The rising prevalence in females
ADHD & Autism Spectrum Disorders:
The rising prevalence in females
Gabriella Campbell | bioceuticals. com. au
This article is reproduced here with the kind permission of BioCeuticals.
Abstract
ADHD is characterised by presentations of inattention and / or impulsivity-hyperactivity. ASD is defined by social interaction and communication challenges and restrictive-repetitive behaviours with sensory sensitivity and interest differences. ADHD and ASD are diagnosed more often in males due to different symptom presentations, with females often exhibiting less obvious symptoms. Females with ADHD and ASD often mask their symptoms, leading to underdiagnosis or misdiagnosis.
Attention-deficit hyperactivity disorder( ADHD) and autism spectrum disorder( ASD) are two neurodevelopmental disorders that typically commence in childhood.( 1,2) ADHD is characterised by presentations of inattention and / or impulsivityhyperactivity.( 3) ASD is defined by social interaction and communication challenges and restrictive-repetitive behaviours with sensory sensitivity and interest differences, but there may also be attention difficulties and hyperactivity.( 3,4)
Research suggests two-thirds of those with ADHD demonstrate symptoms of ASD and that approximately 30-50 % of those with ASD also demonstrate symptoms of ADHD, making these conditions strongly intertwined.( 5) Both ADHD and ASD frequently coexist in families with no primary cause being noted. Interestingly, numerous environmental and genetic factors are believed to contribute, including genes involved in the transportation and metabolism of the neurotransmitters, serotonin, dopamine, and noradrenaline.( 3,6,7) Additionally, risk factors during pregnancy have been noted for ADHD and include low birth weight, maternal smoking, allergies, bacterial or viral infections, and certain autoimmune diseases.( 6)
ADHD and ASD in males and females
To date, a higher prevalence of ADHD has been seen in boys, who are up to ninetimes more likely to be diagnosed than girls,( 8) and in ASD boys are three times more likely to receive a diagnosis than girls. These figures highlight a significant bias in overall diagnosis between genders.( 9) It is now known that females tend to camouflage or compensate for symptoms of ADHD and ASD.
Both ADHD and ASD are linked to genetic and environmental factors, causing issues like gastrointestinal problems, oxidative stress, and nutrient deficiencies. Nutritional support and herbal remedies( e. g., Bacopa monnieri, Panax ginseng, Ginkgo biloba) can help manage symptoms. ADHD and ASD often run in families with risk factors that include genetic variations, low birth weight, maternal smoking, and infections during pregnancy. Emerging research shows that the disparity in the ratio of diagnoses between males and females is likely to be due to their differing presentations.( 10) This is because the diagnostic criteria for both ADHD and ASD have historically been based on the symptom profile in boys: an oversight that has meant symptom expression in females has remained largely neglected, and awareness, along with education as to the differences, continues to be inadequate. As a result, females are often misdiagnosed or not diagnosed until well into adulthood – if at all.( 9,11) The extent of these deficits is such that adult females may not even recognise they are neurodivergent, meaning no diagnosis is sought.( 4,12,13)
Additionally, females often present with different characteristics from those of their male counterparts. For example, in ASD, females tend to engage in imaginative play, may have a fully developed vocabulary that can express emotions, have higher cognitive abilities and are often far more sociable.( 14,15) Additionally, they tend to internalise their emotionally troubling symptoms such as depression, anxiety, and sensory processing problems. Perfectionist tendencies and eating disorders are also common,( 14) with insomnia or general sleep disturbances linked to both ADHD and ASD.( 16,17)
212 | vol31 | no4 | AJNM