5 Ways ADHD Shows Up Differently in Women and Girls
ADHD can appear very differently in women and girls than it does in men and boys.
I’m on a journey to learn as much as I can about ADHD in women because I have a number of ADHD-like symptoms myself.
Until 1980, ADHD was considered a disorder of hyperactivity that occurred in boys and resolved in puberty. To receive a diagnosis, signs of hyperactivity had to occur before the age of seven.
We now know ADHD manifests as three different sub-types, does not always include hyperactivity, and often continues into adulthood.
The three sub-types of ADHD:
Primarily Inattentive
Primarily Hyperactive
Combined (a mix of inattentive and hyperactive symptoms)
Women and girls are more likely to have the Primarily Inattentive sub-type.
Of course, some women and girls have the Primarily Hyperactive or Combined type of ADHD, but this isn’t as common. Or the hyperactivity manifests internally as a constant deluge of thoughts pulling you in different directions or the feeling you must stay busy at all times.
Boys are more likely to have the Hyperactive or the Combined sub-type, which exhibits more overt symptoms and thus is more easily observed by others and diagnosed.
You won’t necessarily see ADHD symptoms in women or girls if you’re primarily looking for hyperactivity—which is what psychologists have done for decades.
This is why ADHD symptoms can be harder to identify in women and girls. Also, many women have become masters at hiding their signs of ADHD or compensating for them, likely due to shame and low self-esteem.
What else do we need to know about ADHD in girls and women?
The American Psychological Association has described Dr. Ellen Littman, Ph.D., as “a pioneer in the identification of gender differences in ADHD.” She is also the co-author of Understanding Girls with ADHD: How they feel and why they do what they do.
Dr. Littman has identified at least five ways ADHD manifests differently in women and girls compared to either men and boys or women without ADHD.
Let’s look at what they are and set the record straight.
1. Hormones Play a Significant Role in ADHD
Estrogen is the sex hormone in charge of the development and regulation of the female reproductive system.
Estrogen also impacts the brain. According to Dr. Littman:
“Estrogen modulates executive functions, attention, verbal memory, sleep, concentration, motivation.”
These are some of the core brain functions that can be challenging for people with ADHD.
Previously, due to studies conducted almost exclusively on boys, ADHD symptoms were understood to be stable over time.
But clearly, that can’t be the case for women and girls because estrogen levels change significantly over the course of a lifetime.
Estrogen flow begins at puberty in girls. That’s why ADHD symptoms may not be apparent in girls until puberty unless they have externalized hyperactive signs.
The emotional ups and downs girls with ADHD often experience after the onset of puberty can be easily misdiagnosed as anxiety or another psychiatric disorder. ADHD may not even be considered by a therapist if the client is a girl without obvious hyperactive symptoms.
ADHD symptoms increase as estrogen decreases, which occurs each month after ovulation until a girl or woman’s next period. The combination of low estrogen and high progesterone, which occurs right after ovulation can worsen ADHD symptoms.
Some women with ADHD, especially those who have impulsive symptoms, can be extremely sensitive even to minor fluctuations that occur from day to day or even in a single day.
Female hormones shift during and after pregnancy as well. Estrogen also begins to decline in peri-menopause and decreases substantially after menopause. A woman can live as much as one-third of her life after menopause.
Research into hormone involvement in ADHD is relatively new, but extremely important in understanding how symptoms manifest differently in women and girls and treating it accordingly.
2. Social Challenges in Women with ADHD
Men with ADHD can experience social challenges, but they tend to be more severe in women and girls with ADHD.
Women and girls with ADHD can feel overwhelmed by the normal requirements that come along with friendships. They can find it hard to initiate and maintain friendships.
As a result, women and girls with ADHD may have fewer meaningful relationships, which can lead to loneliness and self-isolation.
They often experience “Rejection Sensitivity Dysphoria (RSD),” which is common in ADHD.
Rejection Sensitivity describes intense emotional reactions to real or perceived rejection. At the slightest comment, a person with ADHD can feel judged, criticized, or misunderstood. These reactions feel out of the individuals’s control
Some women end up isolating themselves to avoid the discomfort of rejection or the overwhelm that friendships generate for them.
Women and girls with ADHD are also more likely to engage in risky social behaviors in an effort to feel socially accepted.
For example, they’re more likely to begin intercourse early and have more sexual partners and more causal sex. They have more sexually transmitted infections and unplanned pregnancies due to unprotected sex. They may feel shame as a result and hide their degree of sexual activity from others.
3. CNS Hyper-Sensitivities in ADHD
Both men and women with ADHD have Central Nervous System Hyper-Sensitivities. But women with ADHD have more of the following types.
Tactile defensiveness
Tactile defensiveness can manifest as discomfort with different kinds of touch—from light touches to a bear hug.
Things most people don’t notice at all can be very uncomfortable like tags in the back of shirts, wool sweaters, and tight clothes.
Somatic Complaints
These typically include regular headaches, migraines, stomach aches, and nausea. They can occur when a woman wakes up in the morning before she engages in a specific activity.
Sleep Disturbances
Women and girls with ADHD are three times more like to experience insomnia than women without ADHD. Insomnia can have many knock-on effects starting with fatigue and exhaustion.
Reactivity to Pain
Women and girls with ADHD can be more reactive to pain and have a higher likelihood of developing fibromyalgia. Daily pain can affect other brain functions that may already be compromised.
Sensory Overload
Sensory overload can range from trouble with sounds like loud music, chewing, or scraping. Changes in light can affect mood. Or they may be sensitive to odors like perfume, incense, and strong-smelling foods.
These kinds of symptoms can be hard to explain and adversely impact close relationships—something I know from experience.
4. Co-Existing Conditions and ADHD
By adulthood, women with ADHD have at least one co-existing condition or psychological challenge.
These include:
Emotional Dysregulation.
Anxiety and Depression, which are more prevalent in women with and without ADHD in comparison to men.
Dysregulated Eating.
Externalizing Disorders like Oppositional Defiant Disorder and Conduct Disorder, which are more commonly found in impulsive women. Men with ADHD have more externalizing disorders. But (this is a mouthful) girls and women with ADHD compared to women without ADHD have a higher percentage than men with ADHD compared to men without ADHD.
Personality Disorders, with Borderline being the most prevalent.
These co-existing psychological conditions present a complicated symptom picture, which can make it difficult to receive an ADHD diagnosis.
5. More Serious Outcomes for Women with ADHD
Women with ADHD tend to forgo self-care due to poor self-esteem, fear of rejection, or feelings of overwhelm.
The may miss regular dental check-ups, annual medical exams like physicals and mammograms, or overeat. Poor self-care can lead to poor health outcomes on the long run.
Women with a history of childhood ADHD, which typically has meant some signs of hyperactivity or impulsive behavior, are at a greater risk for depression, suicide attempts, and physical and psychological victimization in relationships.
Women with ADHD experience earlier mortality compared to men with ADHD and women without ADHD—as much as nine to ten years. Impulsive women are at the highest risk, but are not the only women affected.
If any of the above sounds familiar, take the ADHD Self-Test for Women and Girls. You cannot receive a definitive diagnosis from a self-test, but it can give you some clues. Only a medical doctor or health care professional can diagnose ADHD through an extensive clinical evaluation.
Concluding Thoughts
This information is not meant to dismiss the challenges faced by men and boys with ADHD. Rather, it’s intended to highlight ways ADHD manifests differently in women and girls.
For example, women and girls more commonly have symptoms of Inattentive ADHD. If hyperactivity is present, it may be mental as in an excess of thoughts rather than behavioral. And due to gender stereotyping, women and girls have learned to mask their ADHD symptoms.
New research shows estrogen plays a significant role in relation to ADHD symptoms in women and girls as well, making symptom severity cyclical rather than constant over time.
When women are finally diagnosed with ADHD, they often report feeling a tremendous sense of relief.
Once your challenges are seen and validated, you can address them head-on. You can access medication, seek the support of an ADHD therapist or coach, and utilize informational resources that can make your life easier.
Learn more about symptoms and treatments for women and girls with ADHD in the video below:
Thank you for your presence, I know your time is precious! Don’t forget to sign up for Wild Arisings, my twice monthly letters from the heart filled with insights, inspiration, and ideas to help you connect with and live from your truest self.
You might also like to check out my Self-Care Shop. May you be happy, well, and safe – always. With love, Sandra
