ADHD, long perceived through a male-centric lens, has left countless women undiagnosed, grappling with its effects in silence. In this insightful guest post, experts Tatiana Rivera Cruz and Emilie Kay discuss this diagnostic gap, shedding light on societal expectations, gender biases in healthcare, and the intricate relationship between hormones and ADHD symptoms. The goal is to empower women and deepen self-understanding about ADHD.
ADHD in Women: Understanding the Diagnostic Disparity and Implications for Treatment (Guest Post)
Attention-deficit/hyperactivity disorder (ADHD) has long been recognized as a condition affecting individuals across their lives, most prominently during childhood. However, the lens of diagnosis has historically been male-focused, leaving many women undiagnosed, misunderstood, and struggling in silence.
The reasons behind this disparity are complex, involving a blend of societal expectations, gender stereotypes, and a fundamental misunderstanding of how ADHD manifests differently in women.
Given these misunderstandings, this article will draw attention to the importance of an early diagnosis and explain the differences in how ADHD impacts women, from common symptoms to implications, leveraging my experience as a Clinical Social Worker (LICSW).
Why are Women Slipping Through the Cracks?
ADHD is not exclusive to males, yet women and girls are diagnosed less frequently due to stereotypes, referral biases, and the internalization of symptoms, among other factors. Current research shows that during childhood, the prevalence of ADHD is approximately three boys for every girl, but by adulthood, the ratio narrows to nearly equal between genders.
This indicates that ADHD in girls and women is likely underdiagnosed in their younger years. Another reason ADHD in women often goes unnoticed and undiagnosed is due to its frequent mislabeling as anxiety or depression, leading to treatments that miss the mark.
Societal Expectations
ADHD is characterized by symptoms of hyperactivity, impulsivity, and inattention, but its presentation is nuanced and unique to each person who has the condition. Unlike males, women aren’t as likely to exhibit signs of hyperactivity, often leading to the perception that they’re less impaired. The diagnosis gender gap widens with common stereotypes that label women as naturally disorganized or emotionally erratic, overshadowing the actual issue: ADHD.
These issues are exacerbated by societal expectations placed on women to excel in roles requiring high executive function, such as managing oneself, the family, and the household, areas where women with ADHD may struggle. In an effort to conform and gain social acceptance, many women mask or refrain from discussing their ADHD symptoms.
Consequently, this apprehension often worsens the internal struggle and delays their path to diagnosis and treatment.
Gender Bias in Healthcare
Gender bias in healthcare significantly impacts the diagnosis and treatment of ADHD in women, rooted partly in the diagnostic criteria. In essence, ADHD symptoms are generally characterized into three primary types: hyperactivity/impulsivity, inattention, and a combined form, with an assumption that these symptoms present before age 12.
The early age criteria can obscure the diagnosis in girls, who may not exhibit or be recognized for their symptoms until adulthood, largely because their symptoms often differ from the traditional, more noticeable hyperactivity seen in boys.
Hormones and ADHD
The interaction between estrogen levels and ADHD symptoms in women is a complex relationship. Estrogen plays a crucial role in various bodily systems, including the brain, and influences executive functions, attention, and concentration. Its levels fluctuate throughout the menstrual cycle and across a woman’s lifespan, which can affect the severity and duration of ADHD symptoms.
For instance, ADHD symptoms tend to intensify during periods of low estrogen, such as after ovulation and before menstruation, when estrogen decreases and progesterone increases. This hormonal ebb and flow means that ADHD symptoms may vary from day to day, with some women being particularly sensitive to these changes.
Furthermore, the onset of puberty introduces increased estrogen levels, coinciding with a period when ADHD symptoms can become more pronounced in girls. Unfortunately, this can lead to symptoms being misconstrued as anxiety or emotional instability, which may eventually lead to an incorrect diagnosis and treatment.
Common Symptoms of ADHD in Women
ADHD in women can manifest as an overwhelming sense of underachievement, regardless of efforts and accomplishments. Symptoms often include difficulty initiating tasks, feeling inundated by the smallest responsibilities, and a tendency to procrastinate, not out of laziness but as a response to emotional distress.
Inattentiveness, Hyperactivity/Impulsivity, and Combined Presentation
Hyperactivity/impulsivity and inattentiveness are the primary ADHD symptoms, though it’s also possible to have a combined form. Hyperactivity/impulsivity might manifest through behaviors like fidgeting, excessive talking, or difficulty remaining seated, while inattentive traits include problems with focusing, daydreaming, and forgetfulness. Since these inattentive traits are more common in females with ADHD, it can make their symptoms less noticeable compared to those with hyperactive behaviors.
Feeling Overwhelmed
Women with ADHD often experience a sense of being overwhelmed. This feeling can stem from the challenges of juggling multiple responsibilities, such as work, family, and social commitments, with the added layer of ADHD’s executive function difficulties.
This is not just about the number of tasks but also the difficulty in prioritizing them, leading to a paralyzing effect where starting tasks feels impossible. In daily life, this can manifest as a woman feeling stuck in a fog of tasks, which significantly impacts their ability to function and cope with everyday demands.
Avoidance Behavior
Avoidance behavior in women with ADHD can be a coping mechanism for dealing with tasks that seem too challenging or overwhelming. This behavior might manifest as ignoring bills, delaying important medical appointments, or shying away from complex projects at work.
The root of avoidance is often the fear of failure or making mistakes, coupled with a history of negative experiences when attempting similar tasks in the past. This means important tasks are left until the last minute or not completed at all, leading to a cycle of stress, anxiety, and sometimes even financial or professional consequences.
Procrastination Linked to Emotional Distress
Procrastination in women with ADHD is deeply tied to emotional distress rather than mere laziness or poor time management. It often occurs because the task at hand sparks feelings of anxiety, inadequacy, or fear of failure, making it emotionally painful even to begin.
This form of procrastination goes beyond typical delay tactics, as it’s rooted in a protective impulse to avoid emotional discomfort. In everyday life, this can result in significant delays in meeting personal or professional obligations, creating a snowball effect of mounting tasks and increased emotional distress, further feeding the cycle of procrastination.
Misdiagnosis and Mix-Ups Involving ADHD in Women
Women presenting with restlessness or inattention may find themselves labeled with anxiety or depression, leading to treatment plans that don’t address ADHD.
For instance, women with anxiety may face constant worry and fear, leading to physical symptoms like restlessness and sleep disturbances, which are also common with hyperactive ADHD. On the other hand, depression often manifests as persistent sadness, lack of interest in activities, and significant energy loss. They might withdraw from social engagements, struggle with concentration, and find routine tasks difficult to start or finish.
The misdiagnosis or underdiagnosis of women with ADHD may stem from an initial diagnosis that didn’t consider other mental health comorbidities that share similarities with ADHD. As a result, this can result in inappropriate treatment plans, delayed treatment, and, in some cases, lack of treatment altogether.
Differences in Treatment for Anxiety, Depression, and ADHD in Women
Treatment plans for women with anxiety, depression, and ADHD must be tailored to address the specific symptoms and challenges each condition presents.
For anxiety, treatment may include cognitive-behavioral therapy (CBT) to help manage worrisome thoughts and behaviors, coupled with medication such as selective serotonin reuptake inhibitors (SSRIs). Depression treatments also frequently involve CBT and SSRIs but may place a stronger emphasis on exploring underlying emotional triggers and fostering strategies for long-term mood management.
Treatment plans for women with ADHD should focus on a combination of behavioral interventions to improve organization and time management skills. Likewise, women may require medication to enhance concentration and impulse control.
Consequences of Delayed ADHD Diagnosis for Women
The delay in diagnosing ADHD can have far-reaching effects on a woman’s personal and professional life, such as strained relationships and challenges in career advancement. Moreover, maladaptive coping strategies may emerge, leading to a vicious cycle of struggle and self-doubt.
Implications
A delayed diagnosis carries significant implications, particularly due to the heightened central nervous system sensitivities they might experience. Women with ADHD often report tactile defensiveness and sensory overload, which can be triggered by everyday stimuli such as the texture of clothing, tags, loud noises, bright lights, and strong smells.
Additionally, they might suffer from somatic complaints like headaches, migraines, stomach aches, and nausea. Sleep difficulties are also common, further compounding the challenges faced in daily life. Over time, these difficulties may cause additional health issues, such as if they consistently lose sleep, neglect their diet, or self-medicate.
Strained Relationships and Career Challenges
Women with ADHD can face unique challenges in their relationships and careers, often stemming from the complexities of social interaction and the demands of maintaining personal connections. Compared to men with ADHD, women are generally more overwhelmed by the nuances and expectations of relationships, which can lead to difficulties in forming and sustaining meaningful friendships.
The effort to avoid the discomfort and confusion that can accompany social interactions may result in a tendency toward isolation, which can serve as a protective measure against potential negative experiences.
In socialization, women with ADHD frequently experience rejection sensitivity, a condition characterized by intense emotional reactions to real or perceived rejection. This sensitivity heightens the stakes of social engagement, making ordinary interactions fraught with the possibility of deep emotional pain. This fear of rejection can severely limit their willingness to initiate or invest in friendships, producing feelings of loneliness and misunderstanding.
These struggles extend into the professional sphere, where relationship-building and networking play crucial roles in career advancement. The challenges of ADHD can make navigating workplace dynamics more difficult, affecting job performance and the pursuit of career goals.
Maladaptive Coping Strategies
The implications of a delayed ADHD diagnosis for women often lead to the development of maladaptive coping strategies. Without understanding the root cause of their struggles, women may adopt harmful practices to manage their symptoms, such as overcommitting to avoid the stigma of underachievement or using substances to self-medicate and avoid feelings of restlessness and anxiety.
These coping mechanisms can create a vicious cycle of stress and burnout as women push beyond their limits without appropriate support or accommodations. Furthermore, the strain of constantly trying to compensate for undiagnosed ADHD can create feelings of inadequacy and low self-esteem, as women perceive their difficulties with focus, organization, and time management as personal failures rather than symptoms of a neurodevelopmental disorder.
Overcoming Misdiagnosis of ADHD in Women
The path to overcoming the challenges posed by ADHD in women lies in early diagnosis and proper treatment. Together, these strategies empower women with ADHD to navigate their daily lives with greater ease and confidence.
Professional Help and Comprehensive Treatment
Treatment plans for women with ADHD must address the core symptoms of the disorder and combat the years of misinterpretation and misdiagnosis that have contributed to secondary psychological issues.
A multi-faceted approach to ADHD in women involves therapy, coaching, and, when appropriate, medication management. Tailored treatment plans that consider the unique challenges faced by women with ADHD can pave the way to more fulfilling lives.
Mindfulness and Practical Strategies
Women with ADHD can leverage mindfulness and relaxation techniques to counteract the misdiagnosis of ADHD and alleviate the anxiety often associated with initiating tasks. Mindfulness practices, such as focused breathing exercises, meditation, and mindful walking, encourage present-moment awareness, which can significantly reduce feelings of overwhelm and anxiety.
By training the mind to focus on the current moment, women can better manage the impulse to procrastinate and the stress that comes with starting new tasks. Additionally, relaxation techniques like progressive muscle relaxation or guided imagery can help soothe the nervous system, making it easier to approach tasks calmly and with a clear mind.
Practical Strategies
To overcome the challenges posed by the misdiagnosis of ADHD, women can adopt practical strategies centered on organization, time management, and task breakdown to mitigate feelings of overwhelm and paralysis. Implementing a consistent system for tracking appointments, deadlines, and tasks—such as using a digital planner or a physical journal—can help with organization and assist with managing daily responsibilities more effectively.
Time management can be improved by setting clear priorities each day and using techniques like the Pomodoro Technique, which involves working in focused intervals followed by short breaks. This method helps maintain concentration and prevents burnout. Breaking tasks down into smaller, manageable steps is crucial in overcoming task paralysis; it reduces the intimidation factor of large projects by making them appear more achievable.
Final Thoughts
The journey toward understanding and managing ADHD in women is ongoing. By shedding light on the nuances of diagnosis, treatment, and coping strategies, we pave the way for a future where women with ADHD can thrive. Encouraging those affected to seek support and learn more about their condition is a crucial step toward breaking the cycle of misdiagnosis and misunderstanding.
About Today’s Writers
Tatiana Rivera Cruz, Clinical Social Work/Therapist, LICSW
Mental health can be difficult, so I’m here to listen and support you. I specialize in treating patients with anxiety, depression, grief, couples counseling, family issues, trauma, and PTSD.
My approach focuses on humanistic, existential, and cognitive approaches, valuing every aspect of life. Let’s work together toward your goals and start your journey of healing and self-love.
Emilie Kay, MSW, LCSW
I graduated with a Master of Social Work (MSW) from the University of Wisconsin-Milwaukee before obtaining my Licensed Clinical Social Worker (LCSW) in 2021. I have eight years of experience in the mental health field working in and with various populations, including case management, intake coordination, and residential, inpatient, and outpatient programs.
I am certified in Brainspotting to help individuals deeply process negative emotions and trauma/significant life events. Additionally, I utilize Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Motivational Interviewing (MI), and safety planning in sessions/groups.
Photos of Tatiana and Emilie used with their permission (via Andrew Borg Costanzi)
Feature photo by Tara Winstead from Pexels (Canva Free).