combined presentation of ADHD were often disliked and rejected by their peers , which Hinshaw notes can be “ devastating .” He said such social isolation can lead girls to lose self-esteem and increases their risk of engaging in antisocial behavior , including substance abuse .
Years later , when Hinshaw ’ s team observed the girls as adolescents , researchers found that the majority of the girls ’ childhood impairments persisted . Only a few of the girls showed improvements in math , memory or planning during this time . Moreover , some new problems had emerged , including eating disorders , suicide attempts and self-harm , behaviors Hinshaw links to ADHD-related impulsivity .
Unsolved puzzles
Patricia Quinn , a retired developmental pediatrician formerly associated with Georgetown University Medical Center in Washington , DC , has published extensively about ADHD in girls and women . She has worked with hundreds of adult women who have struggled with disorganization , distraction , poor planning and social problems without realizing that they had ADHD . “ I think there ’ s still a lot of misunderstanding about the disorder , and a lot of misdiagnoses ,” she says . Quinn , who herself has been diagnosed with ADHD , says such news “ can be a very hopeful diagnosis . These women can be treated , and they can live a very successful life .”
It ’ s clear that ADHD medication helps many . But on its own , “ it ’ s rarely an adequate long-term solution ,” says Hinshaw . “ Even if it works , it ’ s not a cure .” Learning social skills , for example , is an important part of overcoming the disorder . For adults , promising results suggest that cognitive behavioral therapy helps improve organizational and time-management skills , as well as emotion regulation .
The National Institute of Mental Health supported Hinshaw ’ s B-GALS study for 23 years , but Hinshaw says the project is now on hiatus until his team can find a new funder . His goal would be to do a fifth followup study of the girls , who are now reaching their thirties . The UC Berkeley team and other researchers in the field say there are still lots of puzzles to solve . For instance : Why does ADHD manifest differently in boys and girls ? What makes it more or less severe ? What brain structures or hormones play the most important part ? Is there a more objective way to diagnose ADHD , and to track how well various treatments work ? And most important , how can our health and education systems do a better job of alleviating suffering and stigma for both boys and girls ?
There has been some progress . Research suggests that there is a hefty genetic component , although exactly what and how many genes are involved is unknown , and it ’ s clear that environment also plays an important role . Gender-based neurobiological differences may also help explain some of the differences in the way boys and girls experience ADHD . Three years ago , researchers compared the brains of boys and girls with ADHD and their neurotypical counterparts . They found that the volume and shape of the globus pallidus and the amygdala — brain regions important for emotions — were different in boys with ADHD , but not in girls .
Hormonal fluctuations may also play a role . “ Estrogen levels seem to be influencing , in women , their ADHD symptomology ,” says Quinn . But , she notes , there are many more questions than answers at this point .
For Hinshaw , the way forward is to educate teachers , parents , doctors and especially children with ADHD on how to recognize it and its symptoms in both girls and boys . “ We might be able to , in a generation or so , have a very different set of attitudes about mental health and developmental disabilities , as those kids grow up to be adults ,” he says .
— Additional reporting by Rachel Ehrenberg , Bridget Hunnicutt and Katherine Ellison
This article was originally published in Knowable Magazine . Read the original article
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