In recent years, interest in attention deficit hyperactivity disorder, or ADHD, has grown. This increase may be due to social media, the pandemic, or other factors. With an elevated focus on ADHD in women, we sat down with Dr. April Sweeney, M.D., a psychiatrist at the OHSU Center for Women’s Health, to learn more.

Girls and boys may show different symptoms of ADHD in childhood

There are different types of ADHD. One is the hyperactive-impulsive type, with symptoms such as difficulty sitting still or finishing tasks. Another type of ADHD is inattentive. Symptoms can include forgetfulness, daydreaming, or struggling with organization. Traditionally diagnosed in childhood, symptoms presented in girls may be overlooked.

 “What we know is the overall prevalence of ADHD is 7-8% in children, 2-2.5% in adults,” says Dr. Sweeney. “In referrals for children, there is a discrepancy between boys and girls that is anywhere from 3:1 to 16: 1.”

There are a few theories as to why this gap exists. One possibility is that girls may not show symptoms of ADHD until later in life. A second theory suggests that hormones play a role in ADHD, changing the timeline for symptom onset. A third option proposes that the way symptoms commonly appear in boys is simply more noticeable to others.

“If boys manifest more the hyperactive and impulsive symptoms, that may attract more attention in the school setting or the home,” says Dr. Sweeney, “Girls may be presenting more of the inattentive symptoms, which gather less attention from teachers and parents.”

In the end, less girls are diagnosed with ADHD, leaving some women to struggle with symptoms for years or even decades.

Evaluation and diagnosis of ADHD in adulthood

ADHD in adulthood can symptoms such as difficulties with safety or employment, legal struggles, substance abuse, and challenges in work or family relationships. Compared to men with ADHD, women with ADHD may more often demonstrate risky sexual behavior or experience more internalized symptoms, such as difficulties with emotional regulation or anxiety. Only a full evaluation by a qualified professional can rule out other factors for an accurate diagnosis.

“It’s complicated; there can be a lot of overlap with other conditions,” says Dr. Sweeney, “What’s really important is to get a thorough evaluation that also looks at childhood.” Addressing childhood behaviors – such as finding report cards or other sources – can be a hurdle for some adults.

Dr. Sweeney adds that for those who have mild symptoms, there is no harm in learning more about ADHD from reliable sources. For books, she recommends “ADHD 2.0” and “Driven to Distraction” by Dr. Edward M. Hallowell, M.D. She also recommends the podcast “Distraction,” available on most podcasting platforms.

Treatment for ADHD

“I think the good news is that we don’t see a big difference between men and women in terms of treatment response,” says Dr. Sweeney. Options such as symptom management, counseling, and medication appear equally effective in both sexes. On the horizon is research around alternative treatments, such as the role of broad-spectrum micronutrients, which may target the emotion deregulation that can be more common in females.

Your mental health is important. If you have questions about ADHD, speak to your primary care provider about your options for evaluation and treatment.