Feature Archive

Suffering in Silence: Women With Adult ADHD

ADHD can silently follow adults for years but there is help if you know the signs.

By Dulce Zamora
WebMD Feature

Reviewed By Cynthia Haines, MD

Adult ADHD is a sly condition that can secretly affect people for years without their knowledge. Lori-Lynn Dale knows first hand. In her senior year in college, she not only completed her studies, but also managed three jobs and cared for a new baby boy. Dale seemed to handle herself beautifully, but inside the young mother felt alone, tired, and overwhelmed.

Besides staying awake for days to finish projects, Dale admits to alcohol and drug abuse to ease frustration, and to using "underhanded tactics" to get her way. Her manipulative behavior and fear that someone would find out that "something was really wrong" with her made it difficult to make and keep friends. She did not want anyone to know about her shortcomings.

"I was out to prove that I was just like everybody else," says Dale. "It was a huge cost to my personal development and my self-esteem."

Dale did not feel relief until she was in her 30s. That's when she became sober and was diagnosed with adult attention deficit hyperactivity disorder (ADHD).


Could ADHD be Affecting Your Life?

In many ways, Dale's story illustrates the significant impact of adult ADHD on women. Women with the disorder tend to suffer in silence compared with their male counterparts, says Patricia Quinn, MD, director of the National Center for Gender Issues and ADHD, a nonprofit group. She says women often develop strategies to hide their deficiencies, but in the process, feel ashamed and have low self-esteem. They frequently find it difficult to make social connections. And, even when things are going well, they feel frustrated and besieged.

The burden is especially noteworthy given at least 4 million women have adult ADHD and many of them don't know it, says Quinn. "Women have tended to be underdiagnosed with the disorder," she explains. "We have probably not diagnosed one-half to three-quarters of the women with ADHD."

Women are apparently missed early on. "If you go to [children's] clinics and see who's getting treated [for ADHD], the ratio of males to females is as high as nine males for every one girl," says F. Xavier Castellanos, MD, director of the Institute for Pediatric Neuroscience at the New York University Child Study Center.

Research of school-aged children indicates there are actually about 2.5 boys to one girl with ADHD. Yet even this estimate may not be completely realistic, says Castellanos, citing anecdotal reports that there are an equal number of males and females with the disorder.

Adult ADHD: A Great Burden Overlooked

There are many theories as to why fewer females are diagnosed and treated with ADHD. Quinn points to the history of the disorder itself. "We've studied the disorder in males -- usually elementary school-aged males -- and that's how we've defined the disorder," she says, noting that boys with ADHD have traditionally been known for their hyperactivity and disruptive behavior. Teachers and parents, who refer kids to the doctor, notice these symptoms.

Instead of being disruptive, girls with ADHD tend to show their symptoms in more socially appropriate ways, says Patricia A. Pape, PsyD, a psychologist in private practice in Wellington, Fla. She says it's not uncommon for girls with ADHD to become social butterflies. When they feel the need to move around, they usually meet their need by acting as a teacher's helper or monitor.

Girls with ADHD also learn to cover up their symptoms, because they are ashamed of them and generally want to please people, says Quinn. "If [girls with ADHD] forget to bring a project into school, they're embarrassed and humiliated by that, so they work hard, or even develop anxiety and worry so that it won't happen again."


Could ADHD be Affecting Your Life?

Although these girls may get good grades or are praised for their work, they often feel they don't deserve it, and that chance had something to do with their success. So they work harder to prove themselves, to the point of sacrificing sleep and good nutrition, or setting up a very rigid schedule for themselves in a sometimes obsessive-compulsive manner.

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