ADHD, or attention deficit hyperactivity disorder, is the single most common neurodevelopmental disorder among children today, affecting up to 7% of all children worldwide. Despite this, countless individuals go undiagnosed well into adulthood, so much so that an estimated 80% of adults with ADHD do not have a proper diagnosis.
In no demographic is this more represented, however, than in women. In the 21st century, studies show that many women do not receive a formal ADHD diagnosis until their 30s or 40s, which can have profound effects on quality of life, success, and self-esteem.
While new research has begun closing this diagnostic gender gap, the best tool for helping girls and women with ADHD is education. To help, we've compiled some of the most important information to know about ADHD in women, how to spot potential symptoms, and how the disorder differs for women compared to men.
Understanding ADHD in Women
When talking about ADHD in women, it's crucial to first understand the history of attention deficit hyperactivity disorder and the objectively male lens through which it has been studied and treated.
Today, for instance, boys are diagnosed at roughly three times the rate as girls, despite the fact that the condition is diagnosed equally among adults, regardless of gender. Rather than meaning that men develop ADHD more commonly than women, this suggests that ADHD in males is simply more recognized by mental health professionals.
According to experts, this tendency for female ADHD to go under-diagnosed is due to several factors. First, many studies into ADHD used a disproportionate number of male subjects to conduct research, meaning that female-specific symptoms or behaviors often went overlooked or unrecognized. This tendency, known as "referral bias," in turn meant that diagnostic criteria for ADHD overwhelmingly focused on male symptoms.
Secondly, much of the existing research suggests that women with ADHD typically present with more inattentive symptoms, which can be more difficult to accurately diagnose than hyperactive or impulsive symptoms. Not only does this mean that women have historically struggled to obtain a proper ADHD diagnosis, but they also may have been misdiagnosed with other mental health conditions, such as anxiety or depression.
Finally, many experts believe that women and girls are more likely to develop effective coping mechanisms early on in life. While this may mean that women with ADHD can "handle" symptoms better, it may also mask certain behaviors in a way that makes them less noticeable and, therefore, less likely to result in a formal diagnosis.
What Are Common ADHD Symptoms in Women?
Although some research shows that women are more likely to display inattentive ADHD than other presentations of the disorder, this is only relative to men with ADHD. That said, it's important not to discount any potential symptoms of ADHD when pursuing a diagnosis.
Predominantly Inattentive Symptoms
- Difficulty paying attention to conversation
- Difficulties with organizational tasks or systems
- Stopping a task or project partway through
- Frequently misplacing important items (keys, ID, etc.)
- Failing to meet professional, academic, or personal deadlines
- Sensitivity to noise
Predominantly Hyperactive-Impulsive Symptoms
- Mood swings
- Inappropriate spending
- Risk-taking behaviors
- Substance misuse
- Binge eating
When referring to ADHD, combined symptoms simply mean that an individual displays both inattentive and hyperactive-impulsive symptoms in relatively equal amounts, though this can vary greatly from case to case. The combined presentation of ADHD is, by far, the most commonly diagnosed in adults today, regardless of gender.
Additional Indications of ADHD in Women
Due to the historical lack of women’s representation in ADHD research, the general public may often overlook or dismiss potential signs of ADHD in women that they would more readily recognize in men. When evaluating whether you might have an undiagnosed case of ADHD, there are several other signs and indications to consider.
In girls and women, ADHD can often come along with complications in platonic and romantic relationships. Most troublingly, some studies have shown that almost 31% of women with childhood ADHD will experience intimate partner violence during their lifetimes, compared to roughly 6% among women not diagnosed with ADHD.
Additionally, experts say that women with ADHD frequently become sexually active at a younger age, a fact which may put them at greater risk for abuse from potential partners due to social and interpersonal pressures.
Beyond romantic relationships, women with ADHD tend to struggle with making or maintaining friendships. Depending on a woman's symptoms, this can be due to so-called "abrasive" personality traits (too loud, impulsive, etc.) or difficulties staying present and active in conversations or social settings (distracted, distant, etc.).
When mental health professionals diagnose ADHD, they sometimes look at how potential symptoms have affected an individual’s life rather than just the symptoms themselves. Often, unaddressed ADHD can be seen in lifestyle indicators such as the following:
Perhaps one of the most overlooked effects of ADHD on women's day-to-day life is its potential to negatively impact finances. Depending on the severity of certain symptoms and other considerations, this impact can profoundly damage a person's long-term financial health and security. Specifically, many women with predominantly inattentive ADHD who struggle with organizational tasks, such as building and maintaining a budget, may find it more difficult to manage their money.
Conversely, those with predominantly hyperactive-impulsive symptoms may find themselves at risk for unsustainable impulse spending or "splurging."
In a survey of working American adults, researchers found that professionals with ADHD were a staggering 60% more likely to be fired during their careers. For many, this statistic can be attributed to difficulties related to unmanaged or poorly managed ADHD symptoms, such as difficulty focusing at work or failing to meet project deadlines.
Compounding this issue are the frustration and self-doubt that often come along with unmanaged ADHD, both of which can contribute to feelings of dissatisfaction or frustration in a professional environment.
While the negative impact of ADHD on children's learning is well-recognized by the general public, many still fail to understand the ways in which adult ADHD can similarly complicate higher education. Especially for women with untreated or undiagnosed ADHD, inattentive ADHD can make studying, test-taking, or even following along during lectures much more difficult.
According to studies conducted by the American Psychiatric Association, up to 80% of people diagnosed with ADHD will also be diagnosed with one or more other mental disorders in their lifetimes. While these statistics hold relatively true across genders, it's important to remember that your ADHD diagnosis may only be one step in a larger journey of self-exploration and development.
Based on the most recent understanding of ADHD, the most common mental health conditions that may accompany ADHD in women are:
Between an outdated understanding of gender differences in mental health, comorbidity rates, and the tendency for symptoms to overlap, ADHD and depression are closely related—especially in women. Specifically, large-scale studies have established that individuals with ADHD are almost twice as likely to experience a depressive episode and almost four times as likely to attempt suicide.
Even compared to other common mental disorders, individuals with ADHD are most likely to be misdiagnosed with major depressive disorder. Because of this tendency to confuse ADHD with depression, the average person with ADHD is prescribed roughly 2-3 different antidepressants before obtaining a proper ADHD diagnosis, which itself can be delayed by seven or more years due to misdiagnoses.
In young girls especially, who often show more signs of anxiety, an anxiety disorder can further complicate a proper diagnosis of ADHD. All too often, mental health professionals attribute symptoms of ADHD solely to anxiety, meaning that many girls go undiagnosed for ADHD well into adulthood.
This issue is compounded by the fact that girls and women with ADHD are exceptionally more likely to show signs of anxiety. Across multiple studies, it has been shown that between 30 and 40% of women with ADHD meet the requirements for an anxiety disorder diagnosis.
It's important to note, however, that some experts theorize that adult anxiety in women may be caused or exacerbated by undiagnosed childhood ADHD. Because girls are less likely to be diagnosed with ADHD, they often have less clarity or receive less support for their symptoms, which can, in turn, cause feelings of shame, frustration, or low self-esteem.
In recent years, experts have begun establishing clearer links between certain types of disordered eating and ADHD. Specifically, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies bulimia nervosa, anorexia nervosa, and binge-eating disorder as three of the eating disorders most commonly associated with ADHD.
Additionally, an increasing number of studies show a connection between ADHD and binge eating in children, with 26% of diagnosed children exhibiting the behavior (compared to 2% without ADHD). While further research is needed to determine how strongly this trend continues in adult women, an impaired relationship with food is a well-known complication of ADHD, especially the likelihood that an individual will develop obesity at some point in their lives.
While not a "condition," per se, a woman's menstrual cycle can have a significant impact on ADHD symptoms and even interact with some medications. While further research is needed, some studies have shown a relationship between estrogen levels and the efficacy of stimulants. As estrogen drops in women toward the end of their menstrual cycle, stimulant medications may do less to mitigate symptoms of ADHD.
Treatment Options for Women with ADHD
Unlike in years past, the vast majority of modern mental health professionals, like those at ADHDAdvisor.org, opt for a personalized approach to ADHD treatment, often incorporating several methods into a single, customized plan designed to address the specifics of each woman's circumstances. When you begin therapy, you can expect your plan to include one or more of the following types of treatment.
As research into women with ADHD catches up to our understanding of male ADHD, some studies have begun to identify differences in how women react to various drugs and dosages. Because of these differences, it's important to speak with your therapist to explore your options and find the best fit for your needs.
In general, modern medications used to treat ADHD fall into one of three categories, which are:
The most commonly prescribed type of medication for adults dealing with ADHD is, by far, stimulant medications. Typically, these drugs work by helping your brain regulate dopamine and epinephrine in a healthier way, thereby alleviating many of the symptoms associated with the disorder. Because stimulant medications are, by definition, controlled substances, individuals will need to obtain a prescription before starting this treatment option.
For those who respond negatively to stimulant medications, have certain medical conditions, dislike the side effects associated with such drugs, or have a history of substance misuse, your therapist can help explore alternative treatments.
In cases where stimulant medications are ineffective, poorly tolerated, or aren't sufficient to treat a person's ADHD symptoms on their own, medical professionals may suggest additional non-stimulant medication. While this option typically requires slightly more time to take full effect, it comes with several advantages to consider for certain individuals.
Specifically, the non-stimulant medications used to treat ADHD are not controlled substances, which means that they are traditionally easier to obtain. Additionally, non-stimulant drugs avoid many of the potential complications associated with stimulants, such as addiction or negative interactions with other conditions or prescriptions.
Finally, some therapists may suggest using a non-stimulant medication to supplement a more powerful stimulant prescription in order to boost effects, though this is decided on a case-by-case basis and is only appropriate for some patients.
Although no antidepressants are currently backed by the FDA to specifically treat ADHD, they may be used in your treatment to manage certain symptoms or to address related mental health conditions, such as anxiety or depression. Like non-stimulant medications, the use of antidepressants to treat symptoms of ADHD is highly dependent on a person's individual circumstances and the nature of their ADHD.
Cognitive Behavioral Therapy (CBT)
More and more, mental health professionals and patients alike are recognizing the value of cognitive behavioral therapy to manage ADHD symptoms. Similar in many ways to traditional therapy, CBT teaches individuals with ADHD how to build healthy habits and develop coping strategies in order to offset the effects of ADHD symptoms on their daily lives.
Equally important is the way that therapists use CBT to address the low self-esteem, feelings of frustration, or internalized shame that often come along with ADHD—especially in adults who have gone undiagnosed for many years. By combining these two elements, cognitive behavioral therapy can play an integral role in rebuilding a person's self-confidence and ability to take ownership of their day-to-day life.
Just like with any type of therapy, changes must extend beyond the sessions you spend with your therapist in order to truly be successful. Fortunately, ADHDAdvisor.org takes this fact into consideration when developing treatment plans for each of our patients. In addition to any necessary medications and cognitive behavioral therapy, we offer personalized success coaching to help patients incorporate progress from their therapy sessions into daily life.
For most, this involves making deliberate, structural changes to the way they live, from developing a sustainable fitness routine and learning healthy eating habits to joining communities that help them stay accountable and focused. No matter what type of lifestyle changes you ultimately decide are right for you, your therapist will be there every step of the way to support and guide you.
How ADHDAdvisor.org Can Help
Diagnosing ADHD as an adult can be a challenging and profoundly personal experience, and whether or not a person finds success in their treatment often comes down to how comfortable, supported, and empowered they feel during treatment. ADHDAdvisor.org recognizes this—so much so that we founded our entire organization on the principle that our clients should be able to find the ideal therapist for their needs, regardless of location or other restraints associated with traditional mental health care.
To make this principle a reality, we maintain a specially-trained team of matching specialists dedicated to finding you exactly the right therapist for your personality and goals. As an extra layer of assurance, we offer a complimentary ADHD assessment to help us better understand who you are and what types of support might help you find the greatest success during treatment.
We're so confident that our team can help you find answers, in fact, that we ask for only a small deposit to schedule your diagnosis, with a full money-back guarantee if you're at all dissatisfied with the experience. Once you've completed your diagnosis, we'll continue working with you to help build a personalized treatment plan and start taking control of your symptoms. If you're ready to get started building, try our intake assessment today and see if ADHDAdvisor.org is right for you.