ADHD & Women: Juggling Family, Work, Short Attention Spans

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ADHD & Women: Juggling Family, Work, Short Attention Spans
Why ADHD is especially challenging for females.
By Maggie Koerth-Baker for MSN Health & Fitness


Brenda Daverin had a problem. Unable to focus on her job, she'd start spacing out, losing track of time, work tasks, and even conversations she was a part of. By 2006, when Daverin was 38, both she and her boss had had enough. "I received a formal verbal warning about my performance that led me to consult a psychiatrist," she says. Her diagnosis: Attention Deficit Hyperactivity Disorder.
Daverin may not seem like a typical ADHD patient. But the truth is, ADHD can look a lot different than what you might expect. Instead of focusing on young, wildly uncontrollable boys, doctors and researchers are beginning to recognize that both genders and all ages can be affected by this disorder—and that women face special challenges that can make it difficult for them to be diagnosed and treated.

Girls gone mild

For a long time after ADHD was first identified in the 1970s, diagnoses and research focused on the little boy who bounces off walls, does poorly in school, and constantly disrupts the rest of his class.

"You had these boys who were aggressive and difficult to manage and those were the ones being brought into clinics initially. The research was done on clinic populations. And the diagnostic manuals were all based on that research," says Ellen Littman, Ph.D., co-author of the book

Understanding Girls with ADHD and one of the first psychologists to start focusing on gender differences with the disorder. "It wasn't even until 1980 that we started to accept that you could have ADHD without the hyperactive component."

And that's a big deal for women with ADHD, most of whom, according to experts like Littman, don't display that classic hyperactive behavior. Instead, Littman says, women and girls are most likely to be inattentive. The daydreamers. The space cadets. The little girls who making eye contact with the teacher, but whose minds are 1,000 miles away.

To make things more complicated, experts say young girls often have elaborate systems that allow them to compensate and still do well in school. "A girl with ADHD will stay up very late into the night, re-do homework, have parents help her. She turns in good work and looks bright. But what we don't see is the effort she puts in," says Patricia Quinn, M.D., director of the National

Center for Girls and Women with ADHD.

The result has been that girls often don't get the help they need; what's going on with them doesn't look like what their parents and teachers have come to expect from ADHD. Twenty-five years ago, Littman says, it wasn't unusual to see 10 boys diagnosed for every 1 girl. But the situation is improving. Today, now that doctors and researchers know that inattentiveness, and not hyperactivity, is the key characteristic of the disorder, those numbers are closer to equal, "which is what you'd expect for something that isn't a sex-linked disease," Quinn says.

ADHD & Women: Juggling Family, Work, Short Attention Spans
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A lifelong struggle

But for girls who aren't diagnosed in childhood, the struggle continues as they age. That, too, is a relatively new concept in ADHD diagnosis. "The theory used to be that ADD disappeared at puberty, and they said that because the most hyperactive symptoms disappeared around [then]," Littman says.

But, she says, as research has changed the medical community's perception of what ADHD is, more and more doctors and mental health professionals are recognizing that adults can be affected, too. And that's a big help for women like Tracey Hirt, whose ADHD interferes with the ability to manage the household chores women are often expected to manage.

Hirt describes times when she set out to do the dishes, but quickly became distracted by one unrelated chore after another until she ended up reading on the couch for an hour, finishing none of the tasks she meant to.

Quinn and Littman say it's very common for a woman with ADHD to feel overwhelmed, be chronically stressed and disorganized and be unable to prioritize the tasks expected of her, particularly in relationships and parenting. "It's more OK for men to be disorganized at home and hyper-focused on their work and nothing else. But women don't have a backup staff, they are the backup staff," Littman says.

She says that women tend to get diagnosed with ADHD in waves. A common time is just under the age of 30, as many women are getting married or having their first child. Those events can throw off routines and make it difficult to compensate for the symptoms. In their early 40s, many women who've struggled for years often realize they might have ADHD when they bring in one of their own children for testing. Finally, women in their late 40s are also frequently diagnosed. That's because the symptoms of ADHD appear to have strong connections to estrogen levels in the body. As those levels fall during menopause, women who've only had mild symptoms can suddenly lose their ability to juggle multiple responsibilities.


A hopeful diagnosis

ADHD and its treatments can be very differently for women and men. This is especially true when it comes to hormonal cycles, like menopause and periods. For example, as estrogen levels rise and fall over the course of a month, a woman's ability to manage her symptoms can also go up and down. For some women, starting a hormonal method of birth control can make monthly cycles smoother by keeping estrogen at a more constant level.
Women also have unique concerns related to pregnancy and breastfeeding. When Tracey Hirt became pregnant last year, she stopped taking Ritalin, causing a noticeable drop-off in her organizational and social skills. (As with other mental-health drugs, such as antidepressants, experts say it's vitally important that women consult a doctor about what's safe to use before they become pregnant.)

Another problem is that women, more than men, tend to have other mental health disorders, such as depression and chronic anxiety, often brought on or exacerbated by the ADHD. In fact,

Quinn and Littman say that women with ADHD are frequently misdiagnosed with depression. And while it's true that many of them are depressed, that's usually a related symptom of the

ADHD and the way it wreaks havoc in their life.

The good news: Once a woman does get an accurate ADHD diagnosis, things start looking up. "For women, this is a very hopeful diagnosis," Quinn says. "We have effective medication and behavioral therapies and I've seen so many changes. Once they're treated, women can go and be anything they want to be."
Read more information on ADHD in women and girls from the National Center for Girls and Women with ADHD.


Maggie Koerth-Baker’s work has appeared in AARP magazine, The Associated Press and Health magazine.