ADHD and Women: A Vastly Under-Recognized Condition

Treatment makes all the difference.

Posted Dec 20, 2012

Sarah was in the habit of double-parking on a Saturday morning downtown. She had a favourite little café where they made the perfect latte, and she just couldn’t resist making a quick, although illegal stop. Unfortunately, her double parking often took place in a bus route, and as a consequence of parking illegally she had a lot of tickets. She generally flipped them into the back seat or stuffed them into an already crammed glove compartment. Sometimes she collected them into piles, took them into the house, and ignored them. Eventually, she forgot about them. That is until she attempted to get a new licence sticker, and found she would have to pay fines over $10,000 if she wanted to continue driving and stay out of jail. Thankfully, her parents were able to bail her out of trouble once again.

Does this story sound too extreme to be true? Well, the facts have been changed, because the true story was much worse.

This is real example of Attention-Deficit Hyperactivity Disorder (ADHD) in females. And let’s make it clear right from the start – ADHD in females is a bona fide condition. Dennis the Menace might be the old stereotype of ADHD, wreaking havoc in the school, but the chances are very good that the little girl, sitting quietly in the corner of the classroom and gazing out the window, has her own difficulties with attention.

Awareness of ADHD in females continues to grow, but the condition remains vastly under-recognized and under-treated. Roberta Waite, in her 2010 paper “Women With ADHD: It Is An Explanation, Not the Excuse Du Jour,” makes the statement: “ADHD, a legitimate neurological disorder that is often hidden, ignored, or misdiagnosed among women, causes them to struggle in silence.”

And that struggling in silence may well be the reason that females with ADHD continue to fly under the radar. Consider a female elementary school student who is purely inattentive but quite smart. She needs only to hear information once from her teacher to get it, and then she can tune out. Since she is bright, she can compete academically, and because she is not disruptive, she will not come to the attention of educators. No one considers that she might have ADHD until later in life, when balancing a career, a husband, children and running a home becomes overwhelming. That is generally when she will show up at my clinic, wondering why simple tasks, like paying bills on time and getting the kids off to school – tasks that seem so easy to others – seem nearly impossible to her.

ADHD writer, comedian and uber blogger Zoe Kessler (check her out here and here addresses the lack of childhood recognition in a guest spot in my documentary “Her FAST MIND: An In Depth Look at ADHD as it Affects Women”. Never diagnosed as a child, despite doing what she said were “stupid” and “outrageous” things, it wasn’t until Zoe was an adult and a friend suggested she fill out an online ADHD questionnaire that she came to realize she might have a very treatable medical condition. While Zoe was a hyperactive child, and still wasn’t recognized as having ADHD, my other special guest for the documentary, film-maker Karen O’Donnell was the classic daydreamer. A good pupil, she states, “I was a B student, but I believe I could have been an A student”. This simple statement captures so much of what I see in my ADHD practice – this condition, untreated, holds people back from meeting their real potential.

There are two scenarios: untreated and treated ADHD. How it impacts on women if they are untreated is that they are more prone to poor driving records; the development of substance abuse; impulsivity; and eating disorders. Females with ADHD are also likely to have co-occurring medical conditions, including anxiety and depression. Many women have an unrequited sense of underachievement in their lives, as if something has held them back.

But that’s really enough of the bad news, so let’s move on to the good news. Recent data has revealed recognition of this condition among girls in on the grow. E. Mark Mahone, in a story in the October 2012 issue of Psychiatric Times, reported that while the male-to-female ratio of ADHD in the 1990s was around 9:1 in clinical settings and 3:1 in the general population, “More recently, however, a large epidemiological study of 3907 children found that of the 8.7% who met DSM-IV-TR criteria for ADHD, 51% were boys and 49% were girls.”

These recent statistics regarding children are clearly reflected in the adult population, as in my adult ADHD clinics, the ratio of males to females seeking an assessment is 1:1.

The final piece of good news is that women don’t have to continue to suffer with the symptoms of ADHD. The treatments for ADHD are highly individual and for females this can be a combination of various modalities including medication, coaching, mindfulness, counselling and Cognitive Behavioural Therapy, which facilitates the recovery process.

Just knowing that ADHD has been at play throughout her life helps a woman reframe past experiences and develop a new launch and trajectory for her life. Many women suffer low self-esteem, feeling flawed because of undiagnosed ADHD, and recognition of the condition and treatment corrects these factors. Women go on to have a more balanced, hopeful life.

This was the case with a young law student who came to my clinic for an assessment. Struggling in school, and on the verge of dropping out, she was diagnosed with ADHD and treatment was initiated. She has since written us a glowing letter to let us know that she graduated law school, and now has a great career. Hopefully, she won’t be called on to get our double-parking Sarah out of a jam.

(To view excerpts from the documentary, Her FAST MIND, head over to my Tumblr blog:  While you are there, you can also check out some video from the educational program, FAST MINDS™)