Okay, maybe we’re no longer living in a time when women are routinely locked up in mental asylums suffering from PMS, depression, menopause, or simply put there by a philandering husband who needed some freedom, but come a long way? Perhaps not. Especially when it comes to diagnosing adult attention deficit hyperactivity disorder, or ADHD.
There are many reasons for this. One highly contributing factor, according to attention deficit disorder (ADD) coach Pete Quily and others, is that 90 percent of women experience the inattentive subtype of ADD. “Women are extremely underdiagnosed with ADD,” says Quily, “because a lot of people a) don’t think women have it; and b) you’re kind of lucky in a way to have the hyperactive, impulsive type because that means you’re more likely to get diagnosed. If you’ve got the inattentive subtype, which is 90 percent of women, you’re not acting out. They’re just tuning out, daydreaming, spacing out, they’re not bothering other people, and then they get missed.”
Other factors that particularly influence the manifestation of ADHD in women include hormonal changes throughout the lifespan, cultural and societal influences, and gender differences.
In addition, precious little research has been done in the area of women and ADHD. Dr. Lily Hechtman is an internationally recognized researcher in ADHD, and professor of psychiatry and pediatrics at McGill University and director of ADHD research in the division of child psychiatry. According to Hechtman and others, it’s all too easy to miss ADHD when the symptoms are mimicked by symptoms of many other conditions.
Menopause, depression, anxiety disorders, bipolar disorder and others can be confused for ADHD. Normal life changes such as coping with a new career, marriage or having children can all create challenges to organizational skills, and can also look like ADD symptoms when combined with the sleep deprivation that usually accompanies managing a new family, according to Quily.
Let’s examine some of these more closely.
Although we don’t have data for women with attention deficit disorder during the menopausal age range, says Hechtman, “what makes menopause so difficult to distinguish from ADHD, at least in its symptomatology, is that you’re getting the effects of two different things.” Hechtman says it’s important not to misinterpret the symptoms. She explains that menopause can bring on memory problems, organizational problems, anxiety, depression, cognitive and emotional issues, independent of ADHD. She explains that a woman’s ADHD can manifest the same symptoms, making the diagnosis in that age group even more challenging, “because you don’t know whether you’re dealing with someone with ADHD or if it’s just a group of menopausal symptoms.”
The way to differentiate ADHD from menopause alone, she says, “is to really get a good picture of that person before menopause ever started. And if they had no symptomatology of ADHD before menopause ever started, then what you’re dealing with is really just menopausal.”
Culturally, whether we care to admit it or not, women are still expected to carry (or, if not expected to, in actual fact do carry) the larger burden of household and child management. It’s been observed that women’s ADHD symptoms are exacerbated after marrying and starting a family. As that life stage requires heightened organizational skills, that is an unsurprising observation.
Quily, whose clientele includes women between the ages of 30 and 50, observed that women with ADHD experience a great deal of shame and guilt when they are found wanting in domestic areas. Women often feel judged and tend to isolate in response. They’re afraid to have people over, because they’re not living up to either self-imposed or societal expectations. In addition, says Quily, women are more prone to internalize the negatives than men. As a result, “The shame and self-esteem problems can be worse than the original symptoms.”
The ramifications of women being under- or misdiagnosed can lead to dysthymia or depression, low self-esteem, poor self-image, lack of confidence, and disrupted relationships. A woman will devalue herself as she realizes that she is not living up to her full potential.
A woman who is treated for depression alone, regardless of whether she was clinically depressed, might find that she is making little or no overall progress if she has underlying and unaddressed attention deficit disorder.
For these reasons, when it comes to the burgeoning field of adult ADHD, the expression “you’ve come a long way, baby,” is belied. Only when sufficient research, education and awareness are achieved, and comprehensive ADHD treatment is made widely available, will we finally be able to say, yes, we have come a long way. And when women begin to achieve their full potential, we will find that the rest of society will come along with us, to the benefit of all.
Dr. Lily Hechtman, personal interview, July 31, 2008.
Pete Quily, personal interview, July 21 and 24, 2008.
For Further Information
Tartakovsky, Margarita. Living with ADHD
Hartwell-Walker, Marie. It May Not Be ADHD
Weiss, G., Hechtman, L.: Hyperactive children grown up, second edition, Guilford Press, 1993.
Weiss, M., Hechtman, L., Weiss, G.: ADHD in adulthood – a guide to current theory, diagnosis, and treatment. The John Hopkins Press, 1999.