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 second post in the series, Attention Deficit Hyperactivity Disorder in women is examined, particularly the way in which ADHD symptoms can appear different in women than in men.
Research suggests that Attention Deficit Hyperactivity Disorder symptoms are more difficult to recognize in females than in males, resulting in underdiagnosis in females. Attention Deficit Hyperactivity Disorder appears to affect people differently depending on their gender. The bulk of currently available research investigating ADHD by gender does so using the male/ female binary. As a result, that is how research is generally presented in this blog series, though additional research addressing Attention Deficit Hyperactivity Disorder in nonbinary people is certainly needed.
According to the Center for Disease Control (CDC), boys are approximately twice as likely as girls to be diagnosed with Attention Deficit Hyperactivity Disorder (13% vs. 6%); another CDC statistic reports that 15% of boys in the U.S. aged 3-17 are diagnosed with Attention Deficit Hyperactivity Disorder, compared to 8% of girls. While the prevalence rates of ADHD are increasingly similar by gender in adults, the diagnosis rate among American men is nearly 69% higher than it is among American women (5.4% of men in the U.S. have an ADHD diagnosis vs. just 3.2% of women.) Men tend to be identified and receive treatment and supports about ten years earlier than women.
As Attention Deficit Hyperactivity Disorder has been diagnosed later in more women in recent years, the gender gap has decreased among adults; diagnosis for women aged 23-49 doubled between 2020 and 2022. Emerging research suggests that Attention Deficit Hyperactivity Disorder may be more prevalent among transgender and non-binary people, with a 2021 study showing over 40% of transgender individuals reporting Attention Deficit Hyperactivity Disorder compared to 15% in the general population.
How Does Attention Deficit Hyperactivity Disorder Present Differently in Women than in Men?
Women with Attention Deficit Hyperactivity Disorder commonly exhibit more internalizing symptoms of Attention Deficit Hyperactivity Disorder (such as inattention) than externalizing symptoms (such as hyperactivity). Women may also have more symptoms of anxiety and depression and other comorbid psychiatric conditions than men do, which can complicate diagnosis of Attention Deficit Hyperactivity Disorder in women and jeopardize women’s outcomes. Women may develop coping mechanisms such as masking or camouflaging their symptoms, making them harder to identify and treat. Given all these factors, many girls are overlooked, misdiagnosed, or diagnosed later in life. Underdiagnosis has led women with Attention Deficit Hyperactivity Disorder to live without an adequate understanding of their neurological needs, or access to necessary services and accommodations.
Externalizing symptoms (such as hyperactivity, impulsivity, and behavioral acting out) are seen more commonly in males. Though girls present more often with inattentive symptoms, when they do experience hyperactivity it can appear as restlessness and fine-motor fidgeting, cuticle-picking, and nail biting, for example. Symptoms of impulsivity further influence how ADHD presents in women. Impulsivity in females is associated with:
- Gender-atypical behaviors, including behaviors that are perceived as controlling, demanding, and becoming easily irritated.
- High-risk behaviors, such as speeding, risky sexual behaviors, and extreme sports.
- Addictive behaviors, including substance use and gambling.
- A significantly increased likelihood of acting on negative feelings, including self-harm (such as picking skin and cutting).
- Hyperverbal and charismatic behavior.
- Social manipulation and exclusion
- Preferring the company of males
Which ADHD Symptoms are Women Most Likely to Experience?
There are three subtypes of ADHD: inattentive, hyperactive/impulsive and mixed. The subtype depends on which symptoms are present. The inattentive and hyperactive/impulsive subtypes each have nine possible symptoms. To be diagnosed with the inattentive or hyperactive/ impulsive subtype of Attention Deficit Hyperactivity Disorder, adults must meet criteria for at least six of the symptoms. The mixed subtype requires six symptoms from the inattentive subtype and the hyperactive/ impulsive subtype, for a minimum of 12 total symptoms. A common misconception is that women are more likely to have inattentive-type symptoms or receive a diagnosis of the inattentive type of ADHD. However, several studies show that is not the case. Instead, women have the same rates of inattentive-type symptoms as boys and men, but are less likely to have hyperactive/impulsive-type symptoms. That means that women are just as likely as boys and men to have inattentive-type ADHD, but are less likely to have hyperactive/impulsive-type and mixed-type ADHD.
Inattentive Symptoms of ADHD
Inattentive-type symptoms of ADHD in adult women can disrupt work, school performance, and social relationships. To be diagnosed with the inattentive subtype of Attention Deficit Hyperactivity Disorder, you must experience at least six of the following criteria:
- You’re prone to making errors because of inattention.
- You have trouble staying focused and on-task.
- You often seem like you’re not paying attention when others talk (you “zone out”).
- You start projects easily, but have trouble following through and completing them due to losing focus or getting sidetracked.
- You have difficulty organizing and prioritizing (especially with projects or tasks that include multiple steps).
- You dislike or avoid boring tasks, such as busy work, chores or paperwork.
- You’re prone to losing, misplacing or forgetting things.
- You’re easily distracted by what is going on around you, or by your own thoughts.
- You’re absentminded or forgetful during your daily routine, and may forget appointments, bills, and more.
Hyperactive/Impulsive Symptoms of ADHD
Like inattentive symptoms, hyperactive/impulsive-type symptoms can disrupt relationships and performance in multiple areas of life. Women are less likely to experience these symptoms than men, but some women certainly do. To meet criteria for the hyperactive/impulsive subtype of ADHD, you must experience at least six of the following:
- You fidget often.
- You frequently need to stand and move.
- You often feel restless.
- You have trouble staying quiet, and you talk to yourself or make sounds (sometimes without thinking about it).
- You are unusually active, and people have trouble keeping up with you.
- You find yourself talking excessively (this can include over-explaining yourself or talking at length about something you enjoy).
- You have difficulty with self-restraint in conversations, frequently interrupting people or finishing their sentences.
- You have trouble being patient and waiting your turn.
- You don’t always understand social boundaries, interrupting or intruding on others without realizing that others may find this behavior rude.
The content for this article was derived in part from the following sources:
- 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
- https://www.cdc.gov/nchs/fastats/adhd.htm
- https://adhdandautismclinic.co.uk/gender-differences-in-adhd-symptoms/
If you would like to learn more about Attention Deficit Hyperactivity Disorder, you may want to explore additional posts in 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.