I recently listened to a compelling CBC radio story (link below) about the challenges of diagnosing adult ADHD, especially in women. It was extremely eye opening to me and inspired me to do more research on the topic. I learned that more males are diagnosed at a young age due to the fact that they are more likely to show externalizing symptoms (such as acting out, getting in trouble, being violent, etc.) whereas females are much more likely to have the inattentive form of ADHD making them much less likely to show outward problems like their male counterparts. This makes ADHD much harder to diagnose in females and has lead to the common belief that ADHD is more common in boys, however studies have shown that this is likely not true.
So, if we are missing so many of these childhood diagnoses in females how do we diagnose them once they are adults? A good place to start is the Adult ADHD Self-Report Scale (ASRS) screener, which was developed by the WHO (World Health Organization). This test is not a diagnostic test but simply a six-item symptom checklist, and is a good indicator of whether further tests need to be done. If patients score in the significant region on 4 or more of the symptoms than it is highly likely that they are suffering from ADHD. The ASRS has been shown by many tests, including a 2011 study by Adler et al., to be highly reliable (Cronbach’s alpha of 0.83) and a valid scale for predicting adult ADHD.
Since this test is so short and so easily to administer I see no reason why clinicians shouldn’t be giving it out all the time, yet they don’t seem to do it enough. So many females are still going under diagnosed, which is potentially very harmful to their mental well-being, self-esteem, and academic, professional, and social functioning. Since females tend to internalize their ADHD symptoms they have a higher chance of developing other internalizing disorders such as anxiety or depression. This is so common that many of them who do end up seeking professional help are often diagnosed with these other disorders first and ADHD second or may never end up realizing that the underlying cause to their anxiety or depression is due to ADHD, which could have a huge impact on the effectiveness of treatment. I think it is extremely important that clinicians recognize the importance of diagnosing ADHD and start administering the ASRS whenever they can. This should include anytime they see someone suffering from any internalizing disorder, show any symptoms of ADHD and could even be done in during unrelated checkups. It is a simple test that will barely take 1 minute of their time but could make all the difference in the life of a girl suffering from ADHD.
References:
Adler, L.A., Spencer, T., Faraone, S.V., Kessler, R.C., Howles, M.J., Biederman, J., Secnik, K. (Dec. 4, 2011). Validity of Pilot Adult ADHD Self- Report Scale (ASRS) to Rate Adult ADHD Symptoms. Annals of Clinical Psychiatry, 3, 145–148. doi: 10.3109/10401230600801077
