ADHD in Women
Historically, school-age males have been the focus of ADHD diagnosis and treatment. However, in recent years there has been more discussion of how ADHD can look and feel different in women. Despite some concerns that ADHD is broadly over-diagnosed in our society, women are often under-diagnosed. The reason for this seems to be both symptomatic and cultural.
What is ADHD?
The term and diagnosis of ADHD could be something you’ve heard mentioned in conversation or on social media, but what does it actually mean?
The Diagnostic and Statistical Manual of Mental Disorders (DSM V, 2013), the primary diagnostic tool that mental health professionals use, defines ADHD as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development (p. 59)”.
In addition to the DSM, there are other frameworks that can help us understand ADHD. For example, an online ADHD-focused publication ADDitude Magazine, says the following, “neuroscience, brain imaging, and clinical research tell us a few important things: ADHD is not a behavior disorder. ADHD is not a mental illness. ADHD is not a specific learning disability. ADHD is, instead, a developmental impairment of the brain’s self-management system. Both adults and children can be diagnosed with ADHD” (William Dodson, M.D., LF-APA). The differences between these perspectives demonstrate the complexities of ADHD, and how mental health professionals’ understanding continues to evolve.
There are many different experiences of ADHD, both internally and externally. In looking at the definition delineated in the DSM, some keywords are “in-attention” and “hyperactivity-impulsivity,” the two subtypes of ADHD. The Center for Disease Control and Prevention emphasizes specific examples of these symptoms on their website as follows:
Inattention:
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g. loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as homework).
Often loses things necessary for tasks and activities (e.g. school materials, wallets, keys, eyeglasses, mobile telephones).
Often easily distracted.
Often forgetful in daily activities.
2. Hyperactivity and Impulsivity:
Often fidgets with or taps hands or feet, or squirms in their seat.
Often leaves their seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often “on the go” acting as if “driven by a motor”.
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting their turn.
Often interrupts or intrudes on others (e.g, butts into conversations or games).
Often these diagnoses are first discussed when a child starts formal schooling around the age of 5 or 6. It is during this time when issues relating to inattention and hyperactivity-impulsivity become more visible, because a child is no longer operating solely within their own family system, but also interacting with other adults and children.
ADHD and Women
While ADHD presents differently in every person, women are frequently diagnosed as inattentive. Some researchers hypothesize that this may have to do with socialization and gendered expectations, but others suggest there could be a biological basis. Because an inattentive person is typically less disruptive, many women go undiagnosed.
Right now, many professionals are still learning about the ways ADHD presents differently in men and women. It is important to note that the main distinction at this time seems to be the rate at which women are properly diagnosed earlier in life. As a result, many adult women are learning more about themselves and their brains through the lens of ADHD.
Learning about your own ADHD as an adult can be disorienting. While receiving a diagnosis can provide great relief, it can also be overwhelming and frustrating. Perhaps you question how your life might have been had you been diagnosed earlier. Questions like, Why did no one notice? Why didn’t I notice? Could my struggles have been avoided?
Finding Support for ADHD
A crucial component of ADHD treatment is to find support.
In my personal and professional experience, talk therapy can help one process an ADHD diagnosis. Far too often women receive a diagnosis and are treated only with medication. While medication can be tremendously beneficial, I feel strongly that talk therapy should play a role. In the same way that individuals who receive a diagnosis of cancer or an auto-immune disorder might benefit from processing their emotions, I feel it is also crucial when diagnosed with ADHD.
Undiagnosed ADHD can manifest in depression, substance use, and also eating disorders, too. It is crucial to have a therapist who can work through these complicated layers of experience. Coming to an ADHD diagnosis after experiencing substance abuse issues or disordered eating can dramatically change the framework you use to understand your previous struggles.
ADHD, both inattentive and hyperactive-impulsive subtypes can feel isolating. One might also feel anger or frustration around receiving a diagnosis later in life. Perhaps the diagnosis causes you to question your childhood experiences and how it might have contributed to negative self-perceptions. You might wonder, What would my life have been like had I been diagnosed earlier?
One reason I feel passionately about working with ADHD through talk therapy is because I’ve been there myself. While an ADHD diagnosis had been discussed at various points throughout my life, I finally decided to move forward with medication and treatment as an adult. Gradually it felt as if a fog had lifted. My treatment gave me a language and context to comprehend how my brain is unique. I was able to understand why parts of life had been challenging, and that what I experienced was not a moral or personal failing.
The shame that can often accompany women who find themselves diagnosed with ADHD later in life is something that often can be eased with talk therapy. No one deserves to feel shame for challenges they might experience because of neurodivergence.
Finding Compassionate Therapists for ADHD
With an ADHD diagnosis, people may feel emotions that include elation, excitement, overwhelm, confusion, anger. If you’re newly diagnosed or have lived with a diagnosis of ADHD since childhood, the stress and challenges of adulthood can bring newfound struggles.
If you find yourself identifying with any of the symptoms or struggles mentioned here, you might consider reaching out to a licensed therapist. There are many women who have come to therapy to process an ADHD diagnosis, or for continued support and management.
The therapists at Grounded Women's Wellness work with clients in New York, New Jersey, and Maine both virtually and in person. We can help you heal and utilize your unique mind. Please know that you deserve compassionate support to help navigate this disorder.
Julia Wood, LMSW
Julia Wood is a therapist who specializes in working with late adolescents and young adults who are navigating existential anxieties. She also works with women and gender non-conforming individuals of any age seeking to heal their relationship with food or body image.