How is ADHD different in adult women?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterized by a constant pattern of inattention, with or without impulsivity and hyperactivity, that affects normal and day-to-day functioning.

In part one of our blog series on ADHD in adult women, we will look at how ADHD presents differently in women and the common signs and symptoms they experience.

Recognizing ADHD symptoms in women may not be as simple as it is for men [1]. Women do not commonly show typical ADHD traits such as physical aggression and hyperactivity, for example. They are more likely to suffer from inattention which often leads to women being left undiagnosed, diagnosed much later in life, or misdiagnosed with other comorbid conditions. This highlights the importance of early diagnosis during childhood as it can significantly improve self-esteem, employment and professional aspirations, and overall quality of life [2].

Telling the differences

Adult women who have ADHD are more likely to be labeled as lazy or inattentive. This often results in women who do not fully understand their behavior to self-blame and self-shame for failing to meet societal expectations [3]. This includes failing to manage themselves and their work and personal life which all require coordination and multi-tasking skills. Moreover, due to the lack of research conducted on women and girls with ADHD [4], some mental healthcare providers may dismiss the concerns raised by female patients. This is often due to the intricate presentation of ADHD in women being impacted by other factors such as hormonal fluctuations, referral bias, internalized symptoms, and stereotypes. According to recent studies [5], the ADHD diagnosis rate of American men is almost 60% higher than American women – over 5% of American males have ADHD in the US while only over 3% of American females do.

Common ADHD signs and symptoms in women

Although this may vary, women with ADHD typically show the following signs and symptoms [8]:

  • Failure to remain focused on tasks
  • Difficulty paying attention to details and making careless mistakes at work
  • Getting easily distracted and failing to finish tasks and meet deadlines
  • Trouble managing activities
  • Forgetfulness and many others

Andrea Michaels, who was diagnosed with ADHD later in adulthood shares her story: “Life before my ADHD diagnosis was very interesting. Looking back at when I was at school, I always got told that I was bright, but I never paid attention. I was destructive and disruptive. I think that sums it up, how typically ADHD I was, but at the time, this was viewed as naughty behavior.”

“I remember telling stories. I would bend the truth, but make it sound so elaborate and so great, just to draw people in. I didn’t realize I was doing it. It’s with reflection now that I know. I was also extremely disorganized, especially as I moved into my teenage years and my early 20s, it became more obvious,” she added.

Living with ADHD and managing the symptoms

Being diagnosed with ADHD and receiving education about the condition and treatment can make a dramatic improvement for women. Women who suspect they have ADHD must get into contact with clinicians who understand ADHD and how it affects them. Psychiatrists, psychiatric nurse practitioners or equivalent, and other mental healthcare professionals with specialist training can diagnose and prescribe treatment, for example. It may be useful to ask them a few questions such as:

  • The number of ADHD patients they have
  • How many of their patients are women
  • What treatments they offer and how successful they are in helping patients

It is also worth inquiring about how they can accurately detect symptoms of ADHD and distinguish them from symptoms of common ADHD comorbidities such as anxiety or Autistic Spectrum Disorder (ASD).

You can also ask them if they are using objective testing tools such as QbTest with traditional evaluation methods. QbTest is a CE-marked and FDA-cleared medical device used for the assessment of ADHD for patients aged between 6-60. It helps assess patients for three core symptoms of ADHD: inattention, hyperactivity, and impulsivity. Moreover, it produces quantitative reports on the patients’ performance that can be instantly analyzed and compared to a normative group of the same age and gender. Clinicians who use objective testing in their assessment of ADHD are likely to have a shorter waitlist and wait time and could better monitor medication effects, improving confidence in treatment diagnosis, [6] and psychoeducation for all parties involved.

In our recent case study [7], we interviewed Dr. Nicola Reynolds, Clinical Led at Oxleas NHS Foundation Trust, who leads a multidisciplinary ADHD team for the London borough of Greenwich in the UK. Although the case study focuses on ADHD care for children, it is worth highlighting how QbTest has helped their ADHD care pathway.

“It has certainly reduced the time significantly for the first appointment, and partly because of what it has enabled us to do alongside other screening tools that we’ve used when we triage.

We’ve been able to offer different kinds of follow-ups depending on what their QbTest report is telling us. There are cases where the QbTest and the questionnaires and the information from schools and parents indicate that a child meets the criteria or that they don’t. If there’s no evidence of any other co-morbidities, we offer a shorter follow-up appointment than what we’ve done before. But it’s also helping us to identify children who may have significant complexity or co-morbidity, such as Autism Spectrum Disorder (ASD), which is very common (for ADHD and ASD to co-exist). They can then have a follow-up with a specialist and have a slightly longer appointment. It’s freed up some clinical capacity,” says Dr. Reynolds.

ADHD in women is complex and more research is necessary to further understand how it can be detected early on in women and managed effectively. Both clinicians and female patients must work together, free of bias and stereotypes to accurately assess/diagnose symptoms. Likewise, teachers at schools must also pay closer attention to young girls who are frequently inattentive and repeatedly fail to follow simple instructions.

If you have enjoyed this blog and would like to learn more about ADHD, you may find our ADHD & Me helpful. Alternatively, if you are a clinician looking for in-depth research about the benefits of objective testing in current ADHD evaluation methods, you may find our collection of clinical research insightful. For part two of our blog on ADHD in adult women, we will be looking at different ways to manage ADHD and valuable resources that could help women with ADHD.




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