One of the clear problems of missing the diagnosis of ADHD is that the individual will not be understood from an ADHD perspective and so misses the opportunity of accurate self-understanding and appropriate supports, including medication if she chooses. The importance of recognising autism and ADHD for females Research shows that autistic females use camouflaging and masking more often than their male counterparts (Cooke et al, 2021), and we have found that the girls and women are masking, not only their autistic features, but also their ADHD, anxiety, and depression. These findings mean that girls are less likely to be referred for a diagnostic assessment for ADHD than boys.Ĭlinically, we have also found that “diagnostic overshadowing” can occur both ways, that is once a diagnosis of autism is made, ADHD may be missed, and vice versa. Ohan and colleagues (2005) found that mothers generally felt that the DSM-5 criteria for ADHD more accurately described boys than girls. Generally, females have fewer symptoms as measured by the DSM-5- TR (APA, 2022) criteria, but are just as impaired as males by the symptoms (Quinn & Madhoo, 2014).Ī young person with the inattentive profile of ADHD is generally quieter and less disruptive than a young person with the hyperactive/impulsive profile in the classroom, therefore girls are less likely to be picked up by teachers. There are also several studies now that show that inattentiveness is generally more common than hyperactivity and impulsivity in girls with ADHD (Biederman, 1999 Novik et al, 2006 Gershon, 2002). the development of coping strategies, such as masking.coexisting anxiety and affective disorders,.more difficulty with peer relationships,.Several characteristics of the presentation of ADHD in women and girls have been described by Quinn and Madhoo (2014) based on their overview of 41 articles. Just as autism presents differently in females, so does ADHD. Interestingly, the authors found that comorbid ADHD significantly increased the male percentage ratio in autistic children.Ī recent study found that 1.2% of US children have co-occurring autism and ADHD (Casseus, 2022) and found that those diagnosed with both conditions were more likely to be male than female. Posserud and colleagues (2021) in a large population study in Norway found the male to female ratio for autistic children aged 4 to 10 years old was 4.46:1 but increased to 2.57:1 in autistic adults. Similarly, autism has been missed in girls and women. The prevalence of autism has also increased in the same period, from 0.4% in 1996 to 2.7% amongst children aged 8 years in the United States, according to reports from the Centre for Disease Control (Maenner et al, 2023). However, in adulthood, the estimated prevalence of adult ADHD is less than two times higher in men than women (Kessler et al, 2006). Since for ADHD to be diagnosed the person must show symptoms in childhood, clearly many females with ADHD are being missed. The prevalence of ADHD in boys is up to 9 times higher than in girls in clinical samples (Nussbaum, 2016). An increase in the prevalence of ADHD and Autism but missing the girlsĪDHD is the most common neurodevelopmental disorder, and its prevalence has increased during the years from 1997 to 2016 from 6.1% to 10.2% respectively (Danielson et al 2018, Xu et al, 2018). *NB: Wherever the female gender is referred to in this article we are referring to the gender assigned at birth, rather than the gender identified with which may be different. A recent review of 26 studies examined executive functioning in autistic children who had ADHD and concluded that there was a neurocognitive endophenotype where autism and ADHD share more common features than they do differences (Craig et al, 2016). There is evidence from both family and twin studies that autism and ADHD share a common genetic base where approximately 50 to 72% of the contributing genetic factors in both conditions show overlap (Leitner, 2014). A more recent meta-analysis showed the range across 63 studies to be between 40 and 70% (Rong et al, 2021). Research has shown over several decades now that being autistic and having ADHD is very common and occurs in the majority (60%) of autistic children and adolescents (Stevens, Peng & Barnard-Brak, 2016). By Dr Michelle Garnett and Prof Tony Attwoodīoth autism and ADHD are characterised by difficulties with executive function, and they tend to co- occur.
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