08 Jan ADHD in Women: The Common Variances of Attention Deficit and Hyperactivity in Girls and Women

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How Does ADHD Look Different in Women?

ADHD can often manifest differently in women and girls, showcasing distinct symptoms compared to men and boys. Research has shown that girls and women, compared to boys and men, are consistently under-identified and underdiagnosed. Typically, males with suspected ADHD tend to display externalising symptoms such as impulsivity and hyperactivity. On the other hand, women tend to exhibit inattentive ADHD, making it hard to focus, pay attention to details, stay organized, listen, make careless mistakes, and remember things. Females may exhibit internalising symptoms like inattention, daydreaming, feelings of low mood, and anxiety (Quin & Madhoo, 2014). Unfortunately, educators and parents, usually the first to raise concerns about a child potentially having ADHD, might overlook these subtler signs in girls. School reports might merely suggest, “She has great potential but needs to concentrate better.”

Our psychologists are experienced in the different presentations of ADHD, understanding that it manifests uniquely in each individual. In women and girls, ADHD often presents with symptoms that can differ markedly from those typically observed in men and boys. Without assessment and management, symptoms of ADHD symptoms will persist throughout life, and may significantly impact a range of areas on a daily basis. This is due to difficulties with executive function skills including task initiation, as well as emotion regulation..to name just a few but we’ll explore further in this blog! As a result, individuals often grapple with personal relationships and their careers.

When ADHD Symptoms Become More Evident:

Symptoms of ADHD (diagnosed or undiagnosed) often surface during periods of change or significant life adjustments such as the shift from high school to university, the experience of becoming a new parent or when assuming demanding job roles (Fedele et al., 2012). These adjustments place a higher demand on the individual resulting in notable functional challenges. At these junctures, women are found to often experience low self-esteem and performance anxiety (Quin & Wigal, 2004).

Seeking guidance from a professional with a particular focus on adult ADHD ensures you’re in capable hands. At Positive Wellbeing Psychology, our team includes psychologists with a special interest in conducting adult ADHD assessments and evidence-based interventions also targeting other co-occurring mental health conditions such as anxiety, depression, and low self-esteem among other challenges. Our Melbourne psychologists provide neurodiversity-affirming approaches to both assessments and therapy, bringing valuable experience in understanding the variations in ADHD symptoms in women; which can differ, not only from men but also among individuals and across one’s lifespan.

Why ADHD Goes Undetected in Women?

Sometimes, ADHD in women and girls remains undetected throughout the lifespan as anxiety or depression becomes the primary concern. During the assessment process, accurate and thorough differential diagnosis becomes crucial, especially when anxiety or depression has been found not to respond to conventional treatments. At Positive Wellbeing Psychology, our psychologists have an understanding of the diverse ways ADHD manifests in individuals, including the presentations observed in girls and women. This understanding is critical for accurate diagnosis, enabling appropriate referrals for management and support.

Common Secondary Symptoms of ADHD in Women:

Anxiety, depression, and burnout often take centre stage in women with undiagnosed ADHD, appearing as prominent symptoms. However, these challenges very often stem from underlying executive functioning difficulties associated with ADHD. The manifestation of anxiety, depression, or burnout may overshadow the root cause, which involves disorganization and struggles in organizing tasks, maintaining focus, managing time, and regulating emotions. For this reason, it is crucial to consult with a professional who has a specialised focus on ADHD. This ensures exposure to the variations in ADHD symptoms in women, which may differ not only from men but also among individuals.

Here’s an Example of How this Scenario Might Manifest:

Meet Sarah, a woman in her late 20s, navigating through intense bouts of anxiety and intermittent periods of depression. Despite appearing as symptoms of anxiety and depression, these emotions might have a root cause in undiagnosed ADHD, especially concerning meeting deadlines and managing responsibilities.

Sarah frequently finds herself overwhelmed by the demands of her work and home life, struggling notably with submitting assignments on time and frequently overlooking crucial tasks. While her experiences might seem indicative of anxiety and depression, they could, in fact, derive from untreated ADHD.

The executive function challenges Sarah faces, characteristic of ADHD, significantly impede her ability to initiate tasks, particularly evident in submitting assignments promptly. In addition, executive function difficulties also interfere with her capacity to organise her workload effectively, maintain focus during tasks, and manage time efficiently. Consequently, these struggles cause considerable stress, potentially leading to feelings of burnout.

Keeping in mind that Sarah was initially very eager and exceptionally organised when commencing her university degree, yet she has recently fallen behind. The absence of acknowledgment concerning the underlying ADHD-related executive function challenges often results in misinterpretation of her symptoms. Her experiences of anxiety, depression, and sudden burnout are mistakenly perceived as isolated issues, overlooking the fundamental struggle she faces in meeting deadlines and managing her coursework due to challenges including task initiation. The pronounced nature of anxiety, depression, or burnout might conceal the core executive function challenges that individuals with ADHD face on a daily basis. Alternatively, these difficulties might be perceived as a result of the depression rather than being identified as a secondary presentation. Despite their prominence, these mental health symptoms could indeed be secondary to the underlying executive function difficulties linked with ADHD.

Recognising this interconnectedness is crucial to providing comprehensive assessments and interventions tailored not only to manage anxiety, depression, or burnout but also to address and manage the underlying executive function challenges associated with ADHD.

What are the Signs of ADHD in Women?

Executive function refers to a set of cognitive skills that enable individuals to plan, organise, manage time, pay attention, regulate emotions, and complete tasks. In individuals with undiagnosed ADHD, particularly adult women, executive function difficulties often manifest in various aspects of their daily lives. These challenges, including symptoms of inattention and impulsive symptoms, can impact productivity, relationships, academic or professional performance, and overall quality of life. Recognising these symptoms of ADHD is crucial for seeking appropriate support and treatment options to manage the impact of executive function difficulties associated with attention-deficit/hyperactivity disorder.

How can Executive Function Skills be Impacted for Individuals with ADHD?

#1. Organisation and Planning:

Those with undiagnosed ADHD might struggle with organising tasks, maintaining schedules, and planning activities efficiently. The individual might find it challenging to prioritise tasks, leading to disorganisation and difficulties in meeting deadlines or fulfilling responsibilities.

#2. Time Management:

Individuals may experience difficulties in managing their time effectively. The individual might underestimate the time required for tasks or encounter challenges in breaking tasks into smaller, manageable parts, resulting in procrastination or unfinished projects.

#3. Focus and Attention:

Maintaining sustained focus and attention on tasks can be challenging. Individuals might get easily distracted by external stimuli, leading to difficulties in staying on task or completing activities that require extended concentration.

#4. Impulse Control:

Impulsivity can lead to impromptu decision-making without considering consequences. This may result in disruptions, interrupting others during conversations, or engaging in risky behaviours without forethought.

#5. Memory and Recall:

Difficulties with working memory might cause forgetfulness or trouble remembering important information, such as appointments, deadlines, or instructions given moments ago.

#6. Emotional Regulation:

Managing emotions can be challenging, leading to mood swings, frustration, or emotional outbursts when faced with stress or unexpected situations.

#7. Initiating and Completing Tasks:

Individuals may struggle to start tasks or have difficulty completing them once started. This difficulty in task initiation or completion can lead to unfinished projects or a pile-up of incomplete activities.

#8. Adapting to Change:

Difficulty in adapting to changes in routines or unexpected events can lead to increased stress and anxiety, resulting in difficulties in transitioning from one task or situation to another.

What is the treatment for ADHD and does this differ for women?

Treatment for ADHD, for both women and men, will always begin with testing to ensure accurate diagnosis of ADHD by a qualified mental health professional, such as those in psychiatry or clinicians who have a special interest in adult ADHD. The treatment plan for adult ADHD typically involves stimulant medications or non-stimulant options, tailored to manage core symptoms including inattention, impulsivity, and in some instances hyperactivity or fidgeting. Antidepressants may also be recommended if you’re experiencing mood-related conditions like anxiety or depression. However, the first line of treatment is ADHD medication combined with Cognitive Behavioral Therapy (CBT), which can be particularly effective in addressing associated issues such as low self-esteem, depression and mood disorders, anxiety disorders, and social skills difficulties. We recommend the treatment team include a combination of professionals including a psychologist for ongoing therapy and management, as well as a GP and psychiatrist should you opt for pharmacological treatment options. Our team of psychologists are experienced in supporting our clients to set up an appropriate treatment team and provide recommendations to professionals outside of our practice when required.

In addition to medication and therapy, ADHD coaches offer practical strategies for improving executive function, time management, and social interactions. For women, gender differences are critical to consider, especially around the menstrual cycle, menopause, and the impact of gender bias on the diagnosis of ADHD.

It’s important to note that ADHD treatment also involves addressing co-occurring conditions such as eating disorders, substance use, and self-harm, which are more prevalent in those with undiagnosed ADHD. Support groups and coping strategies tailored for adult women and young girls can provide essential support throughout their lifespan.

For those experiencing disabilities related to ADHD, targeted interventions can enhance daily functioning and improve overall quality of life. Ultimately, treatment options must be flexible and adaptable to the individual’s needs, with ongoing monitoring and adjustments as necessary.

If you or someone you know is struggling with symptoms of ADHD and related mental health conditions, seeking a referral to a healthcare professional is the first step toward effective treatment and management.

How a Psychologist Can Help with the Treatment and Management of ADHD Symptoms?

At Positive Wellbeing Psychology, our team of psychologists offer a valuable framework to support individuals exploring diagnosis and strategies for effectively managing ADHD symptoms. This approach prioritises strengths, resilience, and emotional well-being, moving away from focusing solely on deficits. It assists individuals in recognising their unique abilities and fostering a sense of self-worth. Through evidence-based interventions that promote self-acceptance and self-compassion, our approach aims to enhance self-esteem, which is particularly beneficial for individuals encountering challenges associated with ADHD.

How Positive Wellbeing Psychology Can Help?

At Positive Wellbeing Psychology, you can feel confident in obtaining your ADHD assessment in Melbourne with a psychologist experienced in adult ADHD in women. Our assessments will provide a diagnostic impression with testing conducted by a psychologist with a special interest and additional training to provide comprehensive diagnostic assessments. We also have an understanding of how ADHD and Autism in women can co-occur, and utilise standardised testing approaches to accurately evaluate potential co-occurring conditions. Our assessments aim to offer a holistic understanding of each individual’s neurodivergent profile, allowing for personalised and targeted intervention strategies to enhance wellbeing.

Our assessment process is compliant with the recently published National ADHD Guidelines 2022.

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References

Fedele, D. A., Lefler, E. K., Hartung, C. M., & Canu, W. H. (2012). Sex differences in the manifestation of ADHD in emerging adults. Journal of Attention Disorders, 16(2), 109-117.

Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. The primary care companion for CNS disorders, 16(3), 27250.

Quinn, P., & Wigal, S. (2004). Perceptions of girls and ADHD: results from a national survey. Medscape general medicine, 6(2).

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