April 7, 2014 • 47 mins
Boys are four times more likely to be diagnosed with Attention Deficit Hyperactive Disorder, but why? Cristen and Caroline examine the ADHD gender gap, how the disorder impacts girls' lives differently and why so many young women are taking Adderall.
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Episode Transcript
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Speaker 1 (00:03):
Welcome to stuff Mom Never told You from how stupp
Works dot com. Hello, and welcome to the podcast. I'm
Kristen and I'm Caroline, and today we are looking at
attention deficit hyperactive disorder. And this was a listener request.
Someone wrote in saying, Hey, I am a girl with
(00:25):
a d h D, and I've noticed that a lot
of times when I hear conversations about a d h D,
it's focused more on boys, the similar kind of thing
that happens with autism. It's one of those disorders that
you see a diagnostic gender gap. But it does not
mean that a d h D does not exist among
(00:47):
girls and women. Yeah, like a like a lot of
things along these same lines, you know, it just presents
differently in girls and women. And I think that's so
interesting because I too, always just thought a d h
D affected more boys than girls, more men than women.
And while more boys certainly are diagnosed with it than
women are um and girls, that doesn't mean that fewer
(01:08):
girls and women suffer from it. So what are we
talking about when we're talking about a d h D.
I have a feeling that it's such a common term
and diagnosis these days that a lot of listeners are
probably familiar with it, but just for a refresher, it
is one of the most common childhood disorders. Now it's
second only to asthma in the most commonly diagnosed long
(01:33):
term disorders and kids, which is pretty astounding. Um. It
can last through adulthood, and it's marked by things like
excessive motor activity and attention and impulsiveness. And they're actually
three different subtypes of a d h D. Yeah, you
can be predominantly hyperactive, impulsive, predominantly inattentive, and a combination
(01:55):
of hyperactive and impulsive and inattentive. And it's that inattention
mention that is really more associated with girls. And when
you're inattentive, it's it's not that you're not listening, it's
more that you have trouble focusing or maybe you become
bored easily. You have poor attention to detail, forgetfulness. But
this is a less disruptive hallmark of it of a
(02:18):
d h D than being hyperactive and impulsive. So instead
of sitting there tapping your legs really fast, drumming on
your on your desk with your pencil, hitting the student
next to you, children who exhibit in attentiveness as a
hallmark of a d h D are more likely to
just you know, kind of sit there quietly and stare
out the window. And speaking of that hyperactive piece um.
(02:39):
One aspect too, is that it's commonly associated or co
occurs I should say, with oppositional defiant disorder has a
co occurrence rate, and that again is a more outwardly visible,
outwardly manifesting kind of disorder that also tends to happen
more often in boys and tends to get the attention
(03:00):
of teachers and parents because I mean, when you're when
your oppositional defined, I mean that, I mean the definition
is kind of they're in the title like you're going
to notice that kind of hyperactivity, right. Well, there is
an interesting history to a d h D, but also
an interesting history of the diagnoses and the fact that
they have been on the rise for the last thirty years,
(03:21):
but their descriptions and medical literature go back like two
hundred years. It's just a matter of they weren't called
a d h D at the time. Yeah, It's been
known by various terms such as sensibility of the nerves,
having the fidget, having the fidget, having the fidget. I
definitely get the fidgets sometimes. Um. There was also a
(03:43):
period of time too, where you know, when medical science
wasn't so developed, that it was thought that kids, particularly boys,
who had the fidgets really were suffering from defects of
moral control. Yeah. It's interesting the phrasing, um, because they
just assumed that people with these kind of developmental disabilities
(04:06):
or disorders, um, that they weren't sure what they were
at the time, they did have some like lacking of
this internal compass that you know call I don't know,
just it was. It's sort of scary and awful and
terrible to hear a d h D or a d
D described as like a moral problem. Yeah. And then
after you have the moral control issue sort of fade
(04:27):
from the medical literature, it becomes renamed as a minimal
brain dysfunction, which also you know, speaking of scary. Um,
So it for a while, you have it for a
while two hundred years, you have it described here and
there in medical literature, but doctors never exactly figure out
what it is. But throughout that two year history, it
(04:51):
is predominantly described in boys, mostly European boys, and because
of that legacy, that's a a reason why even today
we see often a diagnostic gender gap. Yeah, and we'll
get into more of that, which it's it's super fascinating,
so so stay tuned. But anyway, um, so, moving far
(05:11):
forward in history, in the Diagnostic Statistical Manual includes hyper
kinetic Reaction to childhood, which also sounds scary. It's like
something really terrible is going on and you're having a
reaction to your own childhood. And in that first inclusion
of a precursor to what we now call a d
(05:32):
D and the d s M, it describes it as
being characterized by overactivity, restlessness, distractability, and short attention span,
especially in young children. And that was the thought back
then was that it was particularly something that affected kids
and that you would eventually grow out of it. Sure,
and you have to like, it makes me wonder. You know,
(05:55):
there are a lot of skeptics out there who just
say that, you know, we should just let kids be kids,
and that all kids have a degree of being hyper
or or you know, maybe we should just let them
run free and and be happy and not worry about
diagnosing them with things that were over diagnosing childhood. But
I mean, I guess when you're trying to get your
child actually focus in class, things like that, that could
(06:16):
be an issue. Absolutely, you can have a very real
world impact, not just on behavioral issues perhaps at home,
but on academic performance as well. And we'll also get
into how a d h D can have particularly negative
effects on girls and how that interacts with gendered socialization.
There are a lot of different layers to this, um
(06:37):
but in nineteen eighty the d S M three finally
renames the attention deficit disorder with or without hyperactivity, right,
and we do see some more diagnostic criteria changing a
little bit, which actually benefits girls. I would think, um,
but so where where does where does a d D
come from? Do you catch it? Are you born with it?
(06:58):
Just catch the fidget? No, that was the different episode.
That was That was our maths hysteria episode. Oh yeah.
Can we mentioned though, the German doctor Heinrich Hoffman included
in this paper on the history of a d h
D who created a character called Fidgety Phil. That book
went through something like four editions. Yeah, and this was
(07:21):
sort of along the lines or in the school of
thought of a d h D as a moral deficit,
and so Fidgety fell became this long standing caricature of
a boy who I mean clearly at the fidgets. But
but am I thinking of the right book that the
child always like dies like enters like a fatal like
he's looking up and he's distracted and then he falls
(07:43):
off a cliff. That fidgety Phil. That might be there's
fidgety Phil. There's also like absent minded Abe. There's a
lot of a literation going on, right, But I could
be fidgety Phil, poor fidgety Phil. Fidgety Phil might just
fidget himself on the side of the close. So talking
(08:05):
about where fidgety Fill gets his fidgets from? Do you
like that? I do? How much would would a wood
chuck chuck? If a woodchuck we're on adderall um neuroimaging
suggests that abnormalities in frontal subcordical sarabellar systems involved in
the regulation of attention, motor behavior, and inhibition have something
(08:26):
to do with it. Yeah, and doctors aren't entirely sure
why it happens, But there are now a lot of
studies that have been conducted on a d h D
and there's clearly a genetic component. Um. If your parents
have a d h D, there's a good chance you
will Sames's with your grandparents. Twin. Studies have shown also
that it's highly heritable, and there seems to be a
(08:47):
particular gene that is correlated to thinner brain tissue in
areas associated with attention. And one reason why some people
kind of age out of a d h D is
because that same brain tissue also tends to thicken as
we age. There have also been links in the literature
(09:09):
between a d h D and environmental factors like smoking
cigarettes when you're pregnant, uh, kids exposed to lead. Um.
There's also a brain injury link, but really only a
small number of kids with a d h D have
experienced traumatic brain injury. There's also a question around food additives,
although the research is pretty sketchy on that one. Yeah,
(09:30):
there's the idea that excessive sugar and foods is causing
all of this a d h D, which makes sense
because we often think of kids plush sugar equals rambunctious.
But the sugar theory has been largely debunked by research. Yeah,
exactly so. The previous line of thinking it was that
around five percent of kids in the US were affected
(09:54):
by a d h D, but diagnoses have been truem
endlessly on the rise since the nineteen nineties and today,
according to the National Institutes of Health, nine percent of
US children between the ages of thirteen and eighteen years
old have been previously diagnosed with it, and that rate
(10:14):
of diagnosis has increased in average of three percent between
and two thousand and six, and then five percent between
two thousand three and two thousand eleven. So clearly the
diagnoses are increasing exponentially. And another important piece to this
is not only our children's diagnoses on the rise, but
also adult diagnoses. So now the n i H is
(10:37):
also saying that around four point one percent of adults
in a given year are diagnosed with a d h D. Right,
because people are starting to realize, oh my kids, my
kids have it, and they're learning more about the disorder,
and then they realize, oh, oh, I guess I have
it too. Yeah, And there has been an important change
in the most recently released ds M five which includes
(11:01):
having the symptoms stretched back to age twelve rather than
previously aged seven, which is a recognition of girls symptoms
um as we'll talk about, and also that it can
just generally happen a little bit later. So if you're
an adult and you don't know if it goes all
the way back to seven, that doesn't necessarily mean that Nope,
(11:23):
don't have it right exactly. So, I mean, speaking of gender,
we talked about how a lot of the early studies
and diagnostic criteria were based on just boys. Boys were
thought to be the ones that this really affected girls
not so much, or you know, girls were just different
and they didn't have to experience the horrors of a
d h D. And I mean that's even reflected in
(11:44):
the numbers of studies, you know. Um. One researcher noted
that there were only two studies that she knew of
at the time examining adult women for instance, and a
d h D. It just wasn't thought to be a priority.
This was a boys problem. Yeah, it was really jumped
out at me to see how the arc of a
d h D recognition started out with boys, then moved
(12:08):
into adult populations, and only recently is circling around two girls.
So even adult women might be likelier to get a
diagnosis compared to girls. And it's for that reason that
the National Institutes of Health says that boys are four
times the risk than girls of getting an a d
(12:30):
h D diagnosis. Right, But a lot of experts weighing
in now contend that boys and girls are equally at
risk for those diagnostic and referral gender biases that we mentioned,
And according to one poll, it seems like people do
have a general idea that girls are less likely to
be served in this area. Yeah, I mean, there is
(12:50):
a Harris Interactive poll a couple of years ago, I
think finding of respondents agreed that, yeah, girls are probably
not going to at any kind of a d h
D diagnosis. And even though the common line of thinking,
like we said, is that a d h D presents
itself more outwardly in boys with more hyperactivity, and for
(13:14):
a long time that's been the assumption as to why
there is this gender gap in diagnosis. It's like, oh, well,
girls predominantly exhibit the inattentive subtype of a d h D,
so we're just not noticing it because she just seems
a little dreamy, a little forgetful, No big deal, right,
So when you look back at early referrals to psychiatric clinics,
(13:36):
these were motivated by those outward obvious difficulties presented when
you have the hyperactivity and the disruptiveness. This ended up
being mostly young white boys, so they were the basic
for a lot of the diagnostic criteria. Um Ellen Littman,
who's a psychologist, calls this a referral bias and a
diagnostic bias girls who were diagnosed yours ago, decades ago.
(14:01):
Typically throughout history, girls who were diagnosed with having this
type of disorder had to exhibit the type of behavior
that boys did, because, like Kristen said, if there was
anything else, if it was just an attentiveness, it was
often overlooked. And it was that nineteen eight e d
s M those new diagnostic criteria that allowed for the
possibility of inattention without hyperactivity, and starting at that point
(14:24):
we see this huge jump in the number of girls diagnosed.
But even when that hyperactivity variable remains constant, gender still
plays such a strong role in determining whether or not
children are going to be referred to services. At least
according to results from a two thousand nine study in
the Journal of Clinical Adolescent Psychology, which gave parents and
(14:45):
teachers these short vignettes to read about boys and girls
who were exhibiting a d h d behavior in class
and asked him whether or not they would refer the
kids to learning services, and overwhelmingly whether the girls were
also displaying in these vignettes, these fictional a little short stories.
Even if the girls were also displaying hyperactive behavior, the
(15:07):
boys were still more likely to receive these fictional learning
services because quote the parents and teachers believe that learning
assistance is less effective for girls, which is a little
bit of weird wording in the abstract, because what they
kind of mean to say is they describe more in
the body of the study, is that it seems like
(15:31):
there is a greater emphasis placed on boys academic success
than girls academic success. So it's like, even if all
these girls are struggling in the classroom, we're still a
little bit more likely to pay attention to little Johnny's
progress compared to little Janey's progress. Well, poor little Janie,
(15:51):
poor little Janey. And that's I mean, that's also a
study funding that needs more research on it. But it's
interesting to see that it was notable that even when
that hyperactivity is held constant, gender is still the primary variable.
And it's said to that, um, gender is that being
a girl essentially um is more of a determinant for
(16:15):
you not getting a diagnosis compared to living in a
poor area, not having health insurance, not even having like
access to services nearby. All of those combined, you're still
more likely to get a diagnosis if your boy. Then
if you're a girl, well, um, we will get more
into the gendered aspect of a d h D and
(16:37):
some of the hallmarks of girls experience with a d
h D when we come all right back from a
quick break so we left off, we had established that
there has at least historically been this gender gap in
a d h D diagnosis, but that more recent research
(16:59):
is now ching up to the fact that girls also
experience it as well, but possibly in a different way
than boys do. So let's talk a little bit about
the hallmarks of female a d h D. Yeah, hormones
are a pain in the neck man like the brain,
pain all over your body because of your endocrine system. Um. Anyway, So,
(17:22):
symptoms of a d h D increase with puberty for girls,
but not boys thanks to handy dandy estrogen. At puberty,
girls a d h D related behavior tends to ramp up,
while boys calms down a little bit, not saying that
they outgrow it necessarily, just saying that we tend to
(17:42):
notice the hallmarks the symptoms of it among girls as
they get older and as their hormones start to change
at puberty. So that's a big reason why the criterion
for a d h D has changed from having to
have it since the age of seven up to now
having to have it since twelve, when you, you know,
the classic age for puberty to start. Yeah, and we
(18:05):
also we I mean, girls and women have to deal
with the fact that people are always mixing up our
health symptoms with PMS and PMD D. Oh yeah, I know.
Well they just figure out, well, if you're having trouble
concentrating or etceterric, etceterric, etceterric, it's probably just you know,
something else going on. Um. Dr Littmann, the psychologist that
(18:25):
we sighted earlier, calls this sort of a perfect storm.
You have internalized symptoms, escalating estrogen mounting, shame and demoralization
in response to societal expectations because it's around this time
that you're hitting puberty, your hormones are changing. You're so
worried about fitting in and being like the perfect girl
or whatever. Um, but you know your brain has O
(18:48):
their plans for you. Yeah, And experts on girls and
a d h D often point out that gendered socialization
has a major impact on how girl manage their A
d h D were likelier to internalize and despite probably
having trouble paying attention getting school work done, there's still
(19:10):
more of a perfectionism that tends to run through girls
even with a d h D. Um and we are
three times more likely to have been on antidepressants prior
to an a d h D diagnosis, probably because, like
you mentioned, a lot of times, these kinds of symptoms
that we exhibit are usually mixed up for things like, oh, well,
(19:31):
she's just PMS and her oh she's just depressed, she's
a little bit moody, give us some paxel, right, right,
And a lot of that has to do with the
fact that, uh, our social penalties that we undergo that
we deal with us girls tend to be worse uh
than than the ones experienced by boys. Were more likely
to be rejected by our peers. Um, because if you
(19:54):
think about, you know, let's just let's have an average
stereotypical girl with an antena type A d h D.
You know, she may retreat into herself if she's not
picking up on jokes fast enough, or if she's unable
to kind of pick up on your feelings fast enough
read your face to know, oh I shouldn't make a joke,
she's sad, or oh she's joking. I don't get it.
You know, they can tend to be judged as selfish,
(20:16):
so they internalize their feelings. They try not to. They
don't want to appear selfish. They they're not, but you know,
so they end up retreating into themselves even more. They
might overestimate their social competence, think that they're funnier or
more with it than they are. Uh, they could exhibit
a rebellious stance and relational aggression. And then there's the
whole perfectionism as far as school work goes where um,
(20:38):
I think it was Ellen Littman talking about when girls
with a d h D procrastinate as girls and boys
with a d h D are wont to do, they
are more likely than boys at the last minute to
bust their butts to make this project perfect because they
still have this drive to be little people pleasers. Yeah,
and um, even though we've talked a lot about how
(20:59):
the hallmark symptoms of girls a d h D. That's
in quotes, um, how it's more commonly associated with the inattentive,
dreamy type hyperactivity also exists in girls. That that was
one thing another expert pointed out. She was like, don't
forget that the h and a d h D can
also manifest in girls as well. And I was just
(21:22):
thinking about that and the socialization issue and reflecting back
on middle school years and trying to fit in with girls,
and if like just remembering some girls that I was
around who were clearly hyperactive and how they were socially
ostracized for that, because it's like, uh, in those in
those years and through high school too, and even out
(21:43):
of high school. Unfortunately, it's like this fine line that
girls often have to walk between, you know, being I
don't know, like being not too quiet but not too loud,
you know what I mean. And it's like if if
you have a d h D, you're far more likely
to be either one or the other. And so it's
probably because of this that research has also found that
(22:07):
if left untreated, girls with a d h D are
at risk for chronic low self esteem, under achievement, anxiety, depression,
and team pregnancy and early smoking in middle school and
high school. And that's coming from psychologist Kathleen Nado, who
is another expert in girls and a d h D
that we've been citing, and I mean this, reading all
(22:29):
of these articles too about girls and a d h D,
we're they're heartbreaking because it's the same thing over and
over and over again for this kind of internalization while
striving to make the grade and fit in if possible,
and just manage everything. And we've talked about the impostor
(22:50):
syndrome before on the podcast, but a lot of these girls,
you know, they they're working so hard and they might
be getting as they might be getting always, but they're like,
you know, I have to work so much hard, harder
than little Susie over here. Why do I have to
work so much harder just to get an a when
she seems to breathe through it? And so you feel
like I must not be very smart. And so that
(23:10):
ties into the whole self esteem issue too. And um
a study in the Journal of Consulting in Clinical Psychology
found that UH girls with a d h D, especially
those with signs of impulsivity, are three to four times
more likely to attempt suicide and two to three times
more likely to attempt self injury. And with this study, um,
it's worth pointing out that it followed this group of
(23:33):
girls into adulthood and kind of checked up with them
after a five or ten year period, and it wasn't
this kind of suicidal or self injurious behavior. Wasn't happening
like right then in adolescence when they were first talking
two of them, But it was with girls who perhaps
weren't getting the treatment that they needed and were had
(23:56):
been dealing for years with all of this stuff. And
this is how you know it was manifesting in the
kinds of uh, these kinds of negative behaviors. And also too,
I want to point out that our focus on girls
with a d h D and these kinds of issues
is not to discount, you know, boys struggles with it
as well, or to say that if you know, boys
are just running around, they don't they don't care if
(24:18):
they're having trouble paying attention. But research does find that
the social penalties for girls are often a lot harsher
for boys. But I'm so sure that boys experience a
lot of this as well. It's just the fact that
they are a lot likelier to at least be recommended
for learning services or diagnosis treatment something, um, whereas a
(24:41):
lot of girls are just being kind of left left out. Yeah. Yeah,
you're more likely to expect a boy to have to
come up against a d h D and to have
to treat them for at etcetera, etcetera, whereas you're more
likely to be like that girls such an airhead. Yeah,
or she can handle it, yeah, little Susie, little Janey,
I can push on through. Um. But and you look
at women, like the adult population of a d h
(25:03):
D um, women also experience it, and it's like it's
sort of a grown up version of the same kinds
of stressors piled on top of stressors that maybe have
an even harsher impact honest as women because ho hello
life responsibilities. Yeah. Researchers have found that women adult women
(25:24):
with untreated a d h D tend to have more
trouble with things like time management and organization, stress management,
anxiety and depression, and a lot of it ties into
that constant stress they feel due to managing demands of
everyday life. They they are more likely to exhibit a
learned helplessness style of responding to negative situations and feeling
less control over their lives. I mean if if you
(25:47):
are someone who is struggling with inattention and you can't
focus and you're forgetful, you might feel like everything is
such a struggle. Oh yeah, I mean just thinking about
not to make this Selbot meet Caroline, but thinking just
about that organization factor. Like for me, if my house
isn't clean and organized, I can't get anything done. It's
(26:10):
like this brain organization connection where like if my environment,
like if I don't feel like I have control over
my environment, as I'm sure if you know, for women
with a d h D like that must happen all
the time, then I can't. I just like can barely
handle myself. Yeah, now I I found so I had
(26:30):
to sympathize with one of the scenarios that one of
these psychologists was talking about, as far as like women
with a d h D might exert just just the
way that girls in school might have to work so
much harder just to get that a to focus, to
get that a women with a d h D have
to work so hard to stay organized that it's like
it's just mentally exhausting. And I totally sympathize, Like, I'm
(26:56):
constantly cleaning up after myself, past Caroline screws over future
Caroline all the time. I'm not hanging up my clothes,
I'm not putting my stuff away. So I come into
my environment, whether it's my desk at work or my
dusk at home, or my room or wherever, and I'm like,
I can't focus, I can't accomplish anything. Let me make
fifteen to do lists. Yeah, it feel, it feels chaotic.
(27:17):
And that also reminds me of this article that we
read in the week, and it was written by a
woman with a d h D. But she didn't get
a diagnosis until after college, and she just talked about
how like revolutionary it was for her life, like pre
impost diagnosis, because she talked about how before that her apartment,
(27:38):
I mean, she would lose her keys, she would lose
herself phone, she would find it in just the most
random of places. And not to say that the women
with a d h D like can't get their lives
together anything like that, but you know, it's these environmental
factors make such a difference as well. And what was
interesting um to regarding women in these a d h
(28:00):
D diagnoses is that the primary way that the light
bulb goes off of like oh wait no, this might
actually have to do with something going on in my brain,
not me just being a terrible adult, is that their
kids get a diagnosis and they hear the doctors talking
about these symptoms and they're like, oh, this sounds a
lot like me, because again there's that highly genetic components,
(28:24):
so interesting, so interesting. Yeah, it's just it's so unfortunate
that there's like this whole lifetime of this whole lifetime
cycle of a delay in diagnosis just because I'm a girl,
I must be less likely to have it. Maybe I'm
just an airhead. Maybe I just can't keep track, or
I mean I lose my my mother for like two
(28:44):
separate Christmas. Is has given me these things that you
put on your key ring to like you, if you
can't find your keys, you you beat this little remote
and it helps you find your keys. But what if
you lose the remote? Oh no, trust me, I lost
the remote. I would lose the remote. I would totally remote.
And and this is one thing too where one of
the articles that we read about this was it was
(29:07):
phrased in a way of something along the lines of
women and a d D. It's a diagnosis, not an
excuse because there I think there is this perception because
the rates of diagnosis have increased so quickly, I think
it's raised a lot of skeptical eyebrows. For some people
who don't have these kinds of neurological issues look at
(29:28):
you know, throwing some shade and saying, well, they just
need to pay more attention or do something. But for
these women who have a d h D, I mean,
it's a very real issue. Yeah, you know, speaking of
the skeptics. Doctors will tell you and and psychologists will
tell you that there are a lot of life things
that can happen to you that can mimic these hallmarks
(29:51):
of a d h D. I mean, if you're going
through an incredibly stressful time at work, if you're not sleeping,
if you're drinking too much, going through a break up. Yeah,
there's like all of the stressors that can happen that
can make you feel crazy. And um I started thinking
about it, I'm like, Okay, I see I see that
there are life things like stress that can make this happen.
(30:11):
And I see that you can be a d h D.
And I was like, but but aren't the life situations
like the situational a d h D symptom type things
don't those go away? Might have never gone away, So
I feel like I should Caroline, I think you might
be doing a little bit of your podcast diagnoses you
your your sminty symptom checker. I told my boyfriend last night.
(30:32):
I was like, ah, I think I have a d
h D. And he looks at me and he's like,
what are you doing for the podcast this week? It's true,
but hey, you know, it could be worth checking into
a good fear if you're concerned. Yeah, I could finally
get my apartment organized. But the good news is though
(30:52):
there are so many resources out there specifically focused on
women and girls. There's the National Center for Gender Issues
in a d h D. There's a National Center for
Girls and Women with a d h D. They are
all sorts of books now specifically focused on women in
a d h D, local support groups even so, you know,
the resources and the research are starting to definitely catch
(31:15):
up with the you know, the female population um. But
where the skepticism kind of starts to creep in a
bit more. I think it's not so much with you know,
whether or not a d h D exists, but more
in the treatment of it, because we got to talk
about a d h D meds and how for some
(31:40):
people they have been wonder drugs and for some other
people they've also been wonder drugs, but not necessarily because
they have a d D. Yeah, I mean, I think
we all know people who have misused things like adderall
or riddle in in order to cram for a test,
to lose weight, to do x y Z, to be
like a wonder woman in their lives wives or a
(32:00):
wonder man. Yeah. I mean there have been trend pieces
since you and I were in college, Caroline about college
students in the library buying adderall to stay up all
night to you know, to study, or buying adderall to
stay up all night to party. Well, yeah, I remember
friends doing this freshman year and me just thinking, like
(32:21):
I just like sleep. I'm fine with not studying all night. Um.
But it's interesting to look at like this, this notch
in the timeline because since the number of kids on
a d h D medication has soared from six hundred
thousand to three point five million people. But you also
(32:43):
have to look at the What happened in the late
nineteen nineties, which is, federal guidelines were loosened, allowing marketing
firms basically to market controlled substances like stimulants directly to
the public, a lot of kate in a lot of
cases marketing them to moms specifically. Oh yeah, there were
you know, all these ads. You've probably see them listeners
(33:03):
in magazines or in commercials where there's a happy mom
standing there with her usually son holding up a test
with like a B plus and she's, you know, with
a tagline something along the lines of he's finally living
up to his academic potential. Yeah. They a lot of
(33:26):
ads driving him the fact of like, don't you want
to ease the tension in your family? Don't you want
the best for your son? Don't you want him to
perform better in school? Mom? Yeah? So there has been
this troublesome relationship between pharmaceutical companies like Shire, which makes
adderall and this rise in a d h D diagnoses
(33:49):
in The New York Times magazine recently did a big
piece on how this rise in a d h D
diagnoses among kids and adults has coincided obviously with the
rise in a d h D medication, and I mean
Shire is making billions off of adderall I mean not
(34:10):
to mention all of the other kinds of you know,
name brand medications like concert A, riddling, etcetera. And how
a lot of these pharmaceutical companies have recruited a lot
of doctors with really great titles and research, you know,
heavy backgrounds, who have studies that they've published, to go
out and speak to groups of doctors and suggest that
(34:33):
they really look out for signs of a d h
D and really you know, push some push some adderall
their way. And and that's so unfortunate because clearly this
is you know, a d h D absolutely exists. But
it's once these kinds of murky relationships between doctors and
(34:53):
big pharma come up that you you know, you you
give more credence to skeptics who say, you know, this
is all made up. Yeah. For instance, Dr Keith Connors,
who's a specialist in a d h D, was almost
angry in this story when he heard about the numbers
because the numbers of children and adults on a d
h D meds. He says, the numbers make it look
(35:15):
like an epidemic, but it's not. It does affect people,
for sure, people struggle with it, men, women, boys, girls.
But the fact is that he doesn't think and a
lot of other doctors don't think that the numbers are
accurate as far as who's on medicine versus who actually
has a d h D. Yeah, I think there's definitely
(35:36):
been some over diagnosis that's gone on. And also, and
this is kind of a side note, we don't have
I don't have sources in front of me on this,
but one thing that comes to mind is that we're
now we've come through a generation of kids who received
this diagnosis and maybe a prescription to adderall or riddle
(35:57):
in when they were kids. Now there were there our
age and they still have these prescriptions, And it doesn't
seem like there has been a lot of attention paid
to long term management outside of just popping pills, because
just popping pills when it comes to popping stimulants doesn't
always lead to the healthiest lifestyles or healthiest you know,
(36:22):
physical mental impacts. Yeah, because not only would some people
maybe take them for the wrong reasons, but then you've
got to deal with heart palpitations, insomnia, just general ikey
health issues. From maybe taking the wrong dose, or taking
the wrong pill, or maybe not needing to take it
at all. But the fact of the matter is adderall
(36:43):
and going nowhere. Express Scripts told MPR earlier this year
that it expects a d h D medications to rise
in the next five years um and it's risen thirty
five point five percent between two thousand and eight and
two thousand twelve among people with private insurance um and
(37:06):
while children's use of a d h D medications were up,
adults use rose fifty three percent. Yeah, because, I mean,
there's a lot of reasons for that. Part of it
is that kids are kids are growing up and becoming
grown ups who need medicine. Part of it is that
you've got moms who are looking at their kids saying, oh,
(37:27):
this explains my struggles in school. I need to be
on this medicine. And then you've got a lot of
people who are saying, I need to study for exams,
I need to lose weight, I need to be wonder woman. Yeah.
I mean, because the fact of the matter is, as
as a stimulant, you can get a lot done. You
know you can if you want an edge. Just happens
(37:49):
a lot in academia to where, you know, in a
publishing heavy kind of job where if you need to
sit there and stare at books and read thick you know,
papers and then thick papers. Adderall has been a wonder
drug for a lot of people. There are even some
people There is an article, a couple of articles actually,
I think in Slate for instance, from these writers saying, yeah,
(38:12):
I take adderall. It's amazing, I write so much. Yeah.
And before we make this sounds super attractive to you,
you have to remember that adderall is a schedule to
controlled substance as our morphine and oxy code own, meaning
it has a high risk for addiction or abuse. Yeah,
and there are side effects that go along with chronic abuse,
(38:34):
such as severe rash, insomnia, irritability, personality changes. Um. And
we're focusing so much on adderall use in a d
h D medication because its use is actually increasing the
most demographics wise among young women, which probably has to
do with a lot of what we're talking about in
terms of, you know, the diagnostic gender gap closing, but
(38:59):
it probably also has to do a little bit with
some abuse happening because of the side effects of things
like weight management. Because if you take a stimulant, You're
probably not gonna want to eat too much. Uh, school
cram sessions, maybe staying out and partying. I mean, there
are a lot of I don't know, just hang out
on a college campus. Kids will tell you about it. Yeah,
(39:22):
And I wonder how much of it is tied to
gender norms. You've got to be the right kind of woman.
You know, you've got to be thin, You've got to
be organized, you have to be neat and tidy. You
need to be successful. You have to be successful. You've
got to you know, work all day, come home cooked in,
or do the dishes, etcetera, etcetera, etcetera. Yeah, and I
think that a lot of people have found out her
(39:42):
all to be a you know, a simple way, it's
simple and quotes way to make all of that happen,
to have it all. Um. So, while it's heartening to
see that there, you know, is a greater likelihood that
if you are a girl, are a woman with a
d h D, that there will be resources there for you,
(40:03):
that you might be more likely to be recommended for something.
Um that treatment is available. But there's that other piece
of this whole, a d h D issue, which is
what do we do about I don't think it's so
much in a d h D epidemic that might be
happening as much as an adderall epidemic. Not a sound
(40:23):
like my mother, you know, But I don't know what
do you? Is it too alarmoust to say that. I
think the numbers are pretty crazy. I think Dr Connors
is right when he says that it's not an epidemic
of a d h D. It's not that we're we're
birthing all of these children every day who you know,
(40:43):
are destined to not be able to concentrate. It's it
is more than just I think more and more people
are like, I can get stuff done on adderall. Yeah. Um,
but it's it's just important too that while a lot
of docs hail it, like we keep using the term
wonder drug, but that there are side effects as with
(41:06):
any medication, and it's gonna also, as with every health
issue we talked about on this podcast, affect different bodies differently. Absolutely, So,
who did we end this on a down note? I
don't want to end this on a down note. No,
I think we ended it on a kind of a warning, Yeah,
a warning of of uh, you know, you want to
(41:26):
take care of yourself a little buyer, Beware you should
always be aware a little bit when it comes to
our bodies and brains. We want, we want little Janey
to grow up to be healthy. Yeah, but I gotta
say so so fascinating those gendered socialization issues that often
compound a lot of this a d h D stuff
for girls, fascinating and tragic. They're they're definitely important things
(41:48):
to keep in mind if if you have kids with
a d h D, if you're a teacher, if you're
a doctor, whoever you are, it's it's important to keep
those gender differences in mind. So we now want to
hear from you because at least theistically there are folks
there listening who have a d h D. So I
want to know how how this resonates with you. Um,
(42:09):
let us know your thoughts. Mom Stuff at discovery dot
com is our email address. You can also tweet us
at Mom's Stuff podcast or messages over on Facebook, and
we have a couple of messages to share with you
right now. So I've got a note here from Christina
and it made me laugh because you want to talk
(42:30):
about her Napoleon complex, which, uh, you don't hear about
a lot of women describing their Napoleon complex es. But
she says, I'm about five one, and that's being generous.
Because I'm so tiny, I find myself over overcompensating in
certain areas, such as drinking. I've always ordered whiskey and
coke at bars, one because everyone knows how to make
(42:51):
a whiskey and coke, and too because I know how
bartenders look at petite women like me. It doesn't help
that I look like I'm fourteen. I fig here it's
a respectable drink that's available in many bars, and I
just got used to the taste. Even when I ordered
these drinks, I would still get the occasional condescending comments
or smirks. This personal preference seemed to carry over to
my tastes and coffee as well. I started drinking Americanos
(43:14):
when I started working at a cafe. My friends and
I would also be able to predict what people would
order based on how they look. And in this case,
I am guilty of stereotyping since I judge people on
their drink preferences. I knew firsthand what people thought about you,
and I just didn't want to be placed in that box.
Since then, I've learned to really enjoy bourbon, and I
do enjoy the taste of espresso, even with the occasional
(43:34):
steamed milk. Mostly it's now because it's simpler to drink,
the better it tastes. As much as I don't want
to believe that stereotypes shaped me, I appreciate that it has.
My drinking preference is the tip of my Napoleon complex.
I've been more aggressive and stubborn on certain issues because
of it. I worked so hard on not fitting in
those stereotypes because I didn't want to be defined by them,
(43:55):
but eventually they affect the way I am today. So
thanks for sharing your experienced Christina, that's so funny. I'm
I'm five too. I'm also a shorty, and I feel
sometimes like I have to be a little over aggressive.
I would have never known you were five to you
are seven ft tall in my eyes, Carol, I'm also
wearing wedges today. Usually we're a heel and wedges. Um. Yeah, No,
(44:19):
I I get looks because not only am I really short,
but I think something about my youthful expression makes people
think I am younger than I am. Um. But anyway,
I have a Facebook message here from Amanda. She was
writing in about our thyroid episode and she has a
question for me that I wanted to answer in case it,
you know, helps out anybody else. UM disclaimer. I have
(44:42):
Hashimoto's thyroid itis, which is an autoimmune disorder that causes hypothyroidism,
which can lead to all sorts of things like weight gain,
brain fogginess, tiredness, brittle nails. It's really fun. So anyway,
Amanda wrote to say you said there was a test
that was helpful in diagnosis, but did not mention the
name was that the T s H or free T
(45:05):
three T four that ended up giving you some answers.
I have been going through some of the same struggles.
The brain fog, weight gained despite diet and exercise, irritability, fatigue.
My family doctor has attributed to depression and placed me
on antidepressants. My T s H levels were okay two
years ago, but the symptoms have gotten progressively worse since then.
(45:25):
I will be going back to the doctor and wanted
to know which test to ask for. By the way,
I love the show. My husband actually turned me onto
you guys about a year ago, and I've been binge
listening ever since. So I'm really glad you are Amanda
and husband and Amanda's husband um okay. So the test
that I had that showed there was a problem because
my UH, my T S H, and my T for
(45:47):
free tests results were normal. But my thyro globulin A
B test, so that's the antibodies, showed that there was
an issue. The standard rain ine for thyroglobulin A B
is under twenty amanda Mine was eight hundred and twenty eight.
So that combined with a sonogram of my neck looking
(46:10):
at my thyroid to see if there were any nodules,
if it was misshapen, anything like that, the sonogram confirmed
that I had Hashimoto's thyroid itis. That was back in October,
and so I am due UH in several months for
a repeat of that test. And I just want to
say that it is super common for you, for doctors
(46:34):
or your family to think that you are just depressed
or dealing with anxiety. And if you don't have a
history of depression or anxiety, or if you don't have
a family history of it, I think it is really
important to get a full thyroid work up. If you
just can't shake the weight, if you can't shake the
brain fog because who knows. I mean, what could it
hurt besides a couple of vials of blood. So anyway,
(46:56):
thank you so much for writing in, Amanda, and I
wish you the best of luck, and thanks again to
everybody who's written into us. Mom Stuff at Discovery dot
Com is our email address, and if you want to
find us on social or find all of our podcast,
blogs and videos, there's one place to go. It's stuff
Mom Never Told You dot com for more on this
(47:17):
and thousands of other topics. Is it how Stuff Works
dot com
Welcome to stuff Mom Never told You from how stupp
Works dot com. Hello, and welcome to the podcast. I'm
Kristen and I'm Caroline, and today we are looking at
attention deficit hyperactive disorder. And this was a listener request.
Someone wrote in saying, Hey, I am a girl with
(00:25):
a d h D, and I've noticed that a lot
of times when I hear conversations about a d h D,
it's focused more on boys, the similar kind of thing
that happens with autism. It's one of those disorders that
you see a diagnostic gender gap. But it does not
mean that a d h D does not exist among
(00:47):
girls and women. Yeah, like a like a lot of
things along these same lines, you know, it just presents
differently in girls and women. And I think that's so
interesting because I too, always just thought a d h
D affected more boys than girls, more men than women.
And while more boys certainly are diagnosed with it than
women are um and girls, that doesn't mean that fewer
(01:08):
girls and women suffer from it. So what are we
talking about when we're talking about a d h D.
I have a feeling that it's such a common term
and diagnosis these days that a lot of listeners are
probably familiar with it, but just for a refresher, it
is one of the most common childhood disorders. Now it's
second only to asthma in the most commonly diagnosed long
(01:33):
term disorders and kids, which is pretty astounding. Um. It
can last through adulthood, and it's marked by things like
excessive motor activity and attention and impulsiveness. And they're actually
three different subtypes of a d h D. Yeah, you
can be predominantly hyperactive, impulsive, predominantly inattentive, and a combination
(01:55):
of hyperactive and impulsive and inattentive. And it's that inattention
mention that is really more associated with girls. And when
you're inattentive, it's it's not that you're not listening, it's
more that you have trouble focusing or maybe you become
bored easily. You have poor attention to detail, forgetfulness. But
this is a less disruptive hallmark of it of a
(02:18):
d h D than being hyperactive and impulsive. So instead
of sitting there tapping your legs really fast, drumming on
your on your desk with your pencil, hitting the student
next to you, children who exhibit in attentiveness as a
hallmark of a d h D are more likely to
just you know, kind of sit there quietly and stare
out the window. And speaking of that hyperactive piece um.
(02:39):
One aspect too, is that it's commonly associated or co
occurs I should say, with oppositional defiant disorder has a
co occurrence rate, and that again is a more outwardly visible,
outwardly manifesting kind of disorder that also tends to happen
more often in boys and tends to get the attention
(03:00):
of teachers and parents because I mean, when you're when
your oppositional defined, I mean that, I mean the definition
is kind of they're in the title like you're going
to notice that kind of hyperactivity, right. Well, there is
an interesting history to a d h D, but also
an interesting history of the diagnoses and the fact that
they have been on the rise for the last thirty years,
(03:21):
but their descriptions and medical literature go back like two
hundred years. It's just a matter of they weren't called
a d h D at the time. Yeah, It's been
known by various terms such as sensibility of the nerves,
having the fidget, having the fidget, having the fidget. I
definitely get the fidgets sometimes. Um. There was also a
(03:43):
period of time too, where you know, when medical science
wasn't so developed, that it was thought that kids, particularly boys,
who had the fidgets really were suffering from defects of
moral control. Yeah. It's interesting the phrasing, um, because they
just assumed that people with these kind of developmental disabilities
(04:06):
or disorders, um, that they weren't sure what they were
at the time, they did have some like lacking of
this internal compass that you know call I don't know,
just it was. It's sort of scary and awful and
terrible to hear a d h D or a d
D described as like a moral problem. Yeah. And then
after you have the moral control issue sort of fade
(04:27):
from the medical literature, it becomes renamed as a minimal
brain dysfunction, which also you know, speaking of scary. Um,
So it for a while, you have it for a
while two hundred years, you have it described here and
there in medical literature, but doctors never exactly figure out
what it is. But throughout that two year history, it
(04:51):
is predominantly described in boys, mostly European boys, and because
of that legacy, that's a a reason why even today
we see often a diagnostic gender gap. Yeah, and we'll
get into more of that, which it's it's super fascinating,
so so stay tuned. But anyway, um, so, moving far
(05:11):
forward in history, in the Diagnostic Statistical Manual includes hyper
kinetic Reaction to childhood, which also sounds scary. It's like
something really terrible is going on and you're having a
reaction to your own childhood. And in that first inclusion
of a precursor to what we now call a d
(05:32):
D and the d s M, it describes it as
being characterized by overactivity, restlessness, distractability, and short attention span,
especially in young children. And that was the thought back
then was that it was particularly something that affected kids
and that you would eventually grow out of it. Sure,
and you have to like, it makes me wonder. You know,
(05:55):
there are a lot of skeptics out there who just
say that, you know, we should just let kids be kids,
and that all kids have a degree of being hyper
or or you know, maybe we should just let them
run free and and be happy and not worry about
diagnosing them with things that were over diagnosing childhood. But
I mean, I guess when you're trying to get your
child actually focus in class, things like that, that could
(06:16):
be an issue. Absolutely, you can have a very real
world impact, not just on behavioral issues perhaps at home,
but on academic performance as well. And we'll also get
into how a d h D can have particularly negative
effects on girls and how that interacts with gendered socialization.
There are a lot of different layers to this, um
(06:37):
but in nineteen eighty the d S M three finally
renames the attention deficit disorder with or without hyperactivity, right,
and we do see some more diagnostic criteria changing a
little bit, which actually benefits girls. I would think, um,
but so where where does where does a d D
come from? Do you catch it? Are you born with it?
(06:58):
Just catch the fidget? No, that was the different episode.
That was That was our maths hysteria episode. Oh yeah.
Can we mentioned though, the German doctor Heinrich Hoffman included
in this paper on the history of a d h
D who created a character called Fidgety Phil. That book
went through something like four editions. Yeah, and this was
(07:21):
sort of along the lines or in the school of
thought of a d h D as a moral deficit,
and so Fidgety fell became this long standing caricature of
a boy who I mean clearly at the fidgets. But
but am I thinking of the right book that the
child always like dies like enters like a fatal like
he's looking up and he's distracted and then he falls
(07:43):
off a cliff. That fidgety Phil. That might be there's
fidgety Phil. There's also like absent minded Abe. There's a
lot of a literation going on, right, But I could
be fidgety Phil, poor fidgety Phil. Fidgety Phil might just
fidget himself on the side of the close. So talking
(08:05):
about where fidgety Fill gets his fidgets from? Do you
like that? I do? How much would would a wood
chuck chuck? If a woodchuck we're on adderall um neuroimaging
suggests that abnormalities in frontal subcordical sarabellar systems involved in
the regulation of attention, motor behavior, and inhibition have something
(08:26):
to do with it. Yeah, and doctors aren't entirely sure
why it happens, But there are now a lot of
studies that have been conducted on a d h D
and there's clearly a genetic component. Um. If your parents
have a d h D, there's a good chance you
will Sames's with your grandparents. Twin. Studies have shown also
that it's highly heritable, and there seems to be a
(08:47):
particular gene that is correlated to thinner brain tissue in
areas associated with attention. And one reason why some people
kind of age out of a d h D is
because that same brain tissue also tends to thicken as
we age. There have also been links in the literature
(09:09):
between a d h D and environmental factors like smoking
cigarettes when you're pregnant, uh, kids exposed to lead. Um.
There's also a brain injury link, but really only a
small number of kids with a d h D have
experienced traumatic brain injury. There's also a question around food additives,
although the research is pretty sketchy on that one. Yeah,
(09:30):
there's the idea that excessive sugar and foods is causing
all of this a d h D, which makes sense
because we often think of kids plush sugar equals rambunctious.
But the sugar theory has been largely debunked by research. Yeah,
exactly so. The previous line of thinking it was that
around five percent of kids in the US were affected
(09:54):
by a d h D, but diagnoses have been truem
endlessly on the rise since the nineteen nineties and today,
according to the National Institutes of Health, nine percent of
US children between the ages of thirteen and eighteen years
old have been previously diagnosed with it, and that rate
(10:14):
of diagnosis has increased in average of three percent between
and two thousand and six, and then five percent between
two thousand three and two thousand eleven. So clearly the
diagnoses are increasing exponentially. And another important piece to this
is not only our children's diagnoses on the rise, but
also adult diagnoses. So now the n i H is
(10:37):
also saying that around four point one percent of adults
in a given year are diagnosed with a d h D. Right,
because people are starting to realize, oh my kids, my
kids have it, and they're learning more about the disorder,
and then they realize, oh, oh, I guess I have
it too. Yeah, And there has been an important change
in the most recently released ds M five which includes
(11:01):
having the symptoms stretched back to age twelve rather than
previously aged seven, which is a recognition of girls symptoms
um as we'll talk about, and also that it can
just generally happen a little bit later. So if you're
an adult and you don't know if it goes all
the way back to seven, that doesn't necessarily mean that Nope,
(11:23):
don't have it right exactly. So, I mean, speaking of gender,
we talked about how a lot of the early studies
and diagnostic criteria were based on just boys. Boys were
thought to be the ones that this really affected girls
not so much, or you know, girls were just different
and they didn't have to experience the horrors of a
d h D. And I mean that's even reflected in
(11:44):
the numbers of studies, you know. Um. One researcher noted
that there were only two studies that she knew of
at the time examining adult women for instance, and a
d h D. It just wasn't thought to be a priority.
This was a boys problem. Yeah, it was really jumped
out at me to see how the arc of a
d h D recognition started out with boys, then moved
(12:08):
into adult populations, and only recently is circling around two girls.
So even adult women might be likelier to get a
diagnosis compared to girls. And it's for that reason that
the National Institutes of Health says that boys are four
times the risk than girls of getting an a d
(12:30):
h D diagnosis. Right, But a lot of experts weighing
in now contend that boys and girls are equally at
risk for those diagnostic and referral gender biases that we mentioned,
And according to one poll, it seems like people do
have a general idea that girls are less likely to
be served in this area. Yeah, I mean, there is
(12:50):
a Harris Interactive poll a couple of years ago, I
think finding of respondents agreed that, yeah, girls are probably
not going to at any kind of a d h
D diagnosis. And even though the common line of thinking,
like we said, is that a d h D presents
itself more outwardly in boys with more hyperactivity, and for
(13:14):
a long time that's been the assumption as to why
there is this gender gap in diagnosis. It's like, oh, well,
girls predominantly exhibit the inattentive subtype of a d h D,
so we're just not noticing it because she just seems
a little dreamy, a little forgetful, No big deal, right,
So when you look back at early referrals to psychiatric clinics,
(13:36):
these were motivated by those outward obvious difficulties presented when
you have the hyperactivity and the disruptiveness. This ended up
being mostly young white boys, so they were the basic
for a lot of the diagnostic criteria. Um Ellen Littman,
who's a psychologist, calls this a referral bias and a
diagnostic bias girls who were diagnosed yours ago, decades ago.
(14:01):
Typically throughout history, girls who were diagnosed with having this
type of disorder had to exhibit the type of behavior
that boys did, because, like Kristen said, if there was
anything else, if it was just an attentiveness, it was
often overlooked. And it was that nineteen eight e d
s M those new diagnostic criteria that allowed for the
possibility of inattention without hyperactivity, and starting at that point
(14:24):
we see this huge jump in the number of girls diagnosed.
But even when that hyperactivity variable remains constant, gender still
plays such a strong role in determining whether or not
children are going to be referred to services. At least
according to results from a two thousand nine study in
the Journal of Clinical Adolescent Psychology, which gave parents and
(14:45):
teachers these short vignettes to read about boys and girls
who were exhibiting a d h d behavior in class
and asked him whether or not they would refer the
kids to learning services, and overwhelmingly whether the girls were
also displaying in these vignettes, these fictional a little short stories.
Even if the girls were also displaying hyperactive behavior, the
(15:07):
boys were still more likely to receive these fictional learning
services because quote the parents and teachers believe that learning
assistance is less effective for girls, which is a little
bit of weird wording in the abstract, because what they
kind of mean to say is they describe more in
the body of the study, is that it seems like
(15:31):
there is a greater emphasis placed on boys academic success
than girls academic success. So it's like, even if all
these girls are struggling in the classroom, we're still a
little bit more likely to pay attention to little Johnny's
progress compared to little Janey's progress. Well, poor little Janie,
(15:51):
poor little Janey. And that's I mean, that's also a
study funding that needs more research on it. But it's
interesting to see that it was notable that even when
that hyperactivity is held constant, gender is still the primary variable.
And it's said to that, um, gender is that being
a girl essentially um is more of a determinant for
(16:15):
you not getting a diagnosis compared to living in a
poor area, not having health insurance, not even having like
access to services nearby. All of those combined, you're still
more likely to get a diagnosis if your boy. Then
if you're a girl, well, um, we will get more
into the gendered aspect of a d h D and
(16:37):
some of the hallmarks of girls experience with a d
h D when we come all right back from a
quick break so we left off, we had established that
there has at least historically been this gender gap in
a d h D diagnosis, but that more recent research
(16:59):
is now ching up to the fact that girls also
experience it as well, but possibly in a different way
than boys do. So let's talk a little bit about
the hallmarks of female a d h D. Yeah, hormones
are a pain in the neck man like the brain,
pain all over your body because of your endocrine system. Um. Anyway, So,
(17:22):
symptoms of a d h D increase with puberty for girls,
but not boys thanks to handy dandy estrogen. At puberty,
girls a d h D related behavior tends to ramp up,
while boys calms down a little bit, not saying that
they outgrow it necessarily, just saying that we tend to
(17:42):
notice the hallmarks the symptoms of it among girls as
they get older and as their hormones start to change
at puberty. So that's a big reason why the criterion
for a d h D has changed from having to
have it since the age of seven up to now
having to have it since twelve, when you, you know,
the classic age for puberty to start. Yeah, and we
(18:05):
also we I mean, girls and women have to deal
with the fact that people are always mixing up our
health symptoms with PMS and PMD D. Oh yeah, I know.
Well they just figure out, well, if you're having trouble
concentrating or etceterric, etceterric, etceterric, it's probably just you know,
something else going on. Um. Dr Littmann, the psychologist that
(18:25):
we sighted earlier, calls this sort of a perfect storm.
You have internalized symptoms, escalating estrogen mounting, shame and demoralization
in response to societal expectations because it's around this time
that you're hitting puberty, your hormones are changing. You're so
worried about fitting in and being like the perfect girl
or whatever. Um, but you know your brain has O
(18:48):
their plans for you. Yeah, And experts on girls and
a d h D often point out that gendered socialization
has a major impact on how girl manage their A
d h D were likelier to internalize and despite probably
having trouble paying attention getting school work done, there's still
(19:10):
more of a perfectionism that tends to run through girls
even with a d h D. Um and we are
three times more likely to have been on antidepressants prior
to an a d h D diagnosis, probably because, like
you mentioned, a lot of times, these kinds of symptoms
that we exhibit are usually mixed up for things like, oh, well,
(19:31):
she's just PMS and her oh she's just depressed, she's
a little bit moody, give us some paxel, right, right,
And a lot of that has to do with the
fact that, uh, our social penalties that we undergo that
we deal with us girls tend to be worse uh
than than the ones experienced by boys. Were more likely
to be rejected by our peers. Um, because if you
(19:54):
think about, you know, let's just let's have an average
stereotypical girl with an antena type A d h D.
You know, she may retreat into herself if she's not
picking up on jokes fast enough, or if she's unable
to kind of pick up on your feelings fast enough
read your face to know, oh I shouldn't make a joke,
she's sad, or oh she's joking. I don't get it.
You know, they can tend to be judged as selfish,
(20:16):
so they internalize their feelings. They try not to. They
don't want to appear selfish. They they're not, but you know,
so they end up retreating into themselves even more. They
might overestimate their social competence, think that they're funnier or
more with it than they are. Uh, they could exhibit
a rebellious stance and relational aggression. And then there's the
whole perfectionism as far as school work goes where um,
(20:38):
I think it was Ellen Littman talking about when girls
with a d h D procrastinate as girls and boys
with a d h D are wont to do, they
are more likely than boys at the last minute to
bust their butts to make this project perfect because they
still have this drive to be little people pleasers. Yeah,
and um, even though we've talked a lot about how
(20:59):
the hallmark symptoms of girls a d h D. That's
in quotes, um, how it's more commonly associated with the inattentive,
dreamy type hyperactivity also exists in girls. That that was
one thing another expert pointed out. She was like, don't
forget that the h and a d h D can
also manifest in girls as well. And I was just
(21:22):
thinking about that and the socialization issue and reflecting back
on middle school years and trying to fit in with girls,
and if like just remembering some girls that I was
around who were clearly hyperactive and how they were socially
ostracized for that, because it's like, uh, in those in
those years and through high school too, and even out
(21:43):
of high school. Unfortunately, it's like this fine line that
girls often have to walk between, you know, being I
don't know, like being not too quiet but not too loud,
you know what I mean. And it's like if if
you have a d h D, you're far more likely
to be either one or the other. And so it's
probably because of this that research has also found that
(22:07):
if left untreated, girls with a d h D are
at risk for chronic low self esteem, under achievement, anxiety, depression,
and team pregnancy and early smoking in middle school and
high school. And that's coming from psychologist Kathleen Nado, who
is another expert in girls and a d h D
that we've been citing, and I mean this, reading all
(22:29):
of these articles too about girls and a d h D,
we're they're heartbreaking because it's the same thing over and
over and over again for this kind of internalization while
striving to make the grade and fit in if possible,
and just manage everything. And we've talked about the impostor
(22:50):
syndrome before on the podcast, but a lot of these girls,
you know, they they're working so hard and they might
be getting as they might be getting always, but they're like,
you know, I have to work so much hard, harder
than little Susie over here. Why do I have to
work so much harder just to get an a when
she seems to breathe through it? And so you feel
like I must not be very smart. And so that
(23:10):
ties into the whole self esteem issue too. And um
a study in the Journal of Consulting in Clinical Psychology
found that UH girls with a d h D, especially
those with signs of impulsivity, are three to four times
more likely to attempt suicide and two to three times
more likely to attempt self injury. And with this study, um,
it's worth pointing out that it followed this group of
(23:33):
girls into adulthood and kind of checked up with them
after a five or ten year period, and it wasn't
this kind of suicidal or self injurious behavior. Wasn't happening
like right then in adolescence when they were first talking
two of them, But it was with girls who perhaps
weren't getting the treatment that they needed and were had
(23:56):
been dealing for years with all of this stuff. And
this is how you know it was manifesting in the
kinds of uh, these kinds of negative behaviors. And also too,
I want to point out that our focus on girls
with a d h D and these kinds of issues
is not to discount, you know, boys struggles with it
as well, or to say that if you know, boys
are just running around, they don't they don't care if
(24:18):
they're having trouble paying attention. But research does find that
the social penalties for girls are often a lot harsher
for boys. But I'm so sure that boys experience a
lot of this as well. It's just the fact that
they are a lot likelier to at least be recommended
for learning services or diagnosis treatment something, um, whereas a
(24:41):
lot of girls are just being kind of left left out. Yeah. Yeah,
you're more likely to expect a boy to have to
come up against a d h D and to have
to treat them for at etcetera, etcetera, whereas you're more
likely to be like that girls such an airhead. Yeah,
or she can handle it, yeah, little Susie, little Janey,
I can push on through. Um. But and you look
at women, like the adult population of a d h
(25:03):
D um, women also experience it, and it's like it's
sort of a grown up version of the same kinds
of stressors piled on top of stressors that maybe have
an even harsher impact honest as women because ho hello
life responsibilities. Yeah. Researchers have found that women adult women
(25:24):
with untreated a d h D tend to have more
trouble with things like time management and organization, stress management,
anxiety and depression, and a lot of it ties into
that constant stress they feel due to managing demands of
everyday life. They they are more likely to exhibit a
learned helplessness style of responding to negative situations and feeling
less control over their lives. I mean if if you
(25:47):
are someone who is struggling with inattention and you can't
focus and you're forgetful, you might feel like everything is
such a struggle. Oh yeah, I mean just thinking about
not to make this Selbot meet Caroline, but thinking just
about that organization factor. Like for me, if my house
isn't clean and organized, I can't get anything done. It's
(26:10):
like this brain organization connection where like if my environment,
like if I don't feel like I have control over
my environment, as I'm sure if you know, for women
with a d h D like that must happen all
the time, then I can't. I just like can barely
handle myself. Yeah, now I I found so I had
(26:30):
to sympathize with one of the scenarios that one of
these psychologists was talking about, as far as like women
with a d h D might exert just just the
way that girls in school might have to work so
much harder just to get that a to focus, to
get that a women with a d h D have
to work so hard to stay organized that it's like
it's just mentally exhausting. And I totally sympathize, Like, I'm
(26:56):
constantly cleaning up after myself, past Caroline screws over future
Caroline all the time. I'm not hanging up my clothes,
I'm not putting my stuff away. So I come into
my environment, whether it's my desk at work or my
dusk at home, or my room or wherever, and I'm like,
I can't focus, I can't accomplish anything. Let me make
fifteen to do lists. Yeah, it feel, it feels chaotic.
(27:17):
And that also reminds me of this article that we
read in the week, and it was written by a
woman with a d h D. But she didn't get
a diagnosis until after college, and she just talked about
how like revolutionary it was for her life, like pre
impost diagnosis, because she talked about how before that her apartment,
(27:38):
I mean, she would lose her keys, she would lose
herself phone, she would find it in just the most
random of places. And not to say that the women
with a d h D like can't get their lives
together anything like that, but you know, it's these environmental
factors make such a difference as well. And what was
interesting um to regarding women in these a d h
(28:00):
D diagnoses is that the primary way that the light
bulb goes off of like oh wait no, this might
actually have to do with something going on in my brain,
not me just being a terrible adult, is that their
kids get a diagnosis and they hear the doctors talking
about these symptoms and they're like, oh, this sounds a
lot like me, because again there's that highly genetic components,
(28:24):
so interesting, so interesting. Yeah, it's just it's so unfortunate
that there's like this whole lifetime of this whole lifetime
cycle of a delay in diagnosis just because I'm a girl,
I must be less likely to have it. Maybe I'm
just an airhead. Maybe I just can't keep track, or
I mean I lose my my mother for like two
(28:44):
separate Christmas. Is has given me these things that you
put on your key ring to like you, if you
can't find your keys, you you beat this little remote
and it helps you find your keys. But what if
you lose the remote? Oh no, trust me, I lost
the remote. I would lose the remote. I would totally remote.
And and this is one thing too where one of
the articles that we read about this was it was
(29:07):
phrased in a way of something along the lines of
women and a d D. It's a diagnosis, not an
excuse because there I think there is this perception because
the rates of diagnosis have increased so quickly, I think
it's raised a lot of skeptical eyebrows. For some people
who don't have these kinds of neurological issues look at
(29:28):
you know, throwing some shade and saying, well, they just
need to pay more attention or do something. But for
these women who have a d h D, I mean,
it's a very real issue. Yeah, you know, speaking of
the skeptics. Doctors will tell you and and psychologists will
tell you that there are a lot of life things
that can happen to you that can mimic these hallmarks
(29:51):
of a d h D. I mean, if you're going
through an incredibly stressful time at work, if you're not sleeping,
if you're drinking too much, going through a break up. Yeah,
there's like all of the stressors that can happen that
can make you feel crazy. And um I started thinking
about it, I'm like, Okay, I see I see that
there are life things like stress that can make this happen.
(30:11):
And I see that you can be a d h D.
And I was like, but but aren't the life situations
like the situational a d h D symptom type things
don't those go away? Might have never gone away, So
I feel like I should Caroline, I think you might
be doing a little bit of your podcast diagnoses you
your your sminty symptom checker. I told my boyfriend last night.
(30:32):
I was like, ah, I think I have a d
h D. And he looks at me and he's like,
what are you doing for the podcast this week? It's true,
but hey, you know, it could be worth checking into
a good fear if you're concerned. Yeah, I could finally
get my apartment organized. But the good news is though
(30:52):
there are so many resources out there specifically focused on
women and girls. There's the National Center for Gender Issues
in a d h D. There's a National Center for
Girls and Women with a d h D. They are
all sorts of books now specifically focused on women in
a d h D, local support groups even so, you know,
the resources and the research are starting to definitely catch
(31:15):
up with the you know, the female population um. But
where the skepticism kind of starts to creep in a
bit more. I think it's not so much with you know,
whether or not a d h D exists, but more
in the treatment of it, because we got to talk
about a d h D meds and how for some
(31:40):
people they have been wonder drugs and for some other
people they've also been wonder drugs, but not necessarily because
they have a d D. Yeah, I mean, I think
we all know people who have misused things like adderall
or riddle in in order to cram for a test,
to lose weight, to do x y Z, to be
like a wonder woman in their lives wives or a
(32:00):
wonder man. Yeah. I mean there have been trend pieces
since you and I were in college, Caroline about college
students in the library buying adderall to stay up all
night to you know, to study, or buying adderall to
stay up all night to party. Well, yeah, I remember
friends doing this freshman year and me just thinking, like
(32:21):
I just like sleep. I'm fine with not studying all night. Um.
But it's interesting to look at like this, this notch
in the timeline because since the number of kids on
a d h D medication has soared from six hundred
thousand to three point five million people. But you also
(32:43):
have to look at the What happened in the late
nineteen nineties, which is, federal guidelines were loosened, allowing marketing
firms basically to market controlled substances like stimulants directly to
the public, a lot of kate in a lot of
cases marketing them to moms specifically. Oh yeah, there were
you know, all these ads. You've probably see them listeners
(33:03):
in magazines or in commercials where there's a happy mom
standing there with her usually son holding up a test
with like a B plus and she's, you know, with
a tagline something along the lines of he's finally living
up to his academic potential. Yeah. They a lot of
(33:26):
ads driving him the fact of like, don't you want
to ease the tension in your family? Don't you want
the best for your son? Don't you want him to
perform better in school? Mom? Yeah? So there has been
this troublesome relationship between pharmaceutical companies like Shire, which makes
adderall and this rise in a d h D diagnoses
(33:49):
in The New York Times magazine recently did a big
piece on how this rise in a d h D
diagnoses among kids and adults has coincided obviously with the
rise in a d h D medication, and I mean
Shire is making billions off of adderall I mean not
(34:10):
to mention all of the other kinds of you know,
name brand medications like concert A, riddling, etcetera. And how
a lot of these pharmaceutical companies have recruited a lot
of doctors with really great titles and research, you know,
heavy backgrounds, who have studies that they've published, to go
out and speak to groups of doctors and suggest that
(34:33):
they really look out for signs of a d h
D and really you know, push some push some adderall
their way. And and that's so unfortunate because clearly this
is you know, a d h D absolutely exists. But
it's once these kinds of murky relationships between doctors and
(34:53):
big pharma come up that you you know, you you
give more credence to skeptics who say, you know, this
is all made up. Yeah. For instance, Dr Keith Connors,
who's a specialist in a d h D, was almost
angry in this story when he heard about the numbers
because the numbers of children and adults on a d
h D meds. He says, the numbers make it look
(35:15):
like an epidemic, but it's not. It does affect people,
for sure, people struggle with it, men, women, boys, girls.
But the fact is that he doesn't think and a
lot of other doctors don't think that the numbers are
accurate as far as who's on medicine versus who actually
has a d h D. Yeah, I think there's definitely
(35:36):
been some over diagnosis that's gone on. And also, and
this is kind of a side note, we don't have
I don't have sources in front of me on this,
but one thing that comes to mind is that we're
now we've come through a generation of kids who received
this diagnosis and maybe a prescription to adderall or riddle
(35:57):
in when they were kids. Now there were there our
age and they still have these prescriptions, And it doesn't
seem like there has been a lot of attention paid
to long term management outside of just popping pills, because
just popping pills when it comes to popping stimulants doesn't
always lead to the healthiest lifestyles or healthiest you know,
(36:22):
physical mental impacts. Yeah, because not only would some people
maybe take them for the wrong reasons, but then you've
got to deal with heart palpitations, insomnia, just general ikey
health issues. From maybe taking the wrong dose, or taking
the wrong pill, or maybe not needing to take it
at all. But the fact of the matter is adderall
(36:43):
and going nowhere. Express Scripts told MPR earlier this year
that it expects a d h D medications to rise
in the next five years um and it's risen thirty
five point five percent between two thousand and eight and
two thousand twelve among people with private insurance um and
(37:06):
while children's use of a d h D medications were up,
adults use rose fifty three percent. Yeah, because, I mean,
there's a lot of reasons for that. Part of it
is that kids are kids are growing up and becoming
grown ups who need medicine. Part of it is that
you've got moms who are looking at their kids saying, oh,
(37:27):
this explains my struggles in school. I need to be
on this medicine. And then you've got a lot of
people who are saying, I need to study for exams,
I need to lose weight, I need to be wonder woman. Yeah.
I mean, because the fact of the matter is, as
as a stimulant, you can get a lot done. You
know you can if you want an edge. Just happens
(37:49):
a lot in academia to where, you know, in a
publishing heavy kind of job where if you need to
sit there and stare at books and read thick you know,
papers and then thick papers. Adderall has been a wonder
drug for a lot of people. There are even some
people There is an article, a couple of articles actually,
I think in Slate for instance, from these writers saying, yeah,
(38:12):
I take adderall. It's amazing, I write so much. Yeah.
And before we make this sounds super attractive to you,
you have to remember that adderall is a schedule to
controlled substance as our morphine and oxy code own, meaning
it has a high risk for addiction or abuse. Yeah,
and there are side effects that go along with chronic abuse,
(38:34):
such as severe rash, insomnia, irritability, personality changes. Um. And
we're focusing so much on adderall use in a d
h D medication because its use is actually increasing the
most demographics wise among young women, which probably has to
do with a lot of what we're talking about in
terms of, you know, the diagnostic gender gap closing, but
(38:59):
it probably also has to do a little bit with
some abuse happening because of the side effects of things
like weight management. Because if you take a stimulant, You're
probably not gonna want to eat too much. Uh, school
cram sessions, maybe staying out and partying. I mean, there
are a lot of I don't know, just hang out
on a college campus. Kids will tell you about it. Yeah,
(39:22):
And I wonder how much of it is tied to
gender norms. You've got to be the right kind of woman.
You know, you've got to be thin, You've got to
be organized, you have to be neat and tidy. You
need to be successful. You have to be successful. You've
got to you know, work all day, come home cooked in,
or do the dishes, etcetera, etcetera, etcetera. Yeah, and I
think that a lot of people have found out her
(39:42):
all to be a you know, a simple way, it's
simple and quotes way to make all of that happen,
to have it all. Um. So, while it's heartening to
see that there, you know, is a greater likelihood that
if you are a girl, are a woman with a
d h D, that there will be resources there for you,
(40:03):
that you might be more likely to be recommended for something.
Um that treatment is available. But there's that other piece
of this whole, a d h D issue, which is
what do we do about I don't think it's so
much in a d h D epidemic that might be
happening as much as an adderall epidemic. Not a sound
(40:23):
like my mother, you know, But I don't know what
do you? Is it too alarmoust to say that. I
think the numbers are pretty crazy. I think Dr Connors
is right when he says that it's not an epidemic
of a d h D. It's not that we're we're
birthing all of these children every day who you know,
(40:43):
are destined to not be able to concentrate. It's it
is more than just I think more and more people
are like, I can get stuff done on adderall. Yeah. Um,
but it's it's just important too that while a lot
of docs hail it, like we keep using the term
wonder drug, but that there are side effects as with
(41:06):
any medication, and it's gonna also, as with every health
issue we talked about on this podcast, affect different bodies differently. Absolutely, So,
who did we end this on a down note? I
don't want to end this on a down note. No,
I think we ended it on a kind of a warning, Yeah,
a warning of of uh, you know, you want to
(41:26):
take care of yourself a little buyer, Beware you should
always be aware a little bit when it comes to
our bodies and brains. We want, we want little Janey
to grow up to be healthy. Yeah, but I gotta
say so so fascinating those gendered socialization issues that often
compound a lot of this a d h D stuff
for girls, fascinating and tragic. They're they're definitely important things
(41:48):
to keep in mind if if you have kids with
a d h D, if you're a teacher, if you're
a doctor, whoever you are, it's it's important to keep
those gender differences in mind. So we now want to
hear from you because at least theistically there are folks
there listening who have a d h D. So I
want to know how how this resonates with you. Um,
(42:09):
let us know your thoughts. Mom Stuff at discovery dot
com is our email address. You can also tweet us
at Mom's Stuff podcast or messages over on Facebook, and
we have a couple of messages to share with you
right now. So I've got a note here from Christina
and it made me laugh because you want to talk
(42:30):
about her Napoleon complex, which, uh, you don't hear about
a lot of women describing their Napoleon complex es. But
she says, I'm about five one, and that's being generous.
Because I'm so tiny, I find myself over overcompensating in
certain areas, such as drinking. I've always ordered whiskey and
coke at bars, one because everyone knows how to make
(42:51):
a whiskey and coke, and too because I know how
bartenders look at petite women like me. It doesn't help
that I look like I'm fourteen. I fig here it's
a respectable drink that's available in many bars, and I
just got used to the taste. Even when I ordered
these drinks, I would still get the occasional condescending comments
or smirks. This personal preference seemed to carry over to
my tastes and coffee as well. I started drinking Americanos
(43:14):
when I started working at a cafe. My friends and
I would also be able to predict what people would
order based on how they look. And in this case,
I am guilty of stereotyping since I judge people on
their drink preferences. I knew firsthand what people thought about you,
and I just didn't want to be placed in that box.
Since then, I've learned to really enjoy bourbon, and I
do enjoy the taste of espresso, even with the occasional
(43:34):
steamed milk. Mostly it's now because it's simpler to drink,
the better it tastes. As much as I don't want
to believe that stereotypes shaped me, I appreciate that it has.
My drinking preference is the tip of my Napoleon complex.
I've been more aggressive and stubborn on certain issues because
of it. I worked so hard on not fitting in
those stereotypes because I didn't want to be defined by them,
(43:55):
but eventually they affect the way I am today. So
thanks for sharing your experienced Christina, that's so funny. I'm
I'm five too. I'm also a shorty, and I feel
sometimes like I have to be a little over aggressive.
I would have never known you were five to you
are seven ft tall in my eyes, Carol, I'm also
wearing wedges today. Usually we're a heel and wedges. Um. Yeah, No,
(44:19):
I I get looks because not only am I really short,
but I think something about my youthful expression makes people
think I am younger than I am. Um. But anyway,
I have a Facebook message here from Amanda. She was
writing in about our thyroid episode and she has a
question for me that I wanted to answer in case it,
you know, helps out anybody else. UM disclaimer. I have
(44:42):
Hashimoto's thyroid itis, which is an autoimmune disorder that causes hypothyroidism,
which can lead to all sorts of things like weight gain,
brain fogginess, tiredness, brittle nails. It's really fun. So anyway,
Amanda wrote to say you said there was a test
that was helpful in diagnosis, but did not mention the
name was that the T s H or free T
(45:05):
three T four that ended up giving you some answers.
I have been going through some of the same struggles.
The brain fog, weight gained despite diet and exercise, irritability, fatigue.
My family doctor has attributed to depression and placed me
on antidepressants. My T s H levels were okay two
years ago, but the symptoms have gotten progressively worse since then.
(45:25):
I will be going back to the doctor and wanted
to know which test to ask for. By the way,
I love the show. My husband actually turned me onto
you guys about a year ago, and I've been binge
listening ever since. So I'm really glad you are Amanda
and husband and Amanda's husband um okay. So the test
that I had that showed there was a problem because
my UH, my T S H, and my T for
(45:47):
free tests results were normal. But my thyro globulin A
B test, so that's the antibodies, showed that there was
an issue. The standard rain ine for thyroglobulin A B
is under twenty amanda Mine was eight hundred and twenty eight.
So that combined with a sonogram of my neck looking
(46:10):
at my thyroid to see if there were any nodules,
if it was misshapen, anything like that, the sonogram confirmed
that I had Hashimoto's thyroid itis. That was back in October,
and so I am due UH in several months for
a repeat of that test. And I just want to
say that it is super common for you, for doctors
(46:34):
or your family to think that you are just depressed
or dealing with anxiety. And if you don't have a
history of depression or anxiety, or if you don't have
a family history of it, I think it is really
important to get a full thyroid work up. If you
just can't shake the weight, if you can't shake the
brain fog because who knows. I mean, what could it
hurt besides a couple of vials of blood. So anyway,
(46:56):
thank you so much for writing in, Amanda, and I
wish you the best of luck, and thanks again to
everybody who's written into us. Mom Stuff at Discovery dot
Com is our email address, and if you want to
find us on social or find all of our podcast,
blogs and videos, there's one place to go. It's stuff
Mom Never Told You dot com for more on this
(47:17):
and thousands of other topics. Is it how Stuff Works
dot com
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