How does the clinical picture of ADHD differ in males and females?

Dr Johnson Consultant Psychiatrist in Neurodevelopmental disorders goes through how to recognise the symptoms of attention deficit hyperactivity disorder (ADHD) in girls and women.

Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed behavioural disorders in children and it’s often a lifelong condition. It is known as a Neurodeveoplemtal disorder which means parts of the brain which control emotions, learning, self-control and memory are affected.

The characteristics of ADHD fall under the following domains. Firstly relating to focus and attention difficulties. Then we have impulsive traits and finally hyperactivity symptoms. Some symptoms include:

● having difficulty sitting still
● trouble concentrating or focusing, being distracted
● having difficulty staying organised
● being forgetful
● tasks incompletion

Other examples of neurodevelopmental disorders include Autism, Learning disabilities and conduct disorders. This list is not exhaustive and new changes made to the 5th edition of the DSM include other psychiatric disorders (https://www.psychiatry.org/psychiatrists/practice/dsm).

ADHD and other conditions

Neurodevelopmental disorders frequently coexist. For example, you may have an autism spectrum disorder (ASD) together with intellectual disability. Or you may have (ADHD) and a specific learning disorder.

We have clinical medical research suggesting that ADHD is hereditary. This means if your father or mother has inattentive or hyperactive symptoms, you are more than likely to have ADHD too.

In my clinical practice, I have noticed that ADHD diagnoses among women are on the rise and that more and more women are looking for answers to their difficulties. Most of the new patients who are diagnosed with Adult ADHD are relieved as they can make sense of their difficulties, which nearly always looks different to the typical male ADHD picture. Due to this traditional imagery of ADHD, these women are overlooked and less likely to be referred for mental health services.

What does ADHD in women look like?

It is worth remembering that ADHD is not gender biased. It was not so long ago where we all knew of ADHD in the context of naughty disruptive school boys bouncing off the walls. ADHD symptoms exist in both females and males and in the same proportions. We have a huge gap in the diagnosis profile with males almost three times more likely to be diagnosed with ADHD than females. ADHD really does look different in women.

Therefore it is for this reason, many women grow up feeling misunderstood. Sometimes their difficulties are mistaken for being “hormonal” or “anxious”. At times the ADHD symptoms are attributed to the personality type of being “the chatty ones” and more social.

As with any mental health disorder, symptoms can vary and this can even vary between the genders. Women with ADHD, when reporting childhood experiences, are the ones who “daydream” or doodle on their work. They often report “zoning” in and out, when they should be listening in class.

Research has shown that girls and women are less likely to be diagnosed as parents and teachers are not quite sure what to look out for even if they do notice some difficulties.

Therefore inattentive ADHD is also more common in women than it is in boys and men, who tend to lean towards the hyperactive and impulsive symptoms. As males may display “external” symptoms such as fidgeting and hyperactivity they are more likely than girls to be diagnosed with ADHD.

In school or college women with ADHD are bright and intelligent. This is due to the fact that their symptoms are more subtle. However, they may underperform at critical times such as their exams, due to concentration issues.

Diagnosis later in life

Many women get overlooked until later in life when they begin to struggle to make sense of the difficulties they have been encountering. Often females may get left behind and diagnose later in life because they are able to “cover up” the ADHD symptoms. It’s only later on in life, when responsibilities of family and work build up that it becomes difficult for women to manage ADHD.

“ADHD symptoms in women can often be misunderstood and misdiagnosed by medical professionals, mistaking them for stress, anxiety, or another related condition”

Some common signs of ADHD in Women

Here are some ways that ADHD might show up in your life:

• You struggle to relax and unwind as your mind is on the go
• You are a high achiever but then feel frustrated that you have not met your full potential
• You struggle to move forward with your goals
• Forgotten projects and unpaid bills just keep piling up
• At social gatherings you feel overwhelmed and shy but can end up talking over people as you are nervous
• Your mind drifts during conversations unless you’re the one talking or it’s a topic you find very interesting
• Friendships can be a struggle because social rules seem complicated
• Growing up, you had so much energy and liked to be busy- but later in life you are just exhausted and burning out
• You often overspend to compensate for other problems. For example, you don’t have an outfit to wear for an office party so you buy a new one but don’t really have the money for this.
• Shopping trips and stores overwhelm you, and you find it hard to make decisions about what to buy.

ADHD and Woman power

ADHD as a diagnosis and condition does not need to carry the negative load of chaos and systems failure picture that it might look like. As a woman with ADHD, it is traits such as being enthusiastic, energised and “hyperfocused” where projects and goals can be achieved. The main thing to know it is try to set realistic goals.

ADHD Actions to take

Seek help – ADHD is highly treatable in both women and men of all ages. Our options are medication, behavioral therapy, or indeed a combination of the two which help symptoms very well.

Don’t be discouraged if the first medication or intervention is not an exact fit for you.
Take the time to notice the small progress and improvements in daily life after putting some ADHD friendly strategies in place such as planners and apps.

Try not to see the setbacks as personal failure but setbacks as functions of the condition.

Be optimistic about the condition and treatment – starting treatment in childhood but at any age can have a huge impact on future outcomes and functioning.

Do not get stuck in the negative labelling – visualise success can be encouraged by the progress.