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Understanding and Recognizing ADHD in Women

By Eileen West, MD

ADHD, or Attention-Deficit/Hyperactivity Disorder, is a neuropsychiatric disorder characterized by persistent inattention, with or without hyperactivity. Importantly, it causes deficits in executive function.  Executive function refers to our brain’s ability to carry out self-directed actions, such as identifying and achieving goals.  Being able to complete goal-oriented activities is integral to success in both personal and professional arenas.  When ADHD goes undiagnosed and untreated, it can be horrifically disabling given the impairments it causes in occupational, academic, and social functioning.

This may be especially true in women given societal expectations of the female gender. Women with ADHD often describe hitting a “terrible wall of shame” as they get married and have kids. At this time, “society expects tremendous feats of memory and organization from moms, from keep track of…teachers and pediatricians to organizing meals and multiple schedules.”[1]  The sleep deprivation commonly experienced by parents of young children doesn’t help.

To make things even harder for women with ADHD, hormones may play a role. It is thought that drops in estrogen levels may worsen ADHD symptoms.  Consider the breastfeeding mom[2] with ADHD who is already struggling with how best to care for a new baby in addition to her other responsibilities. She now has an extra handicap.  And hormone variation not exclusive to new moms. Estrogen fluctuations happen across a woman’s lifespan.  Is menopause causing you to become scatterbrained or has it just uncovered your ADHD? 

Thinking of the new mom, it’s easy to see how ADHD might go hand in hand with other psychiatric disorders.  Juggling childcare responsibilities is already a feat, even for moms without ADHD. When a job, the care of aging parents, an ever-pinging cell phone, and other activities are added to the mix, cognitive challenges caused by ADHD can understandably lead to emotional distress. The emotions which follow are often diagnosed as depression and anxiety.  

ADHD is likely underdiagnosed, and more so in women[3].  This happens for multiple reasons.

  1. Girls with ADHD tend to exhibit the inattention subtype, which can lead to the assumption they are “just being ditzy” vs boys who more often exhibit the hyperactive subtype, resulting in being sent to the principal’s office more and thus more likely to be identified as having a problem.
  2. ADHD in women and girls is often misdiagnosed and treated as depression and anxiety.
  3. Women may be more motivated to hide their ADHD, and many are able to figure out ways to compensate.
  4. Historically, because ADHD has been diagnosed more often in boys, the DSM-5 criteria[4] and common screening surveys are skewed toward how ADHD presents in males.  

If you suspect you might have ADHD, try taking this screening test for women.  Here is a related self-test better suited to girls.  Because these are just screening tests, a high score does not mean you have ADHD.  However, if you do score highly please see your doctor to discuss your concerns and get started on the road to feeling better. 

 


 

Reference: Why ADHD in Women is misdiagnosed, underdiagnosed, and undertreated and related articles.

[1] https://www.additudemag.com/adhd-in-girls-shame/

[2] breastfeeding causes a low estrogen state.  Estrogen level fluctuations also occur during every menstrual cycle, thus affects women from menarche to menopause, effects being most prominent at those 2 endpoints. 

[3] As an aside, there are also racial disparities in diagnosis.  A black child with ADHD is more often misdiagnosed as having ODD or just “poor home training.”  Asian children with ADHD often go undiagnosed due to cultural stigma regarding mental health diagnoses.   

[4] DSM-5 guidelines provide the standard criteria by which physicians determine psychiatric diagnoses. 

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