Attention-Deficit/Hyperactivity Disorder (ADHD) is often associated with hyperactive young boys, but this portrayal only scratches the surface of a much more nuanced condition. Currently, the diagnostic manual describes three types (ADHD predominantly inattentive type, ADHD predominantly hyperactive impulsive type and ADHD combined type). ADHD affects both genders, but the ways it manifests and is experienced can differ.
The Centers for Disease Control and Prevention (CDC) reports that boys are more likely to be diagnosed with ADHD than girls (12.9% vs. 5.6%). Women and girls, in particular, may face unique challenges that can complicate diagnosis and treatment. Understanding these differences is crucial for improving support and outcomes for those affected.
1. Recognizing ADHD in Women and Girls
a. Symptoms and Presentation:
ADHD in women and girls often presents differently compared to men and boys. While boys frequently exhibit hyperactivity and impulsivity, girls are more likely to experience the inattentive subtype of ADHD. This means they may struggle more with disorganisation, forgetfulness or misplacing things, procrastination, difficulty following conversations, emotional dysregulation or easily overwhelmed, careless mistakes, easily distracted, verbally impulsive or interrupting and difficulty sustaining attention (‘zoning out’, daydreaming or doodling) or hyperfocus on preferred activities.
ADHD in women and girls is complicated by gender role expectations; society’s expectations of females to take care of themselves and others which requires consistent coordination and executive functions (coordinated skills in organising, planning, prioritising, time management, decision-making, etc). Girls with ADHD often develop coping strategies to mask their symptoms, such as becoming exceptionally organised or diligent to compensate for their challenges. These strategies can make their difficulties less visible, leading to underdiagnosis or misdiagnosis.
Females with ADHD tend to experience more central nervous system hypersensitivities compared to males, including sensory sensitivities, somatic complaints (e.g. headaches, nausea and stomach complaints) and sleep difficulties.
b. Emotional and Social Implications:
Research shows that girls with ADHD are often more prone to internalising symptoms, which can manifest as anxiety, depression, or low self-esteem. The effort to meet social expectations and manage daily tasks can contribute to these emotional difficulties. They may also experience significant stress trying to conform to social norms or expectations and Because they’re not able to do the things that society expects them to do, people assume they don’t care, which can exacerbate feelings of inadequacy. It is often these symptoms that may lead to mental health support, whilst the underlying cause continues to go unrecognised and untreated.
2. The Impact of ADHD Throughout Development
a. Childhood:
In childhood, ADHD in girls might be overlooked due to their tendency to be compliant with expectations. Teachers and parents might focus on behaviour that is less overt but equally problematic, such as disorganisation, difficulty focusing, not having equipment needed or signs of anxiety / stress.
b. Adolescence:
During adolescence, the challenges associated with ADHD can become more pronounced. The demands of middle or high school / secondary school —such as maintaining grades, managing social relationships, and participating in extracurricular activities—can be overwhelming. The demand can outweigh their capacity to cope or mask challenges. For many girls, ADHD symptoms only start to visibly interfere with academic performance and social interactions, in adolescence, which potentially leads to academic underachievement and social isolation. Research studies have shown that girls with ADHD (diagnosed or undiagnosed) score lower than boys on measures of mental well-bring, self-esteem and relationship with parents. These challenges can lead to seeking validation through risky behaviour (e.g. early initiation of sexual activity, more sexual partners, more casual sex, more unplanned pregnancies, etc.).
c. Adulthood:
ADHD is a lifelong condition and symptoms persist into adulthood. Women may face challenges in managing household or daily living responsibilities, maintaining relationships, and advancing in their careers (e.g. due to missing appointments and deadlines, overspending, disorganisation and clutter, indecision). The cumulative effect of years of struggling with unmanaged ADHD can lead to chronic stress and burnout. Additionally, women might experience hormonal changes that can affect ADHD symptoms, such as during pregnancy or menopause.
3. Diagnosis and Treatment
a. Diagnosis Challenges:
Diagnosing ADHD in women and girls can be challenging due to the subtler presentation of symptoms and masking behaviours. Women and girls may be better at hiding their symptoms, or their struggles may be attributed to other factors, such as stress or personality traits.
b. Treatment Approaches:
Effective treatment for everyone with ADHD, including women and girls, requires a multifaceted approach. Behavioural therapy, organisational coaching, and psychoeducation can also play significant roles in managing symptoms. Support systems, including family, friends, and educational or workplace accommodations, are essential in helping women and girls manage ADHD effectively. Understanding and empathy from those around them can make a significant difference in their ability to thrive. Lastly, medication, such as stimulants and non-stimulants, can be effective, but it’s crucial to tailor the treatment to individual needs.
Note: medication is not the first or sole treatment of ADHD, medication should be considered under the advice of a qualified psychologist or psychiatrist working with the individual with ADHD.
4. The Path Forward
Raising awareness about how ADHD manifests in women and girls is key to improving outcomes. Healthcare professionals, educators, and parents should be aware of the less obvious signs of ADHD and be vigilant in seeking appropriate evaluation and support. Encouraging open conversations about mental health and advocating for individualised treatment plans can help ensure that those affected receive the support they need to succeed.
By recognizing the unique ways ADHD can manifest in women and girls, society can better support and accommodate their needs, leading to more accurate diagnoses and effective treatments. Understanding and addressing these differences is essential in promoting a more inclusive and supportive environment for everyone affected by ADHD.
To meet with a professional psychologist or counsellor, call The Other Clinic at 8809 0659 or email us hello@theotherclinic.sg.