Sandy is a mother of three children. She frequently feels overwhelmed and like she cannot balance the responsibilities of her life, her work, and her family. Even though her spouse is involved and supportive, her house is very cluttered and disorganized. She cannot find her keys or her phone, often losing them several times a day. The television remotes have been gone for months. When her children bring home permission slips or materials from school, it is hard for her to keep track of them or when things are due. She procrastinates bills, laundry, and dishes. When she finally needs to complete these tasks, there is a monumental amount of work and stress involved. Sandy is often late when dropping off the children for school, and was asked to leave the neighborhood carpool due to her constant tardiness. She forgets things, like birthday parties, PTA responsibilities, and appointments. Sandy knows these issues are problems for her, but she just cannot seem to do better, no matter how hard she tries.
At work, Sandy performs better, as there is structure in her day. She knows what she needs to do, and when things begin and end. However, it takes her longer to read materials, and she frequently forgets what she has read. She also takes longer to complete her work, and she is very tired at the end of her day. She feels that she is putting in more effort than her peers to get through. When she gets home, she feels like she is already tired, and the most stressful part of her day lies before her. It is the evenings when she has to meal plan, clean, and organize the house for the next day.
ADHD in women is poorly identified
Even though women like Sandy present with many ADHD symptoms, it can be very difficult for women like Sandy to find help. Most of the early research on ADHD is based on studies from 20-30 years ago, which relied on samples “overactive boys.” The diagnostic criteria were developed based on those studies. As a result, those criteria over-represent the symptoms you see in young boys, making it difficult for girls or women to receive appropriate care. It is estimated that there are around 4 million women and girls are not diagnosed, or half to three-quarters of all women with ADHD, even though ADHD occurs equally in both genders. Even when women explain their symptoms to their healthcare providers, they may be met with resistance. Or they may be dismissed as being “normal,” “stressed,” or “hormonal.”
ADHD in women does not look the same as it does in boys
For many ADHD girls and women, ADHD symptoms surface later in life, and tend less disruptive
Many women are not overactive, but ARE frequently overwhelmed. Women with the disorder tend to be less hyperactive and impulsive, more disorganized, scattered, forgetful, and introverted. They may be impulsive eaters, and over-talkative.
Further, while a decrease in symptoms at puberty is common for boys, the opposite is true for girls
The symptoms of ADHD in girls and young women intensify in adolescence as estrogen increases in their system. Common ages for referrals for girls are 7th grade, 9th grade, college, and after having children. Symptoms may still be present early in life, but they often do not interfere with girls’ life functioning until they are older. A study in the Journal of Attention Disorders found that college-age females actually had more symptoms and interference from their symptoms than college-age males and other college-age females.
Women and girls with ADHD often present with additional mental health diagnoses
Approximately, 70% of women with ADHD are first diagnosed with Depression prior to an ADHD diagnosis. A recent study published in the Journal of Consulting and Clinical Psychology found that girls with ADHD have high rates of self-injury and suicide during their teenage years, bringing attention to the distinct severity of ADHD in females. In Pediatrics, a large population study found that the majority of adults with ADHD had at least one other psychiatric disorder, from alcohol abuse to hypomanic episodes to major depression. This poses a particular threat to females, for whom ADHD diagnoses tend to come later in life.
Effective Treatment is Available for ADHD in Women
For women, ADHD treatment is most effective when multiple components are included. For example, many women require a careful psychological evaluation from someone who has expertise identifying ADHD in women. There are rating scales and measures that are normed primarily on women, so that findings are more accurate. A good evaluation will also screen for anxiety, depression, and other concerns that can occur in women. Many times, a good evaluation will also include a review of the person’s early life, and involve the report from other family members if needed.
Additionally, many women with ADHD benefit from cognitive behavioral therapy to learn skills to manage difficulties with executive functioning, anxiety, and depression. Learning to break up overwhelming tasks into more manageable pieces is very important. Furthermore, learning to not blame oneself, but rather use compassion, can be very helpful for people who feel guilty and ashamed of their difficulties. Psychotherapy may also help to address anger issues, communication issues, and family issues that are often related to ADHD in women.
Finally, many patients benefit from specialized medical care in their treatment
For young boys with over-activity, psychostimulants are the most commonly prescribed medications for ADHD. However, with girls and women that may not necessarily be true. Oftentimes, the interplay between ADHD, Depression, and Anxiety, can be complex, and may require a systematic approach to treatment. However, by finally addressing their ADHD symptoms, many women find they are happier, more confident, and less stressed.