Why ADHD in Females Is Often Overlooked
It’s not unusual for me to put important papers in a “safe place” and then find them months or years later. It’s not out of the ordinary to search for my phone for 20 minutes and then discover it in the fridge because I set it there while I was looking for eggs because I remembered I should boil some for my salad on my way to start the laundry, which I didn’t start until hours later because I remembered I needed to do research for a story, while the eggs overcooked because I forgot to set the timer. It’s the same case with the notes I often have written on my hand or the alarms I have to constantly set to remind myself of the most basic things (move the laundry to the dryer, take my medication, make a phone call) or my struggles to get places on time. This madness of stopping and starting, forgetting and remembering, sporadic periods of laser-beam focus, but more often, getting distracted by my hair when I need to be focused, is my daily life.
The thing is, no one, least of all me, had any idea that my real problem was attention-deficit/hyperactivity disorder (ADHD). When a writer friend began discussing her newfound inattentive ADHD diagnosis in a forum a few years ago, I was flabbergasted to find that I had exactly the same symptoms, and exactly the same life difficulties as a result. Because I had always thought of ADHD as something that only affected children, particularly excitable, twitchy children prone to outbursts, it was unfathomable that it could apply to me, a mom in her 30s.
In childhood, males are more frequently diagnosed with ADHD than females at a rate of three to one. In adulthood, that number decreases to two males per one female, probably because more women are diagnosed later. Why are females less likely than males to be diagnosed with ADHD? Though there haven’t been many studies done on ADHD in females specifically, experts believe that in general, ADHD tends to manifest differently in females than males. These differences can lead to overlooking or even misdiagnosing ADHD as something else, usually depression or anxiety.
Inattentive ADHD Is Less Obvious
ADHD is most commonly associated with hyperactive and impulsive behavior, symptoms males typically present with. This is why many people don’t realize there is an inattentive type, the most common presentation of ADHD found in females. The symptoms of inattentive ADD are not as noticeable, and young females may fade into the background of their classrooms as they daydream and doodle. Maria Yagoda puts the difference between male and female ADHD symptoms perfectly: “…think less running around a classroom throwing Cheez-Its and more having a nervous breakdown because you lost your passport somewhere in your laundry basket, which is really just a trash bag at the bottom of your closet.”
Males tend to get diagnosed earlier and more often because their symptoms are usually more physical and therefore more obvious. Symptoms of inattentive type ADHD are more mental and include disorganization, losing or misplacing things, difficulty focusing on a specific task or activity, becoming easily distracted, problems with time management, not paying attention to details, forgetfulness, reluctance and/or avoidance of tasks that take an extended amount of concentration, and difficulty following conversations. Since many of these symptoms take place inside the mind, they can be easy for both patients and mental health professionals to miss, which means there are now more adult women than ever realizing that they have had ADHD since childhood.
“Especially when we are talking about young kids, when we think of ADHD, there is this stereotype of someone who is very fidgety, who can’t sit still, who is up and down and sharpening their pencil all the time, or that kid that constantly has to go to the bathroom,” says Nikki Kinzer, PCC, an ADHD coach. “With females, it tends to be a lot harder because you are seeing someone who is probably daydreaming. They come across as being a little bit more flaky, a little more in their own head, so the teacher isn’t necessarily thinking they have ADHD. If parents and teachers look at other symptoms of ADHD and not just the hyperactivity, they would probably catch it a lot sooner.”
Other Illnesses Can Mask ADHD
Depression and/or anxiety are commonly diagnosed in females prior to an ADHD diagnosis, especially if, like me, you were in school in the 80s and early 90s, when ADHD wasn’t as well-known. The trouble is, the symptoms of all three conditions can be interchangeable, and depression or anxiety may resemble or possibly result from untreated ADHD, another factor that can cause ADHD to be overlooked. These similarities in symptoms can lead to the whole chicken-egg conundrum when an ADHD diagnosis is given—which came first, the ADHD or the depression and/or anxiety? Did one cause the other or was it actually just ADHD misdiagnosed as anxiety or depression?
Kinzer notes that every female client she’s had with ADHD also has had an anxiety or depression diagnosis. “If you think about all of the things that probably happened before you get the diagnosis of ADHD, it’s not that surprising that you would feel anxious or depressed, and that’s probably why those get diagnosed first,” Kinzer says. Indeed, studies show that it’s extremely common for ADHD to co-occur with other mental health disorders, most often depression or anxiety, in both children and adults.
With groceries to buy, appointments to remember, dinner to put on the table every night, kids to shuttle to and from activities, and the heaps of dirty laundry that never seem to dwindle, women have many demands on their attention and time. Even with a partner’s help, they usually end up with many day-to-day responsibilities on their shoulders, and their expectations for themselves are high. Many adult females who weren’t diagnosed with ADHD in childhood have learned over the years to at least partially compensate for their struggles. At the very least, they’ve learned to cover up their symptoms fairly well, often not even realizing that what they’re going through is abnormal. This ability to hide symptoms or compensate for the fallout ADHD causes is likely another reason why women tend to slip through the cracks when it comes to a diagnosis.
These high expectations usually come with a price. Guilt, frustration, shame and anxiety may become constant companions as women try to manage their lives and see other women managing theirs. These feelings may also cause women to be ashamed of a potential ADHD diagnosis. “I think as a culture we haven’t known how to support women with ADHD and how to help them with the stress of what they’re dealing with,” says ADHD coach Paula Altschul, MN, PCC. “Once they get caught in the cycle of anxiety, they need help learning how to work with it and how to turn it off.”
“It’s not to say that you can’t be at a very high functioning level,” says Kinzer. “What happens is women tend to set their goals too high, and they are almost self-sabotaging because they can’t possibly make those. It’s hard to hear because that kind of self-loathing and low self-esteem and shame have been built up for years.” Kinzer helps her clients focus on realistic goals and reframing their expectations. “I talk a lot about perfection not being real. It’s going to sabotage you if that’s what you’re aiming for,” she says.
Dealing with ADHD
Get diagnosed. If you suspect you have ADHD, the first step is to see a mental health professional, such as a psychiatrist, psychologist or a therapist for a diagnosis.
Consider treatment. Treatment options range from medication to counseling to coaching. You may end up using all, some or none of these options at different times in your life. There is no one treatment that’s right for everyone since each individual has unique needs. Medication may help you focus all day, counseling may help you learn new behaviors and coaching may help you achieve specific goals. Altschul works with clients on setting tiny, reachable goals and expanding them over time. “Most of the time people have lots of ideas about what they’d like to do, and they sometimes get stuck just thinking about it. I help them get over the fence,” she says. “If you look at what we’re doing from week to week, it might not look like a lot has happened, but if you look back over three months’ time, a lot has happened.”
Organize a support system. Help your friends and family understand your ADHD diagnosis and how it may affect your relationship and their expectations of you. Consider hiring a cleaner or an assistant or even one of your kids to help you with organizational tasks that become overwhelming. Join an online ADHD forum or group (Facebook has several). Enlist your partner in helping you with or taking over tasks you find overwhelming.
Educate yourself.Search the internet, read books and talk to others with ADHD (you might be surprised how many of us there are). One of the best self-help books I’ve found on adult ADHD is You Mean I’m Not Lazy, Stupid or Crazy?! by Kate Kelly and Peggy Ramundo.
Give yourself a break. So you may not be Super Woman with a spotless house, immaculate children and dinner on the table at the same time every night. That’s okay. You have your own unique contributions and qualities that make you invaluable to your loved ones. Focus on those as you take steps to help make your life more manageable.
Maintain healthy habits. Eat right, exercise regularly, try to get enough sleep every night and make sure you take time to relax, especially when you feel anxious or stressed.
Written by Sarah E. Ludwig