ADHD in women: Why it’s often not detected

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People with ADHD have difficulty concentrating and are often hyper­active. But the disorder doesn’t always present in the same way. In women and girls, ADHD displays different symptoms than in men and boys.

What is ADHD?

ADHD stands for attention deficit hyperactivity disorder. People with the condition have difficulty concentrating and are hyperactive or impulsive. Because the symptoms can vary in intensity, there's no one form of ADHD.

Is ADHD a medical condition?

When people talk about ADHD, different terms are often used: mental illness, neurobiological disorder or neuro­diversity. ICD-11, the international classification of diseases, describes ADHD as a neurodevelopmental disorder. However, the classification of ADHD is controversial – experts also speak of a neurological peculiarity.

ADHD and neurodiversity

Neurodiversity is a newer concept that points to the naturalness of neuronal differences. Characteristics that are traditionally described as mental disorders are seen by neurodiversity advocates as naturally occurring deviations from the norm. Autism and ADHD are such examples.

It’s possible in the Stone Age that having ADHD was an evolutionary advantage. Being quickly distracted and reacting impulsively may have been essential for hunters to survive in hostile environments.

Are boys more affected than girls?

Boys are more commonly diagnosed with ADHD than girls. However, this doesn’t necessarily mean that girls are actually less commonly affected. This gender difference may lie in the fact that ADHD is known as a “boy’s disease” and the hallmark symptoms of ADHD are more common in young men. Such gender prejudices, also known as the gender health gap, mean that ADHD is often not taken into consideration in young women. Even the number of examinations for ADHD, i.e. suspected cases, is significantly lower in girls.

How does ADHD differ between boys and girls?

How ADHD manifests is very individual. Nevertheless, the medical field has been able to identify certain differences in how ADHD is expressed in boys and girls.

  • Boys with ADHD often lack impulse control and are mostly hyperactive. They suffer from motor restlessness – an irresistible urge to move about – and concentration difficulties. They’re likely to be loud and stand out.
  • Girls, on the other hand, tend to suffer from inattentiveness and inner restlessness. They make an effort not to stand out, which is why they often appear passive. This is one of the reasons why ADHD is often not detected in girls.

What’s the difference between ADHD and ADD?

ADHD is divided into three different “subtypes”. Inattentive ADHD is mainly characterised by concentration difficulties and easy distractibility. In some cases, this is referred to as ADD or attention deficit disorder without hyperactivity. In hyper­active-impulsive ADHD, hyperactivity and impulsivity are the main symptoms. Finally, there’s the combined type, in which hyperactivity and concentration difficulties are both prevalent.

ADHD symptoms in girls and adult women

As ADHD is often not suspected in girls, many women aren't diagnosed at all or only in adulthood. Even in adulthood, ADHD presents differently in women than in men. In addition, the symptoms change over time due to hormonal changes caused by ageing.

  • Inattentiveness: Girls and women with ADHD are more likely to get lost in their daydreams and a constant stream of circulating thoughts, with the result that they’re often inattentive.
  • Hyperactivity: Women with ADHD are less likely to be hyperactive than men. And if they are, the hyperactivity tends to be more internal. ADHD women often have difficulty sorting their thoughts. When faced with several things to do at the same time, they find coordinating especially difficult.
  • Emotional regulation: Compared to men, women with ADHD often have more difficulty regulating their emotions. Experts refer to this as emotional dysregulation. These difficulties can express themselves in hypersensitivity or mild irritability.
  • Hormonal fluctuations: Hormonal changes caused by the menstrual cycle or the menopause exacerbate ADHD symptoms in women. Studies also confirm that women with ADHD suffer more from premenstrual mood swings and postpartum depression.

Early detection is important

In order to improve the course of ADHD in children, early detection is important. If ADHD isn't detected, it’s difficult for the child to integrate into their environment. This can continue into adulthood, and cause problems at school, in training, at work and in social situations.

ADHD symptoms can become less severe with age, but in more than 50% of cases, ADHD persists into adulthood.

How can the diagnosis be improved in girls?

In order to improve early diagnosis of ADHD, it’s first important to draw attention to the different symptoms in boys and girls. This is where gender-specific research, also known as gender medicine, comes in. If the symptoms in women and girls are better known, screening procedures and tests can be geared towards them, which increases the chances of correct diagnoses and recognising ADHD cases earlier.

Diagnosis of ADHD in adulthood

Unfortunately, many people with ADHD, especially women, are only diagnosed as adults. This means they’ve often had to struggle their entire lives with problems whose origins couldn't be explained, which can have a severe effect on their mental health. For this reason, an ADHD diagnosis in adults often comes as a great relief because of the clarity it provides – and the resulting therapy can make their daily lives easier to manage.

Concomitant diseases with ADHD

ADHD often appears with other neurological and mental health conditions, known as concomitant diseases. In some cases, these concomitant diseases are the result of untreated ADHD. These diseases and disorders can include:

Treatment of ADHD

ADHD can't be cured because those affected aren't sick. The brains of people with ADHD simply function differently and this can be challenging in today’s society. This is why the treatment of ADHD is primarily aimed at regulating the symptoms.

These therapies can help alleviate ADHD

  • Treatment with medication
    ADHD can be treated with medications known as psychostimulants, such as Ritalin or Concerta. Medication is mainly used if other treatments alone aren't successful or if the ADHD symptoms impair daily functioning.
  • Behavioural therapy
    Behaviour management is a therapy often used in combination with training for parents. Group therapy and cognitive behavioural therapy are also useful to treat ADHD adults with secondary disorders such as depression.
  • Healthy eating
    Studies show that a healthy diet reduces the risk of children developing ADHD, and helps ADHD sufferers in general to cope better with their symptoms.
  • Physical activity
    Doing sport not only helps those with ADHD to better control their symptoms, but also raises their self-esteem through feelings of achievement, as well as facilitating social interaction. Experts recommend a wide range of outdoor sports activities.

Genetics and causes of ADHD

ADHD is the result of disrupted messenger substances (neurotransmitters) in our brain. Because this is often genetic, ADHD can be inherited. In addition to genes, environmental influences also play a role. Premature birth, birth complications or drug and nicotine consumption during pregnancy increase the risk of a child developing ADHD.

Lack of attention

Hyperactivity is often less pronounced in adults, but this is made up for with concentration difficulties and impulsive behaviour. Gender differences may exist here too, with women displaying more inward-looking symptoms and men displaying more outward-looking symptoms. As with children, this makes it more difficult to detect in women.

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