How to Recognize ADHD in Women

Attention-deficit/hyperactivity disorder (ADHD) can cause different symptoms in females than in males. Unlike males who tend to have higher rates of hyperactivity and impulsivity, females with ADHD are more prone to inattention. This includes difficulty organizing or finishing tasks, following instructions, or paying attention to details.

The symptoms of ADHD can also differ in girls and women and may only be noticed in later life when there are problems at work or home, or in relationships.

This article explains the cause of ADHD in females as well as the symptoms seen in girls and women. It also explores the various treatment options for this common neurodevelopmental disorder.

How ADHD Differs in Females

ADHD is a neurodevelopmental disorder characterized by excessive amounts of inattention, hyperactivity, and impulsivity.

According to the Diagnostic and Statistical Manual of Mental Disorders issued by the American Psychiatric Association, there are three types of ADHD:

• Predominantly inattentive type
• Predominantly hyperactive-impulsive type
• Combined type (where both inattentive and hyperactive-impulsive symptoms are present)

While females with ADHD can fall anywhere within this spectrum, they are more often diagnosed with predominantly inattentive type ADHD. There are several physiological and psychological theories for why this is.

It may be due in part to the structure of the female brain in which the hippocampus is generally larger than it is in males. The hippocampus plays a major role in learning and memory and is vulnerable to injury or impairment by any number of substances or stimuli.

Compared to males, the hippocampus of females is populated with more estrogen receptors. These are cellular triggers that are activated by the female hormone estrogen. This is important because hormone fluctuations that occur during a woman's can life dramatically affect brain functions and may contribute to the onset of ADHD symptoms.

Sociocultural issues can further complicate ADHD symptoms in females. These include feelings of low self-esteem and underachievement that commonly stem from childhood but can persist well into adulthood. Because of this, inattentive symptoms may go unnoticed, in part because expectations in girls are often different than expectations in boys.

Depression and anxiety are also more common in females with ADHD because girls are commonly taught to internalize their feelings rather than acting out as boys. These gender expectations can have as much of an impact on females with ADHD as the disease itself.

Signs and Symptoms of ADHD in Females

Although ADHD characteristically starts in childhood and often continues into adulthood, it can present differently at different stages in a female's life.

While predominantly inattentive type ADHD is more common in females, it is also possible to have predominantly hyperactive-impulsive type ADHD or combined type ADHD.

ADHD Symptoms in Girls

Symptoms of inattentive ADHD can vary by the setting and development age of a child. For girls with inattentive ADHD, this may manifest with behaviors such as:

• Not paying close attention to details
• Making careless mistakes in schoolwork
• Trouble staying focused
• Being easily distracted
• Being disorganized or messy
• Forgetting routine tasks, like house chores
• Appears not to be listening when spoken to
• Not following through on instructions
• Difficulty organizing and completing tasks
• Failing to meet deadlines
• Avoiding or disliking tasks that require sustained concentration
• Frequently losing things like books, keys, or school papers

Symptoms of hyperactive-impulsive ADHD in girls may include:

• Fidgeting constantly
• Difficulty staying seated
• Talking excessively
• Difficulty playing quietly
• Difficulty waiting their turn, such as in line
• Interrupting or blurting out responses
• Acting or speaking without thinking
• Trouble keeping on one topic
• Making and losing friends quickly
  

Girls with ADHD are more likely than boys with ADHD to have difficult interpersonal relationships, particularly during puberty when their behaviors may be construed as being difficult, conceited, or disinterested.

While girls with ADHD often succeed academically, they tend to experience higher levels of stress and feel inferior to their peers.

As a result, girls with ADHD may overcompensate and become sexually active at a younger age or remain in otherwise unhealthy relationships.

ADHD Symptoms in Women

For women with ADHD, symptoms of inattention are often more noticeable in a structured environment, such as college or the workplace. Coping strategies used to compensate in grade school may be harder to maintain in these settings.

Women with inattentive ADHD often manifest with symptoms like:

• Being repeatedly called out on careless mistakes
• Inability to multi-task or manage multiple relationships
• Missing deadlines
• Procrastinating and rushing to complete tasks at the last minute
• "Spacing out" at meetings or in conversation
• Difficulty keeping organized or tidy at school, home, or work
  
• Frequently misplacing or losing things, such as your phone or glasses
• Frequently missing appointments or forgetting to return calls
• Trouble making decisions or building manageable strategies
  

While hyperactive and impulsive symptoms are less common in females with ADHD, they can manifest with behaviors like:

• Restlessness and fidgeting
• Jumping from one topic or task to the next
• Talking excessively
• Interrupting frequently or talking over people
• Difficulty sitting still or relaxing with others
• Trouble maintaining friendships

Treating ADHD in Females

ADHD is treated the same in females as males, typically with a combination of medications and psychotherapy.

Medications

Medication is typically the first line of treatment for ADHD whether you are female or male. These include stimulants and non-stimulants that treat the symptoms of ADHD in different ways.

Stimulant medications are more commonly prescribed and generally more effective. Options include:

• Non-amphetamines, such as Concerta (methylphenidate) and Focalin (dexmethylphenidate)
• Amphetamines, such as Adderall (dextroamphetamine)

Non-stimulant medications are typically used when stimulants fail to improve relief or cannot be tolerated. These include:

• Strattera (atomoxetine)
• Kapvay (clonidine HCL)
• Tenex (guanfacine)
  

Therapy

In addition to medication, ADHD-focused therapies can address a broad range of issues, such as self-esteem, interpersonal and family relationships, stress, and life management skills.

Depending on the signs and symptoms of ADHD, psychotherapy may involve:

• Cognitive behavioral therapy (CBT): This form of therapy focuses on identifying and changing negative thoughts and behaviors. It can help improve impulse control and self-regulation. in recent years, CBT programs have been developed specifically for adults with ADHD.
• Neurocognitive psychotherapy: This combines aspects of CBT with therapeutic practices designed to sustain attention and concentration for prolonged periods of time.
  
• Dialectical behavioral therapy (DBT): This is a type of CBT aimed at increasing mindfulness, self-acceptance, and self-esteem through one-on-one or group talk.

The treatment for ADHD should start as soon as a diagnosis of ADHD is received, even in young children.

Summary

ADHD often manifests differently in females than in males. Girls and women are more likely to experience symptoms of inattention rather than hyperactivity or impulsiveness.

Females with ADHD are also more vulnerable to depression and anxiety and tend to be diagnosed later because their symptoms are typically less disruptive.

Although the treatment of ADHD is the same for females as males, females are prescribed ADHD drugs less frequently because their symptoms are either missed or misdiagnosed (or because some people consider ADHD a predominantly male disease).