How Symptoms Of Adhd Differ In Women
You may or may not be surprised to learn that until recent years, most research on ADHD has primarily focused on boys. In fact, the criteria for diagnosing ADHD was originally based on hyperactive boys.
In spite of this, there is plenty of overlap in the actual symptoms of ADHD across genders, although women tend to be more likely to experience inattentive type. The key differences in ADHD presentation between men and women appear to be due to other factorsincluding coping mechanisms, hormones, and societal sex norms.
How Adhd Symptoms Differ In Women
Inattentive ADHD is most common in women. Clinicians look for symptoms that not only persist for long periods of time but are severely disruptive at work or at home. So, for example, while the average person under stress might forget where they put their car keys or an Internet password, a female ADHD-er will forgetbut not recognize this as a pattern that is as disruptive as it is avoidable.
Hormonal systems in females make the experience of ADHD distinctive from that of males and are another factor complicating diagnosis. The role that hormones play is underestimated during crucial timespuberty, early adulthood, childbirth, and postpartum as well as later, during perimenopause and menopause, and can make ADHD feel like a rollercoaster.Female hormone fluctuations and transitional periods of life such as puberty or pregnancy seem to intensify the symptoms of ADHD in women, Nadeau says.
Internalizing painful emotions and experiences causes anxiety of course and makes ADHD women prone to self-injury and suicide. It is common to hear these admissions online and in support groups say the founders of The Anxiety Sisters, an online community whose tagline is Dont go it alone.
Since she began writing about women and ADHD some decades ago things have changed dramatically. I remember being teased at conferences by men who said women didnt have ADHD. We just wanted to be a part of their club.
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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Tips For Women With Adhd
Carly Snyder, MD is a reproductive and perinatal psychiatrist who combines traditional psychiatry with integrative medicine-based treatments.
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Many women feel a huge sense of relief when they find out they have attention deficit hyperactivity disorder . For years, they may have blamed themselves for their shortcomings and their self-esteem has taken a hit. Constantly worrying about every detail of their lives may have led to emotional, mental, and physical exhaustion.
After being diagnosed with ADHD, they finally have an answer, and they know that their symptoms are not their fault. When they realize they have ADHD, feelings of inadequacy can begin to fade away, putting them in a better position to treat and manage their symptoms.
Types Of Adhd And Symptoms In Women
The CDC estimates 8 million adults4 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 three types of ADHD: 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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The Face Of Adhd In Women
Studies show that adult ADHD is more likely to go undiagnosed in women compared to men.
This starts in childhood as boys are more likely to exhibit the Hyperactive/Impulsive Type of ADHD, girls are more commonly known to have the Inattentive Type of ADHD, which makes it harder to stay focused, organised, listen and retain things successfully in working memory.
This difference in presentation often means that boys are typically more disruptive and hyperactive in class and therefore the ADHD symptoms will be more noticeable and likely to lead to a referral for diagnosis.
Surveys conducted in the UK with children aged between 5 and 15 years old, 3.62% of boys and 0.85% of girls had ADHD.
There are Three Recognised Types of Attention Deficit Hyperactivity Disorder or ADHD in Women:
1) Combination Type Symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
2) Inattentive Type Symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months .
3) Hyperactive/Impulsive Type Symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.
Women with ADHD are more inclined to feeling dysphoria, depression and anxiety. They are also prone to having lower self-esteem and developing coping strategies that are more focused on compensating unfinished and forgotten tasks rather than actually solving an existing problem.
- Diagnosis & Treatment
- Secondary Symptoms
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:
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Adhd In Women: Treatment Considerations
ADHD can be treated with therapy, medication, lifestyle changes, and accommodations. Women with ADHD should consider the following treatment options:
The content for this article was derived from the ADDitude Expert Webinar Why ADHD is Different for Women: Gender Specific Symptoms & Treatments by Ellen Littman, Ph.D., which was broadcast live on December 15, 2020.
How Does Gender Influence Adhd Treatment
Pharmacological treatment for ADHD is generally the same for everyone.
Doctors often prescribe stimulants, such as methylphenidate and amphetamine , to treat ADHD. This is because they increase a persons attention and focus.
However, some people experience unpleasant side effects, such as a loss of appetite. In these cases, a doctor may prescribe a non-stimulant medication. These take longer to work, but they are just as effective at controlling ADHD symptoms.
Although everyone receives the same medications, they may not receive them at the same rates. For example, one 2020 study found that in an analysis of 21 studies, girls received significantly fewer ADHD medication prescriptions than boys. This disparity was not shown in adult females.
Many researchers say that doctors can make some changes that will make treatment better for girls and women with ADHD.
- ensuring that ADHD medications do not interact with other co-existing conditions, such as anxiety and depression
- reviewing a persons medication during menopause or pregnancy
- educating people on the risk of self-harm and other risky behaviors
- paying attention to side effects that affect appetite, as eating disorders seem to be more common in girls and women with ADHD
Often, girls and women with ADHD experience co-occurring conditions. These include low mood, anxiety, and depression.
However, these conditions other ADHD symptoms. This means that doctors often treat the resulting symptoms, not the root cause: ADHD.
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What Are Adhd Symptoms In Women
The symptoms of ADHD can vary from person to person, and they may not be the same for boys and girls. Girls with ADHD tend to have more problems with inattention than boys. This is because the symptoms of ADHD in women are often more subtle than in men. They may not be as disruptive or as obvious.
For example, a man with ADHD may be constantly fidgeting, while a woman with ADHD may only have trouble sitting still when shes feeling anxious. There are many different types of symptoms. Here are the top 8 ADHD symptoms in women
Going Under The Radar
ADHD is a neurodevelopmental disorder, and those who have it can have difficulty controlling impulsive behaviour.
There are three types of the condition: impulsive/hyperactivity inattentive/distractible or a combination of the two. The latter is the most common.
While ADHD is the most common disorder among boys aged four to 11, only about half the number of girls the same age are diagnosed, according to the Australian Institute of Health and Welfare.
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Symptoms Specific To Women
One reason women may be diagnosed less is because symptoms can present differently than with men. According to the DSM-V, there are three different ways ADHD may present. Essentially the underlying condition is the same, but the symptoms can appear a bit differently, and are split into three categories.
Heres a look at the symptoms of each type, including hyperactive, inattentive and combined type. Symptoms may lean towards one category or may be mixed. Women and girls more often have the predominantly inattentive type.
This symptom list is based on the DSM-V, however additional examples have been added for your reference.
Adhd Symptoms In Girls And Women
We now better understand how ADHD tends to show up in girls, but some still go undiagnosed for years. “We know girls are much less likely to receive a diagnosis of ADHD than boys because boys tend to be more hyperactive and disruptive. Girls tend to be inattentive, which can go unnoticed by parents and teachers,” says Nebraska Medicine psychiatrist Sharon Hammer, MD, who specializes in women’s mental health. An increasing number of adult women seek help, many of whom ultimately look back and recognize a pattern of symptoms since childhood. “ADHD is the most genetic and inheritable illness of all psychiatric illnesses,” says Dr. Hammer. “The most at-risk people are those with a family history of ADHD. We see a lot of women come in for help when they have a child of their own get diagnosed and realize they have many of the same symptoms.”
As opposed to boys, girls with ADHD tend to internalize their struggles and blame themselves without garnering the attention of the adults in their lives. They may manifest anxiety or depression, which is secondary to inattention. “About 50% of adult women with ADHD have a comorbid condition. Many times we end up seeing a person due to anxiety or depression, and through that, we end up discovering the ADHD,” says Dr. Hammer. “In my practice, it seems rare to have a woman come in and say ‘I think I may have ADHD.’ They come in and talk about how anxious, frustrated or irritable they are.”
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How Many Women Go Undiagnosed With Adhd
As noted previously, men are four times more likely to be diagnosed with ADHD. An earlier study showed that despite similar prevalence rates in both genders, the diagnosis rate among American men is nearly 69% higher than it is among American women .3,4
While there is no exact number of undiagnosed women in the United States, it’s common to hear women say, people didnt believe me! or my doctor told me I was autistic but did not realize I had ADHD. Then there are women who say, I was anxious and depressed, and I didnt know why. Their doctors treat them for anxiety and depression, missing their ADHD until much later, for example, when they are fired from a job or have a child who is diagnosed with ADHD.
Despite ongoing attempts to include women and girls in studies and to change diagnostic criteria research isnt there yet. Governments, healthcare, and school systems have little collective understanding that girls mental health and academic performance are suffering due to missed diagnoses. If you are looking for resources devoted specifically to women, there are cutting-edge centers that are now filling the void, including Dukes Center for Women and Girls with ADHD.5
Presentation Of Adhd In Females
Although much of the scientific literature indicates an overlap in the clinical presentation of males and females with ADHD, the available evidence often draws on predominantly male samples due to the higher prevalence of ADHD in males . Some sex differences have been reported, which are described below, and briefly summarised in Table .
Table 1 Summary of key points for detection of ADHD in females
Research in population-based samples indicates that for both sexes the hyperactive-impulsive type predominates in pre-schoolers, whereas the inattentive-type is the most common presentation from mid-to-late childhood and into adulthood . By contrast, clinical studies typically report a greater prevalence of combined-type ADHD . Early meta-analyses of gender effects have found lower severity of hyperactivity-impulsivity , or all ADHD symptoms in girls than boys, although individual studies show more mixed results .
Inconsistent findings may reflect that clinic referral and diagnosis tends to favour combined subtypes equally across genders, whilst community sampling points to greater prevalence of inattentive type ADHD in girls than in boys . Hyperactive-impulsive symptoms have been linked to higher clinic ascertainment rates , and may be more commonly seen in boys , with inattention symptoms being less obvious and therefore less likely to be detected. These differences may lead to the perception that females with ADHD are less impaired .
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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
Why Are Women With Adhd Often Undiagnosed
It seems that one of the main reasons is that men and women often have different types of ADHD.
Most of the ADHD research was done in the 70s and centred around young, white males with hyperactive tendencies. Female ADHD often presents very differently to male ADHD, so it might be that less women are diagnosed because people simply arent looking out for the symptoms commonly experienced by females with ADHD.
Often people with Inattentive ADHD go undiagnosed as the behaviours are not disruptive enough to raise concern, so whilst there may be girls in your childrens class with Inattentive ADHD, they may well be under the radar as from the outside their behaviour is not disruptive enough to intervene.
Different expectations of women:
Or is it just having too much to do?
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Do Boys Get Diagnosed With Adhd More Than Girls
In an era of growing awareness about wage gaps and social inequities, researchers are devoting more energy to health disparities like this one. Boys still receive ADHD diagnoses much more often than girls, according to the Centers for Disease Control and Prevention 12.9 percent compared with 5.6 percent.
Is it just that boys have ADHD more often than girls do? Or does the culture around research, diagnosis, and treatment of the disorder heavily skew toward boys? Researchers are realizing its more complex than that.
Many girls with undiagnosed ADHD grow up hearing themselves mislabeled as spacey, way too talkative, and disorganized.
As teenagers, they may fall behind academically, even though their frustrated parents and teachers know these young women are intelligent and capable. And in adulthood, many still have trouble with increased responsibilities and different roles.
The difference in diagnosis rates and resulting access to treatment can have a considerable impact on women with ADHD. It affects the ways they navigate their lives, develop their self-esteem, and build relationships.