Long considered a childhood disease affecting mostly boys – and thus with boys being the focus of most research – attention deficit hyperactivity disorder (ADHD) can frequently be missed in girls, whom it affects differently, and for whom it can pose some very real health risks, reports NPR.
When Kate Jarvis was a little girl, back in the 1980s, she was a straight-A student, creative and super organised
Then puberty hit, and everything started to fall apart. She found it harder to focus in school, and her grades slipped. “It hit my self-esteem badly. I felt pretty awful about myself,” she said.
In high school, she was diagnosed with anxiety and depression. She struggled to fit in. She says it stung when teachers would write comments like, “Kate has so much potential, if only she'd apply herself”.
“So it felt like character flaws rather than what it really was, which was undiagnosed ADHD,” said Jarvis, who didn’t get a diagnosis until her late 30s.
Researchers say her story is pretty common.
For decades, ADHD was regarded as a condition that affected boys, said Julia Schechter, a clinical psychologist and co-director of the Duke Centre for Girls and Women with ADHD. But ADHD often manifests differently in girls.
“They’re more likely to appear distracted, disorganised, kind of have their head in the clouds rather than show that overt, hyperactive or impulsive behaviour that can disrupt a classroom,” she said.
Those symptoms in girls are easier to miss, added Scheckter. That’s one reason why girls tend to get diagnosed years later than boys, often not until adulthood. Instead, women will spend years wondering what’s wrong with them, being treated for anxiety or depression without addressing the underlying cause.
“Sometimes those conditions are truly present,” Schechter said. “Other times they’re secondary to years of undiagnosed and untreated ADHD.”
Heavy health cost of missed treatment
But there’s a cost to those years of missed treatment. ADHD is a neurodevelopmental condition that influences many aspects of a person’s life and can bring challenges with social relationships, impulse control and low self-esteem.
“For women, the risks are even more striking,” Schechter said. “Compared with girls and women without ADHD, those with ADHD have more problems with friendships. They’re more likely to experience abuse by romantic partners, more likely to have a teen pregnancy compared with boys and men with ADHD. They’re also more likely to have feelings of worthlessness and self-harm or attempt suicide.”
And there are other health risks for women, including a higher incidence of obesity, eating disorders, type 2 diabetes and cardiovascular disease than their peers without the condition, said Dr Patricia Quinn, a developmental paediatrician who has specialised in ADHD in women and girls for decades.
She said several factors linked to ADHD can contribute to these risks. They include impulsivity, trouble sleeping, an inability to maintain healthy routines, the chronic stress of living with unmanaged symptoms and poor food choices, driven by the need to seek dopamine.
Last year, a large study from the UK found women with ADHD die on average nearly nine years earlier than their peers without the disorder – and two years earlier than men with ADHD. Yet many people don’t realise just how serious ADHD can be.
“It’s not just an excuse for ‘why I’m always late for work’,” Quinn said. “It’s a significant problem in their lives.”
In recent years, growing recognition of gender differences in ADHD has helped lead to a surge in diagnoses among adult women – nearly 7m women in the US had the diagnosis as of 2023, according to federal data analysed by the non-profit Children and Adults with Attention-Deficit/Hyperactivity Disorder, or CHADD.
While boys are still diagnosed at roughly two to three times the rate of girls, those disparities even out in adulthood.
A breaking point in midlife
Often, women can spend years masking their symptoms, said Ellen Littman, a clinical psychologist who specialises in women with ADHD. But when life gets more complex, their compensation systems can crumble.
“And it just reaches a critical mass point of, ‘I can’t manage all of this’,” Littman said.
Emerging evidence suggests fluctuations in oestrogen levels can exacerbate symptoms of ADHD, and perimenopause might be a particularly vulnerable time. Research suggests women with ADHD enter perimenopause years earlier than those without the disorder and experience more severe symptoms during this menopausal transition.
One survey of more than 3 000 women with ADHD found that most had been diagnosed for the first time during the menopausal years. “The big, big shift was brain fog and executive functioning problems during the menopausal years,” said Jeanette Wasserstein, a neuropsychologist who conducted the survey. She specialises in ADHD and is on the faculty at the Icahn School of Medicine at Mount Sinai.
Reyer said she’d first suspected she had ADHD after her son was diagnosed, because the disorder is highly genetic. She said when she was diagnosed in her late 40s, it changed her life because it led to treatment. Once she found an ADHD medication that worked for her, it was as if a lightbulb had cpme on.
“I remember just saying to myself, ‘Oh my gosh, this must be what normal feels like’,” she said.
Treatment beyond medication
Medication is just one part of treatment. Quinn, who recently released a guide for clinicians to treat ADHD in women, said for women in perimenopause, hormone replacement therapy can also be helpful.
And because so many women have dealt with a lifetime of demoralisation and shame, she said therapy, especially cognitive behavioural therapy, is also key, “because you need to rewrite all those scripts that are going on in your head”.
Psychologist Littman said in her practice, the focus is on helping women reframe their understanding of themselves “from ‘I’m a broken loser and I’m useless’ to helping them see themselves through the lens of this neurological information”.
“And it changes their self-esteem and their ability to be effective in their lives and more confident as a parent and a partner.”
Lifestyle changes like exercise, meditation and a healthy diet can also help, said Kathleen Nadeau, a clinical psychologist who’s been working with women and girls with ADHD for more than four decades. She said she encourages patients to find environments that play to their strengths – which can sometimes mean career changes.
“The metaphor I use is to plant yourself in the right garden, where the things that you’re good at can be nourished and expanded,” Nadeau said. “And the things that you struggle with are not what is emphasised in terms of what you’re supposed to do every day."
NPR article – ADHD looks different in women and poses unique health risks (Open access)
See more from MedicalBrief archives:
Adult-onset ADHD may not exist, study suggests
Why do so many students have ADHD today?
White children likely to be over-diagnosed, over-treated for ADHD – US study