Adhd In Women: Diagnostic Considerations And Challenges
Clinicians use DSM-5 guidelines to diagnose ADHD, as well as rating scales, interviews, and other practices. Research indicates that girls and women, compared to boys and men, are consistently under-identified and underdiagnosed for ADHD using these diagnostic criteria2. Reasons for this disparity include the following.
What Causes Adhd In Women
Proven causes of ADHD include gene variations that are inherited, but scientists are also studying how environmental causes and pregnancy can trigger ADHD. There are theories about low birth weight and premature birth, exposure to toxins, brain injury and drug and alcohol exposure.1
Most experts agree that a combination approach of medication and talk therapy is most effective. I would argue that this is one area of treatment in which sex and gender do necessitate more focus on self-regulation.² Behavioral therapy takes time in both men and women and the effects of the medicine can also vary in each gender, too. The key is to be an active participant in treatment and have a continuous and open line of communication with anyone giving you medical advice.
How Can Women Navigate An Adhd Diagnosis
The technicalities of receiving an ADHD diagnosis are the same in males and females. Yet, inaccurate assumptions and gender stereotypes prevent females from getting help. Since their symptoms dont reflect those of hyperactive boys, women often remain undiagnosed until adulthood.
If your doctor dismisses your symptoms, provide real-life examples of their impact. Discuss the many treatment options available and find out what is best suited for you. Receiving appropriate diagnosis and treatment ensures symptoms dont interfere with daily function.
Behavioral management, cognitive behavioral therapy , and medication are effective treatment options used to treat a broad range of issues. CBT is often used in tandem with medication to address comorbid mental conditions. However, women with ADHD face unique challenges and may require additional support.
Support groups allow women struggling with ADHD to share experiences and find encouragement. They may also benefit from marital counseling and family therapy with non-ADHD loved ones. This way, all parties can work out problem-solving and de-escalation techniques. Personal wellness plans and stress management techniques can help set reasonable goals and promote self-empowerment.
Countless women live with undiagnosed ADHD, unaware that their symptoms can be alleviated. Though it is a lifelong condition, ADHD can be managed with early diagnosis and treatment.
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Mom Discovers Her Adhd After Sons Diagnosis
Many women, like Sarah Fuller, who was diagnosed with ADHD at age 33, struggled with issues during childhood. When she learned about the symptoms including trouble staying organized, having a messy desk and room and outbursts of anger, a lightbulb went off.
When asked by Daly is she had ever been diagnosed with a mental disorder as a child, Fuller said she recently learned she was told she had oppositional defiant disorder, a diagnosis she now thinks was incorrect.
“I was a royal terror at home,” she now admits, saying her parents didn’t know what to do with her. Fuller resisted going to therapy and continued to struggle through high school and college. Now, an English professor at a community college, she recalls being kicked out of AP English because though her test scores were high, she couldn’t keep herself motivated and organized. In college, a roommate even asked her to move out. “My half of the room was a pigsty,” she says, recalling a lifelong pattern of messiness.
“I knew something was different about me,” she told Daly. “Like, this seems easier for other people.”
Fuller explained how different ADHD can be for girls and women, saying that it’s not always a lack of attention they suffer from, but rather the challenge to focus on the right things. Unfinished projects in her home are a testimony to her struggles, for example, a wall she had a spark of motivation to paint, but which has been in limbo for a couple of years.
What Should I Do Next
- If you suspect you might have ADHD, getting a diagnosis is the first step. Whilst this might seem scary and you may have lots of worries about how your friends and family will react, many women who have received a diagnosis say they experience a huge relief. Suddenly there is a reason as to why they have been struggling for years, the treatment plans can make a considerable difference to how the individual is able to cope and more often than not, friends and family are hugely supportive.
- Talk to a GP or mental health professional about your concerns.
- Consider taking notes to your appointment about things you find difficult or have struggled with.
- Talk to family members about whether they noticed any behaviours in childhood
ADHD is a condition that can be hugely disruptive to peoples lives. Those with it often say that their life is characterised with underachievement, frustration and confusion as to why things seem so difficult. A diagnosis can significantly improve things suddenly there is an understanding as to why things are tricky and therapies such as CBT and medication can help improve peoples lives. If you think you might have ADHD consider whether an might be useful.
Read more about ADHD in adults here:
Read more about ADHD in children here:
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Adhd In Women: Inattentive Symptom Presentation
- A subtle symptom presentation with a greater likelihood of inattentiveness marks the ADHD experience for many women and girls, who are not outwardly disruptive to others. Many clinicians, however, are most familiar with the hyperactive, disruptive presentations of ADHD that are more common in men and boys. Studies indicate that hyperactivity and impulsivity, along with other externalizing symptoms are strong predictors of diagnosis compared to other ADHD presentations.3
- Camouflaging symptoms: Research shows that women are highly motivated to hide their ADHD symptoms and compensate for them. The symptoms that are observable are often anxiety or mood-related, which can lead to misdiagnosis.
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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Adhd In Women: Impulsivity
Symptoms of impulsivity further influence how ADHD presents in women. Impulsivity is associated with
- gender atypical behaviors, including behaviors perceived as controlling, demanding, easily irritated, etc.
- high-risk behaviors, like speeding and extreme sports
- addictive behaviors, including substance use and gambling
- a significantly increased likelihood of acting on negative feelings, including self-harm
These Women Never Knew They Had Adhd A Diagnosis Changed Their Lives
Think Attention Deficit Hyperactivity Disorder , and the image of a hyperactive boy might come to mind. Its a misconception that has caused some people to struggle for decades before they learnt the truth, and found their tribe.
Cheyenne Seah, 39, had always felt she had to work twice, even three times as hard as others. An ADHD diagnosis changed her life.
SINGAPORE: Growing up, Cheyenne Seah always felt she had to work twice, even three times as hard as the people around her to get things done.
I felt like I was the stupid one, she said.
Seah, now 39, would forget even the simplest of things. Organisation and administrative tasks stressed her out to no end. She could never motivate herself to get her homework done until the last minute and would end up copying from friends.
At the age of 10, she realised that her brain worked when she drank coffee, so she picked up the habit to give herself a hit. By the time she was in her early 20s, she was downing eight cups to get through the day.
After the caffeine overload, she would drink alcohol 500ml or so in the evenings to sleep. When she won a scholarship and began pursuing a PhD in biology and research, however, the demands became too much to bear.
I felt like I was the stupid one.
I didnt shower for days. I just wanted to die, she said. It was like seeing a car crash in front of you in slow motion and you cannot help yourself.
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I Might Have Undiagnosed Adhd What Do I Do
Do you have difficulty focusing or feel as if you lack control over your life? Or perhaps you notice these traits in a partner or child? If so, this might be a sign of undiagnosed ADHD. Consult with your doctor and get referred for an assessment. Following a period of observation, your symptoms may be diagnosed with one of the three subtypes of ADHD.An ADHD diagnosis is not a limitation. Early detection and treatment can ensure a normal life largely unhampered by symptoms.
If you think you or a loved one is living with undiagnosed ADHD, speak with one of our counselors at Konrad Psychiatry to schedule an assessment.
When Problems Arise In The Classroom
To address the problem of girls with ADHD not being referred for treatment by teachers and to prevent girls with ADHD from being overlooked in the classroom, it is important to screen girls who are not doing well or require extra help to succeed. In a retrospective analysis of young women diagnosed with ADHD as children, ADHD was recognized as contributing to impaired academic progress by the parent but not by the individual with ADHD.45 Lack of academic progress also resulted in an increased use of tutoring services, repeating of grades, and placement in special education classes for girls with ADHD compared with controls.8,15 Educational impairments were also reflected in lower rates of graduation from high school in girls with ADHD compared with non-ADHD controls.16
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Growing Up With Female Adhd
At the ADHD Centre, we have seen a number of patterns emerge around gender and ADHD. As everyone experiences ADHD in their own way, the observations that we discuss here are not true of all of our clients, they are merely what we observe the most often in clients who are female or who present themselves as female. What we describe are commonalities that we have found between different women with an ADHD diagnosis.
This is how female ADHD could manifest itself at different life stages:
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.
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How Do Gender Norms And Stereotypes Play A Role
In media, portrayals of male characters with ADHD-associated traits are frequently viewed positively . Negative traits of ADHD, such as disorganization, tend to be looked on more judgmentally in women and more easily “forgiven” in men.
Many girls and women with ADHD try hard to suppress behaviors that may be counter to the norms of feminine behavior, such as hyperactivity, impulsiveness, disruptive behavior, and disorganization, for fear of judgment.
Adhd Signs And Symptoms In Adult Women
Most women with ADHD get an accurate diagnosis in their late 30s or early 40s. Experts say there could be several reasons behind the late diagnosis.
It could be that parents, teachers, or pediatricians miss ADHD symptoms and behaviors in young girls because they arenât obvious. Itâs also possible that doctors diagnose girls and young women with other mood disorders like anxiety or depression rather than ADHD. Some new research also suggests that women may develop ADHD symptoms later in life. But scientists say they need more research to prove it.
Symptoms and signs of ADHD in adult women can include:
- Difficulty with time management
- History of anxiety and depression
- Difficulty with money management
ADHD can run in families. If you have undiagnosed ADHD, youâre more likely to notice your own symptoms if your child or sibling gets a diagnosis. Itâs also not uncommon for women with ADHD to have other problems at the same time such as compulsive overeating, chronic lack of sleep, or drinking too much alcohol.
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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
The Presentation Of Adhd In Women And Girls
Several characteristics are unique to the expression of ADHD in women and girls. These characteristics include specific symptom presentation, greater incidence of low self-esteem and more difficulty with peer relationships, coexisting anxiety and affective disorders , and the development of coping strategies that mask underachievement and performance issues .
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Winging It All The Time
“At 35 years old, I worked it out myself. Motherhood was my undoing. I couldn’t ‘wing it’ any longer. The official diagnosis was a massive relief. Finally I had an explanation! Meds have changed my life now I can cope! Yes, my house may feel disorganized, but at least I can keep on top of all the basics and not feel completely overwhelmed ALL the time, just some of it.” Jodi H.
Our Perspective: Own It
We believe ADHD does not make us flawed or broken. We are unique and our differences can be a source of compassion and power. We encourage those with ADHD to get connected with the support they need, learn about ADHD, and build on their strengths so they can show up as their best selves, and thrive at work and in life.
ADHD is real and has its challenges, and there are also many reasons to be proud. Here are a few: 25 Things to Love About ADHD.
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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:
Signs And Symptoms Of Adhd In Teenage Girls
While the symptoms of ADHD dont necessarily change between boys and girls, how the symptoms present can be quite different. A recent study states that girls more commonly tend to have ADHD with an inattentive presentation. More boys are diagnosed with the hyperactive-impulsive presentation than girls.
When looking out for signs of ADHD in the classroom, teachers are much more likely to notice a child who is acting out, cant sit still, and is consistently speaking out of turn. These signs of ADHD align with the hyperactive-impulsive presentation of ADHD that boys tend to present with. This means that more boys are evaluated and eventually diagnosed with ADHD.
Inattentive presentation, which girls commonly present with, can be easily missed since it isnt as disruptive as the hyperactive-impulsive presentation. The inattentive presentation can be misinterpreted as a gendered personality traitfor example, assuming a girl is moody or socially awkward.
Symptoms of inattention among girls include:
Girls can internalize symptoms of inattentive ADHD. Hyperactive impulsivity tends to be quite external and visible to others. On the other hand, some can overlook inattention as a mere personality trait that is internal and unique to the individual rather than part of a challenging neurodevelopmental condition.
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