What does ADHD look like in women?

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Verfasst von Kate
Dr. Katharina Repnik (ADHS Coach und Beraterin) zeigt: ADHS bedeutet auch frei sein!

What is ADHD?

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common (prevalence up to 8%) neurodevelopmental disorder that starts during childhood and often persists into adulthood. It is characterised into three subtypes:

  1. Predominantly Inattentive Presentation: Individuals with this type struggle to organise tasks, pay attention to details, and follow instructions. They may be easily distracted and forget daily routines.

  2. Predominantly Hyperactive-Impulsive Presentation: These individuals exhibit excessive fidgeting, talkativeness, and restlessness. Sitting still for extended periods is challenging, and impulsivity leads to interrupting others or taking unnecessary risks.

  3. Combined Presentation: This type involves a mix of inattentive and hyperactive-impulsive symptoms.

The exact cause of ADHD remains unknown, but genetics play a significant role. Other factors being studied include brain injuries, environmental risks (such as lead exposure during pregnancy), and alcohol/tobacco use during pregnancy. 

There is a persistent myth that ADHD affects only young boys. However, many women in their 30s and 40s today are being diagnosed with ADHD. This article focuses on the presentation of ADHD in girls and women.



What are common symptoms of ADHD in women?

Whilst women can have any subtype of ADHD, the inattentive presentation is most common in women. 

Here are some common symptoms experienced by us women with ADHD:

  1. Struggling with Time Management: Our busy lives demand a lot of planning and efficient scheduling, yet many women find themselves wrestling with time management. From juggling appointments to meeting deadlines, the constant battle to stay on track can feel overwhelming.

  2. Disorganisation: Ever feel like your to-do list has a mind of its own? You're not alone. For women with ADHD, maintaining order and structure can feel like an uphill battle. Tasks pile up, and before you know it, chaos is back.

  3. Feeling Overwhelmed: It's not just about the tasks at hand—it's about the mental load that comes with them. Psychological distress, feelings of inadequacy, and chronic stress often accompany ADHD in women, leaving them feeling like their lives are spinning out of control.

  4. History of Anxiety and Depression: The struggle doesn't stop at ADHD. Women with ADHD are more likely to grapple with anxiety and depression, adding another layer of complexity to their diagnosis and treatment journey.

  5. Symptoms of Inattention: Focus, attention to detail, organisation—these are the cornerstones of productivity, yet for many women with ADHD, they remain elusive. Inattentive ADHD makes it hard to stay focused, listen, and remember things, leaving women feeling frustrated and misunderstood.

  6. Verbal Aggression: While some may associate ADHD with physical outbursts, for many women, it's the verbal aggression that takes centre stage. Words can be just as powerful as actions, and women with ADHD often find themselves struggling to tame their tongue.

  7. Low Self-Esteem: It's hard to feel confident when you're constantly battling against your own mind. From struggling to keep up with daily tasks to feeling like you're falling short in every aspect of life, many women with ADHD find themselves grappling with low self-esteem.

  8. Anxiety: It's the constant companion of ADHD—the knot in your stomach, the racing thoughts, the overwhelming sense of dread. Anxiety and ADHD often go hand in hand, amplifying feelings of overwhelm and stress for women trying to navigate their way through life.

Remember that ADHD symptoms in girls and women are sometimes mistaken for personality traits rather than signs of a condition. Seeking professional evaluation is crucial for accurate diagnosis and effective management.



Challenges in recognising ADHD in Girls and Women - hidden ADHD

An ADHD diagnosis in girls and women is difficult.

Here is why:

Subtle Symptoms: Girls with ADHD tend to exhibit internalised symptoms that are less noticeable and overt. Unlike boys, who may display hyperactive or disruptive behaviour, girls often appear distracted, dreamy, or forgetful. It often seems these girls are living in their own imaginative world.

However, girls are more likely to develop coping strategies to cover up their symptoms. For example, they might read ahead in class but consistently fail to complete homework or sit quietly while doodling instead of paying attention. They might also be interested in certain subjects and hyperfocus in those areas where they may then receive higher grades.

Parents, educators and teachers are less likely to refer girls for diagnosis and treatment, assuming their behaviour is within the normal range. As a result, many girls with ADHD don’t receive the right support to the detriment of the girl’s mental health also later in life. Societally, girls are also more expected to just cope better, as they are seen as emotionally more mature in many ways.

Stereotypes frame ADHD as primarily affecting boys. While boys have a higher chance of receiving an ADHD diagnosis, this doesn’t necessarily mean they are more likely to have the condition. Girls often slip through the diagnostic net due to these old and outdated stereotypes.

Instead of being outwardly disruptive, girls may struggle internally. They might be called “chatterboxes” by adults, but their symptoms remain less obvious.

Recognising ADHD in girls is crucial for providing appropriate support and preventing long-term challenges in adulthood.

Hormones and ADHD in women

A life with ADHD - for a woman this means playing “Rollercoaster Tycoon” on steroids without a joypad or a controller. As women undergo many hormonal fluctuations throughout their lives - puberty, early adulthood, childbirth, postpartum, perimenopause and menopause - the symptoms of ADHD are often intensified. Hormones as well as ADHD directly impact emotional regulation of women, but neither can be directly controlled by a woman herself. This can make the experience of living with ADHD like a constant battle you’re bound to lose.

Let’s explore how hormones intersect with ADHD at different stages:

ADHD in Puberty

  • Puberty is a time of abundant change and emotional irregularity due to surging hormones. For girls with ADHD, these hormonal fluctuations can worsen symptoms.

  • Oestrogen, the primary sex hormone in those assigned female at birth, plays a crucial role. It affects neurotransmitters like dopamine, serotonin, and norepinephrine, which influence memory, focus, and mood, and are already impacted by having ADHD.

  • During puberty, oestrogen levels rise and fall monthly, potentially intensifying ADHD symptoms.

ADHD and the Menstrual Cycle

  • A woman’s menstrual cycle involves significant hormonal shifts. While the exact connection between sex hormones and ADHD remains unclear, some women report changes in symptoms during different phases of their cycle.

  • Oestrogen levels impact attention, executive thinking, and mood. Higher oestrogen levels may improve cognitive function, while lower levels can worsen ADHD symptoms 

ADHD during the Reproductive Years

  • Throughout a woman’s reproductive years, oestrogen levels constantly fluctuate. These variations can influence how ADHD symptoms are experienced and managed.

  • Women with ADHD may find that their symptoms ebb and flow with hormonal changes, affecting focus, impulsivity, and emotional regulation.

ADHD during Pregnancy

  • During pregnancy, massive hormonal shifts occur, as the female body prepares for child birth. These will be affecting neurotransmitter balance. Some women experience changes in ADHD symptoms, while others find relief.

  • Balancing ADHD management and pregnancy-related challenges is essential for maternal wellbeing, but also very difficult. Additionally, the notion of “becoming a good mum” drives many women with ADHD to immense internal pressure, such as having to read all the pregnancy literature there is, or taking courses.

(Peri-)Menopause and ADHD

  • Perimenopause and menopause bring their own package of hormonal changes. Oestrogen levels decline, impacting cognition, mood, and memory.

  • Women with ADHD may face challenges during menopause, including increased forgetfulness, mood swings, and cognitive fluctuations.

In summary, understanding the complex interplay between hormones and ADHD is crucial for tailored management strategies across a woman’s lifespan. However, more research in this area is still needed, which makes it vital for each woman to become aware of changes and seek support when needed. Seeking professional guidance and support can help navigate these complexities.

ADHD Comorbidities and Coexisting Conditions

Women with ADHD often face additional challenges due to the presence of comorbidities, or co-occurring mental health conditions. Some of the most common comorbidities in women with ADHD are anxiety, depression, eating disorders, and substance use disorders. But also traumatic experiences or complex trauma impact the development of ADHD. These conditions can exacerbate the symptoms of ADHD, such as inattention, impulsivity, and hyperactivity, and interfere with the quality of life, academic performance, and social relationships of women with ADHD. 

Therefore, it is important to address these comorbidities in a comprehensive and holistic manner, using a dual diagnosis approach that considers both the ADHD and the comorbid condition. A dual diagnosis approach may involve a combination of medication, psychotherapy, behavioural interventions, and lifestyle changes, tailored to the specific needs and preferences of each female with ADHD. By addressing the comorbidities in women with ADHD, the goal is to improve their overall well-being and functioning, and to help them achieve their full potential. That being said, it can often be difficult to disentangle that beneath these more obvious conditions lies also ADHD. Thus, many women are often treated for “wrong” thing first, when in fact co-occurring mental health conditions often arise due to undiagnosed ADHD.

Why is ADHD diagnosed late in women?

Women with ADHD often face difficulties in getting an accurate diagnosis, as their symptoms may not match the typical profile of ADHD that is based on male samples. For example, women may show more inattentive and less hyperactive or impulsive behaviours, which can be overlooked or attributed to other factors, such as personality, mood, or motivation. 

Additionally, women may face referral bias, as they are less likely to be identified and referred for evaluation by teachers, parents, or health professionals, who may have lower awareness or expectations of ADHD in women. 

Referral bias is the tendency to overlook or misinterpret the symptoms of ADHD in women, leading to underdiagnosis or misdiagnosis. Referral bias occurs when teachers, parents, or health professionals fail to recognize or refer women with ADHD for evaluation, due to differences in symptom presentation, gender stereotypes, or low awareness of ADHD in women. As a result, many women with ADHD remain undetected or mislabeled, and miss the opportunity to receive appropriate care and support. 

Comorbidities are common in women with ADHD, and include anxiety, depression, eating disorders, substance use disorders, and suicidal behaviour. These conditions can make it harder to diagnose ADHD, as they may mask or mimic the symptoms of the disorder. They can also interfere with the effectiveness of treatment, as they may require different or additional interventions. Moreover, they can increase the severity and impairment of ADHD, as they may affect various aspects of life, such as self-esteem, relationships, academic performance, and health. Therefore, it is important to identify and address both referral bias and comorbidities in women with ADHD, in order to improve their access to care and quality of life.

“ADHD is not just a small boy thing.”

Every woman with ADHD.

If you are struggling with the management of your ADHD symptoms, have received a recent diagnosis and don’t know where to start, or just need an open ear and heart from someone, get in touch with Dr. Kate Repnik for a free consultation.

Kate

ADHD Coaching for creative and successful women

https://unfoldwithkate.com
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