1.3.4 Culture, gender and diagnosis
Research suggests that cultural attitudes towards the interpretation of behaviour can have an impact on diagnosis (APA, 2013). It has been found that perceptions of hyperactivity and attitudes towards appropriate childhood behaviour vary significantly across cultures; for example, there are lower rates of identification of ADHD in African American and Latin American populations in comparison to white populations within the United States (Coker et al., 2016).
Additionally, as mental illness can be a source of shame in some cultures, this can prevent individuals and their families seeking help. Belief that mental illness is a sign of personal weakness may be more common in educationally disadvantaged minority populations, which may also contribute to differences in diagnosis in some areas (Bailey et al., 2014). Irrespective of the exact reasons for differences, it is important that those involved in diagnosis are mindful of the possible impact of culture.
Differences are also reported according to gender. For example, there is a higher worldwide prevalence of ADHD reported in males overall (Polanczyk et al., 2007) but there are differences in presentation types, with females more likely than males to have the inattentive presentation (Biederman et al., 2002). Research shows that females with ADHD have also been shown to be more anxious than boys with ADHD but have less disruptive behaviour and lower rates of hyperactivity (Gaub and Carlson, 1997; Nøvik et al., 2006). However, no gender differences have been seen in impulsivity, peer functioning and academic performance (Gaub and Carlson, 1997). Activity 4 looks more closely at why gender may be an issue in the diagnosis of ADHD.
Activity 4 Diagnosing ADHD
Watch Video 4 Interview on ADHD in females [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] in which Dr Aleya Karim explains why females may go undiagnosed with ADHD and the consequences of this [open the link in a new tab/window so you can easily return to this page after viewing]. When you have watched the video, answer the following two questions.
How does Dr Karim explain the presence of the same symptoms in males and females but less diagnosis of ADHD in females?
She suggests that while the symptoms are the same, the expression of them is less disruptive in females. Hyperactivity in young girls, for example, may be expressed as being talkative or helping the teacher. She also mentions that girls are more inattentive which can be a reason for low esteem, as they don’t do well at school.
What consequences might there be for females with undiagnosed ADHD?
Dr Karim suggests that they may become anxious, have low self-esteem and may be obsessive. Later in life this may manifest as diagnosable anxiety or depression.
Culture and gender have been considered separately here, but it is possible that the two may interact. For example, gender differences may also be linked to cultural differences due to gender stereotypes within different cultures. There may also be other factors that have an impact on diagnosis and prevalence.
The next section will turn your attention to risk factors for the condition, the presence or absence of which may also feed into the diagnostic process.