ADHD in Women: Signs and Why it’s Under-diagnosed

Attention Deficit Hyperactivity Disorder (ADHD) has long been associated with hyperactive behavior in young boys, but the reality is that it affects individuals across genders and ages. One particular subset that often goes unnoticed is adult women with inattentive ADHD. This under-diagnosed condition can significantly impact various aspects of a woman's life, from education and careers to relationships and mental health.

This article will explore signs of ADHD in adult women, why it often goes undiagnosed, and options for managing ADHD symptoms.

Undiagnosed ADHD in adult women: A hidden struggle

ADHD in women vs. men can look very different. Traditionally, ADHD has been linked to boys who display hyperactive and impulsive behaviors. However, recent research has unveiled a more nuanced picture, revealing that girls and women tend to present symptoms of inattention rather than hyperactivity. 

One of the primary reasons for the underdiagnosis of ADHD in adult women is the lack of awareness and understanding surrounding the unique ways it manifests in their lives. Girls with inattentive ADHD might appear quiet, lost in thought, or daydreaming, which can be easily mistaken for shyness or disinterest. As they grow into adulthood, these women might continue to struggle with organizational tasks, time management, and focusing on activities they deem less engaging.

Why does ADHD often present differently in women?

The differences in how ADHD presents in women compared to men can be attributed to a combination of biological, hormonal, and societal factors. Here are some key reasons that contribute to the distinct manifestation of ADHD in women:

1. Biological and Neurological Differences: ADHD is thought to be related to differences in brain structure and neurotransmitter functioning. It's possible that the neurological differences between men and women contribute to the variation in how the disorder presents. Brain imaging studies have suggested that women with ADHD might have patterns of brain activation that are distinct from those observed in men with ADHD.

2. Hormonal Influences: Hormonal fluctuations during the menstrual cycle can influence the symptoms of ADHD in women. Some women with ADHD experience a worsening of symptoms in the premenstrual phase, suggesting a link between hormonal changes and symptom severity. The fluctuating levels of estrogen and progesterone might interact with neurotransmitter systems implicated in ADHD, potentially affecting attention, mood, and impulsivity.

3. Societal Expectations and Conditioning: Societal norms and expectations can play a significant role in shaping how ADHD symptoms are perceived and expressed. From a young age, girls are often encouraged to be attentive, organized, and well-behaved, which might lead them to develop coping strategies that mask their symptoms. This can result in a discrepancy between their internal experience of ADHD and their external behavior, making it less obvious that they are struggling with attention-related challenges.

Unmasking Inattentive ADHD in Women: Signs and Symptoms

Inattentive ADHD, often referred to as ADHD-PI (Primarily Inattentive), is a subtype of Attention Deficit Hyperactivity Disorder that is characterized by a lack of hyperactivity and impulsivity, but a significant difficulty in sustaining attention and staying focused. In women, the symptoms of inattentive ADHD can manifest in subtle and sometimes even counterintuitive ways, leading to misdiagnosis or being mistaken for personality traits.

1. Difficulty Sustaining Attention: Women with inattentive ADHD often struggle to maintain focus on tasks that don't capture their immediate interest. They may find it hard to pay attention during conversations, meetings, or even while reading, often drifting off into their own thoughts.

2. Poor Organization and Time Management: These women may have trouble keeping track of appointments, deadlines, and daily responsibilities. They might frequently misplace items like keys, phones, or important documents, leading to frustration and anxiety.

3. Forgetfulness: Forgetfulness is a hallmark of inattentive ADHD. Women may struggle to remember important dates, events, and even details of conversations. This forgetfulness can impact relationships, work, and daily functioning.

4. Procrastination: Chronic procrastination is common among women with inattentive ADHD. Tasks that require sustained effort and attention may be put off until the last minute, leading to stress and rushed work.

5. Daydreaming: Women with inattentive ADHD may frequently drift into daydreams or get lost in their thoughts, especially during activities that don't fully engage them. This can be mistaken for disinterest or aloofness.

6. Difficulty with Details: Focusing on minutiae can be challenging for these women. They might struggle with tasks that require careful attention to details, such as proofreading or following complex instructions.

7. Avoidance of Tasks Requiring Mental Effort: Tasks that demand sustained mental effort, especially if they aren't immediately stimulating, can be particularly daunting. Women with inattentive ADHD might avoid such tasks altogether.

8. Disorganization: Their physical space might mirror their mental state, with disorganized workspaces and living areas. Keeping things tidy and organized can be a constant struggle.

9. Impaired Working Memory: Women with inattentive ADHD might find it difficult to hold and manipulate information in their mind, making multitasking and complex problem-solving challenging.

10. Perfectionism: In an effort to compensate for their struggles, some women with inattentive ADHD develop perfectionistic tendencies. They might spend excessive time on tasks to ensure they're done perfectly, leading to stress and burnout.

11. Social Challenges: Difficulty focusing during conversations can lead to misunderstandings, while forgetfulness might cause them to miss social events or forget important details about friends and acquaintances.

It's important to note that while these symptoms can be indicative of inattentive ADHD, they can also overlap with other conditions such as anxiety, depression, or even simple personality traits. A comprehensive evaluation by a qualified healthcare professional is essential to determine an accurate diagnosis and develop a suitable treatment plan.

ADHD vs. Anxiety in Women

The similarities between ADHD and anxiety symptoms further complicate the diagnostic process. Women with ADHD might experience restlessness, racing thoughts, and even social withdrawal—features commonly associated with anxiety disorders. This confusion between the two conditions can delay accurate diagnosis and appropriate intervention.

Moreover, according to the Anxiety and Depression Association of America, approximately 50 percent of American adults with ADHD also have an anxiety disorder, so it could be both!

Managing ADHD in Women

The treatment of ADHD in women typically involves a combination of approaches, including both pharmaceutical and natural strategies. It's important to note that treatment should always be tailored to the individual's specific needs and preferences, and consultation with a healthcare professional is essential to determine the most appropriate course of action. Here are some (but not all) typical strategies for managing ADHD in women:

1. Stimulant Medications: Stimulant medications, such as Adderall and Ritalin, are often prescribed to manage ADHD symptoms. They work by increasing the levels of certain neurotransmitters in the brain, which can help improve focus, attention, and impulse control.

There are unique side effects of Adderall that are more common in women. This is mainly due to the different ways women process the substance. That being said, women may experience more serious side effects, including:

• Dry mouth
• Headaches
• Dizziness
• Increased anxiety
• Trouble sleeping and trouble staying asleep
• Changes in bowel movements
• Decreased libido

2. Non-Stimulant Medications: Non-stimulant medications like Strattera and Intuniv are alternatives for those who cannot tolerate stimulants or don't find them effective. These medications may be particularly beneficial for individuals with comorbid conditions, such as anxiety or cardiovascular concerns.

3. Supplements: Supplementing with cognitive enhancers like amino acids L-tyrosine and L-theanine, or vitamins and minerals like omega-3 fatty acids, magnesium, and B vitamins, can support neurotransmitter health, cognitive function, mental clarity, focus, and energy.

4. Nutrition: Avoiding processed foods and additives with seed oils, processed sugar, food coloring dyes, caffeine, and preservatives have been shown in research to improve ADHD symptoms. 

5. Behavioral Therapy: Behavioral therapy, particularly Cognitive Behavioral Therapy (CBT), can help individuals with ADHD develop strategies to manage their symptoms. It focuses on changing thought patterns and behaviors that contribute to difficulties with attention, organization, and time management.

In conclusion, the prevalence of undiagnosed inattentive ADHD in adult women is a pressing issue that requires greater recognition. Shifting societal perceptions about how ADHD presents in different genders and breaking free from stereotypes is crucial for timely diagnosis and support. By understanding the nuances of ADHD in women and the potential impact on various aspects of their lives, we can pave the way for better mental health and well-being.