When undiagnosed and untreated, ADHD can impact every area of someone’s life. However, girls and women do not fit the stereotype of an overactive boy, so they often fall through the cracks when it comes to diagnosis and early intervention. Getting an accurate diagnosis can often be life changing. They may discover that difficulties that they put up with, can in fact be managed with an effective treatment plan.
1. How does ADHD present in girls and women?
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, or neurotype (brain type), that is primarily characterised by an under stimulation of the brain. This under stimulation can lead to the person struggling to regulate their attention and concentration, such as their attention flicking off and on and becoming easily distracted or becoming highly attentive in what is called ‘hyperfocussing’, whereby the person may be able to pay attention to a topic of interest for a lengthy period of time. This under stimulation can also lead the person to seek stimulation in other ways, such as by moving and fidgeting, or talking a lot, as well as struggling with other aspects of executive functioning such as planning and organisation, or controlling their behavioural impulses, as well as regulating and being aware of their emotions.
Whilst an ADHDer’s brain fundamentally operates in the same way between boys and girls, the way that some ADHDer girls and women may present outwardly to the world can differ to boys. This can be both due to biological sex differences, but also due to different societal expectations. Many societal expectations placed upon girls and women can lead to ADHDer girls and women trying hard to “fit in” and so internalising their difficulties and placing the blame on themselves. For example, many neurodiverse girls and women may believe that because they are not meeting the expectation to be organised, that it is their fault for “not trying hard enough”, rather than something their brain finds difficult.
ADHDer girls and women may learn different ways to move and fidget that are less disruptive or noticeable to others, such as by moving their hands and fingers, nail picking or biting, or hair twirling. They can be more likely to be more talkative, which can enable them to make friends, however they may struggle to keep friends as they may struggle to remember to text back, keep plans or may interrupt their friends when conversing with them.
ADHDer girls may be labelled by others as being “in their own world”, “spacey”, or “dream-like”. They are likely to still hand in assignments, complete the work, and keep their commitments, however they may procrastinate on tasks, run late and always seem in a rush.
ADHDer women might be labelled by others as being a “whirlwind”, “too much”, or “chaotic”. ADHDer women tend to be more likely to engage in impulsive behaviour, which may present as risk taking, increasing alcohol and drug intake, or accidentally injuring themselves.
2. What are some of the reasons that girls are not referred for assessment?
Though this is improving, girls may not be referred for assessment for a number of reasons, including;
- Lack of awareness that ADHD is not just a “boy” presentation.
- Teachers may not have raised concerns of being disruptive in class towards other children.
- Individuals may be considered as anxious, and be treated for anxiety disorders prior to parents, teachers and health professionals considering ADHD.
- Girls and women who may be achieving to a high level at school, university or in their work can often be overlooked, as there is a stereotype that ADHD always negatively impacts upon your performance. Whilst this can be the case, it is best to also look at the manner in which girls and women are meeting performance expectations, as this can be where others may notice significant procrastination, disorganisation and anxiety.
- Diagnostic criteria do not generally get updated as quickly as research and knowledge within health systems can be, and so the current diagnostic criteria is more geared towards detecting a typically “male” or “externalising” presentation, which can lead to girls and women having their diagnosis missed.
3. How does treatment for girls/women differ from boys/men?
Treatment does not differ between ADHDer girls and boys, or ADHDer women and men. As mentioned, ADHD is the same neurotype irrespective of gender, and so both girls and boys should be offered the same gold standard treatment.
In Australia, according to the Australian Evidence-Based Clinical Practice Guideline for Attention Deficit Hyperactivity Disorder (ADHD), individuals and their families diagnosed with ADHD should be offered both pharmacological intervention and therapeutic supports aimed at reducing their symptoms and providing neurotype specific strategies for coping with their difference in executive function. However, either one of the approaches alone is also helpful for ADHDers.
4. What can be improved?
General awareness of ADHD in the community would help significantly to reduce the stigma associated with this neurotype and also increase the general public’s awareness of the diversity of ADHDer individuals.
Greater training should be provided to schools and educators, especially teachers, teaching assistants, learning support officers and school counsellors as these individuals are critical to both the initial recognition of symptoms, but also diagnosis and ongoing treatment and support. Teachers need to feel confident in making reasonable adjustments in their classroom settings, assessments, and examinations to ensure that their ADHDer students are able to achieve to the best of their abilities. This should also help teachers feel confident in creating Individualised Education Plans to ensure equitable access to learning.
Greater training in neurodiversity should also be provided to GPs, Psychiatrists and Psychologists, especially within training programs to ensure that neurodiversity is adequately covered and understood, especially diagnosis and treatment. Drug and Alcohol services should also adequately train their staff to recognise ADHD in their adult clients, due to the high rate of co-morbid difficulties with substance use and ADHD.
Book an online ADHD Assessment
Spencer Health provides online assessment services for autism, ADHD, learning and giftedness. We are well known for our diagnostic services in both adults and children, and we use all the gold standard tools associated with those. Our online assessments are extremely thorough.
The process of assessment involves:
- An initial meeting with your clinician where we will discuss your needs and then decide on whether you want to progress to a formal assessment.
- A formal assessment process that may involve completing online assessments, questionnaires, interviews or whatever is most appropriate for you or your child’s presenting question.
- We will then prepare a very thorough report and confirm a diagnosis if it's present or provide an explanation for what is happening for you or your child.
- A feedback session where we will discuss the process, the outcomes and recommendations for what the next steps are for you or your child.
The assessments range in time and cost depending on whether this is for an adult or a child and what is the presenting issue. Adult ADHD assessments range in cost from around $1600 to about $2000 if you have decided you want a cognitive assessment as part of that. For children the cost is around $2000.
For questions or to book an appointment visit https://spencerhealth.com.au/online-assessment-campaign/
References:
- ADHD Guideline Development Group. Australian evidence-based clinical practice guideline for Attention Deficit Hyperactivity. Melbourne: Australian ADHD Professionals Association; 2022.
- Diagnostic Interview Voor ADHD, J.J.S. Kooij, MD, PhD & M.H. Francken, MSc 2010, DIVA Foundation, The Netherlands
- Young et al., BMC Psychiatry, 20, 404, 2020
- Nussbaum, J Attention Dis, 16, 2, 2012
- Hinshaw et al., J Consult Clin Psychol, 80, 6, 2012