ADHD in Women Looks Different: Here's What to Know

At a glance

Most women don’t find out they suffer from ADHD until much later in life. In fact, 50 to 75 percent of girls with ADHD symptoms are overlooked and only diagnosed later in adulthood(1).

Attention-deficit/hyperactivity disorder (ADHD) currently affects 11% of American children, ages 4-7(2). Just in the last few years, doctors have started to diagnose and treat women for ADHD. It is still unclear why young girls are overlooked for this condition. Even today, the majority of research about women with ADHD has been carried out by mental health professionals as part of their everyday practice.

Researchers suspect undiagnosed cases are due to men and women showing different symptoms of the same disorder. Children are typically diagnosed based on symptoms they show at home or in the classroom. This lack of knowledge among parents and teachers could be the reason girls are often overlooked.

As girls grow into women, their symptoms can change even more and sometimes become more severe. These symptoms can make daily tasks incredibly overwhelming and are a key reason why women seek out medical help. Understanding ADHD in women and recognizing symptoms early can help women gain more control over their mental health and minimize the risk of side effects later in life

What is ADHD?

ADHD is a common mental disorder that creates a consistent pattern of inattention and/or hyperactivity and impulsivity both in children and adults(3). In most people, symptoms are revealed when children start school and can continue well into adulthood.

Children with ADHD tend to be more hyperactive and less attentive than other kids in their age group. They often struggle with tasks like chores or classwork and struggle in social situations. These symptoms are mostly visible in a classroom setting which is why teachers are usually the ones to notice this behavior first and recommend a child be tested for ADHD(3).

Children who show ADHD symptoms are medically evaluated for vision and hearing issues first to rule out other medical conditions. They are then diagnosed based on information from parents and teachers in aquestionnaire. There is no lab test to diagnose ADHD.

In many cases, people assume children are acting out or simply unable to understand directions, causing ADHD to be diagnosed later in life(3). Since they have experienced symptoms for the majority of their lives, many adults with ADHD may not even realize they have the disorder and never seek help even if they are struggling.

Researchers claim that the majority of women do not share their struggles and instead believe they need to push past them. Women with ADHD often seek medical help with complaints of feeling overwhelmed, exhausted and out of control of their daily lives (4).

Still, women’s symptoms are often overlooked possibly because they are more successful at hiding their ADHD and internalizing their feelings. For example, a woman with ADHD could struggle to keep up with daily tasks and although she completes everything, most of her free time is spent trying to “get organized”(4).

Similar to diagnosing children, mental health professionals review past and present symptoms and conduct a medical exam before referencing a checklist of symptoms for ADHD. Both children and adults are often treated with medication, psychotherapy or a combination of the two. Some doctors may also recommend adults learn behavior management skills which can help them manage ADHD symptoms by minimizing distractions and becoming more organized(3).

While there is no identified cause for ADHD, some research shows the disorder can be genetic. Studies show three out of four children with ADHD have a direct relative with the same disorder. Some researchers believe that prenatal smoking, stress or alcohol consumption as premature birth or brain injury can also cause ADHD(3).

Symptoms of ADHD

Symptoms need to occur for more than six months to be considered ADHD. The disorder is diagnosed through a checklist of three categories: inattentive type, hyperactive/impulsive type or combination of the two, as referenced by the infographic below(3).

This checklist is mostly used to diagnose children since this is when most people are diagnosed; however, adults are subject to the same criteria. According to the Center for Disease Control, the following conditions also have to be met in addition to the symptoms above(4):

• The person showed several inattentive or hyperactive-impulsive symptoms before age 12.
• The symptoms above are present in two or more settings such as both at home and at school or work.
• The symptoms interfere with the person’s daily life and reduce their quality of interactions in school, work or at home.
• There is no other medical reason for the symptoms such as a mood, anxiety or personality disorder.

Symptoms of ADHD in women

Women are tested with the same criteria as above but often show additional symptoms that are overlooked or attributed to other conditions. Women with ADHD can also show

• Emotional reactivity.
• Decreased self-esteem.
• Academic difficulties or struggles in the workplace.
• Risky behavior such as drug or alcohol abuse.

These symptoms can also be linked to anxiety disorders or depression which can actually be driven by internalizing ADHD (5). Some women can also show symptoms for obsessive-compulsive behavior and perfectionism as a result of coping with ADHD which mental health professionals can be misdiagnosed as obsessive-compulsive disorder and delay treatment for ADHD.

How is ADHD different in men and women?

Women may show fewer symptoms than men, but they are just as impaired by this disorder.

As children, girls are more likely to appear inattentive or unfocused rather thanhyperactive like boys. A girl with ADHD is also more likely to interrupt impulsively during a class or conversation. Boys may leave their seats often while girls express their restlessness verbally(1).

Studies show that physical aggression is more apparent in boys rather than girls with ADHD(5). Therefore, many teachers and parents see the boys’ symptoms more clearly while girls may not show as much disruptive behavior outloud but are experiencing the same issues. This results in more boys receiving referrals for ADHD testing than girls.

As adults, women may hide their struggles in the workplace and instead put in extra hours to complete tasks. Men, on the other hand, may be more impulsive and interrupt during meetings or avoid certain tasks. If not diagnosed and managed, ADHD can lead to performance issues at work for both men and women that can negatively impact a company’s overall performance.

Hormone function in ADHD

Some studies show that hormones play a role in the expression of ADHD symptoms, especially in girls and women. Estrogen hormones, which help regulate the female reproductive system, play a significant role in developing midbrain dopamine neurons. These neurons control voluntary movement, reward processing and working memory. Studies show that those with ADHD have slightly lower functioning dopamine neurons in the brain, contributing to impulsivity and lack of focus. Certain steroid medications, antibiotics and contraceptives can increase estrogen levels and therefore affect focus, mood and memory(5).

Commonly found in female contraceptives, estradiol (a form of estrogen) and progesterone can interact with dopamine neurons and affect decision-making as well as emotional and social behavior. Researchers suggest that fluctuations in these hormones can affect existing conditions in women with ADHD(5).

Studies also show that overall healthy children with higher thyroid-stimulating hormone levels are more likely to exhibit ADHD symptoms. Women are also more likely to have thyroid disorders than men (5).

Hormones can be imbalanced by medical conditions, diet, medication or environmental factors. Eating foods that naturally contain certain nutrients and taking supplements likeashwagandha can help maintain healthy hormone levels.* While more studies need to be conducted on the role of hormones in ADHD, early research shows that maintaining balanced hormones could have positive effects.

Women are diagnosed with ADHD later in life

As adults, women with ADHD are more likely to develop issues such as anxiety and depression. They’re also more likely to exhibit high-risk behaviors as they age if their conditioan remains undiagnosed. One study showed teenage girls with ADHD developed more emotional problems and engaged in smoking and alcohol abuse(1).

Other risks of undiagnosed ADHD in women include overeating, chronic sleep deprivation and mood swings. While men with ADHD are also susceptible to depression and anxiety disorders, women are more prone to psychological distress and have lower self-image than men (6).

Currently, few medical professionals specialize in women with ADHD which makes receiving an accurate diagnosis and treatment for this disorder more challenging.

Treatment

Treating ADHD in women specifically includes medication, psychotherapy, stress management and potentially working with a life coach.

Medications, however, can affect hormone fluctuations across the menstrual cycle which can make symptoms more difficult to control. Since ADHD symptoms can increase as estrogen levels decrease, women may have changes in symptoms during puberty, menstrual cycles, perimenopause and menopause. Working with a medical professional who understands ADHD in women is essential to getting the proper treatment(6).

For women who may be diagnosed with ADHD or struggling with symptoms, there are steps to help ease symptoms:

• Seek out medical help from a licensed practitioner who specializes in women with ADHD.
• Learn to accept your ADHD challenges and avoid judging or blaming yourself.
• Identify stress in your daily life and look for ways to lower stress levels.
• Ask for support from friends and family in developing structure.
• Schedule time for yourself to decompress throughout the day.
• Develop healthy self-care habits including getting enough sleep, exercise and a healthy diet.
• Consider taking natural supplements to boost brain function or help with sleep or anxiety.

In Summary

Men and women have different needs when it comes to managing ADHD challenges. This disorder could have significant effects on mental health and result in other conditions if not diagnosed and managed properly, including depression and anxiety. For women in particular, it’s important to receive an accurate diagnosis and work with a professional who specializes in female ADHD in order to develop a treatment plan. Getting support from coworkers, family and friends is also essential as this will create an environment that is supportive(6). It’s important that healthcare professionals generate more awareness on the appearance of ADHD in women to diagnose the disorder as quickly as possible and help women get the treatment they need.

Regina Kaza - Contributing Writer, Physician's Choice