ADHD in Women and Girls: Why Female Symptoms Slip Through Diagnostic Cracks
Our approach to ADHD in women and girls has been broken for too long. To fix it, we must challenge everything we know about the assessment, diagnosis, and treatment of ADHD today.
ADHD in Women and Girls: Why Current Approaches Are Flawed
The Problem of Bias
Traditionally, many scientific efforts excluded women entirely from clinical trials. As it relates to ADHD in females, bias contributes to missed diagnoses and misdiagnosis in the following ways:
1. Self-fulfilling prophecies perpetually deny help to women: The prevailing notion has been that girls and women don’t “get” ADHD, so they have been habitually overlooked for diagnosis and study.
2. An overemphasis on comorbidities blinds clinicians to ADHD. Clinicians, wrongly convinced that ADHD in women and girls is outside the arena of possibility, tend to explain more easily observable symptoms through other conditions, including anxiety and depression as well as conduct problems.
3. Diagnostic tools favor male presentations of ADHD. And most screeners overlook the underlying executive dysfunctions that affect a clear majority of females with ADHD.
4. Clinical samples rarely mirror representative samples. The “combined” ADHD presentation, which is often associated with the greatest impairment, is overrepresented in clinical samples of both boys and girls.
ADHD in Girls and Women: Salient Findings and Important Considerations
1. Females with ADHD Are More Likely to Engage in Self-Harm and Suicidality
Teen girls and women with ADHD are at a significantly higher risk for self-harm than are boys and men with ADHD or than girls without ADHD.
By the time they reached early adulthood (average age of 20), about 23% of the girls with combined type ADHD and 8% of girls with inattentive ADHD had made a serious suicide attempt.
2. Girls with ADHD Experience Poor Academic and Vocational Outcomes
Compared to the neurotypical group, girls with ADHD experienced fewer years of education and lower achievement scores by the time they reached their mid to late 20s, and they had more work-related problems.12 These factors could further contribute to low self-esteem in girls and women with ADHD.
3. Women with ADHD More Likely to Face Unplanned Pregnancy
By the time they reached their mid to late 20s, about 43% of participants in the ADHD group had one or more unplanned pregnancies compared to about 10% of individuals in the comparison group.12 Poor academic achievement during adolescence was linked with unplanned pregnancy.
4. Women with ADHD Endure More Intimate-Partner Violence
Females with ADHD are at increased risk for physical victimization by an intimate partner by adulthood (about 30% of participants with ADHD reported victimization compared to about 6% of participants in the neurotypical group.)
ADHD Complications: Compensatory Behaviors, Gender Norms, and Stigma
Gender norms and expectations dictate that girls and women should excel socially and academically, and that they should demonstrate few or no problems with self-regulation. These standards may explain why girls with ADHD are more likely than boys with ADHD to devise and exhibit compensatory behaviors for their symptoms.
Girls are also more likely than boys to exhibit perfectionistic behaviors and to be more achievement-motivated.
People who receive public stigma are also more likely to internalize such stigma. Longstanding myths about ADHD – that it’s caused by poor parenting, for example – is another example of stigma at work. Together, these forms of denigration further compel girls and women with ADHD to hide or even deny their symptoms.
ADHD in Girls and Women: Conclusions
ADHD in females is understudied and often overlooked, but we do know this: ADHD is a highly impairing condition for girls and women, linked in research to self-harm, internalizing symptoms, peer difficulties, and other female-specific impairments. Standing in the way of more accurate diagnosis and more effective treatment for women are longstanding research and clinical practices that favor male presentations of ADHD and ignore female-specific manifestations.
Excerpted from “ADHD in Women and Girls: Why Female Symptoms Slip Through Diagnostic Cracks” b and published in ADDitude magazine.
The content for this article was derived from “ADHD in Girls and Women: Historical Perspectives, Current Realities,” presented at the APSARD 2022 Annual Conference. Read the full article for a detailed exploration of the findings as well as recommendations for clinicians and researchers.