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
WebMD Feature

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).


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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.

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."


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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.


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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.

"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.


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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.

© 2005 WebMD Inc. All rights reserved.
Source: http://www.medicinenet.com

Thanks for sharing that, Lindsay. Good article.

Hi,

I am a 53 year old female with ADHD. I was diagnosed in my mid 20's and I remember at the time thinking the my psychiatrist made this up just to pacify me. But as I learned more about it, my confusion about my childhood finally began to make sense. It was a relief, a validation for me of sorts, that I was not bonafide psychotic as many people thought I was.

I don't think I ever fit the description of girls with ADHD, as cited in this message. I can remember being in the 2nd grade doing things that even embarrassed me some time after the great event, even at my young age. Every birthday of my life began with the family marveling that I was still alive.

Impulsivity is the strong crime for me. And man oh man, it is not good. My impulsivity shows in so many ways. I fear nothing. I am much calmer now that I'm older. But when I was young, I was quite the risk taker, unintentionally.
My parents sent me to a Catholic school when I hit the 6th grade, in hopes that the strict structure would straighten out whatever it was that was wrong with me.

In the 9th grade, I was called into the principal's office where my mother was waiting. I went from school directly to an institution and never had a clue what the problem was. My mother is the queen of denial, if we don't acknowledge it or talk about it, then it ain't so. To this day, it has never been spoken of. I have no idea what my older brother and older sister knew of the time I was gone.

When I was age to graduate, my high school gifted me with a diploma, despite my having not been there. Back then they could do that and get away with it.

My time in the hospital was a period of great learning for me. I don't harbor any ill will towards the idiots that were clueless about me, as I was the same. However, the shrink that spoke with me for a couple minutes each day insisted that I had been sexually abused by my father, even though that couldn't have been any further from the truth. He neglected to remember that I had been in Catholic School, my mother never told me that my grandmother who lived with us had Alzeihmer's and wasn't crazy like I thought. I was so naive, it was sad. I didn't know a thing about sex, and I didn't know enough to be able to have a rational talk with this dumb doctor. But I know that back then, no one knew about ADHD, and he was hard pressed to come up with a diagnosis. His conclusion saved me from being committed for my entire life, so that was good. It didn't do a thing for my relationship with my father, even though I protested continually that the doctor was wrong. But of course, when you are where I was, you have zero credibility. We were all zombies, so anything we had to say, no matter what it was, wasn't even noticed or heard. But back on track here, (another symptom, I can't stay focused enough to stay on topic) I did learn a lot about people in general and I do believe that it was that experience that made me the empathetic person that I am today.

My mouth engages before my brain ever does. There have been too many times where I have said something and then looked around the room with as much horror on my face as everyone else's.

Unfortunately, my 2nd daughter inherited this from me. She struggles as much as I did. The only thing helpful for her during her school years was that I genuinelly did understand her and could explain even to her, why she did what she did. What was going on inside of her. I was her best advocate throughout all of her school years. She was diagnosed when she was in the 2nd grade, along with OCD. At this point in her life, I just thought she was a cool kid. She was full of life, highly active, entertaining as could be, I loved her! But it was her teacher that quite bluntly enlightened me to the not so good side of her that was causing her to be excluded from more activites than she was included in. To this day, it rips my heart out to see her struggle. Inside of me I know it will never get better for her, in fact it most likely will worsen. Of course I won't say this to her. But it wrecks her life as much as it did mine.

30 years ago my doctor told me that the day would come when I would either end up in jail or on disability due to my inability to take care of myself. Of course I can't hold a job. Neither could anyone else who may have had to work in the same room with me. I've reached the end of the line with any savings I had. So that MD's premonition is about to come true. That fact in itself rips me apart as that is a place I never wanted to go to. But at least it isn't jail.

School? Hah! I have not read a book from cover to cover in my entire life. I have a jillion magazine subscriptions that I flip through. If an article is longer than a paragraph, I can't read it. Even this message I am writing, I fully expect you, (yes, YOU) to read it in it's entirety, but for me to do so, not a chance. So please forgive any typo's you see, but I simply can't re-read this for any editing.

I could go on for days and days about my dysfunctional life and the people that enter my life and leave it within 6 weeks, guaranteed. I've had 2 marriages that didn't work out because the guy couldn't tolerate me. Both were infatuated with me before marriage, for the same reasons that I felt about my daughter when she was young. But to live with me drove them nuts.

About 12 years ago, I ran a support group for Adults with ADD/ADHD. It was good for us, but in fact it was a comedy sketch to me! Try having a room full pf people who can't NOT TALK and everyone's words just have to be said at the moment it crosses their mind. I would have guest speakers that I went to great pains to explain to them their audience, so they would be prepared. No matter what I said, they will still walk out feeling as if we were intentionally humiliating them. Not so.

Okay, I got enough out for now. But if anyone would like to hear more and dump on me with your story, I'm all ears. One last thing, my support group ended when I attempted suicide, and very nearly successfully. That was because my husband walked out on the marriage with no discussion, no forewarning, I had no idea. I foolishly thought we were happily married. Another trait, gullible as hell.

But, I remain,
Always Trying!

Thanks!