Attention deficit hyperactivity disorder (ADHD) is a well-known neurodevelopmental disorder. Unfortunately, the common picture people have in their minds of what it looks like tends to be heavily stereotyped.
Most people picture the young boy who can’t sit still in class profile. He breaks the rules and is constantly in trouble because he can’t stop talking. The young girl who’s quietly sitting at the back, staring out of the window as she daydreams, is not what most people picture. And almost nobody immediately pictures an adult. ADHD in adult women, therefore, doesn’t quite fit the stereotype.
ADHD starts in childhood, and for a long time, it was largely seen as a childhood condition. However, it can – and does – continue into adulthood. It was also believed that ADHD is a lot more prevalent in males than females.
We’re now starting to see an increase in these beliefs being questioned and researched more thoroughly. Yet, in 2019, we still saw 11.7% of boys being diagnosed with ADHD versus only 5.7% of girls.
Types of ADHD
There are three different types of ADHD: inattentive, hyperactive-impulsive, and combined. As a whole, ADHD is identified through signs of hyperactivity, impulsivity, and inattention.
Most people who have ADHD exhibit symptoms of both types. The type of ADHD you have is based on whether you have more symptoms that fall into the inattentive category or more that fall into the hyperactive/impulsive category – or whether you have an equal amount of both. Common types of symptoms for each type are:
- Getting distracted easily
- Struggling to concentrate
- Being forgetful
- Inability to sit still
- Talking fast and excessively
- Risk-taking behavior
- Combination of both of the above
Understanding the different types of ADHD and the types of symptoms of each helps us understand why diagnosis in women and symptoms in women tend to be seen quite differently than in men.
ADHD Symptoms in Women
We can see that symptoms of ADHD are generally split into two categories: hyperactive and impulsive, and inattention. Though we touched on the symptoms above, understanding how these practically display in life is important if you think you might have ADHD.
Inattentive ADHD symptoms
- Forgetting or not paying attention to details when somebody talks or when doing tasks
- Making careless mistakes
- Constantly losing things, like your keys or your phone
- Not being organized or able to stick to a routine, even when trying to
- You might seem like you aren’t listening when people talk, and you may “zone out” or daydream
- Getting distracted easily, so starting and finishing a task in one go is often difficult
- Hyperfocusing on one task that you find interesting
- Forgetfulness – you tend to have a problem with working memory, so you might find yourself needing to write things down or you’ll completely forget them
Hyperactive and impulsive ADHD symptoms
- Not being able to sit still for long periods of time
- Constant fidgeting like bouncing your leg or picking at your hands
- Impulsively overspending
- Low frustration tolerance
- Talking excessively and interrupting others when they’re speaking
- Struggles to wait your turn so tend to be very impatient when waiting in lines or things like that
- Increased risk taking behavior and doesn’t think about all the consequences before acting
- Trouble sleeping
ADHD Symptoms in Women vs. Men
The overarching difference in ADHD in women vs. men is that women tend to internalize symptoms rather than externalize them and therefore lean towards inattentive symptoms rather than hyperactive and impulsive symptoms.
This does not mean that women don’t experience hyperactive and impulsive symptoms but rather present differently. For example, both women and men may experience a low frustration tolerance but men may present this in aggressive behavior where women may suppress their frustration internally and talk about it more.
Research into why these differences occur has not reached a point where there’s a clear answer. Though ADHD is one of the most researched childhood disorders, it was pointed out back in 1997 already that there were clear differences between female and male symptoms – but that research into it has been largely done on men.
What the research does show us is that symptoms are not fundamentally different but that socialization and cultural norms definitely play a role in why women and men present the symptoms differently.
Women tend to be socialized to contain their actions and emotions more so than men – think about the old phrase “boys will be boys” where men and boys acting out is simply written off as being a part of their gender. The same allowances are not made for women. Women are expected to behave more calmly, less active, and less disruptive – both physically and verbally.
ADHD Diagnosis in Women
Diagnosing ADHD is done by psychologists, psychiatrists, and medical doctors. It’s done according to the criteria in the DSM-5, which can be viewed here. In essence, you need to have a certain amount of symptoms for specific amounts of time, depending on your age.
When you speak to someone, they will ask you for details about the symptoms you’re experiencing and how long you’ve been experiencing them. ADHD does develop in your childhood, so you’ll often be asked about your childhood and whether certain symptoms may have been present then too.
They will also ask you about your general medical history and family history. Then, they will examine whether you have any comorbid mental health problems, like anxiety or depression.
Why Is ADHD in Women Underdiagnosed?
In children, there’s a vast difference between the number of girls and the number of boys who are diagnosed with ADHD. Increasingly, we’re seeing this disparity lower in adulthood, but the disparity is still very clear.
This does not mean that women develop ADHD later; it means that they’re diagnosed later. Therefore, treatment for ADHD in women also starts later. There are a few different reasons for this: stereotypes, differences in symptoms, gender biases, referral biases, and the prevalence and differences in comorbid mental health problems.
As we discussed above, ADHD in women and girls presents differently to men and boys. They’re more internalized, and few people will notice that something may be wrong.
Referral bias is a commonly discussed topic in ADHD. Considerably more men are referred for diagnosis. The presentation of the symptoms feeds into this but so does gender bias. Teachers, parents, and medical professionals still associate men with ADHD more than women.
What exacerbates this is the stereotype associated with ADHD being a predominantly behavior-orientated disorder. Many people don’t truly understand the inattentive symptoms and don’t recognize it as ADHD.
Many mental health problems are made up of more than one diagnosis. For example, generalized anxiety disorder is very often also present in someone who has been diagnosed with major depressive disorder. ADHD is no different.
A big difference in ADHD in women vs. men is their comorbidities. Women are significantly more likely to experience anxiety, depression, bipolar and personality disorders, whereas men are more likely to experience schizophrenia and substance abuse disorders.
How this plays into diagnosis is that women are often diagnosed with their comorbidities only, and only those are treated. Whether the comorbidities show stronger symptoms or whether mental health practitioners are less likely to investigate ADHD symptoms in women is an unanswered question.
Medication is often the first treatment that’s recommended for ADHD. Stimulants tend to be the first approach. Most commonly prescribed are amphetamines (Adderall) and methylphenidates (Ritalin).
For some people, stimulants aren’t an option. Either because they have severe side effects, other health conditions, or stimulants interact with other medications they’re on. Non-stimulant options include atomoxetine (Strattera) and bupropion (Wellbutrin), among others.
Medication is an effective treatment for both women and men. It’s often recommended that medication is started to stabilize symptoms and also to seek ADHD therapy.
ADHD’s effect on people’s lives can cause people to think very negatively of themselves. Missing deadlines, not finishing tasks, interrupting others, missing details can all cause feelings of low self-worth and guilt. This is especially true when ADHD is diagnosed late and when symptoms are internalized, as is common in ADHD in women.
ADHD therapy can address those feelings and can teach effective coping strategies to mediate the symptoms. Online ADHD therapy and in-person therapy are both effective options to treat ADHD.
Online therapy allows you to have more regular and affordable contact with your therapist over various types of communication (text, calls, video calls, etc.). When addressing specific goals, as you’d often do with ADHD therapy for adults, this is particularly helpful.
The Bottom Line
ADHD in women is less likely to be diagnosed and treated for various reasons. The longer it’s left undiagnosed and untreated, the worse it will become. One study, for example, shows that adult women with ADHD tend to experience worse symptoms than adult men. One theory as to why symptoms are worse is that ADHD in women is often diagnosed late – if ever.
If you think you might have ADHD, seeking treatment sooner rather than later is definitely advised. If you’d like to try online counseling, we’re here to help.