Duration: 2 weeks
Course: Health Systems Design, Spring 2022 Instructor: Natalie Privett
Skills: Systems design, research, health, strategy

-https://www.additudemag.com/adhd-in- womenmisunderstood-symptoms-treatment/

adhd- ingirls-and-women



Systems Approach

Methods & Tools

 Ladder of Inference
Iceberg Model

MA in Design focused on Health

Addressing the Gender Gap in ADHD Diagnoses + Treatment

Attention Deficit Hyperactivity Disorder (ADHD) is a neurological disorder that is one of the most common conditions in children, and is often further complicated by existing co-morbidities with overlapping symptoms. Initially measured only by the presence of hyperactivity in children, the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth edition (DSM-5) now includes inattentiveness with studies suggesting persistence of symptoms through the lifespan.

Overall understanding and awareness of ADHD has evolved significantly over the years and continues to improve. However, stigma, stereotypes, and outdated gender role expectations still persist today and contributes to the lack of proper and accurate ADHD research, detection, diagnoses and treatment for women and girls. While the prevalence of ADHD is similar by gender, men and boys are far more commonly diagnosed—nearly 69% more likely— than women and girls in the United States due to perpetuating and harmful ADHD myths. Recent research predicts individuals who are inadequately evaluated, diagnosed, or treated are highly likely to experience serious mental and physical health implications and outcomes.

Design Challenge

How might we close the gender gap in ADHD diagnoses to ensure women and girls can easily access the proper treatment and quality care that they need?

As a woman living with ADHD, having been undiagnosed untillater in adulthood (in 2018, when I was 28), it felt important for me to use the Ladder of Inference as a tool to help me be more self-aware of my own biases.

Before utilizing any other research tools, I wanted to ensurethat I approached my research surrounding the gender gap in ADHD diagnoses and treatment from an objective standpoint, testing my assumptions along the way.

    Insight 1: Research has shown that women and girls (compared to men and boys) are consistently underidentified and under-diagnosed for ADHD using the current DSM- V criteria, with the top two factors forthe disparity being that women mostly exhibit inattentive presentations and are highly motivated to hide their ADHD symptoms and compensate for them. New DSM criteria for detecting and diagnosing ADHD needs to consider the perspectives of women/girls and the different ways that ADHD presents individuals across the spectrum and across the life span, not just the outdated stereotypes that ADHD is a childhood and male disorder.

Insight 2: 
More women and girls should be recruited and involved in research and studies. Gaining insights from multiple perspectives can help us to form a more systemic understanding the ADHD spectrum, which in turn might offer an opportunity to discover common ground (shared needs, values and beliefs) which can help us detect and recognize ADHD symptoms in both men/boys and women/girls and refer them to thorough assessments to obtain proper diagnoses and treatment. This will ultimately lead to better health outcomes in more equitable, inclusive, participatory ways while helping close thegender and age gap in ADHD diagnoses.

Recommended Interventions:
#1:Recruit more women/girlsas well as people of colorto participate in researchstudies about ADHD. Thiswill lead to a more holisticview of the ADHD spectrum,and lead to more accuratedetection and diagnoses ofADHD in women and girls.

#2: Develop a shared languageand common understandingof the ADHD spectrum,including symptoms,causes, risks, andcharacteristics — beyond the genetic factors.

#3: Update DSM diagnosticcriteria based on researchand data involvingperspectives outside of thebehaviors & experiences ofmen/boys. Standardizetesting to be moreaccessible and inclusive.

2. Iceberg Model

Using the Iceberg Model will allow me to further shift myperspectives to see beyond my own personal experiences aswell as the immediate events that are universally recognizedand acknowledged surrounding the ADHD gender gap.

It will help uncover the root causes of why women and girlsare often un- or under- diagnosed for ADHD by taking a deeperlook into the existing structures responsible for trends andpatterns that have evolved and persisted over time. exposingthe underlying societal mental models that need to shift.

    Insight 1: Due to outdated gender role expectations,women and girls tend to mask and/or internalizetheir ADHD symptoms — which is why it consistentlygets overlooked or misdiagnosed— and attributesto the disparity in ADHD diagnoses and treatment.Recent studies have shown that women and girlsare also highly motivated to overcompensate fortheir symptoms, putting them at higher risk ofsocial isolation and engaging in risky behavior,leading to poor health outcomes.

Insight 2: 
ADHD is a spectrum disorder with its presentationsin women and girls leaning more towards symptomsand presentations of inattentiveness, which differfrom their male counterparts, who typically displayhyperactivity and impulsivity. This is a stereotype ofADHD that persists — despite new research findingsand data that challenge it— and contributes togender and referral bias. Along with many otherfactors, these barriers make it more difficult forwomen/girls to receive thorough assessments andappropriate diagnoses or treatment.

Recommended Interventions:
Intervention #1: Increase awareness and advocacy aroundthe differences in how ADHD presents itselfacross the spectrum and lifespan. This willhelp facilitate conversations and develop ashared understanding of the causes/risksof ADHD among stakeholders, ultimatelygaining more buy- in and reducing stigmaby shifting mental models.

#2: Require unconscious bias training forclinicians and educators, to help eliminategender bias when detecting and referringchildren who present ADHD symptoms tothe support they need. Equip clinicians andeducators with ways to provide resourcesto parents and also screen parents, as it isknown be hereditary.