ADHD in Women and Girls: Signs, Symptoms and Treatment

“It’s hard to know because for many years women have been neglected in research. ADHD was seen as a childhood illness associated with boys,” says Ellie Dommett, professor of neuroscience at the ADHD Research Laboratory at King’s College London. “About 3% of adults worldwide have ADHD, and while it is more likely to be diagnosed in boys than girls, once it gets to adults the rate is about equal.”

Unsurprisingly, the NHS is struggling to cope. There has been a national shortage of ADHD medication and there is a three-year waiting list for a referral to the NHS.

“It’s really important to recognize that the impact on everyday life is very diverse and context-dependent,” says Professor Dommett. “If you’re a freelance creative, for example, who can stick to your own schedule and are rewarded for thinking outside the box, daily life might be a lot easier than if you have an office job in a formal setting, which is very common. -related.”

Regardless of your position, there’s no avoiding the daily grind of adult life – and for someone with ADHD, it can be very difficult. “Running a home is a tedious task,” says Dr. Cubbin. “Take out the trash, buy the milk, do the laundry, pay the bills. It can be difficult to stay on top of all of this. Even going on vacation – packing your bags, keeping your passports, not missing the plane – can be extremely stressful.”

Keeping it all together can have serious mental consequences and lead to depression, feelings of guilt, and also downright exhaustion. “People think that ADHD means having a lot of energy, but in reality, fatigue is also common,” says Dr. Cubbin. “Often you don’t sleep well because your mind is spinning and you don’t wake up feeling rested. Then you have to work harder than anyone else to manage the day-to-day.

“This is a generalization, but women and girls are more likely to compensate by making every effort to overcome their difficulties,” says Dr. Cubbin. “They will manage to accomplish something even if it takes a lot of stress, effort and panic and their teacher or employer may not have noticed how much they struggled.”

Research suggests that ADHD is more likely to be detected at school when it presents with learning problems – and that girls with ADHD are less likely to have learning difficulties than boys. Externalizing problems – rule breaking, aggression and criminality – are also more common in boys and men with ADHD (although they are high in both sexes), and are therefore more likely to receive attention . Girls and women with ADHD are more likely to suffer from internalizing disorders – emotional problems, anxiety, depression – which may not be related to ADHD. “Many doctors won’t look for ADHD in women, especially if they’re not hyperactive,” says Dr. Cubbin. “If a woman presents with anxiety or a low mood and says to her GP, ‘I’m not coping, I’m overwhelmed, I’m overwhelmed,’ ADHD often doesn’t come to them. spirit.”

It depends on many factors, including ADHD symptoms, work, family life, and the people around you. “Untreated impulse control issues can lead to unplanned pregnancies and higher rates of STDs if contraception is not considered,” says Dr. Cubbin. “You’re also more likely to lose control over drugs and alcohol – partly because you’re self-medicating for difficult feelings – which can also lead to riskier sexual behavior. »

Women with ADHD are more likely to become smokers and develop alcohol and drug use disorders. Obesity is also more likely, as are bulimia and binge eating. “Again, if you’re not good with impulse control and need constant stimulation, this may come from constant snacking. This has a knock-on effect on health and puts you at higher risk of high blood pressure, strokes and heart attacks.

Work and relationships are also likely to suffer. “You might experience rapid job turnover because you get bored easily, or maybe you have trouble holding down a job. Relationship breakdowns and divorces are more common, perhaps due to mood instability and arguments – ADHD is difficult to live with – or impulsivity which can lead to infidelity.

Some research has shown that ADHD can reduce life expectancy by up to 13 years.

“There are many explanations,” says Dr. Cubbin. “Car accidents – all accidents – are more common. You’re less likely to take care of your health — and if you have a chronic condition that needs to be managed, like diabetes or epilepsy, which are more common in people with ADHD, it’s hard to do with a chaotic lifestyle.

All of these issues fuel low self-esteem – and perhaps the most common result of untreated ADHD in women is a feeling of failure, of being “different.”

“Many women spend their lives blaming themselves, feeling stupid or lazy, and wondering why they find life so much harder than everyone else seems,” says Dr. Cubbin. “They are stressed, overwhelmed and have been told for years that they could and should do better.”

• Anxiety and depression. Research suggests that women with ADHD have twice the rate of depressive disorders and three times the prevalence of generalized anxiety disorder (GAD) than women without the condition.
• Sleep disorders. Insomnia is three times more common in women with ADHD/
• Chronic fatigue syndrome. CFS is common in people with ADHD. A study of adults with CFS found that 30% were diagnosed with ADHD during childhood.
• Chronic pain conditions such as fibromyalgia. ADHD may be accompanied by a higher prevalence of reported pain, likely due to common underlying issues related to neurotransmitters, dopamine, and serotonin.
• Borderline personality disorder and serious mental illness. Women with ADHD are at higher risk of being admitted to psychiatric hospitals as adults.
• Obesity, binge eating and bulimia.

The diagnosis alone can be extremely helpful – studies have shown that an ADHD diagnosis can be a huge relief, helping women make sense of their past, understand their behavior, devise coping mechanisms, and plan – for example by making decisions about their career and relationships – accordingly. Some people no longer want treatment.

“ADHD can be very debilitating for some, but others manage it well,” says Professor Dommett. “They find it has strengths – for example, the ability to think outside the box or the ability to be ‘hyper-focused’. Although not an official symptom, the ability to focus intensely on something that interests you, even if it causes you to lose track of time, is well documented. Treating ADHD can be a fine line between achieving the change you want without flattening what you value.

Stimulating drug

For those who need treatment, stimulant medications are first line and improve symptoms in 70 percent of adults. “This is by far the most effective treatment,” says Dr. Cubbin.

The main drugs, methylphenidate and isdexamfetamine, work by increasing levels of the neurotransmitters dopamine and norepinephrine. “A person with ADHD who is bored and agitated, looking for entertainment, for distraction, is unconsciously looking to increase their dopamine levels,” says Dr. Cubbin. “Increasing levels through controlled medications can make you much calmer and more able to concentrate. They work best if you take them regularly, although it is also possible to take them flexibly, on days that you know will be difficult. Side effects can include difficulty sleeping and headaches, and finding the right dose may take some trial and error.

Non-stimulant medication

Non-stimulant medications such as atomoxetine act on another neurotransmitter called norepinephrine. “They are not a first-line treatment because they are about half as effective as stimulant medications,” says Dr. Cubbin. “They tend to be used only when stimulants haven’t worked.”

Exercise

“Studies show that exercise in people with ADHD can reduce impulsivity and improve most executive functions such as attention and planning,” says Professor Dommett. “Even 10 minutes of regular exercise like yoga or cycling can lead to improvements. People with ADHD often talk about exercising, even before a diagnosis, as a way to burn off energy and clear their minds.

Mindfulness and talk therapy

“Mindfulness appears to be beneficial,” says Professor Dommett. “Research examined the impact of eight-week mindfulness courses, 90 minutes per week and home practice. It has been found that it may not improve attention span or impulsivity, but it can be helpful in other ways, such as eliminating depression and regulating emotions.

Among talking therapies, cognitive behavioral therapy (CBT) is the most effective. A study in Denmark found that CBT for adults with ADHD led to significant improvement in symptoms, increased education and employment rates, and reduced dependence on welfare.