Why ADHD Symptoms In Women Often Go Unnoticed
When most people think about attention-deficit/hyperactivity disorder (ADHD), they think about hyper little boys. It’s true that most ADHD diagnoses occur among male children. The average diagnostic age for ADHD is seven, and males are three times more likely to receive ADHD diagnoses during their lifetimes, according to the Centers for Disease Control and Prevention.
Given those statistics, many people don’t realize that women can also have ADHD. The cultural misunderstanding of what ADHD looks like goes back to the early 1900s. Back then, people referred to ADHD as hyperkinetic impulse disorder. More than a hundred years later, many mental healthcare professionals still fail to recognize cases of ADHD in girls.
Many of these females go their entire lives without being formally diagnosed unless they somehow recognize their own symptoms and seek support. For many women, this occurs when one of their children receives an ADHD diagnosis. As these mothers learn about ADHD’s genetic component and gain a clearer understanding of ADHD symptoms, they recognize those symptoms within themselves.
Researchers continue to explore the relative occurrence and clinical presentation of ADHD among men versus women. In the meantime, researchers and clinicians have identified several possible explanations as to why ADHD symptoms in women often go unnoticed:
ADHD symptoms are less noticeable in women versus men
The American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) posits there are three types of ADHD. Predominantly Inattentive Type involves behaviors like difficulties in listening when spoken to, completing complex tasks, and organizing multi-step activities. Predominantly Hyperactive-Impulsive Type includes things like fidgeting, difficulty remaining seated, irritability/aggressiveness, and a tendency to talk excessively. Combined Type is when there are multiple inattentive and hyperactive-impulsive characteristics.
Research suggests that males exhibit more pronounced symptoms of both hyperactivity and inattentiveness than females. This makes them more likely to receive a diagnosis. A 2014 study led by Anne Arnett, which found that male symptoms were more likely to exceed the diagnostic threshold, supports this view.
A female with ADHD is also statistically more likely to be inattentive but not hyperactive, according to the National Institute of Mental Health. Symptoms of inattention are less obvious than those of hyperactivity, which can cause ADHD symptoms in women to be overlooked.
Women conceal their ADHD symptoms more effectively
According to the Arnett study, women more successfully internalize and mask their ADHD symptoms. Arnett hypothesizes this difference “may be genetically mediated.” There’s also some preliminary evidence that estrogen mediates the presentation of ADHD symptoms.
Cultural pressures, such as the socialization of those raised female should be polite and be caretakers, also play a role. During childhood, girls with ADHD are more willing to put in extra study time and ask for help with homework. Their internal struggles may be great, but their passing grades or ability to sit still during class don’t throw up any red flags that might lead to diagnoses.
Society generally expects women to be organized and to bear the mental burden of keeping their households in order. Rather than face the embarrassment of failing to live up to these expectations, many women with ADHD find ways to conceal their difficulties. For example, a woman with ADHD who struggles with household organization might hire a maid. Alternately, she might avoid inviting anyone over.
Authority figures are more likely to dismiss female symptoms
When boys struggle to pay attention or remember things, parents and teachers often view it as a sign of a possible neurodevelopmental disorder. In girls, people dismiss inattention as a personality trait. Girls who forget things or zone out during conversations are often referred to as “space cadets,” “airheads,” or “ditsy blondes” by people who don’t realize that girls can have ADHD.
Symptoms associated with hyperactivity are likewise dismissed through derogatory labels. While excessive chattiness among boys might be recognized as a sign of hyperactivity, the same behavior in girls raises fewer eyebrows. Girls are expected to be sociable than boys. A hyperactive girl is more likely to be labeled as “bubbly,” a “social butterfly,” or a “chatty Cathy” than a hyperactive boy.
Research by UK psychologist Florence Mowlem also suggests that parents downplay ADHD symptoms in their daughters. At the same time, they play up ADHD symptoms in their sons. Although, the reason for this discrepancy is not yet known. These childhood oversights result in many females reaching adulthood sans diagnoses.
Co-occurring disorders often overshadow adult ADHD symptoms in women
Anxiety disorders are pervasive among women. According to the Anxiety and Depression Association of America, nearly one in four women will develop an anxiety disorder by the time she turns 50. In contrast, diagnostic rates for ADHD among women are currently only 3 percent. As a result, therapists who don’t specialize in ADHD are much more likely to recognize and focus on any anxiety symptoms that may be present in their clients.
Living with ADHD is extremely stressful. Women with undiagnosed ADHD often wake up each day determined to overcome their difficulties and go to bed each night increasingly discouraged and defeated. They simply cannot understand why their efforts aren’t translating into results, causing extreme frustration. When they show up in therapy, they often receive diagnoses of generalized anxiety disorder, panic disorder, or other anxiety-related conditions. Until their ADHD is uncovered, treatment is often ineffective because it fails to address the underlying issue.
Depression is also ubiquitous among women, especially those with ADHD. As a result, non-ADHD specialists falsely attribute ADHD symptoms in women, such as irritability and difficulty concentrating, to depression.
Get Specialized Support
As adolescent and adult ADHD specialists, we can recognize symptoms of ADHD in women that might have been overlooked by other therapists or during childhood. If you are seeking support for yourself or a loved one, we can help. Visit my ADHD treatment page for more information or contact Dr. Lee or Dr. Goldman for a free, 20-minute phone consultation.