ADHD in adult women is emerging as a focus of increased research, and women are being assessed for Attention Deficit Hyperactivity Disorder more commonly than in the past. This blog series addresses ADHD in adult women. In this third post in the series, Attention Deficit Hyperactivity Disorder is examined in women; specifically, issues related to diagnosis of Attention Deficit Hyperactivity Disorder in women.
How Common is ADHD in Women?
According to most available estimates, the male-to-female ratio of ADHD diagnosis is about 2 to 1 during childhood, with some studies estimating that the ratio is much higher. In adulthood, the rates of diagnosed Attention Deficit Hyperactivity Disorder in males and females are more similar, because women are more likely to receive this diagnosis as adults. While research confirms that ADHD is more common in males than in females, there is also evidence to suggest that ADHD commonly goes undiagnosed in females.
Diagnostic Challenges of Attention Deficit Hyperactivity Disorder in Women
Doctoral level specialists – typically a psychologist or psychiatrist – use standard diagnostic guidelines to diagnose ADHD, as well as rating scales, collection of information from corroborating sources, a review of history, and cognitive tests. There are no medical tests (such as blood or urine labs) that can diagnose ADHD. Research indicates that girls and women, compared to boys and men, are consistently under-identified and underdiagnosed for ADHD using these diagnostic criteria. Reasons for this disparity are discussed here.
ADHD in Women May be Underdiagnosed for Several Reasons:
- Symptom Types: Hyperactive/impulsive-type symptoms, which are more common in boys and men, are usually easier to notice than inattentive-type symptoms. A subtle symptom presentation with a greater likelihood of inattentiveness marks the ADHD experience for many women and girls, who are less likely to be outwardly disruptive to others. Many clinicians, however, are most familiar with the hyperactive, disruptive presentations of ADHD that are more common in men and boys. Studies indicate that hyperactivity and impulsivity, along with other externalizing symptoms (like conduct problems) are stronger predictors of diagnosis than more subtle ADHD symptom presentations.
- Gender Bias: Because ADHD is more common in men and boys, healthcare providers and educators may not look for or assume the symptoms will be present in girls and women. This can make it harder for girls and women to receive an accurate diagnosis and appropriate treatment.
- Referrals: Inattentive, non-disruptive symptoms rarely arouse concern, which is why few girls and teens with these symptoms are referred for diagnosis or consultation.
- Rating scales for ADHD are still skewed toward behavioral symptoms that are more typical in males. Internalized symptoms and impairments are often unaddressed, and many instruments are not normed for females.
- Less Available ADHD Research with Women: Early ADHD research mainly focused on the condition’s effects in males, resulting in ADHD research specific to females being years behind that of males.
- Criteria Flaws: Some experts note that the wording of the current diagnostic criteria is less helpful or accurate for diagnosing females than it is for diagnosing males.
- Stereotypes About Gender and Behavior: ADHD behaviors — especially those associated with hyperactive/impulsive symptoms — are often considered more socially acceptable in boys and men. Research shows that women are highly motivated to hide or camouflage their ADHD symptoms and compensate for them. Whereas women often suppress or hide their ADHD behaviors to fit in (leading to a lower likelihood of being diagnosed with ADHD), the symptoms that are observable in women are often anxiety or mood-related, which can lead to misdiagnosis.
The content for this article was derived in part from the following sources:
- https://www.cdc.gov/nchs/fastats/adhd.htm
- Cleveland Clinic: (https://my.clevelandclinic.org/health/diseases/24741-adhd-in-women)
- ADDitude:https://www.additudemag.com/adhd-in-women-misunderstood-symptoms-treatment/?srsltid=AfmBOoqVeQiluZLnL2VZ9dL99n_3OQR04nvRstgSpni6yH5zZi353zXB
If you would like to learn more about Attention Deficit Hyperactivity Disorder, you may want to explore additional posts on my Neuronews Blog. If you are interested in assessment for Attention Deficit Hyperactivity Disorder and are age 16 or older, you can learn more on my page about, Neuropsychological Assessment. Please feel free to contact me from that page or by email at amy@amyblackmonphd.com.