Laura J. Martin, MD
A girl with ADHD may be labeled Chatty Cathy - the enthusiastic school-aged girl who is always telling stories to friends. Or she could be the daydreamer - the smart, shy teenager with the disorganized locker.
But what happens when she grows up? Or when her ADHD isn't diagnosed until she's a woman? Is her experience different from what men with ADHD go through?
ADHD has not been widely researched in women. Much more is known about how it affects children. However, there seems to be some patterns that differ between men and women with ADHD.
The issues adults with ADHD have mirror those in the population as a whole, says Stephanie Sarkis, PhD, a psychotherapist in Boca Raton, Fla.
For example, she says men with ADHD tend to have more car accidents, suspensions in school, substance abuse, and anger and behavioral issues, compared to women with ADHD. But men are more prone to these kinds of issues in general, regardless of ADHD.
Women with ADHD are more prone to eating disorders, obesity, low self-esteem, and depression and anxiety. But they do in the general population, as well.
These challenges also often play out in different areas of their lives. Men with ADHD may have problems at work - unable to complete their tasks or getting mad too easily at subordinates, says Anthony Rostain, MD, professor of psychiatry and pediatrics at the University of Pennsylvania School of Medicine.
Women, on the other hand, are more likely to see conflicts at home. Kathleen Nadeau, PhD, a clinical psychologist and director of the Chesapeake ADHD Center of Maryland in Silver Spring, says her female ADHD patients, especially mothers, come to her in a “constant state of overwhelm.”
“Society has a certain set of expectations we place on women and ADHD often makes them harder to accomplish,” Nadeau says. She points to women's traditional societal roles. “They are supposed to be the organizer, planner, and primary parent at home. Women are expected to remember birthdays and anniversaries and do laundry and keep track of events. That is all hard for someone with ADHD.”
Many women with ADHD remember having these issues for a long time. “A lot of women tell me that (in school) they would look straight at the teacher so they wouldn’t get in trouble, but had no idea what was going on,” Nadeau says. “They are underfunctioning, but bright... their symptoms are more subtle.”
ADHD is one of the most commonly diagnosed behavioral disorders in children, and it is a chronic, often lifelong condition. It affects an estimated 3% to 9% of U.S. children.
The hallmarks of ADHD are hyperactivity, lack of focus, and impulsive behavior.
But there are different shades of ADHD. The most pronounced is the hyperactive-impulsive form, where children have trouble sitting still and completing tasks like school work. They may be overly emotional or randomly blurt out inappropriate comments. Another type of ADHD is inattentive, with symptoms like lack of focus, forgetfulness, boredom, difficulty with organization, and daydreaming.
Though there are always exceptions to the rule, many experts say boys tend more toward hyperactive-impulsive and girls toward inattentive symptoms. “Females tend to be more the inattentive type and internally distracted by thoughts and guys tend to be more hyperactive,” says Fran Walfish, PsyD, child and adult psychotherapist in Beverly Hills, Calif. “I have seen boys who are dreamy and some girls who are hyperactive, but those are the exceptions.”
Women's ADHD sometimes gets overlooked until college, when they begin to show a lack of self-regulation and self-management, Rostain says.
“Risks for them include things like being influenced by a sorority or the recreational drug scene,” he says. “And they are not as wild as the guys [with ADHD], but compared to other girls, they are more risk-taking.”
The underlying mechanisms of ADHD are the same in males and females. Both have difficulties with planning, organization, recalling details, and paying attention.
But how ADHD plays out in symptoms is where the gender differences often lie. And the reason for that is likely social.
Because inattention is much more subtle than hyperactivity, this may be why boys are almost three times more likely than girls to be diagnosed with ADHD. By the time they reach adulthood however, that gap shrinks to two to one. This is likely because girls are often diagnosed later in life, compared to boys.
Girls may "slip through the cracks" and get diagnosed later, Walfish says, because they may be able to cover up their ADHD symptoms.
For women, responsibilities including family and work can make it difficult to cover up or manage ADHD. But there are some things women can do to cope with life's demands.
Nadeau recommends making sure family and friends understand ADHD so they will be more supportive and have realistic expectations. Women should also simplify wherever possible: Reduce unnecessary stresses and commitments and negotiate with their family and partner to take over tasks that challenge them most.
It may also help to hire a professional organizer or work with a coach to develop good organizational habits and systems. One of things Sarkis recommends is hiring an assistant who can come in for six to eight hours a week to do light cleaning, go through papers, and help organize things.
“I have people tell me that it will be too expensive, and it may be, but people with ADHD can’t afford not to have help,” Sarkis says.
SOURCES:Kathleen Nadeau, PhD, director, Chesapeake ADHD Center of Maryland, Silver Spring, Md.Fran Walfish, PsyD, child and adult psychotherapist in Beverly Hills, Calif.; author,The Self-Aware Parent.Stephanie Sarkis, PhD, psychotherapist, Boca Raton, Fla.; author, Adult ADD.Anthony Rostain, MD, professor of psychiatry and pediatrics,University of Pennsylvania School of Medicine.
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