Girls and Women with ADHD

Women with ADHD:  A brief history

When ADHD first started being defined and discussed, we thought it was all about kids. Actually, we thought it was all about boys- hyperactive, jump-out-of-your-seat boys.

But over time we started to realize that the brain difference that was causing those boys to jump out of their seats and run a mile a minute actually stayed with them through their whole lives.

And then the more we looked into it, the more we saw- hey it’s not just about your body running all around.  It’s also about your mind running around too.  

Once we realized that- it was like the world of psychology research started to wake up and they started to see- oh, hey- this brain difference? Girls and women have it too!

But the truth is, when it comes to really understanding ADHD in girls and women, we’re pretty far behind what we know about boys and men.

In fact, most of what we do know is extrapolated from what we know about boys combined with individual reports rather than large-scale research studies on women and girls alone.  But research is rapidly trying to catch up - so let’s check out what we’ve learned so far.

ADHD Prevalence:

Boys are 3 times as likely to be diagnosed with ADHD as girls. 

But as time passes and girls become women and they start to be able to identify  what feels different about their own brains and seek answers themselves  this number drops to only twice as likely 

This is more even for sure.   But it still means that more men are diagnosed than women.  Why?  Well, there are a variety of factors for why that might be:

Why girls with ADHD are less likely to be diagnosed:

1. The Female Protective Effect

The first reason is called the female protective effect. 

This threshold hypothesis states that perhaps there is something about being born female that actually keeps you from developing an ADHD brain.  In fact, it states that female embryos would need to be exposed to a greater amount of biological and environmental risk factors to develop ADHD.

But if this were the only thing keeping the numbers so starkly different between men and women- the rates of women being diagnosed with ADHD wouldn’t be continually rising as they are.

So what else keeps girls and women from being diagnosed?

2. Bias

Well, that brings us to our second reason:  Bias.  You see we all have a bias for what we think ADHD is-  and that includes researchers and clinicians

We still think of ADHD as hyperactive boys bouncing out of their seats, we think of kids that can’t control their impulses and kids that are constantly distracted.  So we look out for that and we listen for that.  But the way that a lot of women and girls experience their ADHD brains is different and so we don’t see their symptoms for what they are.

3. Misdiagnosis

That brings us to the next reason ADHD is diagnosed less frequently in girls and women:  Often because ADHD looks different in girls and women- it’s diagnosed as something different: things like: depression, anxiety, bipolar disorder, or borderline personality disorder.  

Sure, sometimes those things are there too-- but an ADHD brain?  That’s fundamental, that’s primary- oftentimes those other disorders are in reaction to having to live in a world not well suited for your unique brain.

4. Symptoms explained away

But it’s not just other disorders that we explain away symptoms of girls and women with- it’s also their personality.  

Women and girls are more likely to be characterized by their symptoms- they’re called spacy or chatty or ditzy or overemotional.  So rather than suggesting help or identification, girls are given a personality label that often follows them for a lifetime.

5. The Squeaky Wheel Effect

The other thing that keeps girls and women from being diagnosed?  The squeaky wheel effect.  

Girls and women with ADHD are more likely to be inattentive, they are more likely to feel guilt, shame and internalize their struggle.  If they act out they usually act out on themselves through self-harm, addiction, or other self-punishing behaviors.  These things are intensely painful on the inside but can go for years without being noticed on the outside.

(sad girl)

But boys?  They’re more likely to be squeaky.  They’re more likely to be hyperactive, to be impulsive, and act out in a way that is obvious and challenging to others.  

So in a classroom full of kids?  Who’s going to get the attention- the boy bouncing off the walls?  Or the girl staring out the window at the back of the class?

Women with ADHD Symptoms:

So, if girls aren’t as likely to fit our standard conception of ADHD then what does it look like?

• girls and women are more likely to have an inattentive type of ADHD.  

• may appear withdrawn  

• are likely to daydream

• struggle to remain focused.  

• They may cry  easily

• feel like their emotions are out of control

• They can be disorganized and messy and prone to mistakes.  

• They may not seem motivated

• are often forgetful.  

• hypersensitive to noises, fabrics, and lights- but also to emotions, body language, and injustice.  

•  may be hyper-talkative 

• may interrupt people while talking.  

• may also be shy and withdrawn, 

• struggle to fit in 

• Struggle to process the information around them as quickly as others expect. 

• struggle with time management 

• have a hard time completing tasks- instead, shifting from one task to another.  

In childhood these symptoms are often covered over by parents, people-pleasing, intelligence or are explained away.  

Women with ADHD

As adults, however, these symptoms often leave women feeling out of control and deep, intense shame over what feels like personal failings.

But ADHD isn’t about personality.  And it’s not about willpower or moral failings.  ADHD is a neurobiological, structural difference in your brain.  Which, at its most simplified, is about a neuro-transmitter deficiency in the prefrontal cortex.

And you know what makes that neurotransmitter deficiency even more inconsistent and more difficult?

Estrogen.

Yup.  As if this whole picture weren’t messy enough- a woman’s changing hormone levels change her symptoms both throughout the course of a month but also over the course of her lifetime.  Want to know how?  Check out my next video on the link between hormones and ADHD.

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