What About Women With ADD?

Many associate ADHD with boys and, more recently, men. But doing so is a real disservice to women. Here's what you need to know:

Women Have ADHD as Often as Men … and Girls Are Likely Under-Diagnosed

Fewer girls are reported with ADHD than boys (6.2% for girls vs. 13.3% of boys (1)) but by adulthood, about as many women have a diagnosis as men (approx. 5.6% of women (2)). This discrepancy in childhood may be because girls are less likely to have the very obvious ‘hyperactivity’ symptom that many (but not all) boys with ADHD display. In addition, the evaluative criteria may be biased to identify boys more readily. Studies that correct for gender bias demonstrate a good number of girls who would otherwise qualify for an ADHD diagnosis.

Women Suffer at Least as Much as Men—With a Twist

ADHD has been shown repeatedly to have a significant, negative impact on adults across multiple domains in their lives (3). And women, as it turns out, generally suffer the same incidence and types of comorbidities as do men (2). But according to Babinski and Waschbusch, women do seem to stand out in some specific areas. For example, women with ADHD may be even more affected by depression, and they have higher mortality rates than men with ADHD for their age group—perhaps because, as Babinski and Waschbusch note, they are victims of partner abuse, suicide and self-injury more often than women without ADHD.

What’s going on here?

ADHD Women Suffer More in the Relationship Realm

Various studies suggest that strong relationships with partners and others are particularly important for women, vs. men, and that women are more likely to feel they are personally responsible when a relationship breaks down (2). This is bad news for women with ADHD, since at least some research suggests that close to 60% of marriages impacted by ADHD are maladjusted. If the health of a primary relationship is particularly important to a woman’s mental health and general well-being, the hardships that having ADHD symptoms create in this realm would also hit women particularly hard.

Help!

My specialty is working with couples impacted by ADHD, and I am struck by some of the differences I see in how relationships play out when it is the woman who has the ADHD. The two most common (and perhaps disturbing) issues revolve around completing tasks and household responsibilities and, second, lack of willingness of the (usually male) non-ADHD partners to get involved with finding solutions to ADHD symptomatic issues. Men seem less likely to pursue possible avenues of relief on behalf of their partner, while I observe that non-ADHD women married to men with ADHD often make it their mission to help their man (or other female partner) figure out what is going wrong, and find solutions to help manage the issue. Again, this may hinge upon social and gender expectations (women seem expected by both parties to nurture and ‘solve’ relationship issues) but the net result is that women with ADHD often don’t receive the help they need to deal with their issues, even from their closest partners. In fact, if you take it one step further, the increased levels of spousal abuse they suffer suggests they may sometimes be physically punished for their symptomatic behavior.

And Then There is Housework...

No matter who has it, ADHD usually brings with it poor organizational skills; difficulty initiating or completely tasks; trouble remembering what needs to be done; and an easy/constant distraction that often results in things not getting finished or, sometimes, even tackled in the first place. But women with ADHD take a particularly hard hit in this area when compared to men because of social norms and expectations around who is supposed to do the everyday, boring ‘stuff’ of adult life. Research suggests that when women get married, they end up with 70% more housework than they had before they were married, while men end up with about 12% less. In fact, women take on more household responsibility than men in all situations, even if the woman is employed and the male partner is unemployed. (4) There is some variation in this by country, but not a lot.

This spells trouble for women with ADHD. One of the most difficult things to do when you have ADHD is apply yourself to tasks that are mundane, boring and repetitive. This describes home tasks perfectly. The resulting pattern is that women with under-managed or unmanaged ADHD (i.e., not effectively treated) spend a lot of relatively inefficient time on tasks with few results. The house is a mess; the kids may or may not be well supervised; and the fridge is empty. Further, the car keys have been misplace (again) so getting to the store wasn’t an option.

As the statistics on housework suggest, many men do not view it as their job to do housework and household tasks. So when they must pick up extra responsibilities to compensate for a female partner’s ADHD issues, they feel even more resentment than do female partners of ADHD men who do the same thing.

This is where the second issue comes into play. Rather than try to understand what’s going on or adjust, non-ADHD partners (again, men in particular) simply view this behavior as a failure and tell their female partners to ‘do better,’ then disengage from the issue in any sort of physically helpful way. Because women are more likely to agree that they have, indeed, failed than men in similar situations (see above), they ‘try harder’ without typically addressing the issues at the heart of the issue, i.e., the ADHD. They often report feeling ashamed that they can’t do what other women seem to do so easily. The result of the combined actions of the partners is that household "failures" continue on, eroding affection as resentment, shame and misery build.

Family Disconnect?

Distractibility is the number one symptom of adult ADHD. ADHD partners of both genders are often so distracted that they aren’t particularly engaged with other family members. With ADHD, ‘immediate’ is more relevant than ‘important.’ Family members and spouses are just one of a long list of things that might capture the attention at any given moment.

ADHD Essential Reads

How to Get the Most from Your ADHD Meds

ADHD: An 18th-Century Condition in the 21st-Century World

As a result, family members often feel ignored by ADHD adults, and behave accordingly. In the spousal relationship, partners of those with ADHD become frustrated, angry, and suffer from feeling lonely or abandoned in their relationship. In relationships between ADHD parents and their children, it seems as if similar issues exist. Research suggests that lower levels of involvement by ADHD mothers have been associated with negative family outcomes (2). Families benefit when women with ADHD learn the skills they need to overcome their natural, ADHD-related distractibility, and focus their attention more tightly on their children. Interestingly, the opposite is true when men in the family have ADHD. In that case, less involvement by men with ADHD improves outcomes for the kids (2). This could be an entire other blog post, but my observations suggest it may have to do with the role that mothers have in creating stability for their children—greater involvement by ADHD mothers increases stability, which non-ADHD male partners may not step in to create if the mother is distracted. Conversely, non-ADHD women create stability for their children, while their male ADHD partners add an element of chaos, making outcomes worse.

What’s the Fix?

Here are some immediate suggestions to improve the lives, and relationships, of women with ADHD:

Understand that ADHD is just as serious for women with ADHD as it is for men. This means that women need to treat their ADHD just as aggressively as men do (see my free e-book on optimizing treatment for adult ADHD). Women must resist the urge to think ‘this is just my fault’ and place ‘blame’ where it should be placed—on the ADHD and ADHD symptoms.

Take depression seriously and treat it. Again—good, solid medical assistance can help women better manage both ADHD and any associated depression or other diagnosable issues. The higher morbidity incidence for women with ADHD supports just how important this is.

Interpret ADHD symptoms correctly. Both partners need to stop associating difficulty with organizing and completing household tasks with common moral judgments, such as ‘lazy’ and ‘incompetent.’ Focus, instead, on being empathetic to the struggle that ADHD presents in everyday life, and finding creative solutions that help support the ADHD partner in those tasks.

Put ‘leg 2’, behavioral treatments in place (see my Treatment e-book at my website) so that the ADHD partner may function more efficiently. Working with an ADHD coach to develop ADHD-friendly organizational structures can be a great help. Delegating things such as organizing, filing, cooking or housecleaning can also be a great strategy. There is nothing that says that women with ADHD have to do things exactly the same way as women without ADHD.

Have both partners learn everything they can about ADHD and relationships. The stresses that ADHD places on couples is significant, but couples who understand the common patterns and strategies that work for living with ADHD can turn a struggling relationship into one they love. (5)

Get support. Most often, male partners are not going to step in for support on the everyday tasks of life (see chore figures above). Join a support group for partners with ADHD or for women with ADHD. Knowing you are not alone, and getting ideas for managing better provides much-needed confidence and support. If there aren't support groups in your area (look at the CHADD website for good ideas) there are some by phone (see my website.)

Set ‘good enough’ as the goal. Women with ADHD will not become women without ADHD, even with good treatment. They will always need to spend energy on managing their ADHD symptoms. So set reasonable expectations for what can, and should, be accomplished. Women with ADHD shouldn’t compare themselves to everyone around them who don’t face the same challenges.

Set aside time to focus on kids, if there are any at home. This ‘skill’ of focusing more often on children and their needs can be added into an ADHD organizational system, and will benefit the whole family.

If not yet married, but thinking about it, wait at least two years after you meet before doing so. This gets one through the ‘hyperfocus courtship’ stage that the infatuation-related increase of dopamine causes, and will provide more concrete information about how well two partners will negotiate ADHD issues. My experience is that most can do so well, but benefit from learning the skills they need before embarking upon life-long commitment.