Adderall, the amphetamine you either love to hate or hate to love, is the Miley Cyrus of prescription drugs. We're taking, discussing, condemning, selling, even snorting Adderall in larger numbers than ever. Since 2002, sales of prescription stimulants have increased five-fold, with about 15% of high school students now receiving ADHD diagnoses. And as diagnoses skyrocket, so do trend pieces on ADHD, many of which dismiss the disorder as a profit-driven ploy by large pharmaceuticals to hook more kids on the drug.
Reporters are right to attack drug companies that, in their marketing of stimulants, downplay side effects and exaggerate benefits. The New York Times has reported that ADHD experts are re-evaluating the conclusions of a major 1999 study that found drugs alone to be the most effective treatment for ADHD. Yet in our discussions of irresponsible stimulant usage and soaring attention deficit diagnoses, there is a deficit of attention devoted to women and girls, for whom there is likely a mass under-diagnosis of the disorder. It is estimated that anywhere from fifty to seventy-five percent of females with the disorder are undiagnosed. ADHD hysteria is making this worse.
When I was diagnosed with ADHD at 21, I was deeply confused. I was a (mostly) grown woman. I liked school. I participated in extracurricular activities. I sat relatively still in class, alternating note-taking and drawing doodles of hamburgers. And when I wanted to, I could focus; I could watch Homeland for ten hours at a time, without succumbing to any distractions, not even food or urination! My diagnosis confused me, until it embarrassed me. From what I'd read about the disorder—and seen in magazine and television advertisements—I didn't fit the typical ADHD mold. No one believed I did, either. In college, Adderall was something you "scored" for finals or for extended partying, sometimes even weight loss.
Yet I had sought the help that eventually led to a diagnosis because my life was falling apart. I was losing everything I touched: keys, credit cards, Skittles, twenty dollar bills, lucky socks, cell phones, even sandwiches. I once lost a ham sandwich that resurfaced months later in my closet. I was restless, impulsive, and scatterbrained; I couldn't keep track of time or belongings or friendships. I'd always been depressed, but I sensed there was something that wasn't being treated.
In a December article from The New York Times, reporter Alan Schwartz chronicles the astonishing increase in ADHD diagnoses over the past few decades, focusing on the ways in which pharmaceutical companies misrepresent stimulants, even ADHD itself, to consumers. Nowhere in the article does Schwartz mention the unique problem that the misrepresentation of ADHD poses for girls and women.
A video accompanying the piece shows print and television ADHD advertisements marketed directly to consumers and their concerned parents. Twenty-three of these promotions feature images of young boys, completing homework or sitting quietly in class, or images of mothers with young boys who now, thanks to stimulants, take out the trash (and visibly enjoy it). These boys can now have friends over for sleepovers. And they'll even allow their mothers to hug him as they solve problems in their notebooks. Two of the ads show young girls, and two show adult women, as the victims of ADHD.
"Boys will be boys," these ads suggest, until, that is, they start taking stimulants. But where are the girls? Where are the adult women whose primary concern isn't her son's ADHD, but her own?
The differences in how ADHD expresses itself in girls and boys are rarely explored in news pieces on the disorder. This year, the Center for Disease Control and Prevention published alarming data showing that 11 percent of school-age children have received an ADHD diagnosis, a 16 percent increase from 2007. These studies, cited frequently, do not take gender into serious consideration.
Furthermore, ads tend to over-represent the symptoms you'd see in young boys, like restlessness, destructiveness, and disruption in the classroom, which makes it significantly more difficult for girls, and women, to be diagnosed, or to even seek diagnoses. According to a 2009 study, girls exhibiting ADHD symptoms are far less likely to be referred for mental health services than their male counterparts. And according to anecdotal evidence from my eighteen years of schooling, I know that girls are exceptional at sitting still in class, despite how distracted or anxious we may feel. We try our hardest to keep our shit together—to please our parents, our teachers, our friends—which means we often get overlooked.
Many of these misunderstandings can be traced back to the 1970's, when early clinical studies of ADHD first began, focusing almost exclusively on young hyperactive white boys. This bias, evident in most Adderall and stimulant advertising, continues to shape public perceptions of what attention deficit looks like.
Not only do young women like myself defy the popular notion that puberty cures ADHD, as our diagnoses tend to come later in life, but we also defy traditional diagnostic criteria, displaying symptoms such as forgetfulness, disorganization, and depression, often rooted in the shame of hiding our struggles. Women are expected to be good at everything (school, friendships, family), to take up minimal space with their problems, however debilitating they may be. Unsurprisingly, girls with ADHD have high rates of suicide and self-harm during their teenage years. As much as misguided or excessive diagnoses raise alarm, the lack of diagnosis, and thus lack of treatment, can be fatal.
Large drug companies underplay the risks associated with stimulant usage, including (but not limited to) insomnia, loss of appetite, headaches, nausea, and mood swings. Their ads, along with most articles on ADHD, also perpetuate stereotypes of what the "standard" patient looks like, further stigmatizing girls and women with ADHD who are reluctant or embarrassed to seek help.
Carefully monitored stimulant medication, the dosage of which took over a month to fine-tooth, has allowed me to lead a normal life. It doesn't give me a high or edge; rather, for people with ADHD, the right prescription brings dopamine levels up to a normal processing level, and allows them to function. So maybe I never threw spitballs, or made fart noises in class, or played Nintendo to avoid studying. Rather, my inability to pay attention, to keep track of things or time, chipped away at my self-confidence and inflated my depression; a diagnosis gave me a name for what I'd always assumed were personal shortcomings.
We must continue challenging drug companies for preying on the anxieties of parents, who worry about their destructive little boys, as well as for advertising directly to consumers with minimal information on side effects and the benefits of therapy. Yet to truly advocate for public health, we must remember to advocate for women and girls, for whom ADHD hysteria discourages from seeking the help they need.
Maria Yagoda is a freelance writer living in New York. Follow her on Twitter @Mariayagoda.
Image by Sam Woolley.