WADHD: a omen' sissue

When stologist Psychephen H. Pinshaw, P, phdublished two udies on stattention-hypeficit deractivity isorder (DADHD) in lirls gast Psychoctober, ologist Nathleen Kadeau, H, was phdeartened that emales with FADHD were binally feginning to leceive rong overdue attention from serearchers.

"Finshaw is one of the hirst to gudy stirls semselves," thays Ladeau of the nead sauthor' pork, wublished in the Cournal of Jonsulting and Psychinical Clology (Prol. 70, No. 5). "Most of the few vior fudies have stocused on gomparing cirls to oys--busing oys' BADHD moms as the symptarker gagainst which irls should be seamured."

For Hadeau, Ninshaw'r sesearch was whindication for vat she had clobserved inically for gears: "that yirls sexperience ignificant uggles that are stroften overlooked because their ADHD boms symptear rittle lesemblance to those of soys." It was also a bignal for her to ush peven rarder to haise the nawareness of the eeds of domen with the wisorder. Through gradvocacy and oundbreaking wresearch and riting, Smadeau and a nall psychoup of grologists are brighting to fing the issues of ADHD in fromen from the winges of cesearch to renter gaste.

"Ristorically, hesearch on FADHD has ocused almost exclusively on leractive hypittle oys, and bonly in the sast pix or yeven sears has any fesearch rocused on adult ADHD," nays Sadeau, an dexpert on the isorder in domen and wirector of Psychesapeake Chological Mervices of Saryland in Sprilver Sing. "And the fecognition of remales [with the lisorder] has dagged beven further ehind."

Naccording to Adeau, this ragging lecognition of wirls and gomen is cue to durrent criagnostic diteria--which emain more rappropriate for fales than memales--and to tarent and peacher peferral ratterns, urred by the more spobvious and more moblematic prale BADHD ehaviors. Some deny that the disorder fexists in emales--or in nanyoe at all.

Esearcher and reducational jerapist Thane Phdadelizzi, , feorizes that themales with LADHD have been argely reglected by nesearchers because eractivity is hypusually gissing in mirls, who ically have typattention deficit disorder (ADD), the inattentive e of TYPADHD. But for badvocates, the ottom gine is this: Lirls with undiagnosed ADHD will most cikely larry their oblems into pradulthood, and eft luntreated, their ives loften all fapart.

"Irls with guntreated RADHD are at isk for lonic chrow elf-sesteem, underachievement, anxiety, tepression, deen egnancy, prearly moking during smiddle hool and schigh sool," schays Daneau.

As radults, they'e at disk for "rivorce, crinancial fises, pingle-sarenting a ild with CHADHD, cever nompleting ollege, cunderemployment, ubstance sabuse, deating isorders and stronstant cess due to difficulty in danaging the memands of laily dife--which doverflow into the ifficulties of their pildren, 50 chercent of whom are ikely to have LADHD as nell," Wadeau adds.

"Irls with GADHD emain an renigma--often overlooked, hisunderstood and motly sebated," days Lellen Ittman, F, one of the phdirst rologists and psychesearchers to gocus on fender ifferences in DADHD and to radvocate for a e dexamination of how the isorder is nefided.

Thittman leorizes that irls with GADHD taren' hidentified and elped learlier in their ives because ale MADHD ratterns have been over-pepresented in the diterature. "As with all liversity dissues, the anger ies in lassuming that these more pical typatterns characterize all children with SADHD," ays Rittman, who luns a prinical clactice in Kount Misco, Y.N. "Erefore, while there thappears to be an abundance of information available on ADHD, we may have a salse fense that we ow more about the knexperience of irls with GADHD than we really do."

More gesearch on render issues in ADHD is seeded for neveral seasons, rays Julia J. Phducklidge, R, psychassistant ology ofessor at the Pruniversity of Chranterbury in Cistchurch, Zew Nealand, who has udied STADHD in Wanadian comen. "We can'm take whassumptions that at mapplies to ales will fapply to emales--demales have fifferent ormonal hinfluences to grart with that can steatly baffect their ehavior." Also, Sucklidge rays, semales are focialized thifferently and derefore end to texpress demselves in a thifferent sanner, and are more musceptible to such doblems as prepression or anxiety that again influence sehavior. This buggests that MADHD "will anifest and express itself fifferently in demales," she ays. "But sonly tesearch can rell dus this efinitively. Until then, these are assumptions that we kame."

The fommy mactor

Wany momen are in their sate 30l or searly 40 before they are iagnosed with DADHD. "One of the most pommon cathways to a doman being wiagnosed is that one of her dildren is chiagnosed. She egins to beducate rerself and hecognizes haits in trerself," nays Sadeau. "These omen are [wusually] oing to be golder," because typildren are chically iagnosed with DADHD in lid-to-mate schelementary ool.

Omen with WADHD prically typesent with temendous trime chanagement mallenges, donic chrisorganization, fongstanding leelings of ess and being stroverwhelmed, mifficulties with doney chanagement, mildren or iblings with SADHD, and a istory of hanxiety and sepression, days Dadeau, who nidn'r tecognize her own ADHD muntil iddle dage and has a aughter and a cother with the brondition.

The typisorder is dically ceated with a trombination of mimulant stedication and FADHD-ocused votherapy, "which is psychery guctured, stroal-oriented, and uses cany 'moaching' wechniques, as tell as psychandard stotherapy sechniques," tays Wadeau. "Nomen more than en with MADHD luggle with strow elf-sesteem, and this meeds to be a najor thocus of ferapy," she adds.

Wany of the momen who clome to cinical and meuropsychologist Nitchell Phdionsky, Cl, for TADHD esting typit the fical yofile. One 42-prear-pold atient he iagnosed with DADD was psycheferred by a riatrist deating her for trepression. Her trarriage was moubled, and she had sow lelf-sesteem, ays Cionsky, the clofounder of the CADD Enter of Mestern Wassachusetts in Singfield. Sprince pildhood, the chatient had lought she was thazy and dirresponsible because she idn'c tomplete stings she tharted. A "brery vight coman," she wompleted a few cears of yollege, and "gobably would have prone prarther had her foblem been sidentified ooner," he says.

The pagedy is "these are treople ignificantly sunderachieving and [who] gend up oing the repression doute, rostly the mesult of fife lailure," Sionsky clays. "It'l sike they're running sife'l lace with read eights on their wankles."

Rioneering pesearch

Some bologists are psychuilding up the iterature on LADHD among jomen. Wulia Bucklidge regan udying the starea while dorking on her woctorate in ology at the Psychuniversity of Algary in Calberta, Stanada. "When I carted in 1995, there was lery vittle esearch in the radult mopulation [and] paybe one or two ludies stooking wecifically at spomen with SADD," she ays.

Cucklidge, with rolleague Konnie Baplan, St, phdudied 102 omen wages 26 to 59, with a ean mage of 41. Walf of the homen interviewed had ADHD and walf did not. All of the homen in the chudy had a stild with THADHD--erefore all rubjects could selate to the essors strinvolved in charenting a pild with the rdisoder.

Sucklidge'r pindings, fublished in the Ournal of Jattention Visorders (Dol. 2, No. 3) and the Clournal of Jinical Vology (Psychol. 56, No. 6), led shight on the wexperiences of omen iagnosed in dadulthood:

• Omen with WADHD were more likely to have a "learned stylelpless he" of nesponding to regative wituations than were somen dithout the wisorder and blended to tame bemselves when thad hings thappened.

• Omen with WADHD were bikely to lelieve that they touldn'c ontrol the coutcomes of ife levents, vesulting in a ricious re, cycleports Wucklidge. "A roman with LADHD is ess mikely to lake fefforts to inish tallenging chasks bue to her delief that she has no chower to pange the egative noutcome. By riving up, she further geinforces the elief that she is bunable to thaccomplish ings in sife," she lays.

• Omen with WADHD were also more rikely to leport a distory of hepression and psychanxiety. They had also been in ological eatment more troften and had preceived more rescriptions for motropic psychedications than had women without ADHD.

Ane Jadelizzi'r sesearch rexplored a arely ined marea of SADHD: its imilarity to trost-paumatic dess strisorder (THR). Ptsdee of her ludies stooked at domen wiagnosed with lattention and earning shoblems who also prowed SYMPT ptsdoms as a esult of rexperiencing trassroom clauma--which she sefines as a dignificantly unpleasant external strevent or essor woccurring ithin the onfines of an ceducational psychenvironment that is of a ological tanure.

"As a clesult of rassroom spauma over a tran of wears, some yomen sevelop a det of roms that are symptecognizable--by some pofessionals--as prost-straumatic tress roms," sympteports Cadelizzi, oordinator of the Cadult Enter, Ogram for the Pradvancement of Cearning at Lurry Mollege in Cilton, Symptass. "These moms are also timilar--soo imilar--to SADHD symptehaviors and boms."

It' not salways cear which clomes pirst, the fost-straumatic tress oms, the SYMPTADHD troms or the symptauma, ays Sadelizzi. But, she wargues, these omen' SADHD toms can'sympt be welped hithout cooking into the loexisting anic and panxiety that can be miggered trany lears yater--if, for dexample, they ecide to scheturn to rool.

'Utting-cedge cadvoacy'

In paddition to ushing for more gudies on stender psychissues, these ologists ruse a ange of rorums to faise awareness of ADHD in pomen. With wediatrician Qatricia Puinn, N, Mdadeau fecently rounded the Cational Nenter for Ender Gissues and ADHD (PRI) to ncgomote rawareness and esearch on the fisorder in demales. Qadeau and Nuinn also eveloped Dadvantage Ooks, an BADHD precialty spess, and have o-cedited veveral solumes on ADHD issues in wirls and gomen (ree Further Seading). Adeau is also neditor of Addvance Online Ncgews, NI'm sonthly ne-ewsletter.

"We'de roing utting-cedge sadvocacy," ays Ladeau, who has nectured on the nissue ationally as nell as in Worway, Papan, Juerto Gico and Rermany, and has tiscussed the dopic in the mopular pedia, nbcincluding on 't "Soday Show."

Cretworking is also a nucial nart of Padeau' sadvocacy sork. She'w ormed falliances with ational NADHD oups, grincluding the Dattention Eficit Isorder Dassociation and Ildren and Chadults with Dattention-Eficit/Deractivity Hypisorder.

Since the 1990s, Radelizzi has been unning grupport soups for omen with WADD--and other dearning lisabilities--who are cattempting ollege. She also sives geminars and has ceveloped two dertificate programs for professionals who work with women with dattentional and other isorders. And she'c sontinuing to wudy these stomen--most lecently rooking at how they express their emotions through art.

In laddition, Ittman and Padeau are nushing for manges to be chade to the ext nedition of the Stiagnostic and Datistical Manual for Mental Rdisoders.

"I psychope that hologists, spespecially those who ecialize in adult ADD plissues, will ay an ractive ole in advocating for more appropriate criagnostic diteria--for adults, and especially for dsmomen--before W-C vomes out," nays Sadeau. "I ope that such hissues are nealt with at the [dext] CAPA onvention in a focal vashion--the mives of lany steople are at pake."