The Underdiagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) in Young Females

Introduction: ADHD is a behavioral disorder characterized by varying patterns of inattention, hyperactivity and impulsivity that may disrupt a child’s daily functioning and development. The gender differences in Attention-Deficit/Hyperactivity Disorder (ADHD) presentation is a topic that until recently has not been well studied or well understood. Research has shown that females are diagnosed for ADHD less often and later in life than their male counterparts, however the population-prevalence of this disorder is thought to be nearly the same between men and women1. These diagnostic discrepancies between males and females highlight a need to answer the questions: What factors influence the underdiagnosis of females with ADHD [P], what are the current diagnostic procedures [I] and what changes can be made [C] to create a more gender- and subtype-inclusive referral and diagnostic process [O]? Methods: A literature search was conducted through Google Scholar and EBSCO in October 2019. A total of 12 articles consisting of cross-sectional, case control and cohort studies were selected based on publication date, population of interest, and language. The study design and results of these articles were then analyzed and compared. Results: Each of these studies provided different results to help answer this complex question. Important findings from these articles include evidence that clinicians more readily diagnose males vignettes when compared to the exact same female vignette, evidence that there are gender-based discrepancies in how parents and teachers rate ADHD symptoms in children1, and use of brain-based cognitive measures as well as quantitative electroencephalographic scans are objective tools that have been found to be both specific and sensitive for diagnosing ADHD. Discussion: Significant results were found in all of the articles, but study design and outcome measures differed among the studies. While the positive findings of these articles have important implications for both clinical practice and answering the question posed in this paper, further study in this area should be performed using more standardized study design and outcome measures. Conclusion: Despite the fact that ADHD is the most common neurologic disorder in children, the diagnostic process has been found to be flawed. The major take away from these 12 studies is that there appears to be a gender-bias in the way that parents, teachers and clinicians identify ADHD in children, resulting in missed diagnoses in young girls, and that there exists other objective tools that can aid in diagnosing ADHD, instead of relying on subjective questionnaires and clinician judgement alone. Implications of these studies lead to the conclusion that awareness of the issue and recognition of one’s own biases as well as incorporation of objective diagnostic tools can lead to a more robust and gender-inclusive diagnostic process