The Unique Challenges Faced by Women With ADHD

Attention-Deficit Hyperactivity Disorder is a neurodevelopmental condition where people experience difficulties sustaining attention, sitting still, or controlling their impulses. The condition is serious enough that it significantly decreases life expectancy by an average of eight years. Women with ADHD face additional challenges.

1. Difficulties Accessing a Diagnosis

A Swedish study on more than 85,000 patients with ADHD showed that women with attention deficit were diagnosed on average four years later than men, even though many had extensively sought help for mental health difficulties. This delay in diagnosis is due to multiple factors.

First, diagnostic criteria are inherently biased and do not consider that ADHD may show up differently in women. By 1998, 81 percent of participants across more than 250 studies were male. In the 70 studies that examined cohorts of only 1 sex, 99.7 percent studied males, and 0.3 percent studied females. Those studies laid the foundations for the diagnostic criteria used today to screen for ADHD.

If only men, and especially children, were studied, the presentation of ADHD in women will be largely ignored, even though we know today that symptoms may present differently.

Women tend to have a more inattentive presentation and internalizing symptoms, which are missed more often during diagnoses and are less often referred. Additionally, women have a higher rate of comorbidities such as anxiety and depression, which makes an ADHD diagnosis even more challenging.

But studies also show that doctors are less likely to diagnose women with ADHD even when their symptoms are the same as their male counterparts. Additionally, once a diagnosis is received, women are also less likely to be treated with stimulants and are more likely to be prescribed antidepressants and anxiolytics. Both are less efficient and have more side effects than ADHD medication.

2. Not Being Heard

One of the main challenges women with ADHD describe when seeking out a diagnosis is that their difficulties are not being addressed. ADHD often comes with comorbid depression and anxiety, and women with ADHD are disproportionately at risk of developing these comorbidities. When seeking out an alternative diagnosis after endless cycles of depression, doctors are quick to dismiss their pleas and simply prescribe antidepressants.

In a study that analysed the stories of 52 British women, one of them said that before her diagnosis, she had cycled through 16 different antidepressant medications, all of which were inefficient to address the underlying ADHD. On average, reports in this study also describe that the support received post-diagnosis ranged from insufficient to non-existent, which severely affects quality of life.

These experiences are not limited to the National Health Service; women worldwide experience difficulties being heard and treated by medical professionals who often dismiss their struggles and suffering. This is the story of Nelly, who saw psychiatrists and mental health professionals since age 7, was prescribed anxiolytics at age 13, and received an official ADHD diagnosis only at age 28. Like many women, stimulant medication got entirely rid of the recurrent episodes of depression.

Another study on 16,000 ADHD patients showed that women with ADHD were more likely to have previously sought help, were more likely to already take antidepressant medication, and had already extensively sought help before their diagnosis compared to men, and then were more likely to discontinue said treatment after starting ADHD medication.

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3. Unique Interactions With Hormones

Women with ADHD have to deal not only with the classic symptoms of inattention and hyperactivity of ADHD but often have a unique presentation that changes and shifts across the menstrual cycle. They also have more intense difficulties in periods of hormonal transitions like puberty or menopause.

Women with ADHD tend to have more hormone-related issues. A study showed that they have higher rates of postpartum depression and that around 49 percent of them also have PMDD. Menopause also appears to exacerbate ADHD symptoms and to increase the risks of depression.

But that is not all; a large study showed that women with ADHD taking the contraceptive pill were six times more likely to have depression than women without ADHD. Another study showed that natural hormonal fluctuations during the menstrual cycle altered the intensity and presentation of ADHD symptoms.

What Can We Do?

Increasing awareness around the unique issues faced by women with ADHD is essential to increase accessibility to diagnosis and treatment. The latest findings in medical curricula could also help medical professionals stay up to date on the diagnostic criteria or symptomatology of common issues.

Additionally, doing more research on women and analysing the interactions with hormones may be ideal to create treatments or interventions tailored to these unique challenges. The Welsh study on 16,000 patients with ADHD found that women were more likely to discontinue antidepressant treatment after starting ADHD medication. This shows that the right diagnosis and treatment can be life-changing and have positive effects.

While the diagnosis of women with ADHD has significantly increased in recent years, many are still missed. An increase of awareness, acceptance, and medical training can be key to properly supporting all the women who have gone unheard and have silently suffered for many years.

You can learn more about ADHD and on how to manage it in the book published by the author: The ADHD User's Manual