Predominantly Inattentive ADHD and other ADHD In Girls

You can only truly appreciate how it is possible that girls and people with Predominantly Inattentive ADHD, ADHD-PI get ignored by the medical research community if you have lived with or have, in some other manner, thoroughly experienced the other subtypes of ADHD.  The reality is that the other subtypes are louder, more immediately in need of attention, and in general, at least at first blush, much more difficult to live with.

I do not say this to propose that those of us with ADHD-PI are better off than the other subtypes.  We are not, we have other problems.   I say this to give everyone an understanding of what we are up against.  Girls are at a disadvantage when it comes to being diagnosed with ADHD because they are more likely to have ADHD-PI but they are also at a disadvantage just because they are girls.  All Girls, regardless of the subtype, are viewed differently than boys with ADHD and they are less likely to be identified, diagnosed, or referred for treatment.

 I believe that there is a hierarchy of need that is taken into account when medical dollars are allocated for research.  It is appropriate that there are more research dollars allocated to Cancer and heart disease research than there are for say onychomycosis (nail fungus). 

My contention is that girls get less attention because the problems of ADHD-PI are 'quieter' than the problems of the other subtypes.  Girls are also thought to be less at risk for becoming a societal nuisance, than boys.  Girls with ADHD are perceived by teachers and parents differently than boys with the same symptoms and they get less attention and care for their ADHD problems because of this.

Girls suffer tremendously as a result of their symptoms of ADHD but their symptoms often go completely ignored.  Because, the majority of children with the hyperactive/Impulsive type of ADHD (ADHD-HI) and the combined type of ADHD (ADHD-C) are boys, the studies done on the trends, interventions, and outcomes for these types of ADHD has tended to include a predominance of boys.  To make matters even worse, girls with the combined or hyperactive/impulsive type of ADHD are often mislabeled as having some other condition other than ADHD and so are in turn, not treated appropriately.

Two interesting studies were performed a few months ago.  In one of these studies the researchers gave teachers written vignettes with a case study of a girl with symptoms of ADHD-PI and a case study of a girl with the symptoms of ADHD-C.  Different teachers received different vignettes and were then asked questions regarding the girl's diagnosis and the need for a medical referral.  Ninety-eight percent of the teachers recognized that there was a problem but they classified the girls as having emotional problems rather than ADHD symptom problems.   The combined type case study girl was identified as having ADHD by only 43% of teachers.  Eighty-six percent of teachers failed to identify the girls with ADHD-PI.  Eighty-five percent of teachers reported that medication would not be helpful for either case study girl.

In the second study 140 teachers  and 96 parents were given a vignette with a case study  of a child with ADHD symptoms.  Half the parents and teachers read the case vignettes with a boys names on them and the other half read the vignettes with a girls names on them.  The participants then rated their likeliness to seek or recommend further evaluation or treatment for the child in each vignette.  Parents and teachers were less likely to recommend services for girls than boys with ADHD symptoms.

The researcher of this second study had hypothesized that parents and teachers were not seeking evaluation and treatment for girls because the girls were less disruptive but this turned out to not be the case.  The differences in referral rates turned out to be related to the perception by parents and teachers that "learning assistance is less effective for girls than boys with ADHD." 

The findings from this second study should infuriate any woman reading this.  The bias by parents and teachers is so glaringly biased and unfortunate for girls with ADHD.  Girls with ADHD are likely to go without attention for years and will fall further and further behind in school.  Most girls will carry these symptoms into adulthood and are likely to have coexisting problems such as substance abuse and depression which will only be worsened by ignoring the symptoms of ADHD. 

We have got to do better by our girls.  Researchers are finally starting to research and understand the barrier to treating girls with ADHD.  There is much more work to be done but these studies are at least, a start.