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ADHD Often Misdiagnosed in Women

Disorder Runs in the Family

About 13 years ago, Claudia Day's son was taking part in a Johns Hopkins medical study on Tourette Syndrome. As part of the study, the entire family was tested for Attention Deficit Disorder, ADD, or as it is more commonly known today, Attention Deficit Hyperactivity Disorder, ADHD, because Tourette Syndrome commonly presents in people with ADHD.

The news was mixed, Day's son did not have ADHD, however, she did. "I thought, 'You guys are nuts,'" said Day, 50, a Vienna resident.

It took about a year for Day to accept the diagnosis, she said, that is until a television news program hit too close to home.

"Diane Sawyer was following a man with ADD. I was crying. She looks into the camera and I thought she was going to say my name," Day said. "It explained so many things in my past that I had excuses for or forgot they happened because I didn't know why."

FOR SEVERAL YEARS, ADHD was thought to be a disorder that affected young boys. As a result, young girls were often misdiagnosed or not diagnosed at all, leading to depression, low self esteem, psychotic morbidity, job satisfaction issues and inter-relationship issues, said Dr. Patricia Quinn, director and co-founder of the National Center for Gender Issues and ADHD, located in Washington D.C. Quinn has been studying ADHD since 1971 and has been diagnosed with the disorder, along with several members of her family.

"Most of the research from the 1960s and '70s focused on elementary-school boys. Boys do tend to be more hyperactive, which came to define the disorder," Quinn said. "There has been more than 1,600 published studies on ADHD and only 50 include girls."

The National Institute of Mental Health defines ADHD as "a family of related chronic neurobiological disorders that interfere with an individual's capacity to regulate activity level (hyperactivity), inhibit behavior (impulsivity), and attend to tasks (inattention) in developmentally appropriate ways." In other words, said Quinn, the brain does not produce enough dopamine, a neurotransmitter, which leads to disorganization, forgetfulness, impulsiveness, boredom and an inability to stay focused to such an extent that it interferes with daily life.

For boys, that often means acting out in class or at home, but in girls the reaction is different.

"Girls tend to daydream instead of dashing around to try and stay focused," said Kate Sternberg, 48, of Reston. "Girls would sit in class, be quiet and hope they wouldn't get called on. Girls were raised to be quiet, especially in the 1950s, and if you didn't learn anything it was OK because you would be getting married and raising a family anyway."

Sternberg, an art teacher at Stone Middle School and an illustrator for children's books focusing on explaining medical conditions to children with special needs, wasn't diagnosed until three years ago, even though her two sons, father and brother all have ADHD.

QUINN SAID the diagnosis and treatment guidelines for ADHD were changed about three years ago, which has led to a wider pool of potential disorder sufferers. That has resulted in an increase in an ADHD diagnosis in girls and women.

"It's only been in the last couple of years that people began recognizing ADHD can affect girls, not until the 1990s. Before then the ratio of boys to girls was 9-to-1. The ratio now looks like 2.5-to-1. But we're still missing the young girls, who are not being diagnosed at all until adolescence or young adulthood and instead are being diagnosed with depression."

Both Sternberg and Day, who is an economist for the U.S. Bureau of Labor Statistic, were misdiagnosed with depression. And as with most cases of ADHD, there is a family history for both women. Day, looking back now, believes both her parents have the disorder, as well as a sister and a brother, although none have officially been diagnosed. She does have nephews and nieces that have since been diagnosed with ADHD.

Sternberg, too, can now see ADHD runs in the family.

"All the focus in my family was always on the men. My father is 85 years old and incapable of sitting still without falling asleep. My brother was diagnosed as a hyperactive, so, growing up, all the focus was on him."

For both women, finishing a task can be difficult because their attention is easily diverted elsewhere. They also tend to over commit themselves or lose track of time.

Day, for example, works full time and is also earning a second degree in interior design — she already holds a degree in economics, takes art classes, runs the meeting facilitators program at work, and sits on the board of a local charity.

"When I get into something, I don't stop. I get so absorbed into it and lose track of time," Day said.

Day said one morning she woke up, got a cup of coffee, sat down at the table and began drawing. Before she realized it, it was evening.

Sternberg has found a way to "download." In the evenings, she sits in a corner of the couch, with the television on and her sketchbook on her lap. She begins drawing and before she knows it other images in her head find their way on the page. A recent award-winning image, "Hand in Marriage," began as a drawing of her own hand, but ended up with other images swirling around and in it.

"I usually have the TV on so my left side of the brain is taken care of. I need to be around my family, so I meet that need. And when I create, I'm at peace," Sternberg said.

And despite the difficulties ADHD may cause, both women find positives in the disorder. In fact, Sternberg said today's fast-paced world is perfect for ADHD, although being stuck traffic still presents a challenge for her.

"I think I wouldn't be as creative as I am, and not just in art work," said Day. "I'm thinking new things, hearing new things. I think it has helped me avoid criminals because I've seen things other haven't. I notice people and things going on that no one else pays attention to."