ADHD in Women Often Misdiagnosed
Attention deficit hyperactivity disorder usually manifests differently, making diagnosis difficult for those unfamiliar with the symptoms
Brenda Thomas struggled with organization for years.
“I was always down on myself, questioning, ‘Why can’t I do these simple things?’ What comes so easily to others takes hours and hours for me,” says Thomas of the “hundreds” of craft projects she never finished, appointments she missed, and bills she couldn’t pay on time.
Tired of apologizing “because I was always forgetting things,” the mother of three decided to get evaluated after her son was diagnosed with attention deficit hyperactivity disorder, or ADHD, several years ago. Sure enough, she had it, too. “If someone had told me I had ADHD — even 10 years ago — that would have changed so much for me.”
Thomas is a member of Facebook support group Queens of Distraction, which is run by Birmingham psychotherapist Terry Matlen. Matlen also wasn’t diagnosed with ADHD (also commonly called ADD) until she was an adult. As a mother of two adult daughters, she became especially invested in women’s issues.
Taught to be the primary caregivers from an early age, women feel pressured to plan their family’s social life, cook regular meals, and maintain an organized household, even though a majority of them work, Matlen says. While such responsibilities can be daunting for anyone, “How do you pull all that off when you have ADD?” she asks.
Not easily, Matlen says. To make things worse, ADHD in women often gets misdiagnosed by professionals as either depression or anxiety, leaving the real cause dangling behind.
But what is ADHD and what’s behind the brain-based condition? The National Institute of Mental Health says ADHD is “marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development,” which makes skills such as planning, organizing, and time management — the nuts and bolts of daily life — hard to pull off.
“Most of us in the field agree that the main … cause is genetics, but there’s still much work to be done about this and other factors,” such as brain injuries, nutrition, and social environment, Matlen says. While the NIMH notes that 4.1 percent of the U.S. adult population has ADHD, Matlen says it’s difficult to break it down by gender. Most experts agree, however, that women are significantly underdiagnosed.
Why? Ann Arbor psychotherapist Sari Solden — who wrote Women With Attention Deficit Disorder: Embrace Your Differences and Transform Your Life — says it’s because most women aren’t diagnosed early like boys. While fidgety behavior in boys — who generally have the hyperactive type of ADHD — is easier to detect, the inattentive type of ADHD more frequently seen in girls is not.
Solden says women feel the consequences of missed diagnoses such as low self-esteem, relationship struggles, substance abuse, and underachievement. “They really start to question themselves, their character. That’s why therapy is often needed by the time they get diagnosed,” she says.
The good news: “ADHD is highly treatable if these women take the right route,” says Matlen, who suggests women find health professionals with a “very good understanding” of ADHD. She also recommends tapping into the talents of ADHD coaches and organizational experts, as Thomas, Matlen’s Facebook group member, did.
“I had always made everything so complicated,” Thomas says, but after getting help from an expert who specializes in helping the chronically disorganized, “I realized everything doesn’t have to be that way.”
Medications such as Adderall, Ritalin, and Concerta are also recommended.
“A huge myth is that people with ADD are drug-searching people,” Matlen says. “But what I see is that they are usually afraid to take meds” since they are concerned with side effects or unwanted behavioral changes. However, 70-80 percent of people who take them find them effective, she adds.
The trick is finding the right dosage. Someone who is heavier may actually require a lighter dosage than someone who weighs less, or an adult prescribed Ritalin may find they do better with Adderall. If someone also suffers from depression, “she may require another medication,” Matlen says. “So a lot of things have to be figured out.”
Solden often offers support groups and workshops for women with ADHD in Ann Arbor with her colleague, Dr. Michelle Frank.
“A lot of powerful change occurs in groups,” Solden says. “They see these other women with strengths and warm personalities [who also have ADHD] and it forces them to re-think their own self-image. They can view others more positively than they do themselves,” which can lead them to see their own strengths.