by Varda Epstein
The other day I was thinking about the differences in the way ADHD manifests in girls as opposed to boys. I'd written a great deal about the topic during a stint as a writer for a hi-tech company specializing in software to ameliorate the effects of certain learning disabilities. I knew that girls with ADHD tended to go undiagnosed because instead of being hyperactive and disruptive like the boys, they tend to be distracted, disorganized, and forgetful—they're more quiet, kind of spaced out. This has led to the erroneous perception of ADHD as a boy's disorder. It's also led to a lot of little girls not getting the help they need.
While mapping out the brain difference in children with ADHD is a business that is still in its infancy, some differences have already been identified. Differences have also been noted in the brains of boys as opposed to girls with ADHD. One study that examined the functional frontal lobe subdivisions in both boys and girls (aged 8-12) with ADHD saw that both genders displayed reduced supplementary motor cortexes. The boys, however, showed reduced dorsolateral prefrontal cortexes, while the girls showed reductions in premotor cortex volumes. 
In a nutshell: their brains are different, ergo, their symptoms are different.
I wondered if the same might be true of children with dyslexia.
Like ADHD, I knew a great deal about dyslexia, having researched and written on the topic, back when I was at that hi-tech company and more recently as the communications writer for the Kars4Kids charity whose proceeds underwrite mentoring and afterschool programs for children, many of them with learning disabilities. As with ADHD, the reading disorder known as dyslexia is thought of as a boy's problem. I wondered: could it be the same sort of situation? Might it be that girls with dyslexia are going undiagnosed because their brains and therefore their symptoms manifest differently?
Sure enough I found a study to support this idea. In MRI imaging studies performed at Georgetown University Medical Center, it was found that in boys with dyslexia, there is a reduction in gray matter volume in those areas of the brain used to process language. In girls with dyslexia, there is reduced gray matter volume in brain areas related to sensory and motor processing. 
Clearly, I was on to something.
Well, it makes sense. According to study author Tanya Evans, PhD, it's not just about gender and learning differences manifesting as brain differences, it's also just about male brains as opposed to female brains (could this be a variation on John Gray's Mars/Venus thing?). "There is sex-specific variance in brain anatomy and females tend to use both hemispheres for language tasks, while males just the left," says Evans.
My curiosity didn't end here. I wondered: what about eating disorders, which unlike ADHD and dyslexia, is thought of as a girl's disorder. Could it be brain differences here too, that might lead to boys being undiagnosed? Here, the waters became a bit murkier.
It is true that males make up only 10% of those with eating disorders (anorexia nervosa and bulimia nervosa), but they have a comparable rate for binge eating disorders, the more common type of eating disorders manifested in either gender.  There are certain risk factors that predispose men to eating disorders, including extreme sports  and excessive exercise.  Also, it seems, homosexual men have a much higher rate of eating disorders compared to the heterosexual male population. 
Gay brains? Could it be that the brains of gay people are different than those of heterosexual people? Next thing you know, I turn up some studies that say exactly that: The brains of gay men resemble those of straight women, while the brains of gay women resemble those of straight men.
"Oh my," as actor and gay activist George Takei would say.
Dr Qazi Rahman, a Queen Mary, University of London, lecturer on cognitive biology, concludes that based on these findings from a Swedish study carried out at the Karolinska Institute, there's no longer any reason to frame the discussion on homosexuality in any but a biological framework. "As far as I'm concerned there is no argument any more – if you are gay, you are born gay," he said. 
Not everyone is convinced. There could be influences during a person's development that change a person, both behaviorally and structurally. "I remain skeptical," said Professor William Byne, who teaches psychiatry at the Mount Sinai School of Medicine in New York. "There's been a history of jumping to conclusions and over-interpreting findings in this field." 
I'm thinking that this idea of brain differences and gender could be extended to include many other issues, for example fibromyalgia, which tends to strike more women than men. The main question is whether we should be applying a catch-all treatment plan for males and females suffering from similar diagnoses and conditions, especially when symptoms or onset may differ in the two genders or in homosexuals? Ritalin for all? Or is there something else that might work better in girls? A different dose, perhaps? And that's just for ADHD.
Another issue to consider is how often we miss the signs of learning disabilities in children because they don't manifest the expected symptoms. The idea of gender brain differences may mean we need to look at academic outcomes as symptoms. A girl who doesn't display classic signs of ADHD or dyslexia but is not getting good grades, deserves an investigation as to cause.
In a funny way, we're discriminating against certain sectors and genders when we apply our catch-all norms to them. We don't look for eating disorders in males, and we don't look for dyslexia in girls. Maybe it's time we did, just to make sure we don't end up discriminating against them in actuality by robbing them of the help they need and deserve due to our preconceived gender stereotypes for these conditions.
Varda Epstein is a mother to four daughters and a communications writer at Kars4Kids, an American non-profit national car donation organization based in Lakewood, New Jersey which donates proceeds to Jewish children and their families through the funding of Oorah, a national non-profit organization.
 Mahone EM, Ranta ME, Crocetti D, et al. Comprehensive examination of frontal regions in boys and girls with attention-deficit/hyperactivity disorder. J Int Neuropsychol Soc.2011;17:1047-1057.
 Tanya M. Evans, D. Lynn Flowers, Eileen M. Napoliello, Guinevere F. Eden. Sex-specific gray matter volume differences in females with developmental dyslexia. Brain Structure and Function, 2013; DOI: 10.1007/s00429-013-0552-4
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