Why is ADHD in women undiagnosed so often?

The fastest growing group of people to be diagnosed with ADHD is women and in particular, mothers. Female ADHD is somewhat overshadowed by male ADHD - we know that boys are three times as likely to be diagnosed with ADHD as girls. But the fact is women still do have ADHD and a staggering 50% to 75% of women with ADHD go undiagnosed.

Why are women with ADHD often undiagnosed?

Different Symptoms:

It seems that one of the main reasons is that men and women often have different types of ADHD.

1. Male ADHD tends to be ‘Hyperactive ADHD’ - characterised by an inability to sit still, often interrupting conversations, talking a lot, having intense emotional reactions and embarking on risky behaviours.
2. Female ADHD tends to be ‘Inattentive ADHD’, also known as ADD– the symptoms are less obvious as the individual can look like they are paying attention, but their mind is elsewhere. This type of ADHD is characterised by being disorganised, daydreaming, finding it hard to make decisions, being withdrawn or taking longer to process information.

Most of the ADHD research was done in the 70’s and centred around young, white males with hyperactive tendencies. Female ADHD often presents very differently to male ADHD, so it might be that less women are diagnosed because people simply aren’t looking out for the symptoms commonly experienced by females with ADHD.

Often people with Inattentive ADHD go undiagnosed as the behaviours are not disruptive enough to raise concern, so whilst there may be girls in your children’s class with Inattentive ADHD, they may well be ‘under the radar’ as from the outside their behaviour is not disruptive enough to intervene.

Different expectations of women:

One argument for why ADHD goes undiagnosed in women is that society’s expectations of women are different and symptoms of the type of ADHD more commonly found in women are in line with these expectations. For instance, expectations for girls might be different than they are for boys, so parents and teachers might not worry if a girl is just a bit disorganised, messy or ‘is in her own world’. However, once girls hit adulthood and are expected to be more organised, perhaps balancing work and families, things can get a lot tougher for women. Stereotyped as this might be, it does go somewhat to explaining why women may simply be labelled as ‘ditzy, forgetful or not very practical’ instead of looking deeper at what might be going on. In fact, the women who have ADHD might self-perpetuate this themselves. How many of us know someone who says ‘Oh, I’m always forgetting things’ or ‘Let someone else do that, I’m no good at making decisions’?

It’s very common for women with Inattentive ADHD to feel overwhelmed, a failure, out of control and unable to cope with daily life. With no understanding of what might be causing this, it can lead to low self-esteem, depression and anxiety.

Hormones:

One theory of ADHD not being diagnosed well in women is hormones. Female hormones present in puberty, the menstrual cycle and the menopause change how the symptoms of ADHD manifest. For instance, during the menopause there is a reduction in the levels dopamine and serotonin. These brain chemicals are needed for concentration and mental clarity, so women who are going through the menopause often complain of finding it harder to complete tasks and getting distracted. These symptoms are also common in ADHD. So what might be happening is that normal, female hormonal fluctuations are masking the symptoms of ADHD.

Or is it just ‘having too much to do’?

Another argument put forward about why some women don’t seek an ADHD diagnosis is that many of the symptoms are experienced by women who don’t have ADHD as well. Some wonder if the pressures put on women to balance work, families and home life have increased in the last century, meaning many women feel constantly overwhelmed, disorganised, lack time to sleep or socialise and constantly flit between jobs. Whilst men also have some or all of the same challenges, it might be that the increased profile of ‘women’s multitasking lifestyles’ has meant that women put their symptoms down to this and not the possibility of having ADHD.

What are the symptoms common in female ADHD?

Whilst the symptoms are different in every individual, some common themes are present in Inattentive ADHD. Of course, some girls and women will have the other types of ADHD, but here are the most common symptoms of Inattentive ADHD/ADD.

• Feeling overwhelmed – women with ADHD may often feel ‘on the brink’, as if one more thing will push them over the edge and they are barely coping.
• Easily distracted – environmental noises, their own thoughts, new tasks and phone calls can result in a task being abandoned midway and often those with ADHD find it difficult to focus on a task for any length of time.
• Feeling a fake – many women develop successful coping mechanisms to deal with some of the challenges that ADHD brings with it, but this can mean they feel they are constantly ‘acting’ at being competent. For some, they are able to ‘hold it together’ at work but then might feel things fall apart at home.
• Forgetful – it’s common for those with inattentive ADHD to forget birthdays, appointments or where their phone or keys are.
• Depression and anxiety – unfortunately ADHD is often accompanied with a co-morbidity – another condition caused or a result of the ADHD. Feeling overwhelmed, socially isolated and a ‘fraud’ can leave those with ADHD with low self-esteem, depression and anxiety. It’s thought that 50% of those with ADHD also have a co-morbidity with anxiety being the most common.
• Running late
• Socially isolated – it may be hard for women with ADHD to feel they have much in common with other people and that they simply don’t fit in. For this reason they may isolate themselves.
• Feeling incompetent – studies showed that women with ADHD were much more likely to give up on challenging tasks because they felt the task was outside of their control to complete (Rucklidge, 1997).
• Low tolerance to stress
• Impulsive behaviour – whilst levels of impulsive behaviour might be less than for those with ‘Hyperactive’ ADHD, it’s common for those with ADHD to shop or eat impulsively.
• Disorganised – clutter, an inability to keep on top of paperwork or spending lots of time trying to find the perfect organisation system are common in those with ADHD.

What should I do next?

• If you suspect you might have ADHD, getting a diagnosis is the first step. Whilst this might seem scary, and you may worry about how your friends and family will react, many women who have received a diagnosis say they experience a huge relief. Suddenly there is a reason to why they have been struggling for years, the treatment plans can make a considerable difference to how the individual can cope and more often than not, friends and family are hugely supportive.
• Talk to a GP or mental health professional about your concerns.
• Consider taking notes to your appointment about things you find difficult or have struggled with.
• Talk to family members about whether they noticed any behaviours in childhood.

ADHD is a condition that can be hugely disruptive to people’s lives. Those with it often say that their life is characterised by underachievement, frustration and confusion about why things seem so difficult. A diagnosis can significantly improve things – suddenly there is an understanding of why things are tricky, and therapies such as CBT and medication can help improve people’s lives.

If you think you might have ADHD consider whether an assessment might be useful.

Read more about ADHD in adults here.

Read more about ADHD in children here.