of women with the disorder. Through advocacy and groundbreaking research and writing, Nadeau and a small group of psychologists are fighting to bring the issues of ADHD in women from the fringes of research to center stage.
"Historically, research on ADHD has focused almost exclusively on hyperactive little boys, and only in the past six or seven years has any research focused on adult ADHD," says Nadeau, an expert on the disorder in women and director of Chesapeake Psychological Services of Maryland in Silver Spring. "And the recognition of females [with the disorder] has lagged even further behind."
According to Nadeau, this lagging recognition of girls and women is due to current diagnostic criteria--which remain more appropriate for males than females--and to parent and teacher referral patterns, spurred by the more obvious and more problematic male ADHD behaviors. Some deny that the disorder exists in females--or in anyone at all.
Researcher and educational therapist Jane Adelizzi, PhD, theorizes that females with ADHD have been largely neglected by researchers because hyperactivity is usually missing in girls, who typically have attention deficit disorder (ADD), the inattentive type of ADHD. But for advocates, the bottom line is this: Girls with undiagnosed ADHD will most likely carry their problems into adulthood, and left untreated, their lives often fall apart.
"Girls with untreated ADHD are at risk for chronic low self-esteem, underachievement, anxiety, depression, teen pregnancy, early smoking during middle school and high school," says Nadeau.
As adults, they're at risk for "divorce, financial crises, single-parenting a child with ADHD, never completing college, underemployment, substance abuse, eating disorders and constant stress due to difficulty in managing the demands of daily life--which overflow into the difficulties of their children, 50 percent of whom are likely to have ADHD as well," Nadeau adds.
"Girls with ADHD remain an enigma--often overlooked, misunderstood and hotly debated," says Ellen Littman, PhD, one of the first psychologists and researchers to focus on gender differences in ADHD and to advocate for a re examination of how the disorder is defined.
Littman theorizes that girls with ADHD aren't identified and helped earlier in their lives because male ADHD patterns have been over-represented in the literature. "As with all diversity issues, the danger lies in assuming that these more typical patterns characterize all children with ADHD," says Littman, who runs a clinical practice in Mount Kisco, N.Y. "Therefore, while there appears to be an abundance of information available on ADHD, we may have a false sense that we know more about the experience of girls with ADHD than we really do."
More research on gender issues in ADHD is needed for several reasons, says Julia J. Rucklidge, PhD, assistant psychology professor at the University of Canterbury in Christchurch, New Zealand, who has studied ADHD in Canadian women. "We can't make assumptions that what applies to males will apply to females--females have different hormonal influences to start with that can greatly affect their behavior." Also, Rucklidge says, females are socialized differently and therefore tend to express themselves in a different manner, and are more susceptible to such problems as depression or anxiety that again influence behavior. This suggests that ADHD "will manifest and express itself differently in females," she says. "But only research can tell us this definitively. Until then, these are assumptions that we make."
The mommy factor
Many women are in their late 30s or early 40s before they are diagnosed with ADHD. "One of the most common pathways to a woman being diagnosed is that one of her children is diagnosed. She begins to educate herself and recognizes traits in herself," says Nadeau. "These women are [usually] going to be older," because children are typically diagnosed with ADHD in mid-to-late elementary school.
Women with ADHD typically present with tremendous time management challenges, chronic disorganization, longstanding feelings of stress and being overwhelmed, difficulties with money management, children or siblings with ADHD, and a history of anxiety and depression, says Nadeau, who didn't recognize her own ADHD until middle age and has a daughter and a brother with the condition.
The disorder is typically treated with a combination of stimulant medication and ADHD-focused psychotherapy, "which is very structured, goal-oriented, and uses many 'coaching' techniques, as well as standard psychotherapy techniques," says Nadeau. "Women more than men with ADHD struggle with low self-esteem, and this needs to be a major focus of therapy," she adds.