ADHD in Women

Too Few Doctors Screen Women for ADHD — and We Deserve Better

Women with ADHD are often misdiagnosed with depression and anxiety. Until psychiatrists learn to recognize ADD symptoms in girls, we have to take our mental health evaluations into our own hands. At the very least, we deserve a basic screening — and we must begin to demand it.

ADHD Diagnosis in Women: What Doctors Don't Understand
An illustration of a woman seeking an ADHD evaluation, rather than a misdiagnosis of depression or anxiety.

I have been in and out of psychiatrists’ offices since 2009, when I was diagnosed with prenatal depression during my first pregnancy. It took until 2015, and treatment by the best psychiatrist in the state, before I was tested for attention deficit disorder (ADHD or ADD). My doctor didn’t bring up the subject. However, when we discussed my symptoms, she agreed I should be evaluated.

I had six years of forgotten diaper bags, messy cars, missed appointments, and double-booked play dates; of misremembered names and forgotten faces. Six years. While I was under a doctor’s care.

How About an ADHD Evaluation?

It’s not, of course, that my ADHD had magically developed six years prior. It hadn’t. I’d lived a lifetime of forgetfulness and barely contained chaos. I was screened for depression multiple times, and had multiple diagnoses thrown at me, but no one asked me to fill out a simple, two-page evaluation for ADHD.

Any time I discussed my symptoms with a doctor, they were explained away. If my car was always messy, well, I’d struggled with depression my whole life, hadn’t I? If I had trouble remembering names, I was reminded that untreated childhood depression can cause problems with memory. If my house was a mess and I couldn’t remember appointments, well, depression makes it hard to function.

I followed the typical pattern. Girls with ADHD are three times more likely than boys to be treated for a mood disorder, depression or anxiety, than for ADHD, according to researchers. That’s partially because dealing with ADHD is likely to give us a mood disorder: Our inattentiveness and forgetfulness push us into low-self esteem and feeling inadequate, which leads to anxiety and depression. But when we get on the psychiatrist’s couch, we’re handed our diagnosis and sent on our way, with no discussion of comorbid conditions or what may have caused us to have these feelings in the first place.

[Self-Test: Inattentive ADHD Symptoms in Adults]

Doctors Don’t Understand What ADD Looks Like in Women

Psychiatrists aren’t trained to recognize our ADHD symptoms. They’re familiar with the trope of the hyper little boy and the angry older man. They don’t see the girl in the back of the classroom daydreaming through class, playing with her erasers instead of doing her math problems, not remembering to put her homework in the right place. They don’t see the woman who blurts out unrelated comments during conversations, who spaces out when her friends talk.

Only 4.9 percent of women will be diagnosed with ADHD during their lifetimes, compared to 12.9 percent of men. The fact that so many fewer women get a diagnosis has dire consequences for our mental health. One-third of us with ADHD suffer from anxiety disorders — real ones, not misdiagnoses stemming from psychiatrists determined to stick a label on us. And half of us with anxiety disorders have thought about suicide, a staggering one-sixth of all women with ADHD.

Women Deserve Basic ADHD Screenings

I was lucky. I saw the signs and took my mental health into my own hands. But if the best psychiatrist in South Carolina didn’t recognize my symptoms, after years of treatment, we have a long way to go. Millions of women are left behind, abandoned by their doctors to think that they’re broken and incapable, that they have an irrevocable personality flaw, because they can’t recall dates, remember faces, make friends, keep their cars clean, and put their laundry in piles.

It wouldn’t take much to rectify the situation. Doctors screen women for depression, especially after childbirth, and 10 to 15 percent of us meet the diagnostic criteria. Don’t women deserve the same kind of basic screening when it comes to ADHD? Until that happens, and until psychiatrists learn to ask the right questions about women and ADHD, I fear for our well-being. But most of all, I fear for the little girl in the classroom, daydreaming and catching only every other word the teacher says. She will become one of us, with all of our difficulties, comorbid diagnoses, and frustrations. And no one will have any idea why.

[Free Resource for Women and Girls: Is It ADHD?]

Updated on August 29, 2019

8 Related Links

  1. I was not officially diagnosed until I was in my mid- 30’s. I had learned to handle some things but constantly was at odds with myself over the chaos I created for myself organization wise. So I started to really seek help about five years ago as menopause seemed to make the symptoms tons worse! Well, I loved the effect of Adderall. I had never ever had that clarity before. I had never had my brain be so quiet. It was like all the sound was muted and I was at peace. Then I had such awful side effects of hyperventilating and raised blood pressure that my doctor took me off it and tried two other non-stimulants to no avail. I quit for three years and went back to see if I could find something else- because I miss that clear feeling I had for a brief 6 months in my life. Long long story short- this new doctor suggested just taking MORE Prozac to treat my depression with the ADD. I want to solve the root problem- yes, I do want it solved! BUT what I realistically mean is I want to search for something to help my brain chemistry itself- not just the depression and anxiety symptoms that come with it. The medical profession sure doesn’t seem to get it to me. Just hand the middle-aged woman a pill since she is agitated- don’t go after the real issue. It is SO FRUSTRATING!

    1. Hi Phranke,
      You are not alone. Many people have these same side effects with a stimulant for ADD, and many doctors and patients stop treatment because they don’t know to manage the side effects.
      The good news is there are new ways to be successful. Start by reading through a previous ADDitude article: https://www.additude.com/adhd-medication-mistakes-adderall-dosage/
      If you have pre-existing anxiety or high blood pressure, get them treated first. Daily exercise is the best treatment for BOTH conditions, and even it doesn’t eliminate them, it will decrease any necessary medication doses. Anxiety can also be improved through counseling, especially if it includes meditation (breath control) and coping skill techniques.
      As far as medication to reduce anxiety symptoms such as hyperventilation, you already know that an SSRI (like Prozac) can be effective. A different SSRI to consider is Lexapro, which may work at very low doses.
      For blood pressure, standard BP meds may be considered. However, psychiatrists may select either Intuniv or Inderal, which may be combined with a stimulant for BP associated with ADD. All of these treatments take time to become effective, so it is often best to start them well before re-starting the stimulant. Then you will be prepared!
      The next step in avoiding side effects is almost always to adjust your dosage. Side effects only develop above a certain dose (which is different for everyone) and then get worse as the dose increases. Try to start at the lowest possible dose for a week or two, even though it may not be effective for your ADD, to give your body time to adjust. The Adderall ER 5mg may be the least likely to cause side effects. Then increase very gradually to the point where you feel some positive effect. Proceed with caution beyond this point and be prepared to go back to the previous dose. Try both the ER and IR versions to see which you tolerate better. If side effects still keep you from reaching an effective dose, they can be usually be managed by increasing the treatments described above, while continuing the stimulant.
      Look for a psychiatrist who treats adult ADD and is willing to try some of these approaches. It will take time and patience, but you have been dealing with this for 5 years and still haven’t given up, so it sounds to me like you are ready to try again with some new options and knowledge.
      -remind

  2. I was told ny a trained counselor that i had anxiety not ADHD . so at age 71 i am getting help but 75% of help is my own initiative. I reswarch research research and then take to my counselor. All my life i have had shame for not fitting in. For my awful messy house

    1. Dear Kathi,
      Have you taken the short self-test? https://www.additudemag.com/self-test-adhd-symptoms-women-girls/
      Or the full self-test? https://www.additudemag.com/adhd-symptoms-test-adults/?src=test
      Your may want to show your results to your counselor, and discuss how ADD/ADHD and anxiety are not always “either one or the other” conditions. Many people have both.
      A psychiatrist (doctor) may be able to help you get a more accurate diagnosis.
      -remind

  3. One of the best articles I have read for women with undiagnosed ADHD. I too discovered the possibility that I have ADHD at 58 and got a referral to a psychiatrist who specialises in ADHD. But before that I too had been diagnosed with depression, anxiety after becoming a mum and eventually post natal depression. They never felt quite right. I certainly had anxiety and as I was alone to raise my son, no wonder depression.
    I saw numerous psychologists and psychiatrists, trying to figure out how to “cure” the anxiety and depression, as I felt deeply there had to be a cause.
    I too was the day dreaming, quiet, reserved female, with racing thoughts and ideas that I could never capture. I learn’t the social skills expected and yet still had “foot in mouth” issues that in the end I ostracised myself from people because I would continually embarrass myself and good friends and then feel incredibly deep pain and shame at my lack of control.
    The articles from ADDitude have been wonderful at validating my experiences and allowing me to understand my place in the world. At my age ADHD would never have been diagnosed and so I don’t grieve for that loss. It is now important to get information out to doctors and specialists for female children so they do not have to go untreated and can reach their full potential.
    Keep up the great work. And that wonderful quirky brain has just popped another idea in my mind that maybe I should drop leaflets off to doctors and waiting rooms, to spread the word.
    PS I am on meds and fortunately they work well. Yes blood pressure is a little high though I’m working on weight loss and exercise to lower it. I can take my meds as I need the first time I have had some control over my life my brain.
    Safe travelling to all in the ADHD world.

  4. My counselor sent me for testing when I was suffering post-partum depression after my first child was born. I was 35. The male psychiatrist immediately disregarded everything I said about my symptoms and instead diagnosed me with Obsessive Compulsive Personality Disorder. Reading about that diagnosis was so frustrating because it is the exact opposite of me and everything I’ve struggled with my whole life. An obsession with being on time? I suffer from crippling and chronic time-blindness and daily lateness. It was the main thing I went to him for help for. It took another 6 years and another pregnancy before I finally got a proper diagnosis. My counselor had to fight that therapist hard and get him to retract the diagnosis. I didn’t trust another Psychiatrist again for years. Reading the Reddit subreddits has been extremely cathartic. Listening to women of all ages talk about their experiences helps me to forgive my younger self, work through so much grief and guilt, and feel positive about the future.

  5. I’m a 42 year old woman… For years I was diagnosed and treated for depression and anxiety (while I do have those, the medications and therapy were unsuccessful, well therapy helped a little bit). It wasn’t until I was 39 and trying college for the umpteenth time that I was diagnosed. I went in to see a psychologist for a learning disorder assessment because I was struggling on focusing,learning and keeping up in my classes (as usual) and he suggested that I get assessed for ADHD. Which surprised the heck out of me that he would suggest it, seeing as how even some supposed professionals didn’t seem to know any other type of ADHD but the hyperactive type. Turns out that I have it along with the depression and anxiety. A relief to know, but still difficult to help proper help.

  6. Twenty minutes after taking that first lowest dose of concerta my brain was quiet first the first time in all my 62 years. That first week was shocking and extremely emotional. I’ve been treated for clinical depression many times without much success, and now believe is was purely situational. My interior life has always felt either extremely chaotic or hyper focused, of course never on things everyone around me seemed to manage so easily. You know things like managing a household, paying bills and doing taxes. I did learn to cook using the odd combinations of ingredients that I carted home. My working life was widely varied, continually searching for that perfect career until my recent retirement. Everything new thing became too boring after time. Now I wonder what could have been achieved with an early diagnosis and treatment.

    Medical research has always been and still is male biased, now I’m facing age bias as well. I believe the missed diagnosis is largely because I’m female. It seems there has been NO clinical trials of ADHD medications in seniors.

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