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ADHD and autism spectrum disorders: The rising prevalence in females

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Attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are two neurodevelopmental disorders that typically commence in childhood.1,2 ADHD is characterised by presentations of inattention and /or impulsivity-hyperactivity.3 ASD is defined by social interaction and communication challenges and restrictive-repetitive behaviours with sensory sensitivity and interest differences, but there may also be attention difficulties and hyperactivity.3,4 Research suggests two-thirds of those with ADHD demonstrate symptoms of
ASD and that approximately 30-50% of those with ASD also demonstrate symptoms of ADHD, making these conditions strongly intertwined.

Both ADHD and ASD frequently coexist in families with no primary cause being noted. Interestingly, numerous environmental and genetic factors are believed to contribute, including genes involved in the transportation and metabolism of the neurotransmitters, serotonin, dopamine, and noradrenaline.3,6,7 Additionally, risk factors during pregnancy have been noted for ADHD and include low birth weight, maternal smoking, allergies, bacterial or viral infections, and certain autoimmune diseases.6

ADHD and ASD in males and females

To date, a higher prevalence of ADHD has been seen in boys, who are up to nine-times more likely to be diagnosed than girls,8 and in ASD, boys are three-times more likely to receive a diagnosis than girls. These figures highlight a significant bias in overall diagnosis between genders.9

Emerging research shows that the disparity in the ratio of diagnoses between males and females is likely due to their differing presentations.10 This is because the diagnostic criteria for both ADHD and ASD has historically been based on the symptom profile in boys. An oversight that has meant symptom expression in females has remained largely neglected and awareness, along with education of the differences, continues to be inadequate. As a result, females are often misdiagnosed or not diagnosed until well into adulthood – if at all.9,11

So much so that they may not even recognise they are neurodivergent, meaning no diagnosis is sought.4,12,13 Additionally, females often present with different characteristics than their male counterparts. For example, in ASD, females tend to engage in imaginative play, may have a fully developed vocabulary that can express emotions, have higher cognitive abilities and are often far more sociable.14,15 Additionally, they tend to internalise their emotionally troubling symptoms such as depression, anxiety, and sensory processing problems. Perfectionist tendencies and eating disorders are also common,14 with insomnia or general sleep disturbances linked to both ADHD and ASD.16,17

Common issues and deficiencies

The interplay between genetic and environmental factors in ADHD and ASD can affect several processes within the body, including the formation of glutathione within the methylation cycle.3,6,18 Moreover, it is thought that one potential mechanism contributing to the psychiatric symptoms of ADHD is hereditary metabolic dysfunction, which restricts the availability of several important cofactors, thereby diminishing metabolic activity.19 Increased oxidative stress and mitochondrial dysfunction may also be common contributors in these conditions.18,20,21

Gastrointestinal (GIT) inflammation and problems, such as constipation, diarrhoea, and abdominal pain are common in ASD, with functional GIT disorders (irritable bowel syndrome, constipation, and dyspepsia) also prevalent in those with ADHD, especially in females. These conditions may be due to food sensitivities, altered gut microbiome, and/or decreased nutritional intake.18,22

Adult diagnosis of ADHD and ASD

In Australia, diagnosis of ADHD and ASD should be done by a diagnostic clinician who understands the screening tools and has experience or training in neurodevelopmental and behavioural conditions, such psychiatrists or clinical psychologists. These appointments can be complex, involving multiple assessments with inputs from different aspects of the person’s life,4,23,24 so many adults may choose not to pursue a formal diagnosis.

Medical management of ADHD and ASD

Medical management of adult ADHD includes educational and behavioural treatments and, if indicated, psychostimulant medications to help improve attention and reduce impulsiveness and hyperactivity.6 However, the side-effects associated with these medications can be intolerable and individuals may look for ways in which they can create everyday coping strategies before being medicated.4,25 Behavioural strategies are first-line interventions for ASD.4

Holistic management of ADHD and ASD

Many women present to complementary health practitioners for assistance with any combination of symptoms outlined above. Based on this symptom picture, they may be treated for various conditions; however, it is important to consider if ADHD and/or ASD may be present. Particularly so if symptoms have been present for the last 10-20 years or can be traced back to childhood,26 in which case referral for a diagnosis via a GP should be discussed. If neurodivergent individuals are looking for ways to manage their symptoms without medication, there are several nutrients and herbal medicines that could assist.



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Gabriella Campbell | The Tolerant Table
Gabriella worked in corporate communications for 12 years before commencing a Bachelor of Health Science Naturopathy. She is the author of the successful blog "The Tolerant Table" which focuses on providing information relevant to those navigating food allergies and intolerances. Gabby has a special interest in this field, but also in autoimmune disease, gut dysbiosis and adrenal fatigue. Gabriella is an accomplished writer, both for her own business, but also for an academic journal and for numerous other publications. Find her at: www.thetoleranttable.com