ADHD in Women: An Underdiagnosed Epidemic

The typical image the general public has of someone with attention deficit/hyperactivity disorder (ADHD) is a wild little boy who can't hold still. This stereotype is so pervasive that experts believe that 50% to 75% of girls with obvious signs of ADHD are not diagnosed or treated. If they are diagnosed, it is years later: the average age of diagnosis of boys with ADHD is 7, compared to 12 for girls.

These disturbing statistics mean that many little girls struggle for years with ADHD, and many of these girls grow up and become adult women with undiagnosed ADHD. ADHD is very common; it affects around 15% of the population. That's a lot of girls and women struggling with a very treatable disease because they have not been diagnosed.

Symptoms of ADHD in Adult Women

There are three primary types of ADHD:

• ADHD, combined type. This, the most common type of ADHD, is characterized by impulsive and hyperactive behaviors as well as inattention and distractibility.

• ADHD, impulsive/hyperactive type. This, the least common type of ADHD, is characterized by impulsive and hyperactive behaviors without inattention and distractibility.

• ADHD, inattentive and distractible type. This type of ADHD is characterized predominately by inattention and distractibility without hyperactivity.

Women are more likely to have the inattentive form, but many women have the hyperactive/impulsive form.

Common symptoms of the inattentive form include:

• Disorganized

• Prone to daydreaming

• Forgetful

• Difficulty following instructions

• Difficulty maintaining focus and attention

• Easily distracted

Common symptoms of the hyperactive/impulsive form include:

• Fidgeting and squirming

• Difficulty sitting still

• Talking excessively

• Frequently engage in impulsive behavior

• Little self-control

Some adult women display symptoms of both types of ADHD.

Girls and women, even those with classic ADHD symptoms, are often misdiagnosed with anxiety or depression. When they struggle in school, their parents and teachers assume that they are not academically inclined or immature. When they enter the workplace, they tend to be viewed as chronic underachievers or borderline incompetent, and they tend to get poor performance ratings and be overlooked for promotions and raises.

Causes of ADHD

ADHD is primarily genetic. It is inherited and runs in families. It is a complex multi-gene trait; not everyone in the family will manifest ADHD. It can skip generations, meaning that parents who don't have ADHD can pass the trait on to their children, and not everyone with ADHD will have a child with ADHD.

Brain imaging studies have shown that children with ADHD have abnormal brain development. Their frontal lobes mature more slowly and they have disturbances in the neural networks that make up the brain that persist into adulthood. 

Diagnosis of ADHD

The ASRS Screening Scale was updated in 2017, and the newly revised version is very accurate in detecting patients who are likely to have ADHD. Adults who suspect they might have ADHD can take the test themselves and show the results to their doctor.

A doctor will have to make the final diagnosis based on the ASRS score, an evaluation of the patient's symptoms and cognitive ability, and after ruling out other possible causes of the symptoms.

A newer, more objective way to diagnose ADHD is the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System. It is a non-invasive test that measures the patient's brainwaves. Patients with ADHD have a typical pattern that can easily be distinguished from patients who do not have ADHD.

Other objective methods to diagnose ADHD are being studied. The most promising are MRI and fMRI, which do not expose the patient to radiation, but they are not in mainstream clinical use yet.

Treatment of ADHD

ADHD cannot be cured, but it can be successfully managed. The best results are seen from a combination of medication and behavioral training.  The classic ADHD medications, such as Ritalin, work remarkably well in adults.

A therapist experienced in treating ADHD can help patients learn:

• Time management

• Organizational skills

• Self-control and ways to reduce impulsivity

• Better problem-solving skills

• How to cope with the memories of past academic and personal failures caused by the untreated ADHD

• How to mend family relationships strained by the untreated ADHD

These last two points are very important to address in therapy, Many women with untreated ADHD go through life feeling like they've failed, and consequently, they have poor emotional and mental health as a sequela of ADHD. They may even have developed anxiety and depression because of their untreated ADHD. Understanding that their failures were due to an untreated disease is vital for achieving good emotional wellness. 

Conclusion

If you're dealing with ADHD there's hope! Treatment methods such as medications, behavioral therapy, lifestyle changes, professional support, support groups, and others can help. Our app, Aspyn Coaching, offers self-guided therapy and coaching sessions on topics such as organization, time-management, goal-setting, and more that can help with the symptoms of ADHD.