ADHD in Women and Girls: The Importance of Early Diagnosis

Women and girls with attention deficit hyperactivity disorder (ADD/ADHD) are not only less frequently diagnosed than their male counterparts. ADD/ADHD girls and women often require gender-specific treatments to help manage symptoms, succeed at school and work, and have successful relationships.

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ADD/ADHD Diagnosis Rates in Women and Girls

Barely 31 years after “Attention Deficit Disorder” first appeared in the bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM), front-line clinical therapists say that increasing awareness of the condition has led to many more girls being diagnosed while they’re young. Even so, while girls and boys currently are diagnosed at a ratio of about 1 to 3 — up from about 1 to 8 in the 1990s — the rate for diagnoses of adult women and men is about 1 to 1.

“It’s only a matter of time before we find this is an equal-opportunity disorder, although a less glaringly obvious one for girls,” says psychologist and author Kathleen Nadeau, Ph.D., a pioneering expert on women with ADD/ADHD.

That’s not a unique opinion, nor is it unanimous. Experts including psychologist Stephen Hinshaw, Ph.D., head of a major longitudinal study of girls with ADD/ADHD, and psychologist and author Russell A. Barkley, Ph.D., believe the current 1 to 3 ratio of girls to boys diagnosed with the condition is accurate. “Boys seem to be more vulnerable to psychopathology,” Hinshaw says, citing rates of childhood autism that are also dramatically higher for boys — on the order of 5 to 1.

Hinshaw, author of The Triple Bind: Saving Our Teenage Girls from Today’s Pressures, speculates that higher rates of ADD/ADHD in adult women might be explained by women having a variation of the disorder that lasts longer than it does in males.

It’s well known by now, he explains, that boys with ADD/ADHD are more likely than girls to demonstrate hyperactivity and impulsivity. More girls than boys are diagnosed with the “inattentive,” day-dreamy type of the disorder. Yet several longitudinal studies show that symptoms of activity fade during adolescence, whereas underlying problems with attention and organizational skills usually persist through adulthood.

Still, other factors might also explain why the male-female rates change in adulthood, Hinshaw says. Perhaps women are more honest than men about attention problems in adulthood. Moreover, he suspects that Nadeau and other experts may be right in suggesting that many young girls with ADD/ADHD are under the radar, to be identified only as adults.

Indeed, hyperactivity, and often aggression, goes along with many cases of ADD/ADHD. It usually gets more boys with ADD/ADHD noticed, and helped, while girls turn their frustration inside. The cost for women is years of low self-confidence and psychological damage.

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