Diagnosing ADHD: Mental Health and Human Rights

Playground adventures. Source: BrownZelip, Creative Commons

Mental health is a topic that is becoming increasingly recognized as an important public conversation.  It is usually focused on depression and anxiety and is often overlooked in the context of human rights. It is important to recognize that mental health is a public health issue, and therefore a human rights issue. Mental health has an irrefutable impact on an individual’s physical health and their quality of life.  It can also harm their ability to receive an education. This blog will discuss Attention-Deficit/Hyperactivity Disorder (ADHD) and the issues created by the stereotypes and stigmas related to mental health.

Conditions like ADHD are frequently given a specific popularized depiction. Though the depiction may not be entirely incorrect, it is rarely inclusive of all the individuals experiencing these conditions.  When people think of ADHD for example, they often think of a boy with a lot of behavioral problems and poor grades.  The fact of the matter is that people with ADHD can be any gender and can have any kind of experience in school. Using stereotypes to inform our ideas about the people who have certain conditions impacts if and when people who have these conditions are able to receive a diagnosis and treatment. Because of this, girls with ADHD are frequently unaware of what they are experiencing.

What Is ADHD?

ADHD is a disorder that results from the way the brain develops.  According to the Centers for Disease Control and Prevention, “ADHD is one of the most common neurodevelopmental disorders of childhood.”  It is very important to understand that ADHD is not merely a behavioral issue.  It is a condition that cannot be punished away.  ADHD brains work differently than brains without ADHD.  ADHD brains lack a sufficient amount of dopamine and norepinephrine, two neurotransmitters that transport signals in the brain.  They are like filters for your brain.  Dopamine helps to regulate the reward center of the brain, movement, and emotional responses. Norepinephrine strengthens signals that are relevant and important while blocking information that is unnecessary.  Medicines that treat ADHD typically aim to support the circulation of these neurotransmitters in the brain.  These medicines decrease the frequency of the symptoms of ADHD, though they do not eliminate them.

In addition to the symptoms related to impulsiveness and inattentiveness, the lack of filter ADHD causes in the brain can lead to sensory overload, which can cause a lot of stress and anxiety.  When this occurs, one becomes overwhelmed by all of the noises you hear, the things you see, and the things you feel.  You notice everything around you, including the things that are unimportant.

Depending on an individual’s personal symptoms and experiences, they may have one of three different types of ADHD. One type of ADHD is the “Predominantly Hyperactive-Impulsive Presentation”.  This type can involve a lot of fidgeting, feelings of restlessness, and an unusually large amount of impulsive behavior, such as interrupting people.  Another type of ADHD is the “Predominantly Inattentive Presentation”.  This type often involves forgetfulness and difficulties in fully absorbing new information.  The third and final type is called the “Combined Presentation” and involves experiencing the symptoms of the other types equally.

Differences Between Boys and Girls With ADHD

Girls are significantly less likely to be diagnosed with ADHD than boys are, though they are not less likely to actually have it. One study, using data from the Danish National Birth Cohort, found that children whose parents reported ADHD behaviors and who were undiagnosed were girls more often than boys.  Because of this, girls with ADHD are more likely to go untreated than boys are.  The differences in how boys and girls experience ADHD contribute to the underdiagnoses of girls. Another study, which combined the results of 8 prior studies to have a sample of 772 boys and 325 girls, suggests that boys with ADHD are more likely to display symptoms of impulsivity that girls with ADHD are, based on the children’s performances on “Continuous Performance Tests”. Symptoms of impulsivity are often easier to recognize than inattentiveness and result in behaviors that catch people’s attention.  Inattentiveness, which girls more frequently experience, does not lead to behaviors that are as disruptive as the behaviors of impulsivity.

Children in a classroom reading with their teacher.
students-in-class-with-teacher-reading. Source: Ilmicrofono Oggionom, Creative Commons

Why It Matters

ADHD is highly connected to the issue of mental health. According to one study, girls with ADHD are more likely to experience comorbid disorders such as depression, anxiety, oppositional defiant disorder, and conduct disorder than girls who do not have ADHD. Individuals with ADHD may internalize what they are going through, blaming themselves and feeling like what they are going through is their own fault.  They may externalize what they are going through, impacting the way they interact with other people and their environments.  Internalizing and externalizing behaviors occur in individuals with ADHD regardless of the existence of a diagnosis but being undiagnosed can make the situation more difficult.

The possibility of being diagnosed with ADHD is also impacted by many social determinants. Social determinants are defined as “conditions in which people are born, grow, live, work, and age.” They lead to avoidable health disparities. It is important to recognize social determinants when it comes to mental health and human rights, because they highlight the fact that people of different backgrounds do not have access to the same resources. Factors that are out of an individual’s control impact their ability to access their human rights and maintain a good quality of life. By identifying social determinants, we can begin to identify changes that can be made to diminish injustice in the world. For example, even the country that someone with ADHD lives in can impact the chances that they will be diagnosed.

In France, 0.5% of children are diagnosed with ADHD, while about 12% of children in the United States receive a diagnosis. Different countries around the world have different views of ADHD, affecting their rates of diagnosis and the methods of treatment. The treatment of ADHD in France frequently involves prioritizing methods such as therapy and family counseling over medicines. In Germany, it is likely that students with ADHD benefit from the “outdoor component” of their education, as being outside can be more favorable for them than a traditional classroom. The United States relies more heavily on using medicinal methods to treat ADHD.

Another social determinant that impacts treatment is socioeconomic status. Even if a child in poverty has received a diagnosis, it is still possible that they cannot afford treatment. If they are uninsured, it would be difficult for them to access medication or therapy. Race also acts as a social determinant. The results of one study suggest that there is a large disparity in ADHD diagnosis and treatment that negatively impacts African-American and Latinx children.  According to the study, it is more likely that the disparity is due to African-American and Latinx children being underdiagnosed and undertreated than white children being overdiagnosed and overtreated.

Social determinants like nationality, socioeconomic status, and race can be barriers to a child’s diagnosis and treatment for conditions like ADHD. These factors are out of the child’s control and create disparities that cause further harm.  Even if an individual knows what a problem is, they cannot work towards alleviating it if they do not have the resources they need. If a black girl is born is born into a New York family in poverty, she may lack the ability to spend time outside, receive certain medications, or go to therapy. She would not have access to the same resources as children from families with higher incomes or different geographical locations. This injustice feeds into comorbid disorders and has a negative impact mental and public health, as emotional issues can develop from being able to understand the injustice.

The Universal Declaration of Human Rights includes the right to education (Article 26) and the right to an environment that promotes health and wellbeing (Article 25), along with many others.  Access to these rights is limited when individuals with conditions like ADHD are unable to seek treatment, whether that treatment be medicinal or a form of counseling.  The effect that these conditions have on one’s mental health makes a significant difference. Education is one of the human rights that is fundamental to growth and flourishing in life.

We, as a global society, must recognize the relationships between mental health, public health, and human rights. They are not isolated issues. The way we approach one impacts the outcomes of the others.  Mental health is a part of public health, impacting an individual’s physical health and their quality of life. Both mental health on its own and public health as a whole are largely influential in one’s ability to access their human rights. Everything is connected.

The Right to Menstrual Hygiene

a picture of three girls smiling
Jordanian School Girls. Source: David Stanley, Creative Commons

It probably goes without saying that periods are difficult to manage. They are painful, expensive, and often quite problematic for people who experience them.  We use resources such as pads, tampons, pain relievers, and bathrooms in an effort to manage menstruation. According to the WHO-UNICEF Joint Monitoring System, menstrual hygiene management (MHM) is when people with periods are able to use sanitary materials to absorb menstrual blood, change and dispose of these materials in privacy as needed, and have access to soap and water to keep clean.  For those of us who do have access to what we need to manage menstruation, it seems that we often take these things for granted. But what if someone doesn’t have these resources within reach? The bottom line is that a lack in opportunity to practice proper menstrual hygiene is a violation of human rights due to its negative impact on mental and physical health, access to education, and gender equality.

What Is the Problem?

The aspect of this issue that might be the easiest to recognize is the inaccessibility of products like sanitary pads and tampons. One study in Kaduna State, Nigeria reported that only 37% of women in their sample had all the products needed for proper menstruation management. In Uganda, 35% of women reported the same thing. This can partly be attributed to financial issues and the frequency at which the products must be purchased. Some products, such as menstrual cups or washable pads, can be washed and reused over an extended period of time, making them cheaper in the long run. However, they are initially far more expensive than the disposable options. They are simply outside of the budget for many people. Even when someone can afford to pay for the reusable materials, finding somewhere to purchase them may be a problem.

Issues of accessibility do not end with menstrual hygiene products. In many countries, schools lack proper sanitation facilities, like bathrooms, which are vital to being able to safely and comfortably replace and dispose of used menstrual products. This is seen in Cochabamba, Bolivia, where there is an average of 1.2 “toilets” per primary school. These “toilets” are actually pit latrines. They are not usually kept in good condition and rarely have sufficient waste disposal options. In situations like this, there is little to no access to a truly safe and private place to change menstrual materials.

a picture of a traditional pit latrine, which looks like a very small building with a tin roof and two tin doors
Traditional Pit Latrine. Source: SuSanA Secretariat, Creative Commons

Exacerbating this issue are the stigma and shame associated with menstruation. Around the world, girls are taught from a young age that having a period is something to hide and to be embarrassed of. In many countries, girls are even considered to be “dirty” when on their period. This can be seen in western Nepal, where there is a tradition called “chaupadi” which requires that girls and women stay outside throughout menstruation. If they enter a home, it is believed that all of the people and animals of the household will fall ill. This perspective puts both their mental and physical health at risk. Menstruation is frequently viewed as a taboo subject, so many girls are not taught anything about it before their first period. Even after they begin to experience menstruation, they do not have access to much knowledge of why it happens or what good menstrual hygiene management is.

It is also important to recognize the relationship between menstrual hygiene management and the transgender community. Menstruation is typically referred to as a strictly feminine issue, but that is simply not the case. Many transgender men and non-binary individuals experience periods, and they should be included in the conversation about menstruation. By failing to recognize their connection to menstruation, we fail to recognize the validity of their experiences and identities. This failure is a problem within itself, but it can also have repercussions on the mental health of transgender and non-binary individuals and their ability to access sanitary materials and bathrooms for menstrual hygiene management. We need to actively work towards being more inclusive with the language we use when discussion periods and related topics. This involves choosing gender neutral terms over gendered terms, such as choosing to say “menstrual hygiene products” rather than “feminine hygiene products”.

Why Does It Matter?

According to Article 25 of the Universal Declaration of Human Rights, every individual has “a right to a standard of living adequate for the health and well-being” of themselves. When you are told that one of the basic biological processes that you experience and cannot control is shameful, it has the potential to lower the value that you see in yourself. Combined with the common lack in understanding of menstruation, this can lead to significant amounts of fear and confusion and have a considerable negative impact on mental health. Article 26 dictates that everyone has a right to education. Without access to clean menstrual management products or places to change and dispose of used ones, many girls around the world miss school during menstruation to try to keep it hidden. Some girls do not even have the option to go to school during that time. This creates a disparity between the educational and career opportunities of men and women, violating Article 2 of the declaration, which says that everyone is entitled to their rights without discrimination based on distinctions like one’s sex. It is unacceptable to allow limitations to be placed on individuals’ access to their human rights based on something that is uncontrollable. In order for things to change, individuals must take action.

What Can We Do?

Part of the reason why access to menstrual management products is such a difficult issue to deal with is that the majority of people are not comfortable talking about it. Even in the United States, where we generally have access to education about the most basic aspects of menstruation and know that it is normal and healthy, there seems to be some sort of collective, irrational fear surrounding the topic. Periods have a direct impact on half of the world’s population and an indirect impact on all of the population. We cannot continue trying to pretend that the obstructions of human rights that are caused by poor menstrual hygiene management do not exist. Conversations about menstruation might be uncomfortable at first, but they are absolutely necessary. uncomfortable at first, but they are absolutely necessary.

Many organizations have begun working towards improving MHM worldwide. AFRIpads, for example, works to provide menstrual kits with reusable sanitary pads and storage bags to women and girls throughout Africa, while creating job opportunities within the organization for women in Uganda. They also collaborate with Lunapads in a program called One4Her. For each eligible product that is purchased from Lunapads, an AFRIpad is donated to a student in need. On UAB’s campus, we have access to a chapter of Period: The Menstrual Movement, an organization that is dedicated to improving access to menstrual hygiene products for homeless women in the United States. If you are interested in taking action, the group is currently hosting a donation drive for pads and tampons through October 31. You can find donation boxes by the elevators in any of the residence halls. They are also hosting a Period Packaging event at the Spencer’s Honors House from 6:30pm to 8:30pm on November 1, where people will come together and pack menstrual hygiene products in kits to be given to those in need. Additionally, the Blazer Kitchen is hosting a toiletry drive through October 30, to which you can donate menstrual hygiene products, as well as many other non-perishable items.

If you lack the resources to financially support the improvement of MHM, do not be afraid to speak up and get involved in the conversation. Be a part of spreading awareness and breaking the stigma surrounding periods.