Our clinical psychologist, Dr Aspasia Karageorge, writes about the specific challenges of ADHD in women, and how these challenges can be addressed.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects both men and women, but there are important differences between how ADHD presents and is managed in each gender. In this blog post, we will explore the ways in which ADHD can differ in women compared to men across the lifespan, as well as strategies for managing symptoms and addressing female-specific aspects of the disorder.

First, let’s look at how ADHD differs in men and women across the lifespan.

ADHD is often diagnosed in childhood, and boys are more likely to be diagnosed with ADHD at a younger age than girls. However, this does not mean that girls do not experience ADHD or that their symptoms are less severe. In fact, research suggests that girls with ADHD may be more likely to have internalising symptoms, such as anxiety and depression, while boys with ADHD are more likely to have externalizing symptoms, such as aggression and impulsivity. This difference in symptom presentation may contribute to the gender gap in ADHD diagnosis, as girls with ADHD may be less likely to be identified and treated.

As women with ADHD move into adulthood, they may continue to experience difficulties with executive functioning, such as organisation, time management, and impulse control. These difficulties can impact daily life and work performance, and may lead to social and emotional challenges. In addition, research suggests that women with ADHD may be at increased risk for certain co-occurring conditions, such as anxiety, depression, and eating disorders.

Now, let’s look at the ways in which ADHD can differ in men and women in terms of medication.

Research suggests that women may be more sensitive to the side effects of stimulant medications, such as sleep disruption and appetite suppression. Women may also experience more side effects from non-stimulant medications, such as dry mouth and dizziness. It is important for women with ADHD to work closely with their healthcare provider to find the right medication and dosage, as well as to monitor for side effects and adjust treatment as needed.

The difference in symptom presentation for men and women may also impact the type of treatment that is most effective for each gender. For example, stimulant medications may be more effective for boys with externalising symptoms, while non-stimulant medications or therapies may be more effective for girls with internalising symptoms. The research is not clear about this yet, however, so speak to your doctor to find what is right for you.

There are also important social differences to consider between men and women with ADHD.

Women with ADHD may face additional challenges in their social and work lives due to societal expectations and stereotypes. For example, women may be expected to be more organised and detail-oriented than men, which can be difficult for those with ADHD. In addition, women with ADHD may face discrimination or stigma related to their disorder and the way that it challenges particular stereotypes about how females behave, for example how quiet vs. disruptive a female student may be in the classroom. Over time, these accumulated judgments and reactions from others about their behaviour can lead to long-term influences on their self-concept, confidence, and belief in their ability to be valued by others.

Finally, hormonal differences may play a role in how ADHD symptoms and medication effects differ for women, as compared to men.

Hormonal changes throughout the lifespan can impact the severity and presentation of ADHD symptoms in women, as well as the effectiveness of their usual medication regime.

First, the menstrual cycle is an important consideration. Recent research suggests that ADHD symptoms may vary throughout the menstrual cycle, with some women experiencing an increase in symptoms just before or during their period. Similarly, the effectiveness of ADHD medication may also vary throughout the menstrual cycle, with some women experiencing a change in the effectiveness of their medication just before or during their period. These monthly fluctuations to symptom severity and medication effectiveness may be due to fluctuations in oestrogen and progesterone levels, which can affect the metabolism of medication as well as general brain function and mood.

Second, hormonal changes that occur during pregnancy can impact the severity and presentation of ADHD symptoms. Some women may notice an improvement in their symptoms during pregnancy, while others may experience an increase in symptoms. Use of medication during pregnancy and breast-feeding is also a consideration and a matter worth discussing with your medical practitioner so you are informed about your decision-making during this time.

Third, menopause can impact ADHD symptoms and the effectiveness of medications. Menopause is the natural transition that occurs when a woman’s menstrual cycles stop and she is no longer able to become pregnant. This transition is marked by a decrease in oestrogen and progesterone levels, which can affect brain function and mood. These hormonal changes can also affect the metabolism and effectiveness of medication, meaning you may need to discuss your medication dosage with your medical doctor during this time as well.

So, what can women with ADHD do to manage their symptoms and address female-specific aspects of the ADHD experience? Here are a few strategies to consider:

  • Work with a healthcare team to find the right treatment plan: This may include medication, therapy, or a combination of both. It is important to find a treatment plan that works for you and to be open and honest with your healthcare provider about any concerns or side effects. Medication is managed by a GP and/or a psychiatrist, whereas therapy and skills training work is generally managed by a psychologist. Look for psychologists who are experienced in managing ADHD, or ask your GP or psychiatrist if they can recommend one. If you are in Sydney or willing to see a psychologist online from anywhere else in Australia, our psychologists at Sydney City Psychology may be a good place to start given that we have worked with ADHD for many years and have established an ADHD group program as well.
  • Build a support network: Having a supportive network of friends and family can be helpful for managing the challenges of ADHD. Consider joining a support group online of other women with ADHD, or seeking out a workplace mentor who can offer guidance and encouragement.
  • Take note of menstrual-related changes: If you have ADHD and experience changes in your symptoms throughout your menstrual cycle, start to keep a diary of these changes and see if they fall into a regular pattern that relates to your cycle. This will serve as valuable information that you can then discuss with your healthcare team when considering medication and/or skills and therapy work.

If you want further support around this issue, our team at Sydney City Psychology may be a good place to start. Our psychologists and our GP can discuss the options with you. In addition, we will be running an online group called Women and ADHD this year designed for women with ADHD (or who think they may have ADHD) who want to learn more about ADHD-related challenges related to hormonal fluctuations, stage of life, parenting stressors, relationships and dating, inattentive subtype presentation, and experiences of ADHD symptoms as girls and women. Contact us today to find out more about this group if interested.