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What does ADHD in women look like and what's the path forward in terms of treatment?
By tracy deagan — Written on Oct 22, 2021
A generation ago, clinical wisdom strongly suggested that ADHD rarely existed in girls, much less adult women. Research on ADHD almost exclusively focused on boys and men.
However, research now shows that ADHD in women and girls simply presents differently. This is why the myth that only males have ADHD has persisted for decades.
What does ADHD in women and girls look like?
ADHD in boys is often fairly noticeable because they're disruptive at home and at school. ADHD symptoms in boys often affect others.
They "act out" aggressively, are hyperactive, restless, and interruptive. Their problems are very noticeable to teachers and parents, so they're more likely to be assessed, diagnosed, and treated.
ADHD in women and girls and is often "inattentive" ADHD.
In some cases, this is also mixed with hyperactivity.
Generally, these girls tend to turn their emotions and behaviors inward — that inward vs. outward focus is apparent in many of the behaviors, reactions, and disorders that affect both men and women.
A leading ADHD expert in women’s and girls’ ADHD, Stephen Hinshaw Ph.D., says that girls', and later women’s, symptoms include that they "tend to take their problems out on themselves rather than others. Compared with boys who have the disorder, as well as with girls without it, girls with ADHD suffer more mood disorders such as anxiety and depression as well."
Due to these differences in presentation, teachers and parents often believe girls are just daydreamers, absent-minded, "dumb," or socially awkward.
Since they often turn inward, they "act out" less and are not as disruptive as boys. Thus parents and teachers often miss these more subtle clues and their significance.
Or they focus solely on concerns about the girls' home life or depressive and anxious behaviors, missing the ADHD part of the picture altogether.
Recent research posits that potential adult-onset cases of ADHD are more likely to exist in females.
Research has not been conclusive so far however as to whether this is due to the factors explained above — that it's just not seen or assessed due to presenting differently — or if it's truly absent before adolescence or young adulthood in more females than males.
Why does ADHD occur in girls and women?
There's evidence that genetics plays a large role. Statistics indicate levels of genetic impact align with disorders such as schizophrenia or bipolar disorder.
Genetic factors are thought to contribute up to 40 percent of causes when it comes to these disorders.
Whether it's genetics or another factor — such as nurture or situational aspects— or all of these factors together in some measure, young, older onset, and ongoing adult female ADHD has been found to have a profound impact in women’s lives.
The bad news is that girls and young women with undiagnosed ADHD can become women with higher risk for multiple social and emotional problems, intimate partner violence, self-harm (NSSI, "nonsuicidal self-injury," harming themselves through cutting, etc.) as well as have a greater incidence of actual suicide attempts.
Females with ADHD have been shown to have impulsive behaviors that lead to factors like strikingly high rates of unplanned pregnancies, substance abuse, and other "impulse control" problems.
Research has shown that 40 percent of women with ADHD encounter these life events versus just 10 percent of young women without ADHD.
Obviously, these effects can come from many factors besides ADHD including situational factors like exposure to trauma, poverty, or societal/community harms.
The good news is that ADHD has several positive aspects.
Women with ADHD often site their ability to focus for long periods of time — usually called "hyperfocus" — as a benefit of ADHD.
Some feel the eclectic point of view ADHD can bring allows them to be more creative. Many have an artistic bent and believe they are able to “think outside of the box” more easily due to ADHD.
While self-report tests can try to answer the question, "Do I have ADHD?", most professionals believe such tests are only indicators that consultation with an expert is needed.
Assessment and diagnosis are very important. Most women report a sense of relief and clarity upon being diagnosed. They experience a boost in self-esteem and improved functioning when they understand their diagnosis and prognosis.
Another benefit to women with ADHD and symptoms of ADHD is understanding that no matter the cause of their ADHD, it is treatable.
Some believe medication is the answer.
Medications like Adderall (mixed amphetamine salts) greatly improve focus for some and lessen anxiety. The majority of therapists and doctors agree that the most beneficial treatment includes a blend of medication and talk therapy.
A combination of Cognitive Behavioral Therapy (CBT) and Relational Multicultural Theory (RMT)-based therapy can be the most helpful to women experiencing ADHD.
Research backs up this view.
While Cognitive Behavioral Therapy provides a structured way to challenge one’s automatic thoughts and choose new ones that better fit our current life circumstances and beliefs, RMT can provide an important addition, especially for women.
Relational Multicultural Theory (RMT) addresses the social anxiety and sense of self or self-esteem aspects of ADHD in women.
RMT was developed by the Stone Center at Wellesley College which bases its longitudinal research on girls and women and how they develop and grow.
Their research shows that most teen, young adult, and adult women with ADHD benefit from discussion, education, and therapy experiences that focus on their unique needs as females.
Therapy should include assistance with interactions in relationships, realistic and aspirational relational and personal expectations, and a connection with a therapist that is positive and supportive.
RMT addresses these concerns to help women with ADHD see themselves, their own needs and others' needs, and their path forward in a clearer and more positive light.
This blend of CBT, RMT, and improved research and treatment can help women with this disorder improve their lives and regain their sense of agency in the world.
Though ADHD in women and girls receives less attention than ADHD in men and boys, there are viable options for individuals to lead successful, healthy lives.
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Tracy Deagan is a psychotherapist with a strong background in working with those that experience PTSD, Dissociative disorders, and Healthy Multiplicity from traumatic experiences.