ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental disorder characterized by interference in the normal functioning of daily life due to symptoms of inattention, impulsivity, and hyperactivity. Most commonly, it gets diagnosed in children when the parents or teachers notice the symptoms, but it is also seen in adults.
Undiagnosed ADHD in Women
Women with Attention Deficit Hyperactivity Disorder often stay undiagnosed during their lifespan because their symptoms are not as disruptive as those in men (1). Moreover, traditionally it was considered that ADHD affects more men than women (2).
The presentation of symptoms in men and women with ADHD is significantly different. The symptoms of ADHD have three presentations, i.e. attentive, hyperactive-impulsive, and a combination of the two. Most males have hyperactive/impulsive ADHD. It makes them fidgety, disruptive, restless, and impatient. They are always on the go. However, women tend to have inattentive ADHD, which makes it hard for them to focus on little details, stay organized, and take care of belongings. The hormonal changes during menopause adversely affect the symptoms of ADHD due to decreased estrogen levels.
The Centers for Disease, Control and Prevention (CDC) reports that men are more likely to develop ADHD than females. The research has proved that this disparity is not because males are more susceptible to ADHD, but because females remain undiagnosed (4).
Studies have also shown that adolescent females have fewer coping mechanisms and low self-esteem than boys. Girls usually have less externalizing symptoms, including aggression, while having more anxiety and depression (5). Females tend to show more verbal aggression, whereas men show more physical aggression.
Why Is ADHD Underdiagnosed/Misdiagnosed Women?
The symptoms of ADHD in women are usually characterized as personality traits. A girl who talks too much is considered chatty, a girl who forgets things is considered forgetful and a girl who is always daydreaming is considered spacey.
Later in life when a woman reaches out for her symptoms, she is diagnosed with depression, anxiety, or other mental health disorders. The latest research has shed light on the reasons for the under-diagnosis of ADHD in women. As a result, more women can get the help that they need. Women, with ADHD, often find it difficult to cope with their life, and they usually think that their life is very chaotic. Sometimes even daily tasks seem impossible to them, and they are unable to fill their role as caretakers.
Symptoms and Signs of ADHD in Women
Symptoms of adult ADHD appear in different contexts of life. They may get exaggerated at work or home. Most women feel that they have to put in a lot of effort to look normal and do normal things.
The symptoms of inattention include the following:
- ADHD makes completing tasks difficult. For example, schoolwork or office work. A person with ADHD often makes careless mistakes and overlooks small and important details.
- A person struggling with ADHD has difficulty in time management. They are often late for school, work, or social engagements. They often forget appointments, spend a lot of time procrastinating, and have a very hard time meeting deadlines.
- A person with ADHD is prone to forgetting things. They often misplace or lose keys, cards, phones, and wallets. They have inferior organizational skills. Hence, they have a cluttered home, office, cabin, and car.
- ADHD people find it very difficult to listen to others with concentration and focus. They quickly lose track of what they’re being told. It is hard for them to follow conversations and stay on them.
- ADHD people have a very hard time focusing on the task at hand. They get distracted very easily and they are often found daydreaming.
- They are often compulsively checking their social media, and text messages when they’re struggling to focus.
- The other side of the coin is that people with ADHD hyperfocus on some tasks. These tasks usually contain something that they find stimulating.
Hyperactivity/impulsivity includes the following.
- Fidgeting, squirming, tapping hands and feet.
- Difficulty in sitting still
- Feeling agitated and impatient in lines where they have to wait.
- Having a chain of thoughts all at once, racing through the mind.
- Excessive talking.
- Obsession with social media.
- Easily bored.
- Seeking stimulating activities
The symptoms of impulsive type ADHD are as follows
- Impulsive shopping can result in financial problems
- Blurting out responses.
- Finishing other people’s sentences.
- Interrupting others while they’re trying to finish a task
- Impulsive remarks or behavior
- Risky sexual behavior, results in unwanted pregnancy and sexually transmitted diseases.
- Impulsive driving can risk the life
Women with ADHD are often described as tomboys while growing up because of their excessive energy. Growing up, it is difficult to make friends because people find it hard to keep up with excessive talking, mood swings, and impulsive habits.
On the other end of the spectrum, instead of being talkative, a woman may be very recessive. She may dislike going to parties or other social engagements because she feels shy and overwhelmed. She might find it hard to stay in the conversation because her mind drifts off.
Comorbidity in Women Dealing with ADHD
Since most women have ADHD, it leads to the development of other disorders in them. Some of these disorders include the following:
- Anxiety: There are so many overlaps in symptoms between ADHD, and anxiety, that it gets difficult to differentiate between the two. Some of these symptoms include restlessness, lack of concentration, and sleeping problems. The difference between the two is that forgetfulness, and fidgeting are not associated with any anxiety in ADHD. In anxiety disorders, a person is consistently worrying.
- Depression: The inattentive type of ADHD has symptoms that overlap with depression, including unmotivated behavior, and forgetfulness. The depressive disorders, however, are long-lasting.
- Eating Disorders: Men and women both are at risk of developing eating disorders with ADHD, but women are more susceptible to this particular disease. Women have a higher incidence of bulimia, nervosa, and anorexia nervosa. The unhealthy eating habits are mostly associated with impulsive behavior. These eating habits also make the symptoms of ADHD worse.
- Self Harm: Nonsuicidal self-injury is also common in young girls, struggling with ADHD. It includes self-cutting, burning, scratching, or similar harmful behaviors. It can also lead to behaviors like alcohol abuse, and substance use and abuse.
- Mood disorders
- Other mental health disorders and disability
Coping Strategies and Tips for Women Dealing with ADHD
If you feel that you have symptoms of ADHD, you should immediately go to a doctor to get a professional diagnosis or referral. There are various treatment options available for ADHD.
Apart from medical intervention and psychotherapy, you can take control of your health by improving your lifestyle and inculcating some useful habits in your daily life. Some of these coping strategies are given below:
Physical activity not only alleviates the mood and boosts energy, but it also controls the symptoms of ADHD. Regular exercise and meditation relieve neurotransmitters like dopamine, which improves attention and focus span. For people who experience symptoms of hyperactivity, exercise plays a very crucial role in burning off excessive energy.
- You can do 4 to 5 sessions of exercise per week.
- Going to the gym is not necessary.
- Going out for a brisk walk, running, or doing yoga can do the trick easily.
- You can also take up swimming, pilates, or start playing a sport.
Instead of listening to music during exercise and yoga, try being hyper-focused on your body movements. It will help you stay in the present moment and improve your focus.
Mindfulness is very effective in improving focus, attention, and ability to resist distractions. It also reduces impulsivity and helps a person in managing his emotions. For women who have hyperactivity symptoms, meditation becomes a little difficult. So you can start with short-term meditation and then build up on it. The more you practice meditation, the better you will become and regulate your emotions, blocking all distractions, and keeping your body and mind calm.
Although nutrition and food have nothing to do with the symptoms of ADHD. However, it is seen that some things make the symptoms of impulsivity and restlessness worse.
- Aim for a balanced diet that contains a lot of food and vegetables along with healthy fats and proteins.
- Avoiding foods that are high in sugar and carbohydrates has a positive impact on the symptoms of ADHD.
- Eating several small portions throughout the day is healthier than taking less large portions to maintain energy levels throughout the day.
- Avoiding caffeine can also help with the symptoms of hyperactivity because it causes irritability, nervousness, and anxiety.
Disorganization can be dealt with by taking calculated steps.
- You can break down large tasks into smaller parts and focus on one part at a time.
- Start organizing your office or home one item at a time. For example, you can start by sorting out your clothes and then move on to the next things. Staying conscious of your habits helps in better organization.
- Make a to-do list daily and allocate time to perform each task.
Insomnia and Sleep Problems:
Not getting a good night’s sleep also makes the symptoms of ADHD worse. The sleep problems get worse with age in ADHD women. Good sleep hygiene is necessary for repressing ADHD symptoms.
- Establish a regular sleep time.
- Do not eat large meals before going to bed.
- Limit screen time before bed.
- Sleep in a dark, cool atmosphere.
- Use a weighted blanket if it helps you.
- Go for a walk in the morning or before going to bed.
Diagnosis of ADHD
ADHD is diagnosed by psychologists, and psychiatrists. It does not have any medical testing.
According to the American Psychiatric Association, to be diagnosed with ADHD children should have had at least six symptoms for at least the previous six months, and adults above 17 should have had at least 5 symptoms for the past six months following DSM – 5 criterion. Depending upon the type of symptoms, the patient is diagnosed as predominantly inattentive, predominantly hyperactive, or combined type ADHD. Additional criteria for diagnosis include
- Children should have some symptoms before age 12.
- Symptoms should be present in at least two settings like office, home, social gatherings, etc.
- The symptoms are strong enough to interfere with the normal functioning of life.
- Other mental health disorders should be ruled out.
Treatment of ADHD
If you’re diagnosed with ADHD, your clinician will discuss comprehensive treatment options with you. According to the CDC, the ADHD treatment plan includes behavior, therapy, medications, and lifestyle modification.
ADHD not only affects the ability to focus, but also interpersonal relationships. The behavior of an ADHD adult can be very distressing for those around him. Behavior therapy helps in reducing and coping with those behaviors. The goal of this therapy is to reinforce positive behavior and eliminate problematic actions. Behavior therapy for ADHD children includes
- Patent training.
- Behavior therapy with the child
- Behavioral intervention in the classroom
- Cognitive behavioral therapy
Patients can join different support groups to cope with the symptoms of ADHD.
Medications can also help manage the symptoms from day-to-day life. FDA-approved medications include both stimulant medications and non-stimulant medications. Medications alone are not able to treat ADHD.
ADHD in females remains undiagnosed due to less disruptive symptoms. Females with ADHD are often diagnosed with anxiety or depressive disorders. Increasing research has made it possible to be vigilant about ADHD diagnosis in women. Lifestyle changes, along with cognitive behavioral therapy (CBT) and medications help with the symptoms of adult ADHD.
- Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of Attention Disorders, 27(7), 645–657. https://doi.org/10.1177/10870547231161533
- Cortese, S., Faraone, S. V., Bernardi, S., Wang, S., & Blanco, C. (2016). Gender differences in adult attention-deficit/hyperactivity disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The Journal of Clinical Psychiatry, 77(4), e421–e428. https://doi.org/10.4088/JCP.14m09630
- Quinn PO, Madhoo M. A review of attention-deficit/hyperactivity disorder in women and girls: Uncovering this hidden diagnosis. Prim Care Companion CNS Disord. 2014;16(3). doi:10.4088/PCC.13r01596
- Skogli EW, Teicher MH, Andersen PN, Hovik KT, Øie M. ADHD in girls and boys – Gender differences in co-existing symptoms and executive function measures. BMC Psychiatry. 2013;13(1):298. doi:10.1186/1471-244X-13-298
- Rockledge JJ. Gender differences in attention-deficit/hyperactivity disorder. Psychiatr Clin North Am. 2010;33(2):357-73. doi:10.1016/j.psc.2010.01.006