ADHD in girls -an historical review focusing on the 1990’s

[Posted on 7 February, 2018 by Svenny Kopp]

The first conference on gender differences in ADHD was held in the United States in 1994 (E. Arnold 1996). The central aims of this conference were to both examine and discuss gender differences in ADHD and how ADHD manifested in girls and women over a lifetime perspective. The hope was that ADHD in girls would not merely be compared with ADHD in boys but that one would also recognise areas that are more specifically significant for girls and women, such as hormonal factors, socialisation, motherhood, symptoms across different ages, comorbidity and treatment. Other questions included whether ADHD was a “certain”/”accurate” (i.e. valid) diagnosis for girls or whether one should have other or less criteria, as well as whether the diagnostic instruments were effective at detecting girls’ symptoms.

Even though there were fewer girls than boys with ADHD, population studies showed that girls were not a negligible group, and the concluding remarks from the conference emphasised that ADHD in girls constituted a significant general health risk. The reason behind this grave statement was that ADHD was considered a condition that would persist even in adulthood. This conference was the first time that it was scientifically demonstrated that girls had virtually been excluded in the comprehensive field of ADHD research. This was in spite of ADHD being one of the most well-studied diagnoses in child and adolescent psychiatry. Another important issue during the conference was how to explain the uneven gender distribution in ADHD. After this conference, research on ADHD in girls expanded. In 1997, the first meta-analysis on gender differences and ADHD was published (M. Gaub & C. Carlson). The article summarised 16 studies and the results showed that ADHD among girls went undetected by teachers, and that these girls acted out less than boys with ADHD, and also faced more exclusion from peers. It also became clear that girls with ADHD seeking care had greater difficulties compared to boys. Two years later, a study on girls with ADHD, perhaps still to this day the most important one ever written on the subject, was published by J. Biederman. He compared 144 girls with ADHD with the same number of girls without ADHD and with equally large groups of boys with and without ADHD. Biederman was able to show that there was no difference between the ADHD symptoms of boys and girls and that their level of disorder was equally extensive. Soon after came the release of the book “Understanding girls with ADHD” by K. Nadeau, E. Littman, P. Quinn. The book was translated and released in Sweden in 2002.

In Sweden, girls with DAMP (Deficits in Attention, Motor control and Perception)/ADHD were addressed separately for the first time at a conference in Gothenburg in 1998. The following year saw the start of the “Girl project” headed by Svenny Kopp and Christopher Gillberg at The Queen Silvia Children’s Hospital and the Department of child and adolescent psychiatry (what is now the GNC) in Gothenburg (where girls with ADHD had been studied since the mid-1970’s, albeit not to the same extent as boys). One hundred girls ages 3-18 who had sought clinical care for concentration difficulties and/or social interaction problems were examined multiprofessionally. The Girl project was funded by the Swedish Inheritance Fund and led to increased knowledge and a kind of awakening to the need for focusing specifically on girls with ADHD and autism, culminating in a doctoral thesis on Girls with Attention and/or Social Deficits (S. Kopp 2010). The girls in the Girl project have now been followed up in adulthood and publications based on this study are expected in the next few years.

[This is a blog. The purpose of the blog is to provide information and raise awareness concerning important issues. All views and opinions expressed are those of the writer and not necessarily shared by the GNC.]