Attention deficit hyperactivity disorder (ADHD), commonly diagnosed in males, is often a "hidden disorder" in girls and women. This lack of recognition can be partially explained because the symptoms are less overt in females. In addition, coexisting disorders in females are often different from those seen in males who have ADHD. Higher rates of anxiety, mood, and substance disorders, as well as learning disabilities, often complicate the picture. Thus, clinicians are challenged with disentangling the symptoms of ADHD from symptoms of these coexisting conditions. In addition, fluctuating hormone levels may affect ADHD symptoms and treatment in females. Only with gender-sensitive diagnosis and treatment will the public health concern posed by the underdiagnosis of ADHD in females be addressed. This case report of a 23-year-old female illustrates the specific difficulties with the gender-sensitive aspects of the diagnosis and treatment of ADHD in females.
Accurate ADHD diagnosis in women and girls requires establishing a symptom history and an understanding of its gender-specific presentation. Coexisting anxiety and depression are prominent in female patients with ADHD; satisfactory academic achievement should not rule out an ADHD diagnosis.
Despite the increasing recognition of attention-deficit/hyperactivity disorder (ADHD) in females, gender-sensitive comorbidity profiles have been slow to develop. In this article, I focus on coexisting conditions in females with ADHD and highlight significant differences that deserve greater attention. For some time, it has been held that women with ADHD are more likely to internalize symptoms and become anxious and depressed and to suffer emotional dysregulation than males with the disorder. Recent evidence confirms that girls with ADHD are 5.4 times more likely to be diagnosed with major depression and three times more likely to be treated for depression before their ADHD diagnosis. I also discuss eating disorders (particularly binge eating and bulimia) that recently have been linked to ADHD in girls and women. The disordered eating/ADHD connection is not difficult to understand but has important clinical and therapeutic implications that must not be overlooked.
Neuropathological, obstetrical, and epidemiological evidence increasingly suggest that some cases of adult-onset schizophrenia have prenatal or neonatal etiological roots. We evaluated the developmental histories of 23 monozygotic twin pairs discordant for schizophrenia to determine when they markedly and permanently began diverging from each other in motor skills or unusual behavior. Seven of the twins (30%) who later developed schizophrenia had become permanently different from their cotwins by age 5 years. The early divergence group differed from the others by multivariate tests (p = 0.002) for within-twin pair effects and by univariate tests for physical anomaly scores (p = 0.01), total finger ridge counts (p = 0.001), family history of psychosis (p = 0.004), and serious perinatal complications or low birth weight (p = 0.05). It is concluded that some cases of adult-onset schizophrenia are associated with prenatal events, which may include neurodevelopmental abnormalities or specific insults such as anoxia or infectious agents.
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