Clinical Presentation of ADHD in Women


Attention-deficit/hyperactivity disorder, commonly referred to as ADHD, is classified as a neurodevelopmental disorder in which symptoms often manifest in childhood and can persist throughout adulthood. As the name suggests, individuals with ADHD may have difficulty concentrating on tasks, paying attention to others or their surroundings, or regulating impulsive behaviors. ADHD is divided into three subtypes: inattentive, hyperactive/impulsive, or combined type. Inattentive type ADHD is characterized when an individual predominantly displays inobservant behaviors or distractibility relating towards a task. This may include having a difficult time focusing on lectures or classroom discussions, forgetting daily tasks, or having difficulty following details in a conversation. In the hyperactive/impulsive type, one predominantly displays symptoms associated with erratic or restless behaviors such as difficulty engaging in leisure activities, appearing to need constant movement, or inability to wait for their turns in social functions or activities. In combined type ADHD, one presents symptoms of both inattentiveness and hyperactivity (American Psychiatric Association, 2021). 

ADHD is mostly diagnosed in early childhood, school-aged children with boys more commonly being the recipients of the diagnosis in contrast to girls,12.9% compared to 5.6% respectively (Centers for Disease Control and Prevention, 2020). While the prevalence of ADHD may appear more apparent in boys than girls, research shows that this gap in diagnosis is not necessarily the result of boys being more susceptible to ADHD, but rather, it may be due to girls being misdiagnosed or undiagnosed for ADHD in their younger years. 

Physicians Quinn and Madhoo, who specialize in ADHD treatment, conducted a review of varying clinical presentation of ADHD in women in contrast to men to analyze the differing factors in the recognition of a diagnosis and treatment options. In their review, they examined 41 ADHD articles, on Pubmed, over the span of the years 2002 to 2012 to identify the relevance of ADHD in women. Results signified that women and girls with ADHD to prominently display inattentive behaviors rather than hyperactive or impulsive symptoms. Internalizing symptoms, such as distractibility or inability to remain focused on a task, are more likely to be overlooked by teachers and parents in comparison to externalizing symptoms, which are associated with more disruptive behaviors as markers for ADHD diagnosis (Quinn & Madhoo, 2014). With public perception of ADHD heavily focused on the presentation of hyperactivity or impulsivity, behavioral symptoms relating to inattention are widely neglected in individuals who may present a different set of ADHD symptoms but are equally impacted by the condition. Typically, there is a greater emphasis on noticing disruptive or loud behaviors as common symptoms of ADHD; however, most do not realize individuals with inattentive or varying levels of combined type ADHD may have their symptoms go unnoticed and untreated for a great length of time. This inevitably would exacerbate negative behaviors that can disrupt the daily lives of individuals with these subtypes of ADHD. Quinn and Madhoo additionally noted that women and girls with ADHD are more likely to develop secondary presentations of anxiety and depression in association with their ADHD symptoms. Females with ADHD are more likely to exhibit lower self-esteem than males with ADHD. This negative self-perception is correlated with impaired peer and family relationships which is evident as females with ADHD are more likely to exhibit inattentive behavior which may make it difficult for them to focus on conversation building with others (Quinn & Madhoo, 2014). Overlooking an ADHD diagnosis in childhood can directly correlate with further exacerbation of symptoms related to depression and anxiety which travel to adulthood in women.  In this manner, it is seen how ADHD symptoms in women may be misdiagnosed even in adulthood for the coexistence of anxiety and depression. 

ADHD symptoms of all subtypes need to have greater recognition, so more individuals with ADHD can be included in the conversation for proper treatment and diagnosis. Because most diagnoses of ADHD happen in childhood years, it would be very beneficial to have additional instruction given to teachers, caregivers, and family members of the manifestation of ADHD behavioral markers that commonly go unnoticed. Additionally, with growing awareness of how clinical presentations of ADHD may be different in various groups, there should be a greater research focus on obtaining ADHD data on underrepresented populations. With proper diagnoses, more individuals with ADHD will be able to seek out proper medications and therapies to help them better understand their condition.

 

References

Image Citation: (Open Learn, 2021)

American Psychiatric Association. (2021). What is ADHD? https://www.psychiatry.org/patients-families/adhd/what-is-adhd

Centers for Disease Control and Prevention. (2020, November 16). Data and statistics about ADHD. https://www.cdc.gov/ncbddd/adhd/data.html

Open Learn. (2021, February 3). Understanding ADHD [Animated Photograph of a Young Girl with ADHD.]. The Open University. https://www.open.edu/openlearn/health-sports-psychology/understanding-adhd/content-section-0?active-tab=description-tab

Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/Hyperactivity disorder in women and girls. The Primary Care Companion For CNS Disorders, 16(3). https://doi.org/10.4088/PCC.13r01596

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