Women and ADHD: It’s More Common Than We Thought!
Procrastination, forgetfulness, irritability, and anxiety are all normal parts of human life. For people with ADHD, however, these are some of the more common challenges they face every day. For them it is nearly impossible to “get it together” and “stop being lazy”. Even the simplest tasks can require excessive effort, which is hard to understand if you don’t have ADHD. Women especially have trouble getting diagnosed and treated for ADHD.
Attention-deficit/hyperactivity disorder (ADHD) is stigmatized and rarely talked about even though more than 9% of children aged 3–17 in the US have been diagnosed. It is still common for people to associate ADHD with little boys who are loud, fidgety, and inattentive. We now know that there is much more to it. In recent years the scientific community has slowly to come to the consensus that girls and women are just likely to have the disorder as men, only they are less than half as likely to be diagnosed.
ADHD or attention-deficit/hyperactivity disorder is a chronic mental condition that affects various processes in the brain. It was long believed to be a childhood neurodevelopmental disorder sufferers grew out of, a problem found only hyperactive children, usually boys. New research shows that, while the challenges of childhood ADHD can diminish over time, symptoms can persist into adulthood for both sexes—they just look a bit different.
ADHD vs ADD
The name of the condition has two parts—attention-deficit and hyperactivity; these used to be considered two different categories. The term attention deficit disorder (ADD) is an obsolete classification; it was once used to refer to what is now known as the inattentive type of ADHD.
Modern medicine recognizes three types of ADHD:
- Hyperactive/impulsive
- Inattentive
- Combined
A person with ADHD will usually have symptoms at both ends of the spectrum, but one or the other type—hyperactive or inattentive—often plays a more primary role in their cognitive processes.
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The hyperactive type is characterized by a constant need for action and physical movement. People with the hyperactive type of ADHD tend to be impulsive, they may interrupt conversations, “finish” other people’s sentences, or talk more than other people can easily process; they often require excessive physical activity to feel good, they fidget and can’t sit still. This is the more overtly noticeable type that many people typically associate with little boys and men.
People who suffer from the inattentive type of ADHD also have trouble focusing, but the condition presents as an inability to retain information from conversations or remember instructions. They may seem “distant” and forgetful and are often losing things. They struggle with time management and routines, regardless of whether they are dealing with daily chores or very important tasks. This type is more commonly found among women and girls.
Outcomes are actually very similar for both types of ADHD sufferers. They have trouble focusing, maintaining conversations, sticking to a daily routine, and performing certain tasks requires much more effort for them than seems reasonable to others.
Distinguishing between the hyperactive and inattentive types of ADHD is a means of categorizing the outward expression, which can be important for treatment. However, the underlying cognitive processes are often very similar for both types.
The way we express our thoughts and emotions is related to our individual personalities, to our upbringing, and to cultural norms. This applies to everyone, including people with ADHD.
One person may express their feelings of irritation and anger loudly and visibly, but a quiet and reserved person may be inwardly just as angry. Similarly, talkativeness and impulsivity can mask forgetfulness and apprehension.
How does ADHD present in women?
Some of the most common symptoms of ADHD in women include:
- Inability to concentrate in conversations
- Difficulty focusing on and completing tasks
- Difficulty with time management and following routines
- Easily getting bored
- Easily getting distracted
- Easily getting overwhelmed
- Forgetfulness
- Impulsivity that leads to overspending and ill-considered decisions
- Messy living and workspaces
- Persistent anxiety
- Hyper-focusing on topics of interest
- Overthinking
- Difficulty in making decisions
- Engaging in busywork
- Tendency towards overworking, which can lead to burnout
What causes ADHD?
While the exact cause of ADHD is still unknown, research is ongoing. There is a well-documented genetic component.
If a parent shows signs of ADHD, it is very possible the condition will be passed on to their children in some shape or form. What’s more, the genetic clues can lead to realizations both ways. Many people who are diagnosed as adults, especially women, recognize their own symptoms only after discovering ADHD in their children.
If you are genetically predisposed to ADHD, various triggers can intensify the symptoms, for example:
- Premature birth
- Other health conditions such as epilepsy
- Trauma and brain damage
- Chronic stress
- Overstimulation
- Lack of routine
- Poor eating habits
- Use of inappropriate medication and stimulants
- Hormonal changes, for example, during menopause
For people with ADHD, poor habits can create a cycle of distress. Living in a messy home, eating unhealthy meals, and feeling the stress of missing deadlines can all intensify the symptoms of ADHD, and having ADHD in the first place makes taking positive action to change things extremely challenging.
This is not laziness. There are structural differences in the brains of people with ADHD, which means they have no choice but to operate from their own baseline, which is different from that of neurotypical people.
The ADHD brain
ADHD is a broadly defined condition. Although there are many variations in expression, some unifying features have been identified.
Neurological research on ADHD brains has revealed that certain areas of the brain may develop faster or slower than in neurotypical brains and the connectivity between areas can also be different.
The neurotransmitters responsible for “typical” brain function are “dysregulated” in people with ADHD. Simply put, the messages sent between different parts of the brain are not always passed on effectively.
The two most important neurotransmitters that are commonly disordered in ADHD brains are dopamine and noradrenaline. Both are directly related to mood and motivation, among other things. Depending on the levels of these neurotransmitters being produced in the body and how effectively the brain uses them, a person can become either hyperactive and hyper-focused or completely devoid of motivation. Both extremes are typical “features” of ADHD. An accompanying feature is that perception of time is often distorted for people with ADHD.
Why is it so hard to get an ADHD diagnosis?
Although it is clear that ADHD brains function differently from neurotypical brains, we simply don’t know enough to say exactly why—yet.
To establish an ADHD diagnosis, doctors are still following guidelines set nearly 40 years ago. A checklist is used to screen for ADHD, but the list was originally modeled on white boys from similar social backgrounds. The criteria are being adjusted as our scientific knowledge improves, but this isn’t happening fast enough.
Given that the main symptoms of ADHD are seemingly common human behaviors—forgetfulness, lack of motivation, procrastination, and so on—not many people get referred by their doctors for further testing. Instead, people with ADHD are often labelled as lazy and untrustworthy and can face a great deal of stigma at school and in the workplace.
For a long time, it was believed that ADHD is first and foremost a disorder found in little boys; this idea is still prevalent. In the US approximately 13% of boys but only 6% of girls are diagnosed as having ADHD. We now know that almost as many girls and women suffer from ADHD as boys and men, but the signs are often ignored in females. There are several reasons for this.
In women ADHD presents as the inattentive type much more often. Little girls with ADHD daydream, have trouble retaining information and keeping a schedule but aren’t bouncing off the walls like their male peers. Their difficulties are less noticeable because their behaviour is less problematic for adults, but that doesn’t mean the difficulties are not real.
Women tend to be socialized from early childhood not to exhibit outward expressions of negative emotions. Rather than acting out, women are much more likely to internalize their struggles. Little girls are taught not to interrupt and are much more likely to be reprimanded for unruly behavior, so they become exceptionally good at masking their experience.
Masking is a term used to signify a set of behaviors employed specifically to accommodate the needs and expectations of others. Women are strongly encouraged to adapt to their environment. They often do it so well that others have no idea they are struggling, even if they have a disorder such as ADHD.
And women are in a double bind. Even when they do talk about what they are experiencing, they are still less likely to be referred for further medical investigation.
Unfortunately, being inattentive, impulsive, or forgetful is often erroneously considered normal for women. Such trying symptoms are frequently attributed to PMS, when they might be the result of a condition that, if properly diagnosed, could easily be treated.
Mood swings and brain fog are a normal part of the human experience and can indeed be caused by hormones, but they can also signal real disorders that shouldn't be ignored.
Women's negative emotions such as anger and frustration are also often dismissed as less serious than when a man shows anger.
Anxiety and depression often go hand in hand with ADHD in women and girls, as do other associated conditions such as eating and sleeping disorders.
How to live with ADHD?
While the ADHD brain is considered divergent from the neurotypical brain, by now we are well aware that there is no such thing as a “normal” human being. Instead of striving to fit the perfect mould, we can become better at accepting and celebrating our differences. If you suspect you might have ADHD, consult a health professional for screening.
There are a number of things we can do to manage the symptoms of ADHD:
Simplify and structure. If daily chores are taking too much effort and energy, simplify and automate wherever you can. Put routines in place for shopping and paying bills, for example, set up a weekly grocery order. Keep the things you use every day in easily accessible places and put them back in the same place every time. Choose items that don’t require much upkeep—clothes and bedding that don’t wrinkle, succulents that don’t need much watering, food staples that store well and can be supplemented with fresh produce. Consider investing in household appliances such as a slow cooker or a vacuum robot to simplify chores.
Limit distractions both at work and at home. Turn off unnecessary notifications from your digital devices, unsubscribe from overwhelming email lists, use white noise or special ADHD soundtracks to help you focus while you work.
Exercise. Physical exercise is important in managing stress levels and reducing restlessness in your daily life. Twenty to thirty minutes of activity can be enough to stimulate dopamine production that will see you through several hours of getting things done. Some people become very good at identifying when they need to take a break and go for a walk, and just how long they need to walk to get the dopamine flowing again.
Establish food and lifestyle habits that reduce the impact ADHD has on your life. Many people with ADHD benefit from a low carbohydrate, low sugar diet and may also have difficulty breaking down gluten and/or the milk protein casein in their digestive systems.
Use a daily planner to keep track of tasks and list them in order of priority. This can help you make sure you get the most important things done in good time. Sometimes you can give yourself a dopamine boost by taking care of a few easy, less urgent tasks. Crossing things off your list can free up your mind to deal with something more challenging. Just be careful not to fall in the trap of busywork.
Break down tasks into small chunks and commit to one chunk at a time. Decide to fold laundry for 10 minutes. Use a timer. Then take a moment to appreciate your accomplishment. Even if you haven’t finished, you will have done more than if you hadn't started and just kept worrying. You may find it possible to set the timer for another ten minutes or move on to a different task. Try the “pomodoro technique”.
Respect your limitations and nurture your well-being. Accept that everyone experiences setbacks, but the setbacks don’t define you as a person. Individual or group therapy can help you recognize behavioral patterns and give you tools and perspective. Sometimes, something as simple as a breathing exercise allows you to recenter yourself and notice what you need—to stretch, to get a drink of water, to find out the answer to a question that will let you move on to the next step.
Prescription medication can often help alleviate the symptoms of ADHD. Many people report that life becomes much easier with the proper medication. Both stimulants and non-stimulants may be prescribed to help with focus and motivation. Some type of antidepressant may also be prescribed to treat accompanying depression and anxiety.
Our lives are dynamic. The symptoms of ADHD may change over time, and you can change your routines in response.
Although ADHD is a lifelong condition, it is possible to adapt and even thrive by making smart tweaks to your surroundings—especially when you have a clear diagnosis and support from the people around you. Many successful entrepreneurs report having ADHD: the constant need for change and aversion to routines can be a powerful driving force to spark innovation.
Unfortunately, ADHD is not a “superpower”. It is a challenging condition that affects many people, preventing them from organizing their lives successfully, even if everything seems fine from the outside.
The good news is that there is a growing recognition of how many people are affected by ADHD and help is available. The first step is acknowledging that you are worthy of help—every single day.
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