Misunderstood: ADHD in Women
By Jessica Lund
Sarah Fuller had struggles in her childhood, like being unorganized, “messy”, and angry outbursts (Koeing, 2022). She would describe herself as being a “royal terror” as a child and was diagnosed with oppositional defiant disorder when she was young. Sarah recalls getting good grades; however, she had a hard time staying motivated and organized, especially in high school and college (Koeing, 2022). After being diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) when she was 33, Sarah stated that “a lightbulb went off” after learning about the symptoms. According to Koeing (2022), Sarah explained how ADHD for females is not just “lack of attention”, but instead, “the challenge to focus on the right things”.
According to Taylor and Keltner (2002), ADHD is an early onset disorder characterized by “inattention, impulsivity, and hyperactivity”. ADHD was previously thought to have only been a childhood disorder, although now we know the symptoms present differently into adolescence and adulthood. Previous misconceptions about ADHD have also caused many individuals, mostly women and girls, to go un- or mis-diagnosed compared to men and boys. According to a study referenced in Psychology Today, the clinical ratio for diagnosis of males and females with ADHD is 10:1, but the ratio of males to females in real life with ADHD is 2:1 (Martin, 2000).
Why are boys more likely than girls to get diagnosed with ADHD? Taylor and Keltner (2002) suggest there are 3 main reasons for this; females have a “later age of onset”, ADHD manifests differently with females, and the criteria in the Diagnostic and Statistical Manual of Mental Disorders for ADHD was geared toward the male presentations.
When most people think of ADHD, they may think of a child in elementary school that has a hard time sitting still or is disruptive to the classroom. This is because theories around ADHD and the clinical approaches taken to treat it were mainly based on studies observing elementary aged boys (Chronis-Tuscano, 2022). This has resulted in under- or mis- diagnoses of females because they don’t start presenting until after childhood, when clinicians typically look for signs.
ADHD was previous thought to have just been a disorder known for its hyperactivity type, however, the inattentive types of ADHD get overlooked because they are less disruptive and attention grabbing. Girls with ADHD may seem “shy, withdrawn, compliant”, and may even be seen as “people pleasers” (Taylor & Keltner, 2002). They rarely display the stereotypical disruptive behaviors associated with this disorder. Females with ADHD may know that they aren’t the same as their peers, but internalize and mask that it, which prevents a correct diagnosis from clinicians. According to clinical psychologist Kathleen Nadeau, who has ADHD herself, ADHD in females can be split into 3 subtypes: “daydreamers”, “tomboys”, and “Chatty Kathys” (Taylor & Keltner, 2002). The “daydreamer” subtype refers to inattentive type ADHD: quiet, overlooked, and “typically anxious and depressed”. The intelligence of the “daydreamer” is usually underestimated (Taylor & Keltner, 2002). This type is referred less to clinicians because they are unlikely to display problems behaviorally. The “tomboy” subtype refers to the hyperactive-impulsive type ADHD: more sporty, messier handwriting, eager to please people (Taylor & Keltner, 2002). “Tomboys” are more likely to engage in “risk-taking behaviors” and may be described by teachers are “nonacademic and undisciplined”. The “Chatty Kathy” subtype refers to combined type ADHD (hyperactive-impulsive/inattentive): “often overemotional, excitable”, and “very sociable”. They are verbally hyperactive, or “hyper-talkative”, and their thoughts are disorganized (Taylor & Keltner, 2002).
The 3 subtypes described above fall under the umbrella of ADHD, but what defines Attention-Deficit/Hyperactivity Disorder? According to Moore (2023), ADHD is “a neurodevelopmental disorder that is characterized by three major classifications of symptoms: inattention, hyperactivity, and impulsivity”. A major role in ADHD is the lack of “executive functioning”, which helps you make and meet goals, and aids in the regulation of behavior (Moore, 2023). The DSM has made progress in its considerations of women in the criteria for Attention-Deficit/Hyperactivity Disorder. One thing that has changed is the age of onset, the DSM-IV stated that symptoms had to have been present before age 7 but has since been changed to age 12 in the DSM-5 (Moore, 2023). The DSM-5 has added specific language for the different criteria for the subtypes and examples in its criteria to help clarify. For ADHD in adulthood, the DSM used to require 6 present symptoms to meet criteria, however in the newest edition, it has been changed to 5 present symptoms across both subtypes (Moore, 2023).
The more we spread awareness on the prevalence and manifestation of ADHD in females, the more clinicians can properly diagnose and treat this disorder. There are many girls and women out there that know they aren’t like their peers but are afraid to ask for help. The more we acknowledge the presence of this disorder in adolescence and adulthood, we can help people feel less alone and more supported. If you feel like you were described well by one of the subtypes above, I encourage you to speak to a licensed clinician about ADHD. If you have been diagnosed with ADHD, male or female, I encourage you to acknowledge your strengths and know that you are not alone
References
Chronis‐Tuscano, A. (2022). ADHD in girls and women: a call to action – reflections on Hinshaw et al. (2021). Journal of Child Psychology and Psychiatry, 63(4), 497–499. https://doi.org/10.1111/jcpp.13574
Koenig, R. (2022, March 7). 4 women who live with ADHD as adults share their stories. TODAY.com. https://www.today.com/health/mind-body/adhd-girls-women-3-people-share-diagnosis-stories-rcna18883
Lannette, J. (2021). Women and ADHD. The Counseling Palette. Jennie Lannette Bedsworth and The Counseling Palette. Retrieved 2024, from https://www.thecounselingpalette.com/post/womenwithadhd.
Martin, W. E. (2000, November 1). Paying Attention to Girls with ADHD. Psychology Today; Sussex Publishers. https://www.psychologytoday.com/us/articles/200011/paying-attention-girls-adhd
Moore, M. (2023, December 27). DSM-5 Diagnostic Criteria for ADHD. Mentalyc; Mentalyc Inc. https://www.mentalyc.com/blog/dsm-5-criteria-for-adhd
Taylor, E. W., & Keltner, N. L. (2002). Messy purse girls: Adult females and ADHD. Perspectives in Psychiatric Care, 38(2), 69-72. https://www.proquest.com/scholarly-journals/messy-purse-girls-adult-females-adhd/docview/200707495/se-2