ADHD Diagnoses in Women
Graph created with data from the American College Health Association, 2023. It depicts an increase in many disorders for college students in the United States.
An Increase in ADHD
Data from the most recent American College Health Association survey is startling. Across the board, college students are showing an increase in a variety of disorders from 2009 to 2023. Untangling the possible reasons for this increase is difficult, as the world is quite different now than it was in 2009. Think about it: in 2009, the iPhone was 2 years old. Many people still had BlackBerries and flip phones. Now, BlackBerries feel like an ancient relic; it would be bizarre to see someone using one. That’s not to imply that our heightened use of technology alone is to blame for this shift, but to illustrate one of many possibilities, and one of many differences in day-to-day life compared to 2009.
One noteworthy trend in the data is an increase in ADHD diagnoses, which tripled during this period. Unlike some other mental illnesses, ADHD is thought of as a disorder diagnosed exclusively in childhood. In addition, ADHD is considered to be a neurodevelopmental disorder, which often implies it is present in the brain at a young age. Pinning the rise of ADHD diagnoses on environmental factors alone may not paint a full picture of what’s going on.
ADHD in Women and Girls
Until the 1980s, there was a common belief that only men, often diagnosed as boys, could have ADHD. We know now that this is false, but there are important consequences of this previous assumption. For example, much of the diagnostic criteria for ADHD was based on the symptoms present in boys, not girls. This means that possible differences between the way that boys and girls present ADHD were not taken into account until relatively recently. In adulthood, it is believed that the proportion of men to women having ADHD is 1:1, but in childhood, the proportion of boys to girls diagnosed is 3:1. Given that we don’t expect ADHD to begin showing symptoms later in life, this difference is puzzling.
This means that there are girls with ADHD who are not getting diagnosed at the onset of their symptoms in childhood. Why? The big hypothesis around this is the way we socialize boys compared to girls. For boys, an obvious symptom of ADHD is disruptive behavior, like talking in class, fidgeting often, or even aggression. For girls, it appears that one of the main symptoms that manifests in childhood is inattentiveness. Why would the same disorder show such different behaviors? It is possible that young girls, aware of the environment around them, suppress some ADHD-caused behaviors because the behaviors, such as being disruptive, are not viewed as feminine.
The Importance of a Diagnosis
This lack of diagnosis in childhood can have negative consequences, as it may delay access to the right treatment. Women with ADHD are at a heightened risk for self-harm and trouble in relationships. Without diagnosis in childhood, women with ADHD are more likely to have symptoms of depression and anxiety, sleep disorders, eating disorders, substance abuse, and low self-esteem. Diagnoses can sometimes serve as an explanation for why certain patterns of behavior keep repeating, and proper treatment can be helpful. Without a diagnosis, the burden of the disorder may fall on the individual. Not understanding what may be causing issues can be difficult.
Conclusion
Is it possible that the increase in ADHD diagnoses is simply because we are getting better at correctly diagnosing it? The increase in awareness around ADHD in women could be leading to more diagnoses, as more clinicians become aware of the diagnosis gap. There is also a whole range of other possibilities for this increase; for example, the diagnostic criteria for ADHD shifted in 2013.
It is important to think about the reasons behind sizeable shifts in diagnoses because not all trends can be described at the same level of analysis. It is possible that ADHD is simply more present now than it was in 2009 due to environmental factors, such as new technology. However, it’s also possible that we are seeing an increase in the diagnosis of ADHD given an increased awareness of the presence and symptoms of ADHD in women and girls.
Citations
Abdelnour, E., Jansen, M., & Gold, J. (2022). ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis? Missouri Medicine, 119(5), 467–473.
Da Silva, A. G., Malloy-Diniz, L., Garcia, M. S., & Rocha, R. (2020). Attention-Deficit/Hyperactivity Disorder and Women. In Women’s Mental Health: A Clinical and Evidence-Based Guide (1st ed.). Springer Nature Switzerland. https://ebookcentral.proquest.com/lib/columbia/reader.action?docID=6110037&ppg=217
Hinshaw, S., Nguyen, P., O’Grady, S., & Rosenthal, E. (2021). Annual Research Review: Attention-deficit/hyperactivity disorder in girls and women: Underrepresentation, longitudinal processes, and key directions. The Journal of Child Psychology and Psychiatry, 63(4), 484–496. https://doi.org/10.1111/jcpp.13480
Hinshaw, S., Owens, E., Sami, N., & Fargeon, S. (2006). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into adolescence: Evidence for continuing cross-domain impairment. Journal of Consulting and Clinical Psychology, 74(3), 489–499.
Quinn, P. (2005). Treating adolescent girls and women with ADHD: Gender-Specific issues. Journal of Clinical Psychology, 61(5), 579–587. https://doi.org/10.1002/jclp.20121