ADHD in Women: An Underdiagnosed Epidemic

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ADHD in Women: An Underdiagnosed Epidemic

The typical image the general public has of someone with attention deficit/hyperactivity disorder (ADHD) is a wild little boy who can't hold still. This stereotype is so pervasive that experts believe that 50% to 75% of girls with obvious signs of ADHD are not diagnosed or treated. If they are diagnosed, it is years later: the average age of diagnosis of boys with ADHD is 7, compared to 12 for girls.

These disturbing statistics mean that many little girls struggle for years with ADHD, and many of these girls grow up and become adult women with undiagnosed ADHD. ADHD is very common; it affects around 15% of the population. That's a lot of girls and women struggling with a very treatable disease because they have not been diagnosed.

Symptoms of ADHD in Adult Women

There are two primary types of ADHD, hyperactive/impulsive and inattentive. The inattentive form used to be called attention deficit disorder (ADD), but this term has been abandoned since doctors realized ADD is just another manifestation of ADHD. Women are more likely to have the inattentive form, but many women do have the hyperactive/impulsive form.

Common symptoms of the inattentive form include:

Disorganized
Prone to daydreaming
Forgetful
Difficulty following instructions
Difficulty maintaining focus and attention

Easily distracted

Common symptoms of the hyperactive/impulsive form include:

Fidgeting and squirming
Difficulty sitting still
Talking excessively
Frequently engage in impulsive behavior
Little self-control

Some adult women display symptoms of both types of ADHD.

Girls and women, even those with classic ADHD symptoms, are often misdiagnosed with anxiety or depression. When they struggle in school, their parents and teachers conclude that they are not academically inclined or immature. When they enter the workplace, they tend to be viewed as chronic underachievers or borderline incompetent, and they tend to get poor performance ratings and be overlooked for promotions and raises.

Causes of ADHD

ADHD is primarily genetic. It is inherited and runs in families. It is a complex multi-gene trait; not everyone in the family will manifest ADHD. It can skip generations, meaning that parents who don't have ADHD can pass the trait on to their children, and not everyone with ADHD will have a child with ADHD.

Exposure of a fetus or infant to lead, alcohol, and tobacco smoke can cause them to manifest ADHD-like symptoms later in childhood. Some brain injuries caused by trauma and strokes due to premature birth can also cause ADHD-like symptoms later in childhood.

Brain imaging studies have shown that children with ADHD have abnormal brain development. Their frontal lobes mature more slowly and they have disturbances in the neural networks that make up the brain that persist into adulthood.

Diagnosis of ADHD

The ASRA Screening Scale was updated in 2017, and the newly revised version is very accurate in detecting patients who are likely to have ADHD. Adults who suspect they might have ADHD can take the test themselves and show the results to their doctor.

A doctor will have to make the final diagnosis based on the ASRS score, an evaluation of the patient's symptoms and cognitive ability, and after ruling out other possible causes of the symptoms.

A newer, more objective way to diagnose ADHD is the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System. It is a non-invasive test that measures the patient's brainwaves. Patients with ADHD have a typical pattern that can easily be distinguished from patients who do not have ADHD.

Other objective methods to diagnose ADHD are being studied. The most promising are MRI and fMRI, which do not expose the patient to radiation, but they are not in mainstream clinical use yet.

Treatment of ADHD

ADHD cannot be cured, but it can be successfully managed. The best results are seen from a combination of medication and behavioral training. The classic ADHD medications, such as Ritalin, work remarkably well in adults.

A therapist experienced in treating ADHD can help patients learn:

Time management
Organizational skills
Self-control and ways to reduce impulsivity
Better problem-solving skills
How to cope with the memories of past academic and personal failures caused by the untreated ADHD
How to mend family relationships strained by the untreated ADHD

These last two points are very important to address in therapy, Many women with untreated ADHD go through life feeling like failures and losers, and consequently, they have poor emotional and mental health as a sequela of ADHD. They may even have developed anxiety and depression because of their untreated ADHD. Understanding that their failures were due to an untreated disease is vital for achieving good emotional wellness.

Conclusion

ADHD is very common and is underdiagnosed and misdiagnosed in girls and adult women. It is a neurodevelopmental disorder caused, in most cases, by genetics. It is inherited. It causes persistent problems throughout life, such as forgetfulness, inability to focus, and disorganized, impulsive behavior. It cannot be cured. However, if properly diagnosed, it can be successfully managed with a combination of medication and behavioral training.

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