EXPERT GUIDE WOMEN AND ADHD

Maybe it’s time we discuss the issue of ADHD and women.

ADHD has been considered a boy’s thing for a long time. There are some reasons for this. ADHD does not present in the same way in men and women. When we try to picture the idea of someone with ADHD, the things that come to mind –the hyperactivity, the boisterous behaviour, the unruliness– makes us think of a difficult boy misbehaving at school, or maybe of a difficult man being angry. That’s not what we see when ADHD happens in women. It looks different.

ADHD symptoms can be a bit of a puzzle.

There is not a single way to have ADHD. It’s more like a collection of symptoms all mixed up. We find a bit of hyperactivity, a bit of impulsivity, a bit of difficulty in keeping one’s attention focused, a bit of anger, a bit of being disorganised, and a bit of procrastination. The restlessness we see in women becomes less visible, more internal, more like an inner sense of not being in control. It’s a different presentation, and it can be hard to identify. There are other factors as well, such as depression and anxiety, that can complicate the picture even further. And then, we have the hormones playing havoc. Most women are aware of how much one’s periods can alter one’s mood. Be mindful that those hormonal disbalances will complicate an already quite complicated situation. There is interesting research that shows that, even if girls are somehow protected from the symptoms of ADHD due to their early maturation, the changes in hormones that happen in adolescence will then lead to an increase in the symptoms. (1)

Then, we have the problem of what society expects from us. In our competitive world, we are expected to be productive and organised, and women, in particular, can be seen as the ultimate multitaskers, people able to juggle home, child-rearing, and work simultaneously. If your online experience is anything like mine, you will likely be bombarded with ads for different apps designed to make you as efficient as possible. If you have ADHD, you are going to struggle in that world. It is not uncommon for people with ADHD to collect those apps and, once they’ve used them once or twice, forget about their existence. If this is your case, just keep your rhythm and don’t allow yourself to be pressured.

Diagnosing ADHD is less than straightforward in women.

The hyperactivity is less evident, the lack of attention is more prominent, and mood problems are often part of the puzzle. In those cases, it is not uncommon for women to be diagnosed first with depression or with anxiety. It is worth considering that, sometimes, the stress produced by untreated ADHD can be behind those other mood problems. I don’t want to suggest that all women diagnosed with depression and anxiety also have undiagnosed ADHD, though, but be mindful of that possibility.

ADHD is a neurodevelopmental condition. It is a problem of how your brain develops from when you were born and sometimes from when you were in the womb. Genetics are important, and events that happen after birth are also relevant. People with ADHD often find other people with similar symptoms among their blood relatives. However, be aware that the symptoms of the men in the family will be different from those of the women. There is a study that shows that the genetic risk for ADHD in males and females is the same, but despite that similar risk, females still end up diagnosed more often with depression and anxiety. (2)

We have talked about how ADHD presents in women, but what about the treatment?

The medication to treat ADHD is the same for men and women, but the psychological part of the treatment may be different. Sometimes, we need to pay more attention to psychological approaches like CBT since mood disturbances are so common. Then we have the problem of pregnancy. Some women find that their symptoms improve when they are pregnant, but others find that the opposite is the case. And, if the symptoms are bad, should the woman keep taking the medication? It is normal to worry about it. Stimulants do not appear to cause harm in pregnancy, but the data is limited, and sometimes, we need to weigh the pros and cons carefully. (3)

I know it all sounds quite negative so far, but trust me, there are also some advantages to having ADHD. One of them is creativity. Creativity has three elements: divergent thinking, conceptual expansion and overcoming knowledge constraints (4). People with ADHD are good at that. One study called that type of creativity ‘uninhibited imagination’ (5).  That’s not a bad thing to have.

There are many other things you can do to manage your ADHD apart from taking medication. There’s diet, exercise, and many other activities, like mindfulness and yoga. Mindfulness, in particular, seems to be particularly effective (6).

Then, if you are a woman and you have ADHD, you should not worry too much about not fitting the mould. That mould was designed for someone else. Embrace your creativity and your capacity to think differently, and, by any means, get yourself treated.

ADHD is a treatable condition, and some of the worst parts of the condition (poor attention span, distractibility, impulsive behaviour (7))  respond well to therapy. Even if your ADHD is successfully treated, you’ll still be as creative and as good at lateral thinking as before. Medication will not change your personality; you can be sure of it. But maybe you’ll be a bit better organised. Perhaps you will start using the apps you’ve bought. And possibly your mood won’t be as affected by an inability to concentrate.

I hope I have given you enough information to consider how ADHD may affect women and what can be done about it. If you feel you have the condition, even if your symptoms do not quite fit what you think ADHD is about, do ask for an ADHD assessment. The results can be life-changing.


Written By Dr Josep Vilanova, LMS, MRCPsych, Consultant Psychiatrist. 

6th December 2023

With Expertise in treating a wide variety of mental health conditions, including ADHD, depression, anxiety, Personality Disorder, Bipolar Affective Disorders and Schizophrenia.

Dr Vilanova has a particular interest in developmental disorders, like ADHD and Autism, along with mood disorders and anxiety.

References:

  1. Mahone, E. M., & Wodka, E. L. (2008). The Neurobiological Profile of Girls with ADHD. Developmental Disabilities Research Reviews, 14(4), 276. https://doi.org/10.1002/ddrr.41

  2. Martin, J., Taylor, M. J., Rydell, M., Riglin, L., Eyre, O., Lu, Y., Lundström, S., Larsson, H., Thapar, A., & Lichtenstein, P. (2018). Sex‐specific manifestation of genetic risk for attention deficit hyperactivity disorder in the general population. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 59(8), 908-916. https://doi.org/10.1111/jcpp.12874

  3. https://doi.org/10.1176/appi.ajp.2013.13050680

  4. Abraham, A. (2014). Creative thinking as orchestrated by semantic processing vs. Cognitive control brain networks. Frontiers in Human Neuroscience, 8, 77220. https://doi.org/10.3389/fnhum.2014.00095

  5. Abraham, A. (2014). Creative thinking as orchestrated by semantic processing vs. Cognitive control brain networks. Frontiers in Human Neuroscience, 8, 77220. https://doi.org/10.3389/fnhum.2014.00095

  6. Kolar, D., Keller, A., Golfinopoulos, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of adults with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 4(2), 389-403. https://doi.org/10.2147/ndt.s6985

  7. Kolar, D., Keller, A., Golfinopoulos, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of adults with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 4(2), 389-403. https://doi.org/10.2147/ndt.s6985