psy304-adhd

[psy304-adhd]

1/6

Context: Attention-Deficit Hyperactivity Disorder in Assigned Female at Birth Individuals

Attention-Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition present from childhood which can put individuals at higher risk for other psychiatric comorbid conditions (Young et al., 2020, p. 2; Marraccini et al., 2017, p. 684; Okumura et al., 2021, p. 636). One study in Japan showed that 12-year-olds with persisting ADHD symptoms and no diagnosis did not perform as well as their peers diagnosed with ADHD and peers without ADHD symptoms in several quality-of-life areas (Okumura et al., 2021, p. 640). While diagnosed ADHD contributes to additional life challenges than may be faced by those without ADHD, those with undiagnosed ADHD face many of the same challenges without the tools to better handle day to day life. Undiagnosed ADHD can negatively affect a person’s wellbeing.

Undiagnosed ADHD may become apparent when a student enters college and struggles or displays impairment unnoticed when in a structured environment (Young et al., 2020, p. 7). College is a key transition period from adolescence to young adulthood, a time when a individual’s actions can have significant consequences for the rest of their lives. Undiagnosed ADHD puts individuals at a further disadvantage than their diagnosed ADHD peers as they do not start this transition period with the same resources and support which can be provided to those with an official diagnosis. If undiagnosed ADHD can provide such a barrier it brings to question how students make it through grade school without receiving a diagnosis.

One major group that often does not receive a diagnosis until their adolescent and young adulthood stages of development are female individuals (For simplicity’s sake the term female or any other traditionally feminine gendered term in this paper is referring to an individual assigned female sex rather than their gender identity and similarly with traditionally masculine gendered terms; Marraccini et al., 2017, p. 685; Young et al., 2020, p. 2). Women with undiagnosed ADHD and therefore untreated ADHD face greater challenges and hurdles to a successful early adulthood and college or vocational career than their peers with a diagnosis and treatment (Young et al., 2020, p. 2). This key period of life has significant impact on one’s opportunities to enter careers which can provide stable income and opportunities which can be afforded to those with such careers. Women with undiagnosed ADHD face significant challenges that are not typically taken into consideration by much of society.

[psy304-adhd]

2/6

The Problem Space: Diagnosing Female ADHD During Childhood

Many women seek out a diagnosis when older through help seeking behavior and self-identifying potential symptomology of ADHD (Marraccini et al., 2017, p. 685). Female individuals with ADHD often go undiagnosed because they do not present the disruptive behaviors associated with stereotypical ADHD (Young et al., 2020, pgs. 6-7). The stereotypical ADHD which might trigger a referral for diagnosis is largely based on what is typical behavior for male ADHD. Comorbid internalizing disorders are more common among women than men with ADHD suggesting a potential difference in presentation of ADHD between the two groups (Young et al., 2020, p. 2). When identifying a psychiatric condition often the comorbid condition, like anxiety or depression, will be identified and labeled as the primary challenge for a female patient without considering ADHD as a potential primary cause (Young et al., 2020, p. 5).

The underdiagnosis of childhood ADHD among girls highlights a two-pronged issue in the diagnostic process. When young girls are flagged as needing mental health care if their health care provider assumes anxiety or depression is a stand-alone issue for that girl, she will not receive further evaluation to discover she may have ADHD. If there are not many girls with diagnosed ADHD, then research on diagnostic processes is not likely to include a truly representative sample unless this factor is specifically considered. The image and understanding of ADHD needs to change in a way that accommodates female ADHD just as it does male ADHD, so young girls can be identified and receive the same treatment as their male peers with ADHD. If ADHD so often gets undiagnosed in young girls, females with ADHD face significant challenges people with diagnosed ADHD and those without ADHD may not face, putting them at a disadvantage.

[psy304-adhd]

3/6

Potential Methodology: Investigation of Female ADHD

Working with children there are a few different groups of people that can be involved in identifying ADHD, the teacher, the mental-healthcare professional, and the parent. The teacher and parent may recognize a child is struggling or acting out in some way and bring them to a counselor or psychologist. The mental-healthcare professional, say a psychologist, then will choose how to work to identify the root of the child’s challenges. The teachers and parents can be seen as forming one group and the psychologists form the other. These two groups play a key role in identifying children who may have ADHD, so their understanding of female ADHD and ADHD in general must be better understood to improve ADHD identification among girls.

Critical Narrative Analysis provides a strong framework for exploring through narrative study the ideas and things influencing an experience (Souto-Manning, 2012, p. 161). This experience or incident can be used to understand and explore potential underlying thought processes of individuals. This could be a useful tool for exploring what teachers and parents consider concerning behavior needing professional attention and any differences between these concerns for male or female children. Discussions with psychologists could be used to explore why a psychologist would investigate further diagnosis for a boy than a girl. While this would not fix the problem, it would provide a strong foundation to understand how to move forward.

[psy304-adhd]

4/6

Community Partners: Support and Information

Kaleidoscope Society and Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)are two groups that have information, resources, and communities which can be joined by those with ADHD. Kaleidoscope Society specifically is a group that focuses on women with ADHD. These groups likely already have work focusing on female ADHD. These would be good groups to find resources for literature reviews and to ask about academic partnerships they have.

[psy304-adhd]

5/6

What I Know and Where I Go From Here

I am AFAB and my second year of college I found out I had ADHD when I went to get neuropsych evaluation only after a year of struggling with debilitating anxiety and receiving treatment for that anxiety. After this I did a bit of reading on my own. AFAB individuals are significantly less likely to be diagnosed with ADHD as children than their AMAB counterparts, largely because girls with ADHD are not disruptive and can often perform at a typical average level. This highlighted the context under which I defined a problem. The subject of my potential investigation is the process of identifying girls with ADHD.

As an undergraduate student there is a limit to what I can do without professor assistance. My plan going forward is to continue into a graduate degree program in clinical psychology. I want to research and work on topics surrounding neurodiversity in girls, so this is the type of research I will look for when applying to other schools. In the more immediate future for my senior honors project, I am going to work on a resource on symptoms of girls with ADHD which I plan to design to be able to be distributed to parents and teachers to spread awareness.

[psy304-adhd]

6/6

References

Children and Adults with Attention-Deficit/Hyperactivity Disorder. (n.d.). CHADD.Chadd. https://chadd.org/

Kaleidoscope Society. (n.d.). Kaleidoscope Society. Kaleidoscope Society. https://www.kaleidoscopesociety.com/

Marraccini, M., Wyandt, L., Gudmunsdottir, B., Oster, D., & McCallum, A. (2017). Attention-deficit hyperactivity disorder: Clinical considerations for women. Journal of Midwifery & Women’s Health, 62, 684-695. doi:10.1111/jmwh.12671

Okumura, Y., Yamasaki, S., Ando, S., Usami, M., Endo, K., Hiraiwa-Hasegawa, M., Kasai, K., & Nishida, A. (2021). Psychosocial burden of undiagnosed persistent ADHD symptoms in 12 year-old children: A population-based birth cohort study. Journal of Attention Disorders, 25(5), 636-645. DOI: 10.1177/1087054719837746

Souto-Manning, M. (2012). Critical narrative analysis: The interplay of critical discourse and narrative analyses. International Journal of Qualitative Studies in Education 27(2), 159-180. http://dx.doi.org/10.1080/09518398.2012.737046

Young, S., Adamo, N., Ásgeirsdóttir, B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdal, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., Tierney, K., van Rensburg, 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(404). doi.org/10.1186/s12888-020-02707-9

[psy304-adhd]

References

Children and Adults with Attention-Deficit/Hyperactivity Disorder. (n.d.). CHADD.Chadd. https://chadd.org/

Kaleidoscope Society. (n.d.). Kaleidoscope Society. Kaleidoscope Society. https://www.kaleidoscopesociety.com/

Marraccini, M., Wyandt, L., Gudmunsdottir, B., Oster, D., & McCallum, A. (2017). Attention-deficit hyperactivity disorder: Clinical considerations for women. Journal of Midwifery & Women’s Health, 62, 684-695. doi:10.1111/jmwh.12671

Okumura, Y., Yamasaki, S., Ando, S., Usami, M., Endo, K., Hiraiwa-Hasegawa, M., Kasai, K., & Nishida, A. (2021). Psychosocial burden of undiagnosed persistent ADHD symptoms in 12 year-old children: A population-based birth cohort study. Journal of Attention Disorders, 25(5), 636-645. DOI: 10.1177/1087054719837746

Souto-Manning, M. (2012). Critical narrative analysis: The interplay of critical discourse and narrative analyses. International Journal of Qualitative Studies in Education 27(2), 159-180. http://dx.doi.org/10.1080/09518398.2012.737046

Young, S., Adamo, N., Ásgeirsdóttir, B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdal, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., Tierney, K., van Rensburg, 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(404). doi.org/10.1186/s12888-020-02707-9

[psy304-adhd]

What I Know and Where I Go From Here

I am AFAB and my second year of college I found out I had ADHD when I went to get neuropsych evaluation only after a year of struggling with debilitating anxiety and receiving treatment for that anxiety. After this I did a bit of reading on my own. AFAB individuals are significantly less likely to be diagnosed with ADHD as children than their AMAB counterparts, largely because girls with ADHD are not disruptive and can often perform at a typical average level. This highlighted the context under which I defined a problem. The subject of my potential investigation is the process of identifying girls with ADHD.

As an undergraduate student there is a limit to what I can do without professor assistance. My plan going forward is to continue into a graduate degree program in clinical psychology. I want to research and work on topics surrounding neurodiversity in girls, so this is the type of research I will look for when applying to other schools. In the more immediate future for my senior honors project, I am going to work on a resource on symptoms of girls with ADHD which I plan to design to be able to be distributed to parents and teachers to spread awareness.

[psy304-adhd]

Community Partners: Support and Information

Kaleidoscope Society and Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)are two groups that have information, resources, and communities which can be joined by those with ADHD. Kaleidoscope Society specifically is a group that focuses on women with ADHD. These groups likely already have work focusing on female ADHD. These would be good groups to find resources for literature reviews and to ask about academic partnerships they have.

[psy304-adhd]

Potential Methodology: Investigation of Female ADHD

Working with children there are a few different groups of people that can be involved in identifying ADHD, the teacher, the mental-healthcare professional, and the parent. The teacher and parent may recognize a child is struggling or acting out in some way and bring them to a counselor or psychologist. The mental-healthcare professional, say a psychologist, then will choose how to work to identify the root of the child’s challenges. The teachers and parents can be seen as forming one group and the psychologists form the other. These two groups play a key role in identifying children who may have ADHD, so their understanding of female ADHD and ADHD in general must be better understood to improve ADHD identification among girls.

Critical Narrative Analysis provides a strong framework for exploring through narrative study the ideas and things influencing an experience (Souto-Manning, 2012, p. 161). This experience or incident can be used to understand and explore potential underlying thought processes of individuals. This could be a useful tool for exploring what teachers and parents consider concerning behavior needing professional attention and any differences between these concerns for male or female children. Discussions with psychologists could be used to explore why a psychologist would investigate further diagnosis for a boy than a girl. While this would not fix the problem, it would provide a strong foundation to understand how to move forward.

[psy304-adhd]

The Problem Space: Diagnosing Female ADHD During Childhood

Many women seek out a diagnosis when older through help seeking behavior and self-identifying potential symptomology of ADHD (Marraccini et al., 2017, p. 685). Female individuals with ADHD often go undiagnosed because they do not present the disruptive behaviors associated with stereotypical ADHD (Young et al., 2020, pgs. 6-7). The stereotypical ADHD which might trigger a referral for diagnosis is largely based on what is typical behavior for male ADHD. Comorbid internalizing disorders are more common among women than men with ADHD suggesting a potential difference in presentation of ADHD between the two groups (Young et al., 2020, p. 2). When identifying a psychiatric condition often the comorbid condition, like anxiety or depression, will be identified and labeled as the primary challenge for a female patient without considering ADHD as a potential primary cause (Young et al., 2020, p. 5).

The underdiagnosis of childhood ADHD among girls highlights a two-pronged issue in the diagnostic process. When young girls are flagged as needing mental health care if their health care provider assumes anxiety or depression is a stand-alone issue for that girl, she will not receive further evaluation to discover she may have ADHD. If there are not many girls with diagnosed ADHD, then research on diagnostic processes is not likely to include a truly representative sample unless this factor is specifically considered. The image and understanding of ADHD needs to change in a way that accommodates female ADHD just as it does male ADHD, so young girls can be identified and receive the same treatment as their male peers with ADHD. If ADHD so often gets undiagnosed in young girls, females with ADHD face significant challenges people with diagnosed ADHD and those without ADHD may not face, putting them at a disadvantage.

[psy304-adhd]

Context: Attention-Deficit Hyperactivity Disorder in Assigned Female at Birth Individuals

Attention-Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition present from childhood which can put individuals at higher risk for other psychiatric comorbid conditions (Young et al., 2020, p. 2; Marraccini et al., 2017, p. 684; Okumura et al., 2021, p. 636). One study in Japan showed that 12-year-olds with persisting ADHD symptoms and no diagnosis did not perform as well as their peers diagnosed with ADHD and peers without ADHD symptoms in several quality-of-life areas (Okumura et al., 2021, p. 640). While diagnosed ADHD contributes to additional life challenges than may be faced by those without ADHD, those with undiagnosed ADHD face many of the same challenges without the tools to better handle day to day life. Undiagnosed ADHD can negatively affect a person’s wellbeing.

Undiagnosed ADHD may become apparent when a student enters college and struggles or displays impairment unnoticed when in a structured environment (Young et al., 2020, p. 7). College is a key transition period from adolescence to young adulthood, a time when a individual’s actions can have significant consequences for the rest of their lives. Undiagnosed ADHD puts individuals at a further disadvantage than their diagnosed ADHD peers as they do not start this transition period with the same resources and support which can be provided to those with an official diagnosis. If undiagnosed ADHD can provide such a barrier it brings to question how students make it through grade school without receiving a diagnosis.

One major group that often does not receive a diagnosis until their adolescent and young adulthood stages of development are female individuals (For simplicity’s sake the term female or any other traditionally feminine gendered term in this paper is referring to an individual assigned female sex rather than their gender identity and similarly with traditionally masculine gendered terms; Marraccini et al., 2017, p. 685; Young et al., 2020, p. 2). Women with undiagnosed ADHD and therefore untreated ADHD face greater challenges and hurdles to a successful early adulthood and college or vocational career than their peers with a diagnosis and treatment (Young et al., 2020, p. 2). This key period of life has significant impact on one’s opportunities to enter careers which can provide stable income and opportunities which can be afforded to those with such careers. Women with undiagnosed ADHD face significant challenges that are not typically taken into consideration by much of society.