If you feel like you’re hearing about more and more women being diagnosed with ADHD recently, you’re not wrong! Many women don’t receive a diagnosis until well into their 30s or 40s, while the average age of diagnosis for men is much younger.

ADHD affects men and women equally, but many young girls go undiagnosed for years, only to have their symptoms recognized in later years. Let’s talk through what ADHD is, and why there have been challenges in identifying and diagnosing it properly in women.

First, we’ll look at some of the classic symptoms of ADHD, which are commonly broken up into two main categories: hyperactivity and inattention.

Hyperactivity

• Restlessness
• Being uncomfortable sitting still
• Talking excessively or out of turn
• Interrupting others or having difficulty waiting your turn
• Fidgeting

Inattention

• Difficulty focusing
• Trouble staying organized
• Distractibility
• Forgetfulness

There are three main types of ADHD: primarily inattentive type, primarily hyperactive type, and combined type. What previously used to be known as ADD (Attention Deficit Disorder) now falls under the umbrella of ADHD.

These diagnostic criteria seem pretty straightforward, but for many people, especially people who are assigned female at birth, it’s not so simple.

Diagnostic Bias

When ADHD was first being understood, researchers focused heavily on symptoms seen in young boys, there was even a time when it was thought that young girls couldn’t have ADHD!  These young boys showed symptoms like having trouble staying seated, causing major disruptions in class, and having behavioral issues.

To put it frankly, researchers just didn’t see these same concerns in young girls as often, so the diagnostic criteria that resulted didn’t consider how young girls might be struggling. When a young girl started struggling with what we now know to be ADHD, she wouldn’t fit the criteria for ADHD, and then would go undiagnosed and untreated.

Masking

Another major reason women are either undiagnosed or diagnosed later in life is because of social conditioning, and a phenomenon known as masking. If you’ve ever felt like you had to put on an act to get through a social situation, you were likely masking.

For many girls and women with ADHD, the strict social rules of how women are “supposed” to act cause them to mask ADHD symptoms that wouldn’t be viewed positively. Masking to get through a short social interaction isn’t necessarily detrimental, but many women with ADHD end up masking all the time, sometimes even so much so that they don’t realize they are doing it until they learn about their symptoms and let themselves drop the masks.

So what does ADHD look like in women?

The symptoms of ADHD are essentially the same between men and women, but the way they present can be very different.

Women with ADHD often experience things like:

• Rejection sensitivity dysphoria (severe emotional pain to perceived rejection or exclusion)
• Fears of judgment for symptoms of disorganization, forgetfulness
• Self-esteem issues from perceptions of laziness or trouble with motivation
• Sensory issues and being easily overstimulated
• Sleep issues
• Changes in symptoms and severity of concerns in alignment with menstrual cycles
• Mental exhaustion from ongoing masking/symptom management
• Identity issues after struggling to know who they are authentically vs. who they felt they had to be

How is ADHD being diagnosed in women?

 ADHD is formally diagnosed in the same way for men and women. A mental health care provider provides an assessment based on historical and current symptoms, but again many of these diagnostic assessments are focused on male-centric symptoms, so it takes a trained provider to notice the ways this might show up in women.

Many women first acknowledge ADHD symptoms after a major life transition. Moving to college, living on their own, and having children can all be common times for this. It’s not that the symptoms weren’t present prior to these life changes, it’s that the person may have lost systems of support that previously helped them cope, or their responsibilities have increased to a level that they can no longer manage with previous coping skills or masking. For some women, it’s not until they notice symptoms in their own children that they reflect on their own childhood/development!

If any of this sounds familiar, reach out to one of our ADHD specialists for support!

If you have ADHD, you know that finding the right set of tools and techniques that work for you can be a process of trial and error. What works for you might be the opposite of helpful for someone else. Below you’ll find a few techniques to try that go beyond the traditional productivity tips.  

Body doubling:

Have you ever struggled to complete a task when you’re by yourself, but have no problem doing it once someone else is there? This is known as body doubling; completing a task in the presence of someone else. If you have a task you’ve been dreading, putting off, or half-completing, try video chatting a friend and let them know your task. You can also try body doubling online with other folks looking for the same assistance. Check out https://bodydoubling.com/!

O.H.I.O.

An acronym for “only handle it once”, this is a helpful tool for managing the clutter and organizational challenges that many people with ADHD deal with. Often, when we take something out (for example, a box of cereal), that item gets left on the counter as we move on to the next step of the task (milk, spoon, eat). When keeping O.H.I.O in mind, the idea is that the cereal box is dealt with prior to moving on to the next part of the task so you are only handling (literally and figuratively) it once vs. twice (taking it out, and then later cleaning up from the task). While this does immediately reduce clutter, the more importance aid here is in reducing yoru overall mental load. Completing the task in the moment means it’s one less thing for you to have to remember later on, and keeps your space more functional for other tasks. 

Labeling

Another organizational technique is the ever-classic labeling system. This might sound trite, but labeling is another tool to reduce your mental load. Neurotypical brains aren’t typically burdened by remembering which cabinet the strainer goes into, if the tape is put with the gift wrap or the office supplies, and where you put that important reminder card from the doctor. Brains with ADHD tend to forget these things and have to make an in-the-moment decision rather than an automated one. On the back end, that means we spend more time looking for things, sometimes even spending unnecessary money or time replacing things that appear to be lost. Labeling (even things that seem silly or you swear you’ll remember where they go) automates that process, saving you mental energy, time, and even money!

Novelty

ADHD brains love novelty, it’s one of the ways we can trigger a dopamine release. While it would be great to be able to lean on this for every task, inevitably we all have repetitive tasks. Introducing novelty is sometimes as simple as a new location (take it outside or go to a new coffee shop you’ve never been to before), listening to new music, making yourself a new drink or snack, or even just changing the lighting or ambience in your home environment. Novelty is an ever-moving target, so these new things will lose their effect at some point, but once you have the framework for what feels novel and interesting to your brain, you’ll know what to switch up to keep it engaging!

At Star Meadow Counseling, Alissa Loncar is our resident ADHD specialist.