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Is ADHD Different for Women and Girls?

ADHD, aka Attention Deficit Hyperactivity Disorder, has long been the domain of school age boys who seem to come with a built-in jet pack. What’s slowly emerging is that girls and women suffer too, but with slightly different symptoms that often get overlooked. This week, Savvy Psychologist Dr. Ellen Hendriksen examines how ADHD often manifests in girls and women.

By
Ellen Hendriksen, PhD,
October 28, 2016
Episode #129

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Pop quiz: what’s the first thing that comes to mind when I say “ADHD”?

a. Getting distracted

b.  Ants-in-pants

c.  Elementary school boys

d.  Women and girls

Most likely, you didn’t pick D.

If that’s the case, you’re not alone. For most people, ADHD conjures a mental image of school-aged boys squirming at desks or bouncing off walls, not a picture of adults, girls, or especially adult women. Both scientists and society have long pinned ADHD on males, even though girls and women may be just as likely to suffer from this neurodevelopmental disorder.

Back in 1987, the American Psychiatric Association stated that the male to female ratio for ADHD was 9 to 1. Twenty years later, however, an epidemiological study of almost 4,000 kids found the ratio was more like 1 to 1—half girls, half boys.

In both sexes, core symptoms are the same: difficulties with paying attention, getting and staying organized, planning ahead, and time management. There’s also the phenomena I call “The Laser Beam” and “The Disco Ball,” where attention is either hyperfocused or unfocused with not much in between, and toggling in and out of either is difficult.

How Does ADHD Manifest in Women? Low Self-Esteem

ADHD is a bit of a misnomer—because it can exist with or without the “H.” And while girls can certainly be hyperactive, they more often fall into the category without the H, called ADHD Inattentive Type.

For these girls, ADHD looks more like dreaminess, spaciness, or messiness than like Honey Boo Boo after a dose of go-go juice. They get written off as ditzy or dumb, and because they’re not disruptive like individuals with the hyperactive subtype, they fly under the radar. In other words, because they’re generally well-behaved, girls often miss out on diagnosis that could get them treatment and valuable academic accommodations.

Of course, there are boys who appear spacey and dreamy and girls who are hyperactive, but even for a girl with hyperactivity, the “H” doesn’t necessarily look like bouncing off the walls. Instead, hyperactivity could manifest as talkativeness, being “dramatic” (aka overly emotional and reactive), or she might simply be labeled a tomboy. Again, because it’s not necessarily disruptive, and because many girls try to compensate by people-pleasing, all of this frequently gets missed.

For adult women, ADHD often manifests as feeling constantly overwhelmed. Moms in particular are expected to multi-task, be in charge of the family’s social life, keep track of kids’ activities, and generally keep the million little pieces of a family running smoothly. Problems getting organized or planning ahead can have publicly humiliating consequences, like when your kid is the only one without a permission slip for the field trip, or you forget to pick him up after Little League ... again.

Tedious, repetitive tasks, like folding laundry, writing thank you notes, balancing a checkbook, or sorting the mail, are kryptonite to folks with ADHD. But many women feel like they “should” be able to do these things because so many other women seem to without a second thought.

All this leads to the most common symptom of ADHD you’ve never heard of: low self-esteem. So many bright, capable women with ADHD think they’re stupid, incompetent, lazy, or defective. They perpetually feel like they’re not good enough, not smart enough, not together enough. As if that’s not enough, up to 75% of individuals with ADHD have another disorder, most commonly anxiety, a learning disability, or, especially in women, depression. Oftentimes, women suffer for decades, and only begin to suspect they might have ADHD when their child is diagnosed.

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