WOMEN WITH ATTENTION DEFICIT DISORDER

A CRITICAL REVIEW, by Dr Ernest S.L. Luk, Associate Professor of Psychological Medicine, Monash University.

This book has brought into focus a much neglected area in our understanding of ADD. Most of the studies of ADD were carried out in the male population. We know much less about ADD in the female population.

As we know, there is a big difference in the ratio of prevalence of ADHD between males and females. Within epidemiological samples of children, the average ratio is around 3:1. Within clinic-referred samples, the sex ratio rises to 6:1 to 9:1 suggesting that boys with ADHD are far more likely to be referred to clinics than girls. However the reason behind this gender difference is unclear. One argument is that maybe the present diagnostic criteria for ADD is not appropriate for the female population. It is possible that the threshold of diagnosis is set too high for girls relative to the female population. If this is correct, then, many female children with ADD would be undiagnosed.

The author suggests that ADD without hyperactivity may be more common with girls. As a condition, ADD without hyperactivity is less well understood. It is unclear whether it should be considered as a subtype of ADD with hypoactivity or a different kind of problem. If ADD with hyperactivity is a hidden handicap, then ADD without hyperactivity is likely to be even harder to recognise. The author suggested that one of the key problems in female adults with ADD is disorganisation. This is an important concept and deserves more research.

Some recent research on adults with ADD suggests that the ratio of male to female referral is about the same. It raises the possibility that in adult life, females may be more handicapped if they have ADD. A very interesting hypothesis is proposed by the author to explain the interaction between culture, gender and ADD. While in childhood women in general are less aggressive and disruptive and the ADD problem does not cause as many problems as in the males, the demand of culture on women in later life in terms of the different roles of women puts enormous pressure on women. The problem of disorganisation leads to secondary effects of shame, under-achievement, depression and relationship problems.

While ADD may be undiagnosed in females, the author also cautions against the over-diagnosis of ADD in the adult population. She has certainly highlighted the enormous complexity of managing adults who present with the possibility of suffering from ADD. Over all, I find this book interesting. There are many good observations. Hopefully it will stimulate researchers to do more research on ADD in the female population.