ADHD In Women - Humantold

ADHD In Women

Christina Jeffrey, LMHC March 6, 2023

When we consider how ADHD presents in women, we must factor in the impact of both culture and hormones.

Historically, when we think of ADHD the image that most often comes to mind is that of a rambunctious, disruptive, disorganized ball of young, male chaos. And while this is an accurate depiction of a type of ADHD, it is far from a complete representation of the diagnosis, as it completely ignores all the other symptoms that we find with the disorder – and that more than half of the world’s population is born female. 

ADHD presents differently in girls and women

When we consider how ADHD presents in women, we must factor in the impact of both culture and hormones. See, due to the way we acculturate girls in our society, most girls with ADHD are not going to present as hyperactive, rambunctious, or as a “class clown.” No girl would survive her elementary or middle school years behaving this way due to the social shunning she’d endure for her “aggressive,” “too much,” “too loud,” or dare I say “unladylike” behavior. Girls are not rewarded socially for being physical, rambunctious creatures; boys, on the other hand, are expected to behave physically, so their presentation is socially allowable. This is partly why so many girls go undiagnosed into adulthood; they don’t present in “typical” ways. 

Culturally, we operate from an assumption that puts male as the default gender. If you doubt this, consider whether we assign gender to neutral job titles like doctor, mechanic, or teacher. My guess is you, like many, immediately think doctor/lady doctor, mechanic/lady mechanic, teacher/male teacher. This assumption permeates most, if not all, of our systemic structures, an assertion supported by a wealth of research outlining gender bias in research and data collection. Why is this important? It means that when designing everything from psychological assessments to travel systems to safety guidelines, we neglect to consider the everyday, real differences between women and men, like size, care demands, and even cultural expectations. I would argue that girls and women do present in typical ways; we have simply accepted male as the default gender and therefore what is “normal.” Clinically, most will rarely consider the impact of gendered acculturation when evaluating diagnosis, especially since none of the assessments take this into account when they’re written. 

Flaws in the system: what (most) ADHD assessments get wrong 

On most ADHD assessments the question of childhood behaviors comes up. The problem with this is two-fold. First, it assumes the male as default model of presentation. Second, it assumes that people with ADHD can even recall much of their childhoods. Fun fact: most do not. Due to issues of executive functioning, emotional dysregulation, and object permanence found with the disorder, most people with ADHD cannot tell you what happened weeks ago, let alone in childhood. Our brains do not code memories the same as neurotypical brains. We remember snapshots that interest or are important to us, not whole narratives. Further, symptom presentation is subjective. Asking a person with ADHD to describe the severity or frequency of their symptoms is difficult, mostly because it’s like asking a fish to describe water: it’s all we know. This is why often the request is made for a close friend, partner, or family member to weigh in on the assessment; they can see from the outside the behaviors we have normalized. 

Going back to childhood, girls are given the message of what is “acceptable” behavior, messaging that persists into adulthood. Adopting the prescribed behavior for social and cultural acceptance means that girls will often internalize their ADHD symptoms. This can look like interrupting conversations, fidgeting, hair and nail picking, feelings of internal restlessness (often misunderstood as anxiety), difficulty following through on tasks, inattention to small details, daydreaming, distractibility to the point of impairment, zoning out in and out of conversations, and a feeling of overwhelm or “brain exhaustion,” to name a few. Rarely will you meet a girl or woman who presents with externalized hyperactivity.

How estrogen affects ADHD symptoms

Addressing the myth that people outgrow ADHD, we go back to the male as default model of presentation. As men age, their symptoms tend to diminish; gravity is a powerful teacher when it comes to physical rambunctiousness. However, as girls and women age, their symptoms intensify, and this is largely due to one key factor: estrogen. 

When estrogen dips, so does dopamine. People with ADHD have lower levels of dopamine to begin with; more than a “feel good” hormone, dopamine is also necessary for executive functioning. The dive in estrogen, particularly evident during the 10 days premenstrual, triggers a dive in dopamine which in turn causes an increase in symptom presentation. As women age, their estrogen dives become more intense and pronounced; so too do their ADHD symptoms. This is why we see more women in their late 20s-early 40s seeking assessment, diagnosis, and treatment for ADHD. The systems and masking behaviors they have set up and utilized successfully their entire lives are failing them as they try to manage worsening symptoms, hormone fluctuations, and their lives simultaneously. If you are one of the women who has known for a while now about your ADHD diagnosis, just a heads up: your ADHD is getting worse as you age; it’s not just you, and it’s not in your head. Well, I mean, technically it is, but you get what I mean!

This year the American Professional Society for ADHD and Related Disorders (ASPARD) is releasing new guidelines for adult assessment for ADHD. Using the current standards, most adults, regardless of gender, will not meet many of the qualifications outlined in the DSM because they are not tailored to adult presentation. As with most things, one size does not fit all. Hopefully, for women seeking help, this means an adjustment in how we understand the disorder, recognizing it as a spectrum of symptoms, not a monolith.

You don’t have to live in diagnostic limbo (we can help)Our Psychological Assessment team works closely with both children and adults who would like to be assessed for attention-deficit/hyperactivity disorder. The results of this testing can help individuals gain a deeper understanding into their current difficulties, as well as provide diagnostic clarification and enhance treatment recommendations. Learn more about our ADHD testing capabilities here.

Related Blogs

Should You Break Up? A Therapist's Perspective on Relationship Decision-Making

Karen Veintimilla, LMHC May 22, 2024 Read More

Caring for Those Who Care: Combating Compassion Fatigue for Nurses, Teachers, and More

Landon Coleman, DNP, PMHNP-BC May 20, 2024 Read More

What Our Therapists Wish More People Knew About Mental Health

Kimberly Jaso, MHC-LP May 17, 2024 Read More

Is Mother's Day Complicated for You? Here's How to Cope 

Kristina Damiano, MHC-LP May 8, 2024 Read More

Join Our Community: