The ADHD Gender Bias: Why It's Different for Women

ADHD presents differently in women and girls than in men and boys. The presentation of ADHD in women and girls has historically led to misdiagnosis. Gender bias and lack of understanding around inattentive ADHD symptoms contribute to this discrepancy. Unfortunately, missed diagnoses lead to long-term consequences, including low self-esteem throughout life for women.

The under-treatment of ADHD in women results in underachievement and derailment of goals. Many women with ADHD know what they want to achieve. Yet, without a diagnosis, life can become confusing and unmanageable. Goals are rendered unfocused and out of reach. Fortunately, being aware of ADHD symptoms can add awareness that leads to a better quality of life.

Symptoms of ADHD

Lesser-known symptoms of ADHD, many of which are more common in women and girls, include the following:

• Lowered self-esteem. Poor self-esteem is more common in girls than boys.
• High self-criticism. A poor self-image stems from negative self-talk.
• Depression and anxiety. These are frequent comorbidities with ADHD.
• Interpersonal relationship issues. Having more negative interactions with friends is more common in girls than boys.
• Highly sensitive to rejection. Rejection-sensitive dysphoria is severe emotional pain from being rejected. Experts say this is due to altered brain structure.
• Emotional dysregulation. A perceived lack of control over the environment or situation causes sudden outbursts of anger or sadness.
• Sensitivities to overstimulation. Loud, noisy, chaotic environments can cause people with ADHD to become overwhelmed and "freeze."
• Diet sensitivities. Especially to sugar. Sugar can have an extra-stimulating effect on ADHD brains and cause an inevitable energy crash.
• Inconsistent performance. People with ADHD may sometimes perform exceptionally well and other times not perform well at all. This inconsistency perpetuates a cycle of criticism and negative self-image, as ADHD folks often compare themselves to their "better version."
• Being chronically late and having poor time awareness. It's common for folks with ADHD to get totally engrossed in an activity and disregard time, especially something highly engaging.
• Clumsiness. Being a "klutz" and bumping into things frequently or dropping things is common.
• Impulsivity. Things such as acting out on negative feelings through skin-picking or cutting, may occur. Additionally, because of societal and gender roles, women are encouraged to "mask" or hide their symptoms. Ultimately, this leads to the worsening of symptoms and health outcomes.

Background of ADHD

There are three subtypes of ADHD: hyperactive, inattentive, and combined. Inattentive ADHD is the least understood. It's no coincidence that inattentive ADHD is also the type most diagnosed in women and girls.

A neurodivergent brain operates differently than a neurotypical brain. However, there are many hidden strengths folks with ADHD possess. For example, creative pursuits often align perfectly with the ADHD brain. Additionally, they can hold several ideas in their mind at once. They may be risk-takers, seeking out extreme sports and experiences.

Still, it's challenging to function in society when you feel like you're always running behind. It's better to ask targeted questions to identify ADHD in women. One example is, "Are you spending most of your time coping, looking for things, catching up, or covering up? Do you avoid people because of this?" Nuances like this differentiate ADHD in women and girls from their male counterparts.

Inattentive ADHD

Inattentive ADHD looks like forgetfulness, "spaciness," or even laziness. It also appears as distractedness and lack of follow-through on chores, activities, or schoolwork. It's easy for inattentive ADHD types to get distracted by stimuli and lose necessary items like a wallet.

Consequences for women

Memories of negative reinforcement and guilt often contribute to lowered self-esteem. Tardiness or behavioral concerns in ADHD children don't go unnoticed or unpunished. This type of negative reinforcement can have effects later in life, including a hyper-critical perception of oneself. Internalized symptoms like these are more common in women.

"Parents and teachers are less likely to recommend services for girls with ADHD symptoms than for boys with ADHD symptoms."

Overlooked ADHD in women is due to gendered roles and expectations. Frequently, depression and anxiety mask ADHD symptoms in women. Additionally, women and girls are more likely to develop better coping strategies for dealing with ADHD. This can look like multitasking during class or reading multiple books at once.

Misdiagnosis follows as many ADHD sufferers who are female fall "below the threshold" for a diagnosis. Bias in treatment referral is the main reason for fewer diagnoses in women and girls. One study showed that parents and teachers are less likely to recommend ADHD services for girls with ADHD. Participants read the same vignettes about ADHD. However, they were less likely to recommend services when a "girl name" was used compared to a "boy name."

OCD and ADHD

Another reason for ADHD misdiagnosis in girls is the accompaniment of comorbid obsessive-compulsive disorder. One 2005 study showed obsessive-compulsive behaviors were observed in 11.2% of children with ADHD. These perfectionistic tendencies risked a delay in diagnoses since ADHD symptoms were masked. The consequence? Children with obsessive-compulsive behaviors, in addition to ADHD, have worse outcomes than those with only ADHD.

Treatments

Treatments can be medicinal, environmental, and holistic. Holistic therapies that take into account individual symptoms work best. ADHD, like many mental health conditions and disabilities, presents differently in each person. As a result, people struggle with particular challenges more.

Find a psychiatrist or health care practitioner that takes your ADHD concerns seriously. Medicine, like Vyvanse and Adderall, can be beneficial to managing life with ADHD. The efficacy of ADHD medicine in girls is higher than for boys, with up to 36 months of favorable outcomes. Yet, the lack of diagnosis is problematic. Fortunately, the rate of medication usage in adult women with ADHD is steadily increasing.

Tips for coping

• Combination. Combining behavioral and medication interventions is often the most effective way to conquer ADHD.
• Learning style. Identify a learning style, for example, note taking in a designated note taking notebook or app. Finding your best learning style applies to organizational methods as well. Do some research, and experiment with what works for you.
• Say no to perfection. Be gentle with yourself. Make things easy and practical instead of stressful and "perfect." Remember, perfection is not attainable.
• Get active. Focus on both nervous system-regulating activities (yoga, meditation) and high-energy exercises (running, snowboarding). Vary intensity and duration to help balance hormones like cortisol, which modulates stress. And for ADHD, novelty is queen, so mixing it up, in addition to having a loose form of routine, is a good strategy.
• Protein. Eat protein to reduce ADHD symptoms. A 2020 study revealed reduced symptoms of hyperactivity and impulsivity in children after consuming whey protein. ADHD brains thrive on using higher protein for energy. As a result, it takes longer to get tired out and become mentally unfocused or "give up."

Removing gender bias and incorporating gender diversity can reduce the diagnostic bias surrounding ADHD. Getting an ADHD diagnosis makes many women feel relieved. They finally have something concrete to explain why they couldn't "get it together." A diagnosis, treatment, and management of ADHD symptoms for women leads to a better quality of life.