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
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.
Quick GuideADHD/ADD in Adults: Symptoms & Treatments in Pictures
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.
As girls become women and take on more responsibilities, the stakes grow higher, even without ADHD. Many of today's women are expected to not only work, but also take care of the house and children.
The average woman is already doing more, says Terry Matlen, MSW, author of Survival Tips For Women with ADHD: Beyond Piles, Palms, and Post-its. She says, "If you add the burden of ADHD symptoms -- getting overwhelmed, being forgetful, being hyperactive, or being disorganized -- to deal with that, on top of taking care of children... plus being a wife and handling a job, it's just more than one can imagine."
Instead of recognizing the adult ADHD factor, however, many women and their families see their difficulties as merely a part of the stress of modern-day living. Other factors that can aggravate ADHD symptoms and potentially throw women off the ADHD trail include:
- Hormonal fluctuations. Symptoms of adult ADHD could tax already challenged minds and bodies. Women with PMS, for example, can already be oversensitive and irritable. For women with perimenopause, Matlen says it's not unusual to already have some trouble with memory, cognitive skills, and word retrieval. Then there's also the emotional rollercoaster that often accompanies pregnancy and post-partum depression. The drastic changes in hormone levels could certainly wreak havoc with mental health and well-being. Add ADHD to the mix, and the burden could certainly become greater.
- Iron deficiency due to menstruation. Research has shown that mild iron deficiency, as experienced by some females, could affect cognitive skills, says L. Eugene Arnold, MD, a child psychiatrist and author of A Family Guide to ADHD. Coupled with the symptoms of ADHD, iron deficiency could become a significant challenge.
- Other mental disorders. As many as two-thirds of children with ADHD have at least one co-existing condition, according to Children and Adults With Attention Deficit Hyperactivity Disorder (CHADD), an advocacy group. Depression and anxiety are common ailments experienced by people with ADHD. They also tend to be more prevalent in women in general.
- Personal problems. Girls and women who have been physically abused, or those who have not had good role models for things such as motherhood and organization could exhibit ADHD-like symptoms. These, and other personal factors, could complicate the identification of the disorder.
Many girls and women are, indeed, missed in diagnosis of ADHD because other problems have the same symptoms. ADHD could also aggravate symptoms of other ailments. But symptoms of ADHD may not necessarily go away with treatment of other conditions.
Relieving the Burden of Adult ADHD
Like most patients, Dale takes a stimulant to help manage her adult ADHD. She joined Alcoholics Anonymous (AA) to manage her alcohol and drug abuse, and has seen a psychiatrist to work on her low self-esteem. To further her recovery, Dale joined CHADD's support network.
All of Dale's efforts have paid off. Now, the 41-year-old Hillsboro, Ore., resident feels better about herself. She also says she is a much better mother to her two children. Before treatment, she says there were many times when she unknowingly put her kids in harm's way. While driving with her boys, for instance, she used to pay attention to everything else but the road. While cooking a dish on the stove, she would wander off outside and get lost while her young kids were in the house.
"Once I got medicated and learned some behavioral skills for myself, I realized how much safer my children are," says Dale.
Medication is standard treatment for all ADHD patients. Some psychological counseling is also advised to help adult ADHD patients learn more about the disorder and how to cope with it. Beyond these therapies, there are a host of other resources to help people with their disorder and problems related to it.
For women with adult ADHD, certain strategies may be more helpful than others. Quinn says women tend to work well with support groups and ADHD coaches. Matlen says hiring a babysitter, a housekeeper, or a tutor for kids could do wonders for a mother and wife with ADHD.
Russell Barkley, PhD, professor of psychiatry at the Medical University of South Carolina, says there are no special remedies for women with adult ADHD. He says the disorder has an equally great impact on men and women. Both sexes, he says, will have difficulties with memory, driving, school, the workplace, handling substances, regulating feelings, and managing lifestyle factors such as weight.
"Both of them are going to suffer in these domains," says Barkley, noting the differential impact will be in what people choose to emphasize in their lives. Since many women place a premium on their homes, children, and social relationships, those areas of their lives will likely suffer. For many men, the emphasis is on their jobs and moneymaking, areas that will likely suffer. Of course, the roles could be reversed. Many of today's women value their careers, and many men manage household responsibilities.
Initial treatment for all patients is going to be the same, says Barkley, referring to medication and psychological counseling. Where it may be different will be in the secondary treatments, depending on which domains have the most negative impact.
Quick GuideADHD/ADD in Adults: Symptoms & Treatments in Pictures
"Women are more likely to have anxiety and depression so you may see physicians adding antianxiety and antidepressant drugs more often for their female patients," says Barkley. "The guys, on the other hand, you may see much more advice about vocational assessment, time management counseling, and working with an organizational specialist."
Women who suspect they may have adult ADHD are encouraged to visit their doctor. Many mothers have found out they have the disorder after their kids were diagnosed with it. Parents of children with ADHD have a two to eight times increase in risk for ADHD, says Marc Atkins, PhD, professor of psychology at the University of Illinois in Chicago. He also cites research that shows almost 80% of ADHD is attributable to genetic factors.
In Dale's case, she found out she had adult ADHD before her two sons were diagnosed with it. "I don't live in fear anymore," she says. "I know that I have ADHD and I think of it more as an asset now. It's another skill; it's another way of addressing life that other people don't have."
Published Oct. 18, 2004.
SOURCES: Lori-Lynn Dale, adult ADHD patient. Patricia Quinn, MD, director, National Center for Gender Issues and ADHD, a nonprofit group. F. Xavier Castellanos, MD, director, Institute for Pediatric Neuroscience, New York University Child Study Center. Patricia A. Pape, PsyD, psychologist in private practice, Wellington, Fla. Terry Matlen, MSW, author, Survival Tips For Women With ADHD: Beyond Piles, Palms, and Post-its. L. Eugene Arnold, MD, child psychiatrist; and author, A Family Guide to ADHD. Russell Barkley, PhD, professor of psychiatry, Medical University of South Carolina. Marc Atkins, PhD, professor of psychology, University of Illinois in Chicago.
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