For decades, the experience of ADHD in girls and women was largely discounted... 2022 articles

pattismith

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Annual Research Review: Attention‐deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions - Hinshaw - 2022 - Journal of Child Psychology and Psychiatry - Wiley Online Library

(a) Girls meet diagnostic criteria for ADHD at just under half the rates of boys, a ratio that becomes much closer to equal by adulthood.

(b) Girls and women with ADHD show a predominance of inattention and associated internalizing problems; boys and men display greater levels of hyperactive–impulsive symptoms and associated externalizing problems.

(c) Sex differences in ADHD symptoms and related outcomes depend heavily on the clinical versus nonreferred nature of the samples under investigation.

(d) Females with ADHD experience, on average, serious impairments, with a particularly heightened risk for problems in close relationships and engagement in self-harm.

(e) Clinicians may overlook symptoms and impairments in females because of less overt (but still impairing) symptom manifestations in girls and women and their frequent adoption of compensatory strategies.
Brain Sciences | Free Full-Text | Sex Differences in Substance Use, Prevalence, Pharmacological Therapy, and Mental Health in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) | HTML (mdpi.com)

Francisca Castellano-García


The lack of externalizing symptoms in girls and women with ADHD hampers both their referral and earlier diagnosis [75]. Furthermore, the inattentive-type ADHD, which usually involves less disruptive behaviors, is more often diagnosed in women, both in childhood and in adulthood [19]. This could perhaps contribute to the explanation of why girls with ADHD tend to be underdiagnosed [76,77], probably due to sex differences in the presentation of the symptoms and comorbidities of the disorder [65,72].
Follow-up studies have further suggested that women with ADHD may have more serious problems than their male counterparts [67]. For example, they have a higher risk of substance use, admission to inpatient psychiatric units, and higher mortality rates than men [32,76,80]. These results support the idea that the current diagnostic criteria may not adequately detect girls with ADHD [82,83]. Most of these criteria refer to behaviors that are more easily manifested and observed in boys.

Therefore, the DSM-5 continues to present a considerable limitation in this sense because the symptoms it lists for ADHD are not modulated by sex differences. This situation causes a significant obstacle when it comes to recognizing and diagnosing girls with ADHD, thus producing erroneous or late diagnoses, which can lead to a worsening of symptoms in this population over time [77].
 
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Since your quotes are enclosed in the pink quote box, I cant requote them here, so have copied-and-pasted ...

"Therefore, the DSM-5 continues to present a considerable limitation in this sense because the
symptoms it lists for ADHD are not modulated by sex differences. This situation causes
a significant obstacle when it comes to recognizing and diagnosing girls with ADHD,
thus producing erroneous or late diagnoses, which can lead to a worsening of symptoms
in this population over time [77]."

Not meaning to climb on my soapbox here, but the under-evaluating and therefore under-treating of women is pretty much across the board, and in fact, women and our differing nervous systems, physiologies and reactions to everything from drugs to full treatment protocols was completely ignored in research and drug trials til pretty late in the 90's ...

So this additional sad news doesn't, sadly, surprize me .... I think the same is true in autism, where it's assumed that women are rarely autistic, and that it's a malfunction that strikes the male population almost exclusively ... would love to see the research supporting that assumption ....