Attention-deficit hyperactivity disorder is a psychological disorder characterised by three key symptoms: extreme inattention, hyperactivity or impulsivity. ADHD typically emerges before the age of 12, but children displaying symptoms after reaching 7 years old can still meet the criteria for an ADHD diagnosis (APA, 2013).
There is now an understanding that ADHD in females has been widely overlooked in the past. Historically, ADHD studies have neglected the presence of the disorder in females. A lack of understanding of gender differences in ADHD and a long-standing gender bias has caused many females to remain undiagnosed (Dupuy et al., 2013).
In this article, we will delve into a brief overview of childhood ADHD diagnoses and unique challenges faced by women with undiagnosed adult ADHD.
The Types of ADHD
The 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders includes three specifiers of the disorder:
1. Predominantly Inattentive Type:
Difficulty sustaining attention in tasks or play activities
Easily distracted by unrelated stimuli
Frequent careless mistakes in work or other activities
Forgetfulness in daily activities, such as forgetting to complete chores or keep appointments
Difficulty organising tasks and activities
Avoidance or reluctance to engage in tasks that require sustained mental effort
Frequently loses items necessary for tasks (e.g., keys, wallets)
2. Predominantly Hyperactive-Impulsive Type:
Excessive fidgeting or tapping of hands and feet
Inability to stay seated in situations where it's expected (e.g., in the classroom or during meetings)
Inappropriately running or climbing in situations where it's not appropriate (in adolescents and adults, this may manifest as restlessness)
Difficulty engaging in activities quietly
Excessive talking, often interrupting others
Difficulty waiting for one's turn
Impulsive decision-making leading to negative consequences
Intrusion into others' personal space and lack of awareness of social boundaries
3. Combined Type:
This type involves a combination of both inattentive and hyperactive-impulsive symptoms.
Individuals with combined-type ADHD experience a broad range of symptoms from both categories, and their symptoms may vary in intensity over time.
Neurosexism and the Stereotypes in Neurodiversity
Fine (2008) coined the term “neurosexism”, which refers to the claimed bias within the field of neuroscience regarding sex differences, suggesting that it may inadvertently contribute to the reinforcement of detrimental gender stereotypes.This is relevant to the discussion of the gender gap in neurodiversity, as neurosexism contributes to the gender gap seen in neurodiversity diagnoses by perpetuating biases and stereotypes that impact the evaluation and identification of neurodivergent traits.
A Gender Gap in ADHD Diagnoses
Klefsjö et al. (2021) suggest that the presentation of mood and emotional symptoms are a primary reason for missed diagnoses of ADHD in females. A recent review of ADHD literature found that in childhood, there was a ratio of 3:1 of boys and girls diagnosed with ADHD, while in adulthood it is closer to 1:1, suggesting that there is a gender gap of ADHD diagnoses in childhood (Da Silva et al., 2020). Research in the field of ADHD diagnosis, has found that this lack of recognition of ADHD in females may be attributed to the presentation of predominantly-inattentive type symptoms in females, compared to the predominantly hyperactive-impulsive symptoms typically presented in males (Skogli et al., 2013). However, it also cannot be assumed that females only experience ADHD with predominantly inattentive symptoms.
The idea of gender norms and observing symptoms in presentations of ADHD is incredibly important. Societal norms, values and stereotypes on gender-appropriate behaviour play an important role in the way females are perceived when displaying behavioural traits of ADHD, such as impulsivity, hyperactivity or disorganisation. Attoe and Climie (2023) discuss the reception of females presenting such traits as placing females at a higher risk of social judgement and punishment, when displaying such ADHD traits.
The Manifestation of ADHD Symptoms in Females
Some common observations of different manifestations of ADHD in females include:
Internalised Symptoms: Girls and women with ADHD may exhibit more internalised symptoms, such as daydreaming or inattentiveness, as opposed to the externalised hyperactivity often associated with boys (Skogli et al., 2013).
Coping Mechanisms: Females with ADHD might develop coping mechanisms to mask their symptoms, such as social withdrawal, leading to potential underdiagnoses or misdiagnosis due to symptoms being masked (Young et al., 2020).
Academic Performance: Gender differences in academic performance and social functioning may be more pronounced. Despite this, it has been found that ADHD is not solely characterised by poor academic performance (Morley & Tyrrell, 2023).
Social Challenges: Girls with ADHD may face unique social challenges. They might experience difficulties in forming and maintaining friendships due to impulsivity or difficulties in understanding social cues. This can lead to social isolation and feelings of exclusion, affecting their overall social well-being.Feelings of “being different” from peers can contribute to such social challenges (French et al., 2023).
Emotional Impact: ADHD in females may have a greater impact on emotional well-being, contributing to anxiety, depression and related symptoms such as addiction and sleep problems (Young et al., 2020).
The Path to Addressing ADHD in Females
In contemporary society, the acknowledgment and consideration of neurodiversity are progressively extending into various facets of life, including workplaces, educational institutions, and everyday settings. Although there has been a commendable effort to confront and dispel pre-existing stereotypes and stigmas associated with neurodiversity, it remains evident that persistent biases and misconceptions continue to surround neurodivergent females. Despite advancements in recognising and addressing neurodiversity in general, there is a need for more comprehensive efforts to challenge and eradicate the lingering stigmas and stereotypes specifically directed at neurodivergent women.
Breaking the stigma surrounding ADHD in women is a multifaceted endeavour that involves dispelling myths, fostering open conversations, and empowering women to recognise and address their unique challenges. By advocating for increased awareness and understanding, the aim is to create a more compassionate and inclusive society where women with ADHD feel supported, validated, and encouraged to seek the help they deserve.
Where to from here?
Being undiagnosed or diagnosed late can have detrimental effects on a woman's self-esteem, mental health, and overall well-being. Receiving a diagnosis of ADHD can provide a sense of visibility and understanding, making everything one feels seem coherent rather than unusual.
At Sentient Professional Wellbeing, some of our experienced and dedicated therapists are well-versed in supporting individuals experiencing issues related to undiagnosed ADHD.
We recognize the potential harm to self-esteem and mental health that may arise from such circumstances. Our skilled professionals are committed to providing support and guidance to navigate the challenges associated with ADHD. With our respectful and empathetic approach, we aim to help liberate individuals from self-blame, empowering them to embark on a journey towards lives that are more fulfilling and satisfying.
For more information, or to book an appointment with a therapist for ADHD and neurodivergence support, please click below and visit our therapists' profiles:
Resources
Da Silva, A. G., Malloy-Diniz, L. F., Garcia, M. S., & Rocha, R. (2020). Attention- deficit/hyperactivity disorder and women. In J. Renno Jr., G. Valadres, A. Cantilino, J. Mendes-Ribeiro,R. Rocha, & A. G. da Silva (Eds.), Women’s mental health
(pp. 215–219). Springer Nature Switzerland. https://doi.org/10.1007/978-3-030-29081-8
Dupuy, F. E., Barry, R. J., Clarke, A. R., McCarthy, R., & Selikowitz, M. (2013). Sex differences between the combined and inattentive types of attention-deficit/hyperactivity disorder: An EEG perspective. International Journal of Psychophysiology, 89(3), 320–327. https://doi.org/10.1016/j.ijpsycho.2013.04.004
Fine, C. (2008). Will Working Mothers’ Brains Explode? The Popular New Genre of Neurosexism. Neuroethics, 1(1), 69–72. https://doi.org/10.1007/s12152-007-9004-2
French, B., Daley, D., Groom, M., & Cassidy, S. (2023). Risks Associated With Undiagnosed ADHD and/or Autism: A Mixed-Method Systematic Review. Journal of Attention Disorders, 27(12), 10870547231176862–1410. https://doi.org/10.1177/10870547231176862
Klefsjö, U., Kantzer, A. K., Gillberg, C., & Billstedt, E. (2021). The road to diagnosis and treatment in girls and boys with ADHD - gender differences in the diagnostic process. Nordic
Journal of Psychiatry, 75(4), 301–305. https://doi.org/10.1080/08039488.2020.1850859
Kring, A., Johnson, S., Kyrios, M., Fassnacht, D., Lambros, A., Mihaljcic, T., Teesson, M., Matthewson, M., Morton, E., Kate, M-A., Harris, A., Izadikhah, Z., Piosevana, A., Crowley-Cyr, L., Baillie, A., Mewton, L., Johnson, L., & Middleton, W. (2017). Abnormal Psychology. (First Australasian Edition ed.) John Wiley & Sons.
Morley, E., & Tyrrell, A. (2023). Exploring Female Students’ Experiences of ADHD and its Impact on Social, Academic, and Psychological Functioning. Journal of Attention Disorders, 27(10), 1129–1155. https://doi.org/10.1177/10870547231168432
Skogli, E. W., Teicher, M. H., Andersen, P. N., Hovik, K. T., & Oie, M. (2013). ADHD in girls and boys—Gender differences in co-existing symptoms and executive function measures. BMC Psychiatry, 13(1), 298–298. https://doi.org/10.1186/1471-244X-13-298
Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., … Woodhouse, E. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry, 20(1), 404–404. https://doi.org/10.1186/s12888-020-02707-9