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 fifth post in the series, Attention Deficit Hyperactivity Disorder is examined in women; specifically, myths, societal expectations, and related challenges for women with ADHD.
Though Attention Deficit Hyperactivity Disorder was once thought to be a childhood condition characterized by hyperactivity, it is now understood to include inattentiveness and to be present throughout the lifespan, though symptoms often change over time. Outdated ADHD stereotypes remain both within and outside of the medical community, which interferes with research, diagnosis, and treatment of ADHD in women today.
Recent research predicts serious mental and medical outcomes for women who are inadequately evaluated and treated due to ADHD myths, such as:
- ADHD is a Male Disorder. Boys with hyperactivity were referred to clinics, as they were deemed disruptive and unmanageable. Early studies were based on the behaviors of these hyperactive (generally white) boys, and these findings helped shape the diagnostic criteria and assessment scales for ADHD that are still in use today.
- ADHD is a Childhood Disorder. ADHD was classified for years as a Disruptive Behavior Disorder of Childhood, based on the hallmark symptom of hyperactivity. Over time, it has become well-known that ADHD does not resolve with age, and that inattentive symptoms persist longer than hyperactive symptoms.
Gender Role Expectations:
ADHD in women is complicated by gender role expectations. Women often feel the weight of numerous expectations, including managing the self, the family, and the home. Balancing all of this requires consistent coordination of executive functions. Women with ADHD often have more difficulty managing these demands than their neurotypical peers. As women with Attention Deficit Hyperactivity Disorder strive to be accepted socially, they may be determined to meet these gender role expectations, typically by masking or camouflaging ADHD symptoms. Self-blame and shame can result. To understand women with ADHD, clinicians must also understand the extent to which women measure their self-worth according to how well they do or don’t conform to gender expectations.
Socialization:
Women with ADHD, compared to men with ADHD, often have more difficulty with socialization. Why is this? Women are often expected to manage challenging social demands. Women with ADHD may become overwhelmed with the demands of relationships, leading to having fewer meaningful relationships. They may not initiate friendships, and have difficulty maintaining them. Isolation can feel like protection from social discomfort, so women with ADHD may seek out isolation.
Women with ADHD often struggle with rejection sensitivity, an intense emotional response to real or imagined rejection, which can make social interaction painful. Women with ADHD are also more likely to engage in risky sexual behaviors than are women who do not have ADHD. This may occur due to early recognition of their sexuality as a shortcut to social acceptance. It’s common to find a history of early initiation of sexual activity, early intercourse, more sexual partners, more casual sex, less protected sex, more sexually transmitted infections, and more unplanned pregnancies in women who have ADHD. Though these experiences are common, they often result in shame.
Hypersensitivities:
Women with ADHD tend to experience more central nervous system hypersensitivities compared to men with ADHD. They often report more of the following:
- Tactile defensiveness and sensory overload related to being touched, and to common items like clothing material, tags, loud music, lights, and strong smells.
- Somatic complaints, including headaches, migraines, stomachaches, and nausea
- Sleep difficulties
Comorbidities:
By adulthood, most women with ADHD have at least one diagnoseable comorbid disorder that can complicate the ADHD symptom picture, including:
- Anxiety (obsessiveness, phobias, separation anxiety, social anxiety, or Generalized Anxiety Disorder)
- Mood disorders including Major Depressive Disorder
- Dysregulated eating/ eating disorders
- Oppositional Defiant Disorder or Conduct Disorder
- Personality disorders (particularly Borderline Personality Disorder when there is also a history of trauma)
- Sleep disorders
- Nicotine addiction
In addition, women with ADHD are at increased risk of online and in-person sexual exploitation, earlier sexual activity, unplanned pregnancy, somatic discomfort (such as headaches and stomach discomfort), academic and vocational underachievement, and inconsistent health maintenance, increasing their risk of medical problems. Females with Attention Deficit Hyperactivity Disorder are more likely than males to have experienced early neglect and physical and/ or sexual abuse (including physical violence in romantic relationships by early adulthood), predisposing them to some of the most severe outcomes. They are also at higher risk for problematic driving behaviors and criminal behaviors that can lead to incarceration than are their neurotypical peers. Adults with Attention Deficit Hyperactivity Disorder have reduced life expectancies (primarily due to accidents and risk-taking); women to an even greater degree than men.
Given all of these risk factors, it is clear that women with Attention Deficit Hyperactivity Disorder can experience complex life trajectories, particularly when they are undiagnosed and untreated. After experiencing social challenges, social rejection, and stigma regarding their neurological differences, women with Attention Deficit Hyperactivity Disorder may judge themselves harshly, and rely on compensatory tools such as intellect, humor, hypervigilance, obsessiveness, and perfectionism. Many cultivate a “flawless façade,” or an illusion of neurotypical functioning. They may hover around the periphery of social interactions, anticipating criticism or rejection. They may become demoralized over time, and those who struggle with impulsivity are at particular risk of self-harm. The risk factors that women with ADHD face highlight the need for early identification of Attention Deficit Hyperactivity Disorder in girls and women, as appropriate treatment and supports can eliminate or reduce the effects of many of these comorbidities.
The content for this article was derived in part from the following sources:
- https://www.additudemag.com/roe-v-wade-adhd-girls-pregnancy-risk/#:~:text=Why%20Girls%20with%20ADHD%20Face,author%20of%20the%20Swedish%20study
- Littman and Wagenberg, Gender Differences in ADHD and Their Clinical Implications, Psychiatric Times, 2023. https://www.psychiatrictimes.com/view/gender-differences-in-adhd-and-their-clinical-implications
- ADDitude: https://www.additudemag.com/adhd-in-women-misunderstood-symptoms-treatment/?srsltid=AfmBOoqVeQiluZLnL2VZ9dL99n_3OQR04nvRstgSpni6yH5zZi353zXB, reviewed by Ellen Littman, Ph.D., 2021.
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.