How Lack Of Diagnosis Affects Women
When a diagnosis is missed, it can have a negative impact on a womans entire life. Women with ADHD tend to find themselves in relationship, financial, or career trouble. Their symptoms may resemble anxietyproblematic since undiagnosed ADHD can lead to .
Feeling stuck in this cycle of anxiety and depression and lacking a diagnosis, women will often hide their feelings, and any accompanying shame, which doctors refer to as internalizing.
Years of living without a diagnosis can damage a womans psyche. Women and girls tend to internalize ADHD symptoms, says Nadeau, whereas males tend to externalize or more openly and unabashedly display traits such as hyperactivity, fidgeting, frustration, or inattentiveness. Internalization of symptomsbeing secretive or masking feelings of anxiety, self-doubt, and inferioritycontributes to a late or missed diagnosis.
A first-of-its-kind study showed women diagnosed in adulthood responded negatively to criticism, which is clinically referred to as Rejection Sensitive Dysphoria , according to a scientific analysis published in the American Psychological Association.The study of only Canadian women showed they tended to blame themselves when events in their lives went poorly.
The research demonstrated how the female psyche reacted to life events, creating a cycle of negativity and frustration that left them feeling incapable, which they carried into adulthood.
Childhood Vs Adult Adhd
Many adults with ADHD dont realize they have the condition. ADHD in adults hasnt been studied as extensively as ADHD in children and is harder to define. Adult ADHD symptoms may be more subtle, or look different than they do in childhood.
The diagnostic criteria are also slightly different for adults than for children. For instance, the diagnostic criteria for children states that the person needs to have at least six of the symptoms of inattention and six of the symptoms of hyperactivity and impulsivity. In people above the age of 17, the diagnostic criteria requires the person to have five symptoms of each type.
ADHD is not acquired in adulthood it is a developmental disorder that begins in childhood. However, the symptoms may persist into adulthood. Therefore, the diagnostic criteria state that the person should have experienced the majority of the symptoms since before the age of 12. Adults with ADHD often have a pattern of history at school, college, and work.
An adult may not have been diagnosed with ADHD as a child if:
- Their family members and teachers did not recognize the condition when they were young
- They had a mild form of ADHD
- They were able to cope with the condition when they were younger, but started experiencing challenges when faced with the more rigorous demands of college or work
Types Of Adhd And Symptoms In Women
The CDC estimates 8 million adults display the symptoms of attention deficit hyperactivity disorder , which includes a complex grouping of symptoms that impact women and men differently.
Kathleen Nadeau, PhD, director at Chesapeake Psychological Services of Maryland in Silver Spring specializes in treating women and girls. Nadeau says the single most common word women use to describe their symptoms when they see her is a pervasive sense of overwhelmone that evades all kinds of remedies and persists for months or years.
The latest diagnostic manuals include : inattentive hyperactive/ impulsive, or a third combined group. ADHD is far from a monolith. It is a complex neurological condition, says Dr. Hallowell, co-author of ADHD 2.0, a book written for both clinicians and people with ADHD to better understand the most recent brain science and how it can positively and negatively affect peoples lives.
ADHD is divided into three types with the following diagnostic criteria:
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What Are The Symptoms Of Adhd In Women
In girls, ADHD can manifest differently. They tend to present a so-called inattentive form, that is to say with more symptoms of inattention than hyperactivity/impulsivity, reveals the neuropsychologist. Conversely, boys tend to present a predominant impulsive/hyperactive form.This different presentation can, unfortunately, delay the diagnosis of ADHD in women and, therefore, without treatment, cause more difficulties. However, this difference tends to disappear in adulthood., indicates the specialist. For her, we see a difference in the comorbiditieswhich are therefore added to the basic disorder. Women will tend to have internalized disorders while men will tend to present externalized disorders .
Financial Costs And Missed Opportunities
As if emotional problems werent enough, ADHD may also bring significant financial costs.
Youre constantly paying for your disorganization and forgetfulness, says Nadeau. Youre losing your glasses, so you have to buy a new pair. You get a parking ticket because you lost track of time and the meter ran out. Things like that may happen frequently in the life of someone with ADHD.
Lyle Hawkins, a 59-year-old mother of three, long suspected that she had ADHD, but didnt get diagnosed or treated until age 40. She regrets all those years of being misperceived as lazy and careless. But most of all, she laments lost opportunities. Hawkins married right out of high school, but she feels that she likely would have gone to college instead if she had been effectively diagnosed and treated in her early years.
I was from a very educated family, where education was really important, says Hawkins, a patient of Dr. Reimherrs, who is also from Sandy, Utah. But college would have been too stressful. When you have attention deficit, everybodys on page 10 and youre on page three.
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What Other Mental Health Conditions Commonly Occur With Adhd In Adult Women
It is common for other mental health conditions to occur along with ADHD, known as co-morbid conditions. These conditions can sometimes mask or exacerbate symptoms of ADHD and make it harder to get a clear diagnosis. It is important to get a diagnostic assessment with an expert in ADHD in order to properly understand the origin of your symptoms.
Some common co-occurring conditions with adult ADHD in women include:
Stigma Of Adhd: People Think Its A Fake Disease
Public disbelief as a cause of additional problems, and self-doubt
I think that people think ADHD is sort of a made up excuse for being unfocused and undisciplined, that it just takes self-control or something. I dont think that people think ADHD is as real as anxiety and depression. I think that ADHD is often still seen as a kids disease, and I think that theres this perception of adults having ADHD as being immature and choosing not to act like an adult.
Its a disability that cant be seen, its not as if your leg doesnt work or something. It cant be seen, and therefore you get no sympathy from people.
So even today I dont accept it a 100%, because of the way its diagnosed its not like its a brain scan or something, or a DNA test, so since its qualitative I wonder if its really legitimately ADHD that I have.
To tell or not to tell: Selective disclosure
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How Does The Clinical Picture Of Adhd Differ In Males And Females
Dr Johnson Consultant Psychiatrist in Neurodevelopmental disorders goes through how to recognise the symptoms of attention deficit hyperactivity disorder in girls and women.
Attention deficit hyperactivity disorder is one of the most commonly diagnosed behavioural disorders in children and its often a lifelong condition. It is known as a Neurodeveoplemtal disorder which means parts of the brain which control emotions, learning, self-control and memory are affected.
The characteristics of ADHD fall under the following domains. Firstly relating to focus and attention difficulties. Then we have impulsive traits and finally hyperactivity symptoms. Some symptoms include:
having difficulty sitting still trouble concentrating or focusing, being distracted having difficulty staying organised being forgetful tasks incompletion
Other examples of neurodevelopmental disorders include Autism, Learning disabilities and conduct disorders. This list is not exhaustive and new changes made to the 5th edition of the DSM include other psychiatric disorders .
Adhd And Other Conditions
Neurodevelopmental disorders frequently coexist. For example, you may have an autism spectrum disorder together with intellectual disability. Or you may have and a specific learning disorder.
We have clinical medical research suggesting that ADHD is hereditary. This means if your father or mother has inattentive or hyperactive symptoms, you are more than likely to have ADHD too.
In my clinical practice, I have noticed that ADHD diagnoses among women are on the rise and that more and more women are looking for answers to their difficulties. Most of the new patients who are diagnosed with Adult ADHD are relieved as they can make sense of their difficulties, which nearly always looks different to the typical male ADHD picture. Due to this traditional imagery of ADHD, these women are overlooked and less likely to be referred for mental health services.
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How Symptoms Differ In Women
One of the reasons why ADHD frequently goes undiagnosed in women and girls is that their symptoms may present differently from those of men and boys. ADHD comes in three presentations: inattentive, hyperactive/impulsive, or a combination of the two.
Men and boys tend to have hyperactive/impulsive ADHD, which may cause them to be fidgety, always on the go, disruptive, restless, talkative, impulsive, impatient, and have mood swings.
On the other hand, women tend to exhibit inattentive ADHD, making it hard to focus, pay attention to details, stay organized, listen, and remember things.
Gender bias may also play a pivotal role in the misdiagnosis and underdiagnosis of ADHD in women and girls. Some of the characteristics of inattentive ADHD, such as being shy or impulsive, are often viewed as personality traits rather than symptoms when they occur in girls and women.
The Centers for Disease Control and Prevention reports that boys are more likely to be diagnosed with ADHD than girls . However, research suggests that this disparity is not because boys are more susceptible but instead because girls are consistently underdiagnosed.
Studies generally show that while men and women with ADHD are more alike than different, there are a few small differences. During adolescence, girls tend to have fewer coping strategies and worse self-efficacy than boys. Girls and women also have fewer externalizing symptoms such as aggression than men, but higher levels of depression and anxiety.
More Research Is Necessary
As more and more adult women seek treatment and diagnosis for ADHD, scientists say they need more studies that look at gender differences in the condition.
For example, some experts believe female hormones play a role in the ADHD symptoms of young girls and women. Females may need other forms of treatment than what boys or men need. Many girls also are raised to behave differently from boys. This could make them express their ADHD symptoms in other ways.
Ultimately, experts say more research can help them identify, diagnose, and treat ADHD symptoms early in young girls and women. That early intervention is key to better management of the condition in the long run.
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When Behavior Disorders And Problems With Relationships Appear
Oppositional defiant disorder and conduct disorder occur with greater frequency in girls with ADHD than in controls8,9 and could play a role in the problems with relationships that are observed in girls with ADHD.8,9,27 Girls with ADHD tend also to engage in socially maladaptive behaviors such as aggression9 more often than healthy controls, which could contribute to problems with peer relationships. If problems in these areas develop, a girl should be referred for an evaluation for underlying ADHD rather than simply focusing on her behavioral issues.
Adhd In Women: Historical Perspectives
Our understanding of ADHD has evolved significantly. Once considered a condition defined by measures of hyperactivity in children, ADHD is now understood to include inattentiveness and to potentially last a lifetime. Still, many outdated ADHD stereotypes persist both in and outside the medical community, hampering the study, detection, and treatment of ADHD in women today. Recent research predicts serious mental and physical health outcomes for women who are inadequately evaluated and treated due to noxious ADHD myths like the following:
- ADHD is a male disorder. Hyperactive boys, deemed disruptive and unmanageable, were the ones referred to clinics. Early studies were based on the behaviors of these white hyperactive boys these findings helped shape the diagnostic criteria and assessment scales still in use today.
- ADHD is a childhood disorder. ADHD was long classified as a Disruptive Behavior Disorder of Childhood, based on the hallmark of hyperactivity. Over time, it has become clear that ADHD does not resolve at puberty, and that inattentive symptoms persist longer than hyperactive symptoms.
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Common Psychological Comorbidities In Women And Girls With Adhd
Anxiety and affective disorders are common comorbidities in girls with ADHD8,9 and have been reported to persist into adulthood.1517 Significantly higher lifetime prevalence rates were reported in girls with ADHD versus age-matched healthy controls for major depression and multiple anxiety disorders .8 Women with ADHD are also more likely to exhibit specific phobias and generalized anxiety disorder than men with ADHD.5 In an 11-year follow-up study, girls with symptoms of ADHD that persisted into adulthood had higher rates of conduct disorder and bipolar disorder than controls.16 Women with ADHD that was not diagnosed until adulthood were more likely to have a history of depression and anxiety than those without ADHD.32
Obfuscation: Secondary Mental Health Issues
A 2017 study reported that adults with ADHD are three times more likely to develop major depressive disorder , six times more likely to develop dysthymia, and more than four times more likely to have a mood disorder.
Undiagnosed ADHDers are more likely to experience repeated failure, frustration and anxiety. By adulthood, most undiagnosed women develop a secondary mood disorder that further masks the ADHD. ADHD can involve a deficiency in adrenaline levels. Anxiety is a maladaptive mechanism. Maladaptive mechanisms spiral out of control.
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Adhd In Women: Hormonal Impact
Ovarian hormones interact with almost every system in the body, and are essential components in physical, social, and emotional health for all women. The brain is a target organ for estrogen, as it protects the brain by enhancing neurotransmitter activity, which then impacts executive functioning, attention, motivation, verbal memory, sleep, and concentration.
Estrogen levels, which fluctuate throughout the month as well as across the lifespan, impact the expression of ADHD symptoms in women. ADHD is largely thought of as a condition with stable symptoms across time, but this is not the case for women and their bodies. The truth is:
- ADHD symptoms vary with hormone fluctuations.ADHD symptoms increase as estrogen decreases. Estrogen decreases after ovulation, in the middle of the cycle, and even further near the start of menstruation. This combination of low estrogen and high progesterone exacerbates symptoms tremendously. It also means symptoms can vary day-to-day. Some women may be even more sensitive to these micro-fluctuations.
- Estrogen kicks in during puberty, around the time when ADHD symptoms become more prominent in girls. These hormonal changes are often expressed as anxiety and emotional volatility, however, may also be high in this time, which could lead to being misdiagnosed with anxiety or a mood disorder, and treated improperly or insufficiently.
How Does Inattentive Adhd Impact Daily Life
There are both benefits and challenges that inattentive ADHD presents. Some of the benefits of inattentive ADHD include:
- Being adventurous: When ADHD is managed effectively, impulsivity can make life exciting and inspiring. People with ADHD may use this trait adaptively to explore their curiosities and interests in life.
- Creative thinking: People with ADHD are often naturally creative, seeing the world in unique ways and coming up with inventive solutions to problems.
- Increased energy: There are times when increased energy is beneficial. People with ADHD may thrive while performing certain tasks or engaging in certain activities that require a lot of energy.
- Self-awareness: People with inattentive ADHD may find that they are tuned in to how they’re feeling at any given moment, which can help them fulfill their needsâwhether it’s time away from a task when they’re feeling distracted or learning a new skill when they’re feeling energetic.
There are also challenges that people with inattentive ADHD may face. These challenges may be made more difficult because schools, jobs, and social norms often don’t account for people who are neurodivergent. It can feel frustrating to constantly have to advocate for yourself if you have inattentive ADHD.
Women with inattentive ADHD may also struggle with anxiety, depression, or other mental health issues.
Below is a list of the potential challenges:
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For Decades Now Adhd Has Been Almost Exclusively Understood As Hyperactive Behavior In Young Boys But That’s Finally Changing Heres What You Should Know
For decades now, has been almost exclusively a boys clubunderstood mostly as hyperactive behavior in young boys. An outdated trope resulting from factors like stereotypes, lack of ADHD symptom knowledge, and adult women being excluded from important ADHD research, discussion, and .
Even one of the most useful metaphors about ADHD was likely thought up to describe ADHD brains in boys: ‘ is like having a Ferrari brain with bicycle brakes.
Its a good one, but its a guys one.
Many women we asked said theyor their daughterswere described as flaky or spacey and diagnosed as depressed, anxious, or even bipolarbut not ADHD. The impact of limited diagnoses, difficult to manage symptoms, and a shortage of experts who specialize in the treatment of females of any age, cannot be underestimated, no matter how small the numbers appear.
Estimates vary but new research found that adult ADHD prevalence is 6.76%.¹ Experts also believe between 20% to 25% of ADHD adults are diagnosed in adulthood. Of that 5%, women typically arent diagnosed until their 30s and are far less likely than men to get professional help.²
What’s with the late diagnosis? Ironically, many mothersin search of help for their undiagnosed childrenrecognize their symptoms when reading about childhood developmental disorders and think, I am not a rowdy boy who has trouble sitting still, but that really does sound like me!
Fortunately, things are finally starting to change.