ADHD can be overlooked in girls, women

Attention deficit hyperactivity disorder (ADHD) is a condition typically diagnosed in childhood, yet adult diagnoses of ADHD have increased in recent years — many among women.

From 2020-2022, the percentage of women ages 23-49 diagnosed with ADHD nearly doubled, according to an Epic Research study.

What’s behind the rise? What does ADHD look like in adulthood, and what should you do if you think you have it?

What is ADHD?

ADHD is a neurodevelopmental disorder, which means it affects the way the brain develops and functions. It’s usually diagnosed in children before the age of 12. People with ADHD may:

• Have difficulty paying attention or focusing (known as inattention)
• Display hyperactivity (persistent restlessness or fidgeting)
• Engage in impulsive behavior

Deandra Cloy, LICSW, an integrated mental health therapist with the MultiCare Behavioral Health Network, frequently works with children who have ADHD. She shares that this condition can be overlooked in girls because of the way it often shows up — potentially contributing to the rise of diagnoses later in life.

“Boys with ADHD tend to show more hyperactive or impulsive symptoms, where they’re blurting out in class or frequently getting up out of their seat,” Cloy says. “Girls, on the other hand, tend to have more inattentive symptoms, where they’re zoning out, daydreaming or distracted. Because these symptoms are less disruptive, they’re more likely to go unnoticed by parents and teachers.”

Although inattentive symptoms of ADHD may be less outwardly disruptive, they can still have a significant impact on a person’s life — in childhood and adulthood.

“Kids with these symptoms tend to struggle with time management and academic performance,” Cloy says. “They may do their homework but forget to turn it in or lose it. Or they may struggle to complete assignments because they missed instructions that were given in class or are unable to get themselves organized.”

“Girls … tend to have more inattentive symptoms, where they’re zoning out, daydreaming or distracted. Because these symptoms are less disruptive, they’re more likely to go unnoticed by parents and teachers.”

One of the common misconceptions about ADHD is that people with this condition are lazy and just need to try harder.

“Their symptoms are due to differences in the way their brain processes information — not because they aren’t putting in effort,” Cloy says. “It’s common for kids with ADHD to feel like they’re constantly failing to meet expectations — a feeling that they can carry with them into adulthood — so I focus on positive reinforcement and teaching them strategies to help them solve problems and be successful.”

ADHD in adulthood

Cameron Maleki, DNP, an advanced registered nurse practitioner, sees a disproportionate number of women in his practice who have been diagnosed with ADHD later in life. Maleki provides psychiatric care for adults at Navos, part of the MultiCare Behavioral Health Network.

Like Cloy, he attributes part of this rise to the fact that ADHD tends to be underdiagnosed in girls. Other factors play a role as well.

“The rise of adult ADHD diagnoses in general is likely due to better awareness of this condition through social media and other venues,” Maleki says. “People are more likely to seek help for symptoms they’ve been experiencing, rather than suffering in silence. Since the pandemic, there’s also increased access to telehealth, which reduces barriers to care.”

A qualified mental health or medical professional typically diagnoses ADHD through an evaluation. But if the condition is missed in childhood, it can be difficult to diagnose in an adult setting.

“There’s a lot of overlap between symptoms of ADHD and symptoms of other conditions,” says Maleki. “So it’s important to rule out other potential causes of inattention or other symptoms a person is experiencing.”

Another challenging part of getting diagnosed with ADHD as an adult is that it can be hard to recall symptoms you may have experienced in childhood.

“Because ADHD has a childhood onset, it’s important to have a sense of what was happening when a person was 12 and under so we can make an accurate diagnosis,” Maleki says. “If you’re a 40-year-old, it may be hard to remember back that far. Sometimes gathering information from family members or close friends can help.”

Like children with ADHD, adults with this condition experience symptoms related to inattention, hyperactivity and impulsivity that are inconsistent with their age or developmental level.

Adults with ADHD may:

• Have difficulty concentrating or staying on task
• Struggle with time management and meeting deadlines
• Frequently lose important items like wallet, purse, keys or phone
• Struggle with school or work performance or unemployment
• Have difficulty maintaining relationships
• Have difficulty controlling impulsive behavior
• Frequently interrupt other people or have trouble listening
• Frequently feel irritable and have difficulty controlling (regulating) emotions

Studies show that teens and adults with ADHD have an increased risk of suicide and are also more likely to develop substance use disorders.

“If you’re experiencing symptoms that are disrupting your life, then it’s a good idea to reach out to a health care provider. Even if it’s not ADHD, we can help you figure out what’s going on and get you the help you need.”

While ADHD is often lifelong, effective treatment can keep symptoms under control and help people live full, productive lives. The first-line treatment for ADHD is medications, such as stimulants (non-stimulant medications are also available).

“Approximately 60 to 80 percent of adults with ADHD experience remission from their symptoms with stimulants,” Maleki says. “Research shows that adults with ADHD tend to have the best outcomes when they receive a combination of medication and therapy.”

Therapy, such as cognitive behavioral therapy, can help people cultivate healthy behaviors, learn effective coping strategies and improve executive functioning skills (skills that help you plan, solve problems, adapt and reach goals).

What to do if you think you have ADHD

We live in a world teeming with distractions, from constant notifications on our phones to new emails populating our inboxes. How do you know when inattentiveness or other symptoms cross the threshold into ADHD?

“People can have ADHD traits in adulthood, but that doesn’t necessarily mean they have a disorder,” Maleki says. “The distinguishing characteristics of ADHD are that symptoms started before the age of 12 and they have led to functional impairments across multiple areas of life — causing problems in their relationships, in their performance at work or school, or in their ability to take care of themselves.”

If you think you may have ADHD, a good first step is to talk to your primary care provider. They can conduct an initial screening and make a referral to a qualified mental health professional, such as a psychiatrist or psychiatric nurse practitioner, for a thorough evaluation. Some mental health therapists may also be able to diagnose ADHD and can provide a referral as needed for medications.

“If you’re experiencing symptoms that are disrupting your life, then it’s a good idea to reach out to a health care provider,” Maleki says. “Even if it’s not ADHD, we can help you figure out what’s going on and get you the help you need.”