17. ADHD and Females

A couple of weeks ago, I discussed some of the unique difficulties of males with ADHD. This time I’d like to talk about females with ADHD. The first major difference between males and females is that females are diagnosed much less frequently than males, and are also usually diagnosed later in life than males. Additionally, most of the research has been done with males.

Males are usually diagnosed with hyperactive type ADHD. Females are far more  likely to be diagnosed with inattentive type ADHD. It is much easier to diagnose hyperactivity than inattentiveness. Both teachers and parents as well as professionals are more likely to miss the subtle signs of ADHD in an inattentive child, while it is easy to spot hyperactivity.

It is unclear why females are more prone to inattentiveness, although most researchers think it has to do with role expectations that allow boys to be rough and rowdy but chastises little girls for “unladylike” behavior. This also makes it more likely that females will try to “mask” their ADHD, trying to look like they don’t have ADHD. This leads to difficulties with stress, anxiety and depression, and makes the diagnostic process more difficult as well as the treatment process. Diagnosticians often mistake Inattentive ADHD for a mood disorder or a borderline personality disorder. Additionally, females frequently feel excessive shame and guilt because they are not meeting the expectations for “ladylike” behavior.

Females also have increased difficulties as they mature. Estrogen and dopamine tend to fluctuate together. As estrogen increases, so does dopamine - but as estrogen decreases, so does dopamine. This means that ADHD symptoms will fluctuate through the menstrual cycle.  Low levels of estrogen tends to cause increased irritability, mood swings and  a lower tolerance for stress. This is compounded by the fact that low levels of estrogen co-vary with low levels of dopamine, so the ADHD symptoms also increase.

The main symptoms that ADHD females have are the executive functions: planning, organizing, time management, sense of time passage, working memory and, of course, inattention. In a classroom, the ADHD boy might be yelling, jumping around, fidgeting and generally drawing attention. On the other hand, the ADHD girl might be sitting quietly, daydreaming about rainbows and puppies. She doesn’t attract any attention and the teacher doesn’t notice her behavior as being unusual at all. This is why ADHD is harder to diagnose – most of the people in this girl’s environment don’t notice anything is wrong. Then when the conscientious psychologist sends the behavioral observation forms to the teacher and the parents, there is not much helpful information because they didn’t notice any problems.

Females with ADHD have a more difficult time getting a proper diagnosis, so the parents will have to be more diligent to get this done.

Thanks for reading and let's make the world safe for ADHD!

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