ADHD in women.

Jason Brien.

     Many girls/women with ADHD will often go undiagnosed and unrecognised as the condition is mostly attributed to boys/males. Some studies suggest that around 13% of boys receive an ADHD diagnosis compared to 5.6% of girls. These studies do not imply that ADHD naturally targets boys more than girls rather the authors suggest that the disparity stems from girls going underdiagnosed and unrecognised. Generally speaking, adult females who were not recognised and diagnosed as a child will come to self-diagnose themselves come adulthood. Why is this the case though? Why do women have to wait until adulthood before they can recognise their ADHD and associated symptoms?

     Childhood ADHD is often picked up by teachers and parents mostly because a child is acting out, can’t sit still, is socially disruptive, won’t pay attention in class, etc. Females however do not always display these externalised/hyperactive behaviours and so they often fly under the radar. The same applies to adult ADHD. Women are less likely to be diagnosed with ADHD in adulthood because they don’t often display these externalised/hyperactive behaviours and so they are more likely to be diagnosed with internalised disorders such as depression, anxiety, etc.

     Females (and some males) with the inattentive form of ADHD (and internalised symptoms) are less recognised than their hyperactive and externalised counterparts. Females often find it hard to focus and pay attention. They can also have difficulty staying organised and they may find it hard to listen and remember complex instructions. These symptoms alone significantly affect their ability to complete assigned tasks. If we were to talk about a school or work setting, it is easy to see why a male who is always talking and running around may have difficulty getting their work done, but it is harder to understand why the quiet female who IS sitting down and who ISN’T running around CAN’T get their work done.

     The male is somewhat ‘forgiven’ for their inabilities as people are quite willing and able to associate the males’ challenges with their ADHD condition. Unfortunately, females are rarely if ever afforded the same courtesy. Society seems eager and willing to chalk up the females ADHD inabilities to their assumed character traits rather than their ADHD condition (diagnosed or undiagnosed). For example, depending on the level of sexism in the school or work setting, the female is more likely to be labelled as  a ‘dumb’ or they may receive backhanded comments that they should remain at home where they are comfortable. If the female is also attractive and sociable, they may be misperceived or mischaracterised as ‘spacey’, or ‘just a dumb blonde’.

     Young girls who are not recognised and diagnosed as having ADHD often grow up confused as to why they are struggling with certain things compared to their female peers. Mischaracterising oneself as “dumb blonde” will obviously impact one’s self-esteem and confidence with these introjections carrying on through into adulthood. They may also suffer from a degree of learned helplessness. Research has consistently shown that women with ADHD often experience dysphoria (unpleasant mood), major depression and anxiety disorders more so than their male counterparts and they also have lower self-image than men with ADHD.

     Again, we can see how if boys and men were not necessarily targeted for their character traits, their self-esteem may not have suffered continued injurious blows like their female peers. The males may also be able to ‘displace’ their hyperactive and externalised symptoms and behaviours by engaging in contact sports for example where again, depending on their ability, their condition and behaviours are praised and rewarded (wins, tries, goals, trophies, etc). How can the females displace their ADHD related symptoms and behaviours? Most likely they cannot and so again they are often left unrewarded and unsupported.

     Adult women with ADHD may also suffer more than males when it comes to the societal expectations placed upon women in general. Look at the societal expectations that are placed upon wives and mothers for example. Wives are expected to keep their homes clean and orderly. Wives may be expected to organise household utilities, (car insurance, etc). Mothers are expected to be on top of their children’s schedules (pack their lunches, organise when and where social or sporting activities will occur) whilst also being employed or studying. If the women do seek therapeutic support, there are few clinicians educated in female ADHD and so women are often misdiagnosed and mistreated.

   ADHD-focused therapies for women (and men) needs to focus on a broad range of issues including self-esteem, interpersonal and family issues, daily health habits, daily stress level, and life management skills. Interventions such as these fall under the umbrella term “neurocognitive psychotherapy”. This type of psychotherapy combines cognitive behaviour therapy (CBT) with cognitive rehabilitation. For example, CBT can help with self-esteem issues, negative thoughts, introjections, etc, and cognitive rehabilitation can help with memory, planning, reasoning, organising and time challenges.   

     Women with adult ADHD may also benefit from parenting classes/training. Not because they are bad parents but because the classes/training can add skills to help them parent and manage as a woman suffering from ADHD. Furthermore, women with ADHD are more likely to conceive children who also have ADHD. Women with ADHD may also benefit from group counselling which can help them meet and interact with other women with similar challenges. Career counselling/coaching can teach women with ADHD how to manage their time better, how to organise and plan and how to co-exist with co-workers. Women with ADHD can also help themselves by remembering that their challenges are the product of their condition not their personality.