Gender Differences in ADHD
While attention deficit hyperactivity disorder (ADHD) is diagnosed three times more often in boys than in girls, it still can cause girls problems. By adulthood, according to Michael J. Manos, Ph.D, men and women receive ADHD diagnoses in roughly equal proportions.
Attention deficit disorder may be initially misdiagnosed in girls because of the symptoms they present. Manos notes that “girls tend to show fewer aggressive and impulsive symptoms, and they have lower rates of conduct disorders,” leading to a diagnosis later in life. The Mayo Clinic adds that female patients’ inattention problems often are combined with daydreaming, whereas males have more hyperactivity and behavioral problems, which are more noticeable during childhood.
In the article “ADHD: A Woman’s Issue,” author Nicole Crawford notes that women more often are diagnosed with attention deficit disorder (ADD), the non-hyperactive version of the disorder. Women with ADHD also tend to have other disorders that can affect their mood and behavior, according to the National Resource Center on AD/HD. These disorders include dysphoria, compulsive overeating, chronic sleep deprivation and alcohol abuse. The rates of major depression and anxiety disorder in female ADHD patients is equal to male ADHD patients, though women suffer from lower self-esteem and psychological distress.
The inattention symptoms of ADHD — which include being easily overwhelmed and having difficulty with time management and disorganization — are more predominant in women. Crawford adds that women with attention deficit disorder show symptoms similar to those found in post-traumatic stress disorder (PTSD). The co-existing panic and anxiety are a result of the classroom trauma the patients experienced during childhood from the undiagnosed attention deficit disorder. For example, if the woman dealt with low self-esteem from attention problems back in grade school, returning to school later in life may trigger those same emotions.
Women also are more likely to be diagnosed with attention deficit disorder later in life, around their 30s and 40s. These female patients become diagnosed when one of their children is diagnosed with ADHD. When undergoing the process with their children, they recognize the symptoms in themselves. Being diagnosed later in life can lead to problems, such as the woman blaming herself for when things go wrong, or believing she cannot achieve higher goals, especially if her symptoms interfered in her school or work performance. Crawford notes that these women are prone to financial problems, underemployment, divorce or lack of education.
The treatment for ADHD in women is a “multimodal approach that includes medication, psychotherapy, stress management, as well as ADHD coaching and/or professional organizing,” according to the National Resource Center on AD/HD. Certain factors are taken into consideration when treating a woman with ADHD, such as comorbid psychological disorders.
For example, if the patient has depression as well, she would benefit from cognitive behavioral therapy (CBT). Substance abuse may also be present at an early age, which can complicate treatment. Another issue with using medication in treating female ADHD patients is fluctuating hormone levels, as ADHD symptoms increase when there is a decrease in estrogen levels. The National Resource Center on AD/HD notes that combining hormone replacement with ADHD medication may be recommended for some women.
Non-pharmaceutical treatment options are also possibilities for female attention deficit disorder patients. As ADHD tends to run in families, parent training can be used, which teaches the mother techniques for dealing with ADHD in her children. For example, parent training can help with monitoring symptoms and establishing rewards and consequences. Then, the mother can use those same techniques to manage her own symptoms. However, the National Resource Center on AD/HD notes that parent training is less effective in women who have severe ADHD symptoms.