Inside the ADHD mind

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Why ADHD in Women is Routinely Dismissed, Misdiagnosed, and Treated Inadequately

ADHD is a neurological disorder characterized by a persistent pattern of inattention — with or without hyperactivity and impulsivity — that interferes with daily functioning. While the prevalence rates are increasingly similar by gender, the diagnosis rate among American men is nearly 69% higher than it is among American women (5.4% of men in the U.S. have an ADHD diagnosis vs. just 3.2% of women.1)

Why? ADHD in women does not comply with stereotypes. Its distinct symptom presentation is skewed toward inattentiveness – a feature that explains, in part, why ADHD in women is still largely misunderstood, overlooked, and inadequately studied.

Despite improved ADHD awareness in general, science still stands to learn and untangle much about ADHD in women — particularly the influence of biology, neurology, and gender constructs on the condition’s appearance, trajectory, and treatment course.

ADHD in Women: Historical Perspectives

Our understanding of ADHD has evolved significantly. Once considered a condition defined by measures of hyperactivity in children, ADHD is now understood to include inattentiveness and to potentially last a lifetime. Still, many outdated ADHD stereotypes persist both in and outside the medical community, hampering the study, detection, and treatment of ADHD in women today. Recent research predicts serious mental and physical health outcomes for women who are inadequately evaluated and treated due to noxious ADHD myths like the following:

[Checklist of ADHD Symptoms in Women]

ADHD in Women: Signs and Symptoms

ADHD in women primarily means a greater likelihood for the following:

ADHD in Women: Gender Role Expectations

ADHD in women is complicated by gender role expectations. Society’s long list of expectations for women — managing the self, the family, and the home — requires consistent coordination of executive functions.

Women with ADHD are not well-wired for these demands. But in seeking social acceptance, they are often determined to meet them, typically by masking symptoms and problems. Shame and self-blame fuel the dynamic interplay between societal expectations and ADHD’s executive dysfunction. To understand women with ADHD, clinicians cannot underestimate the extent to which women measure their self-worth and self-esteem according to their success in conforming to gender expectations.

ADHD in Women: Social Deficits

Women with ADHD, compared to men with ADHD, struggle more with socialization.

[Click to Read: How to Make Friends as a Woman with ADHD]

ADHD in Women: Hypersensitivities

Women with ADHD tend to experience more central nervous system hypersensitivities compared to men with ADHD. They often report more of the following:

ADHD in Women: Comorbidities

By adulthood, most women with ADHD have at least one comorbid disorder that can complicate the ADHD symptom picture, including:

ADHD in Women: Impulsivity

Symptoms of impulsivity further influence how ADHD presents in women. Impulsivity is associated with

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.

1. ADHD in Women: Inattentive Symptom Presentation

2. ADHD in Women: Gender Bias

Gender bias is rarely intentional, but it is insidious and pervasive. It influences how clinicians see and label women.

3. ADHD in Women: Hormonal Impact

Ovarian hormones interact with almost every system in the body, and are essential components in physical, social, and emotional health for all women. The brain is a target organ for estrogen, as it protects the brain by enhancing neurotransmitter activity, which then impacts executive functioning, attention, motivation, verbal memory, sleep, and concentration.

Estrogen levels, which fluctuate throughout the month as well as across the lifespan, impact the expression of ADHD symptoms in women. ADHD is largely thought of as a condition with stable symptoms across time, but this is not the case for women and their bodies. The truth is:

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” (ADDitude ADHD Experts Podcast episode #337) by Ellen Littman, Ph.D., which was broadcast live on December 15, 2020.

ADHD in Women: Next Steps


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Sources

1 Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716-723. doi:10.1176/ajp.2006.163.4.716

2 Slobodin, O., & Davidovitch, M. (2019). Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children. Frontiers in human neuroscience, 13, 441. https://doi.org/10.3389/fnhum.2019.00441

Updated on January 13, 2021