Health | Women’s ADHD

Twice as many boys as girls are diagnosed with attention deficit disorder with or without hyperactivity (ADHD) in Quebec. Over the past ten years, several researchers have shown that it is an under-diagnosis in girls. The causes are better known, but new questions arise.

Hyperactivity and Daydreaming

The conclusion of the first “consensus statement” on Attention Deficit Hyperactivity Disorder (ADHD) in girls could not be clearer: “It is important to abandon the dominant perspective that ADHD is a behavioral disorder, to make way for the more subtle, internalized presentation common in women. »

“Despite the accumulation of studies, most specialists overlook ADHD cases that do not have impulsivity or hyperactivity,” says Susan Young, a London psychologist who is the lead author of this literature review. published in 2020 in the journal BMC Psychiatry.

Martin Gignac, head of the psychiatry department at the Montreal Children’s Hospital, confirms the phenomenon. “Early studies of ADHD focused primarily on behavior,” says Dr.^r Gignac. It stuck, even though we now know that girls have fewer behavioral problems. Moreover, in some cases, impulsivity and hyperactivity decrease in adolescence, as the brain becomes more mature. “Sometimes, an attention deficit is detected during a consultation for another problem, for example depression, notes Lila Amirali, head of the psychiatry department at CHU Sainte-Justine.

Of note, the gender imbalance for ADHD disappears in early adulthood. “It seems that more and more young adult women are finding that attention deficit is taking a toll on their lives,” says Ms.^me Young.

The D^r Gignac, who is chair of the board of the Canadian ADHD Resource Alliance (CADDRA), believes that a consensus statement like that of the BMC Psychiatry shows the evolution of clinical practices. “We talk about the differences between girls and boys in the CADDRA literature, but it is probably time to devote a whole chapter to this question. » The consensus statement of the BMC Psychiatry lists more than 85 studies.

hormones

Taking into account the impact of the female hormonal cycle on ADHD is one of the significant advances of recent years, according to Ms.^me Young, who is chair of the UK ADHD Partnership, similar to CADDRA. “A lot of research is still needed to fully understand the situation,” says Ms.^me Young. But most psychologists are seeing a wave of women going through menopause who are wondering if their difficulty concentrating is related to a previously less pronounced ADHD. »

This phenomenon of ADHD treatment at menopause is also present in Canada, according to Dr.^r Gignac. According to a document he sent to The Pressfemale puberty, and certain times of the menstrual cycle can decrease the effectiveness of ADHD medications, and ADHD can exacerbate premenstrual symptoms.

Pregnancy

The other pressing research question, according to M^me Young, is the impact of ADHD on motherhood. “It is clear that ADHD can negatively affect mothers’ sense of competence with their baby’s needs. There is very little data on this issue, especially since ADHD medications are usually discontinued during pregnancy. And this, even if the only meta-analysis on the subject does not conclude that there are significant risks. At the very least, time-limited medications could be considered during breastfeeding. » According to the D^r Gignac, hormonal surges can worsen ADHD, which in turn can increase the risk of postpartum depression.

Overprescription

Last fall, a study by the National Institute of Public Health of Quebec (INSPQ) sounded the alarm about the prescription of ADHD drugs. Nearly 7.7% of young people under the age of 25 registered with public drug insurance had taken medication for ADHD in 2019-2020. In some regions, the proportion is even greater. The proportion of Quebecers who have been diagnosed with ADHD during their lifetime is slightly higher than that of the United States, with 15% for adolescents here compared to 13% in our neighbor to the south (average from 2016 to 2019), according to the US Government Centers for Disease Control and Prevention (CDC).

Is it better to prescribe medication to a child who does not need it, to prevent another – often a girl – who actually has ADHD from not having access to it? Or limit prescriptions, at the risk of girls with ADHD not being screened? “Ideally, we don’t want to prescribe unnecessary drugs or miss cases,” says Dr.^D Admiral.

A UQAM study, the results of which were unveiled for the first time this week in The Pressseems to show that girls are slightly less affected than boys by overmedication: male “class babies”, born in September, are 8% more likely to be medicated for ADHD than those born in October, whereas the difference is 5% for girls.

The protective effect

Another avenue explored by ADHD specialists in girls is a “protective effect” against certain ADHD-related genes. In 2016, in the Journal of the American Academy of Child and Adolescent PsychiatryBritish and Swedish researchers have concluded, based on the analysis of 11,000 sets of twins from the two countries, that girls diagnosed with ADHD have a greater genetic susceptibility than boys.

“The idea is that something in girls protects against ADHD genes,” says Ms.^me Young. So girls need a higher genetic susceptibility to develop ADHD. In boys, the threshold is lower. Is it linked to cultural characteristics that favor certain cognitive habits, such as the organization of time, in the education of girls compared to boys? It is too early to tell, because other studies do not find this protective effect. Such a protective effect has also been postulated for other developmental disorders, including autism.