The rainbow butterfly symbol, self-ordained by the ADHD and neurodivergent community, perfectly encapsulates the crux of ADHD: the spectrum of colors mimicking the variability in diagnoses and the butterfly flitting from one idea to the next (Disabled World, 2022). Even the understanding of ADHD itself is in the process of metamorphosis, with its gradual improvement and maturation. Despite a massive increase in ADHD diagnoses over the past two decades, a lack of cultural sensitivity and comprehensive understanding of the disorder has led to a fractured, Kafkaesque definition of ADHD, allowing non-hyperactive types and women to fall between the cracks.
Attention-deficit/hyperactivity disorder (ADHD) was first understood to be a neurodevelopmental disorder in childhood; however, more recent studies show that the disorder persists into adulthood, affecting about 65% of individuals diagnosed in childhood, making up approximately 5% of the population worldwide (Cortese and Coghill, 2018). This percentage is likely inaccurate due to the updating diagnostic definition of ADHD along with the many cases of unidentified diagnoses. The most widely accepted definition comes from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which states that an ADHD diagnosis requires a minimum of 5 symptoms (Cortese and Coghill, 2018). The symptoms pare down to abnormal attentional capacities, impaired executive functioning, and low intrinsic motivation (Hinshaw, 2018). Yet, these characteristics are easily overlooked and incredibly broad. Thus, they cannot be taken as either indisputable or absolute.
Within the broad diagnosis, individuals can be characterized as inattentive, hyperactive/compulsive, or, as is most frequently the case, some combination of the two (Salvi et al., 2019). Exclusive inattentive-type ADHD (formerly known as ADD) affects 18.3% of individuals diagnosed with ADHD and is more commonly found in men. In contrast, the hyperactive/compulsive subtype, which affects 8.3% of individuals, is primarily found in women (Salvi et al., 2019).
Recent controversy surrounding this gender bias in diagnoses has raised the question: is this discrepancy between sexes due to biological or social factors? The answer likely lies in some combination of the two propositions. In terms of biological reasons, differences in hormones and hereditary factors can contribute to the sexual dimorphism (Young et al, 2020). The cultural differences are more varied but can be best understood in terms of a U.S. classroom. Far too often, a girl is chastised for daydreaming, while a boy’s ADHD symptoms are praised for creativity due to differences in socially acceptable behavior. This may result in girls compensating for and or masking their ADHD while boys who present the same symptoms are simply written off for rowdy behavior (Young et al, 2020).
In summary, women tend to internalize their ADHD, while men tend to externalize their ADHD. Individuals who present differently than the implicit gender norms are more likely to get an ADHD diagnosis. A hyperactive girl stands out as a greater, less likely disturbance to a classroom, and the inattentiveness in a boy is much more highly assessed (Young et al, 2020). The danger in these differences is that women who present their diagnoses less obviously, possibly due to biological differences or compensatory strategies, are found to experience more severe side effects and comorbidities (such as depression, anxiety, OCD, NSSI, and suicidal thoughts/behaviors) (Hinshaw et al., 2022).
Accurate understanding and diagnosis of ADHD are essential to an intervention of comorbidities. With the addition of strategies and coping mechanisms, individuals with ADHD can have an increased quality of life where they can be functioning members of society (Retz-Junginger et al., 2008). Gone unchecked or unnoticed, comorbidities can clip the wings of the ADHD butterfly. Instead, individuals with ADHD should value their varying patterns and fly to untethered possibilities in life.
References
Cortese, S., & Coghill, D. (2018). Twenty years of research on attention-deficit/hyperactivity disorder (ADHD): looking back, looking forward. Evidence-based mental health, 21(4), 173– 176. https://doi.org/10.1136/ebmental-2018-300050
Disabled World. (2022, August 12). ADHD and add: Information, Statistics, Research. Retrieved from https://www.disabled-world.com/health/neurology/adhd-autism/#:~:text=The%20rainbow%20butterfly%20symbol%2C%20based,ADHD%20felt%20best%20represented%20them
Hinshaw S. P. (2018). Attention Deficit Hyperactivity Disorder (ADHD): Controversy, Developmental Mechanisms, and Multiple Levels of Analysis. Annual review of clinical psychology, 14, 291–316. https://doi.org/10.1146/annurev-clinpsy-050817-084917
Hinshaw, S. P., Nguyen, P. T., O’Grady, S. M., & Rosenthal, E. A. (2022). Annual Research Review: Attention-deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions. Journal of child psychology and psychiatry, and allied disciplines, 63(4), 484–496. https://doi.org/10.1111/jcpp.13480
Retz-Junginger, P., Sobanski, E., Alm, B., Retz, W., & Rösler, M. (2008). Alters- und geschlechtsspezifische Besonderheiten der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung [Age and gender aspects of attention-deficit hyperactivity disorder]. Der Nervenarzt, 79(7), 809–819. https://doi.org/10.1007/s00115-008-2509-z
Salvi, V., Migliarese, G., Venturi, V., Rossi, F., Torriero, S., Viganò, V., Cerveri, G., & Mencacci, C. (2019). ADHD in adults: clinical subtypes and associated characteristics. Rivista di psichiatria, 54(2), 84–89. https://doi.org/10.1708/3142.31249
Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., Tierney, K., … Woodhouse, E. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC psychiatry, 20(1), 404. https://doi.org/10.1186/s12888-020-02707-9
