MHM Magazine

non-conforming, gender neutral) that may or may not correspond to a person’s sex assigned at birth or to a person’s primary or secondary sex characteristics.” • Sexual orientation:  this defines who a person is physically and emotionally attracted to, based on their sex/gender.  • Gender diversity: This concept encompasses the many ways that people express their gender identity (not just the binary male/female concept). This is expressed through their appearance, behaviour, and use of pronouns or names (gender expression). Gender diversity also includes a person’s sexual orientation and people who identify as transgender, nonconforming, non-binary, genderfluid, genderqueer, etc. • Gender dysphoria: This is a negative reaction to a person’s gender identity which creates discomfort and distress due to the incongruence between a person’s sex assigned at birth and their gender identity. Both ADHD and gender diversity affect how people understand themselves and interact with others. There have only been a few studies conducted on the correlation between ADHD and gender variance. A study from 2014 found that people with ADHD were more likely to experience gender diversity (gender variance). Another study from 2017 found that ADHD was a leading comorbidity (75%) in people who are struggling with gender dysphoria. It’s important to note that there is still a lot of research that needs to be done in this field. Although the research is limited, it does appear that people with ADHD may be more likely to question their gender identity than people without ADHD. There are several reasons that researchers have theorised for this including: • People with ADHD frequently face social exclusion, harassment, and disapproval from both their peers and the figures of authority in their lives. Consequently, many individuals with ADHD start to view the world from a different perspective and recognise that many of the demands imposed on them lack a clear rationale. As a result, they may choose to disregard these conventions in favour of developing their own systems and behaviours that more effectively accommodate their requirements and preferences.  • People with ADHD seem to have challenges with social interaction and self-regulation which may affect the way a person explores and express themselves.  • Gender identity development is a complicated process and symptoms of ADHD may impact this. People with ADHD often have challenges with their executive functioning, fitting into social norms, self- regulation, and self-concept and this could potentially lead to more exploration of their gender identity. Many people with ADHD and gender identity diversity face a lot of stigma, discrimination and misunderstanding from others who do not experience or share their experiences or perspectives. This can affect a person’s mental health and overall well-being. This may be further compounded by environmental and cultural factors.  Gender differences in ADHD prevalence  It’s also important to be aware that throughout history, boys are more likely to be diagnosed and treated for ADHD-related symptoms than girls. It’s thought that girls may be consistently underdiagnosed or misdiagnosed because of how the symptoms manifest in girls. Girls tend to internalise more of their symptoms, are less impulsive and have better coping skills than boys, so it may not appear as if they’re struggling. Because they are less likely to seek help or be aware of their difficulties, it can result in the development of secondary psychological distress or co-morbid anxiety and depression. Some of the gender differences are highlighted in the table below: • Less obvious and "internal" symptoms • Tend to withdrawmore than boys • More likely to develop comorbid depression and anxiety • More inattentive symptoms • More likely to be more verbally aggressive rather than physically aggressive (teasing and namecalling) • Hormonal fluctuations can influence ADHD symptoms • Obvious and "external" symptoms • More impulsive than girls • Seem to display more outward symptoms of hyperactivity • More physically busy (running around) • May be more physically aggressive It’s important to also consider these differences when thinking about ADHD, gender, and gender diversity. Healthcare professionals should be aware of the potential intersection of ADHD and gender diversity when a diagnosis and supporting their patients. Unfortunately, people who are gender diverse or transgender tend to experience more difficulties with their mental health and are more prone to self-harm and suicide. Providing a safe, supportive, and understanding environment for those who have ADHD and/or diverse gender identities, can help them significantly to improve their well-being. While there is no significant evidence to support the intersection of gender diversity and ADHD, it’s important to be mindful of this topic and understand the unique experiences that individuals may have, especially with the gender perspectives of the new generation of youth. It’s also important to highlight that ADHD doesn’t “cause” a person to question their gender identity or experience gender dysphoria. However, it has been suggested that ADHDmay increase the likelihood of someone’s exploration of gender. Although it can be a complex and sensitive subject for some, the more people are aware of these unique differences and challenges, the likelihood of people reaching out for support increases. References available on request. 20 | MENTAL HEALTH MATTERS | 2023 | Issue 6 MHM