"Chatty Cathy" and ADD: How Gender Expectations Influence the Diagnosis and Treatment of American Girls

We’ve spent a lot of time this semester teasing out the differences between how men and women are understood, and how that relates to the legal profession and society at large. A theme that keeps re-emerging is objectivity – whether it exists, how it is used by the patriarchy, and whether it is simply an idea that is used to silence “emotional women.” The subtle and persistent idea that women’s intelligence is suspect because it will be side-tracked by their unpredictable emotions plays out in the workplace and in interpersonal relationships. Recently, I was surprised to see it also crop up in another area – identification, diagnosis and treatment of Attention Deficit Disorder (ADD).

Could the fact that men are expected to be objective, focused and level-headed lead to a more quick diagnosis of a man who does not conform to that expectation? Can we expect that women who are disorganized and inattentive are more likely to be shrugged off as emotional, hormonal or sensitive? Is it possible that our societal expectations of women’s emotional instability leads to less empathy for women who struggle, and less narrative directed towards legitimate psychological conditions shared by both genders? There is evidence that suggests the answer to all of these questions, currently, is yes.

A few months ago, a friend sent me an article about under-diagnosis of ADD in women.While women are just as likely to suffer from ADD as men, they are much less likely to be diagnosed and receive treatment. Instead, women are more likely to be diagnosed with depression or anxiety, psychiatric illnesses that can result from untreated ADD. The article explained part of the reason for the under-diagnosis:

Girls with ADD tend to try harder than their male counterparts to compensate for and cover up symptoms. To keep up their grades, girls are often more willing to put in extra hours of studying and to ask their parents for help. In addition, girls are more likely to be “people pleasers” doing all they can to fit in – even when they know they are ‘different.’

When ADHD was first identified, researchers focused on young, white, hyperactive boys. Guidelines for identifying ADD and ADHD were geared towards these boys, leaving girls overlooked. Because teachers are often asked to identify children with ADD or ADHD, the common perception that it is a young boy’s problem leads to under-diagnosis in girls. In her book Understanding Girls with AD/HD, Dr. Ellen Littman explains that theillness can display much differently in girls and women: carelessness, disorganization and difficulty following instructions are more likely indicators than hyperactivity. 

Dr. Littman believes that girls with undiagnosed ADD/ADHD may “internalize their symptoms – disorganization or carelessness - as personal flaws rather than medical issues.” Self-esteem and even academic challenge brought on by struggling with undiagnosed ADD can often lead to anxiety and depression. Studies show that these are more frequently diagnosed in women, and it could be because they are more stereotypically “women’s issues.” However, the research that Dr. Littman and others have done suggest that anxiety and depression may be masking a deeper struggle in girls. (In fact, women are twice as likely asmen to be diagnosed with generalized anxiety disorder).
 

Situations like this gender difference in diagnosis of ADD illustrate the subtlety of the patriarchy, which impacts women in unexpected ways. Sure, it could be easier to diagnose a hyperactive boy than a “chatty” girl, but could that partially be attributed to our gender expectations? If we expect women to struggle with emotions more than men, we are less likely to legitimize symptoms that fit gender stereotypes. Perhaps increasing education about psychology, mental illness and the human brain can ultimately impact society’s expectations for women in all aspects of their lives.