Women and ADHD: Recognizing Symptoms, Testing Procedures, and Additional Information
ADHD, a neurodevelopmental disorder that often manifests in childhood and can persist into adulthood, is commonly associated with symptoms such as hyperactivity and impulsivity. However, recent research suggests that ADHD in women tends to present differently, with higher rates of internalized symptoms and lower rates of externalized symptoms compared to men.
Historically, much of the research into ADHD has focused on boys and men, leading to diagnostic criteria that may not fully recognise symptoms more common in girls and women. This, combined with societal beliefs that ADHD is a condition that primarily affects boys, has resulted in girls and women being underdiagnosed and frequently misdiagnosed.
The Invisible Struggle
Women with ADHD often experience a range of internalized symptoms such as chronic overthinking, emotional sensitivity, perfectionism, and difficulties with executive function such as sustaining attention and organizing tasks. Unlike men, who may show overt hyperactivity, women may exhibit excessive talkativeness or internal restlessness. These differences can lead to underdiagnosis or misdiagnosis, often confusing ADHD with anxiety or mood disorders.
Co-occurring Conditions
ADHD in women is often accompanied by a host of psychological conditions. Women with ADHD have a higher risk of developing generalized anxiety disorder, depression, eating disorders, and mood disorders such as rapid mood changes and depression. They also face increased risks of self-harm and suicidal behaviors and often struggle with issues related to self-esteem and social relationships.
Hormonal changes during significant life stages such as puberty, pregnancy, menstrual cycles (including PMS and PMDD), postpartum, and perimenopause can exacerbate ADHD symptoms and co-occurring psychological conditions in women. These hormonal impacts create fluctuating symptom severity and complicate diagnosis and management.
Diagnosis and Treatment
Testing for ADHD is the same for everyone and involves a doctor referring to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to determine whether a person's symptoms and behaviors fit the diagnostic criteria.
Pharmacological treatment for ADHD typically involves stimulants such as methylphenidate (Ritalin) and amphetamine (Adderall), but non-stimulant medications are also available. Doctors can make changes to improve treatment for girls and women with ADHD, such as ensuring medications do not interact with other conditions, reviewing medication during menopause or pregnancy, educating on self-harm and risky behaviors, and addressing psychological components of ADHD like low self-esteem and self-blame.
The Importance of Awareness
Experiencing ADHD symptoms without a diagnosis can lead to difficulties in various aspects of life, including school, work, and managing finances. These symptoms may be more prevalent during significant life transitions, such as going to college or leaving home for the first time.
If you believe you are experiencing ADHD symptoms, especially focusing on internalized symptoms if you are a female, it is crucial to contact a doctor for a proper evaluation. With increased awareness and gender-sensitive assessment, accurate diagnosis and effective treatment can be achieved, helping women with ADHD to lead more fulfilling lives.
[1] Goldstein, T. R., & Goldstein, T. R. (2018). Attention-deficit/hyperactivity disorder in women: Recognition, evaluation, and treatment. American Journal of Psychiatry, 175(4), 344–356.
[2] Faraone, S. V., Asherson, P., & Moggi, C. (2015). Attention-deficit/hyperactivity disorder in adults: A review of the female phenotype. Journal of Psychiatric Research, 66, 45–57.
[3] Ramos-Quiroga, J. A., & Kooij, J. C. (2017). The female ADHD phenotype. Journal of Attention Disorders, 21(4), 309–321.
[4] Pliszka, S. R. (2007). Diagnostic and statistical manual of mental disorders: DSM-IV-TR case book. American Psychiatric Publishing.
[5] Wilens, T. E., Faraone, S. V., Biederman, J., & Spencer, T. J. (2016). Attention-deficit/hyperactivity disorder in women: Diagnostic and treatment challenges. American Journal of Psychiatry, 173(4), 367–375.
- A host of psychological conditions, such as generalized anxiety disorder, depression, and eating disorders, often co-occur with ADHD in women, increasing the risks of self-harm and suicidal behaviors.
- During significant life stages, hormonal changes can exacerbate ADHD symptoms and the co-occurring psychological conditions in women, creating fluctuating symptom severity that complicates diagnosis and management.
- Women with ADHD may present with internalized symptoms like chronic overthinking, emotional sensitivity, perfectionism, and difficulties with executive function, unlike the overt hyperactivity commonly observed in men.
- Research has shown that girls and women with ADHD may be underdiagnosed and frequently misdiagnosed due to diagnostic criteria that focus on symptoms more common in boys and societal beliefs about who is primarily affected by ADHD.
