According to CDC statistics, health care providers diagnose boys with ADHD at a rate of 13.2 percent while about 5.6 percent of girls are diagnosed with the disorder. However, a large study of children found that of those who met the criteria for ADHD, 51 percent were boys and 49 percent were girls.
This difference in diagnosis rates suggests health care providers aren’t correctly diagnosing females in their practice.
ADHD isn’t the only disorder where sex-biases in diagnosis are unwarranted. Researchers at the University of Exeter found that even when girls and boys displayed similar severe symptoms, boys were more likely to be diagnosed with an Autism Spectrum Disorder (ASD).
Currently, the ratio of males to females diagnosed with high-functioning autism varies from 4:1 or 10:1. Some researchers, like Dr. Judith Gould, the director of the National Autistic Society’s Lorna Wing Centre, think the ratio could be around 1.5:1, males to females.
The misdiagnosis rate of ADHD is generally blamed on differences in how girls and boys present symptoms of these disorders.
Research in children suggests girls are more likely to present the inattentive subtype, while boys present the combined subtype (impulsive and hyperactive).
The hyperactive subtype is most easily spotted by adults working with the child. The inattentive subtype presents itself as more inconspicuous behavior that often won’t attract teacher attention.
Even if girls do present hyperactive-impulsive behaviors they “don’t necessarily fit the so-called ‘classic’ profile of ADHD,” said Patricia Quinn, director of the National Resource Center for Girls and Women with ADHD.
People generally view girls with this subtype as pushy, aggressive or overemotional, which is more likely to be considered a personality problem rather than a disorder.
Autism is conceptualized as a primarily male disorder. Hans Asperger, the physician who is well-known for his work on Asperger’s, said “the autistic personality is an extreme variant of male intelligence.”
To those who believe the different sexes have distinct brain patterns — something scientists still debate — autism is an extreme form of the male tendency for logic, numbers and a weakness in empathy. According to this theory, the current ratio of males to females with autism is perfectly natural.
With females with autism becoming more visible, and sharing their stories of learning to hide their disorder, this theory becomes questionable.
Socialization and gender roles appear to play a large part in why these females are undiagnosed or misdiagnosed. Newer research suggests the ratio of males to females with the disorder may be lower than previously recorded.
What parts of male-female differences are due to genetics and hormones and what is due to socialization and gender roles has remained a topic of debate.In addition, different sociocultural forces are at work with females and males.
These forces may help to explain why females with autism can go so long without being diagnosed. Women with autism often describe learning how to mask their differences, by engaging in “normal” behavior that seems foreign or difficult to them.
Because girls are expected to be social in communication, girls with autism, especially if they are high-functioning, may learn to engage in social behavior most boys with autism do not. The strain of appearing “normal” can lead to secondary problems, such as anxiety or depression.
Describing autism as “extreme maleness” falls back on the issue surrounding ADHD and other misdiagnosis of women, which often leads to disastrous results. Most medical research uses a male model when studying disorders.
A study by Annaliese K. Beery and others of publications in the “Neuroscience and Biobehavioral Reviews” found that out of 2,000 animal studies, 8 out of 10 disciplines were biased towards the use of male subjects. In the neurosciences, 5.5 males were used for every 1 female.
Even when a disorder, like depression or heart disease, may be more prevalent or deadly in women, male subjects still outnumber female subjects in many studies.
The male model of treatment can lead to misdiagnosis of many ailments. For example, if the male model of ischemic heart disease were applied to women, physicians would end up under-diagnosing the disease.
Specifically in the case of ADHD, Ellen Littman, a clinical psychologist specializing in ADHD gender differences, said the original studies of ADHD were based on the symptoms of “really hyperactive young white boys who were being taken to clinics.”
But failing to study women means that proper dosing or different ways disorders present themselves are not studied. Because of women’s menstrual cycles, their hormones tend to fluctuate, leading to differences in systems compared to men, which can cause issues when a male model is applied.
Using primarily males, or failing to note sex differences, leads to the generation of models that while claiming to be universal, generally only represent one sex.
The reasons for the use of a male model are many. Because women have a hormonal cycle caused by their menstrual cycles, good scientific studies should include women on all stages of this cycle, which can be costly. Analyzing this data can also be more difficult, as the population isn’t homogenous.
Part of the issue also stems from a historical background. Historically, medical concerns for women focused on the reproductive organs.
Emotions were also a common cause of ailments, according to doctors. From 1977 to 1994, the FDA banned all women who could become pregnant — which ended up including those on contraceptives and lesbians — from drug trials, in an effort to protect women after the thalidomide incidents. This ban helped perpetuate a bias that continues today.
When females do not meet the male model, their symptoms may either be ignored or blamed on another issue.
A National Autism Survey found 42 percent of females had been wrongly told they suffered from psychiatric, eating or personality disorders, compared to 30 percent of males. Several women who had been misdiagnosed reported their doctors saying, “girls don’t get autism,” and suggesting they should just “act normal,” even as their symptoms suggested autism.
Since ADHD often presents itself differently in females than in males, females with the disorder are often believed to have a personality disorder, or to just be forgetful and imaginative.
The use of a male model in treatment of disorders is a self-perpetuating cycle. By describing the symptoms generally experienced by males, males are generally diagnosed more than females. The imbalance of diagnosis further confirms researchers’ suspicions about the disorder being primarily male-focused, which ignores females with the disorder to their great detriment.
To correctly understand health issues affecting humans today, researchers need to use more females in their studies, and discover what, if any, sex differences there are.