The Silent Struggle: Understanding ADHD's Impact on Girls and Women

Announcer:
You’re listening to NeuroFrontiers on ReachMD. On this episode, we’ll discuss how ADHD impacts women differently than men with Dr. Kathleen Nadeau, who’s the Founder and Clinical Director of the Chesapeake Center for ADHD Learning and Behavioral Health in Bethesda, Maryland. Let’s hear from her now.

Dr. Nadeau:
A lot more research is starting to come out of Europe and maybe starting to impact us, but it’s really interesting, and it in some ways explains why females are diagnosed later because our hormones begin to fluctuate when we hit puberty. And guess what? If you look at the diagnostic criteria for ADHD, it has to be present before age 12. Well, a lot of girls haven’t hit puberty before age 12, but puberty is a real common time for girls to be diagnosed. And the reason for that is that as our hormones fluctuate, those hormones interact with the neurotransmitters that impact ADHD, and so it’s very literally true that we’re less able to pay attention, we have brain fog, and we have greater anxiety and more moodiness because of those hormonal fluctuations. 

So we’re different hormonally starting at puberty. It hugely impacts how women experience pregnancy because we go through this huge drop in estrogen as we have our baby, and that means that our ADHD is at its most intense just at a time when we just had a baby and are sleep-deprived and all the other things that make it so difficult for us to cope as brand new mothers, so it’s different there. 

And the other interesting fact about hormones and women is that we were doing studies of self-referred women. Oddly enough, women were diagnosed first, and now we’re beginning to diagnose more girls, which is just the opposite of what happened in males. But when they were adult ADHD clinics and women could self-refer for diagnosis, the most common age at self-referral was 39. And guess what? Age 39 is, on average, the beginning of perimenopause. It is the time in our lives when our estrogen levels slowly start to decline, and perimenopause lasts a full decade and has a big impact on women’s ADHD, so that’s No. 1. 

Huge No. 2 in terms of what’s different about women—it’s the same way all of us women are impacted differently, ADHD or not—and that is as I like to put it, somebody didn’t do the math. And when I say somebody didn’t do the math, they didn’t suddenly supply us with somebody to do all the things we were doing before we went to work, and so we’ve been in a state of stress and distress ever since women entered the workforce full time. 

No. 3 is we women are wired differently and interact differently interpersonally. I mean, there’s much more of an issue for girls and teenagers and women in terms of feeling badly, feeling anxious, or feeling worried that we’re being judged by other women. You may have heard of the phrase ‘rejection sensitive dysphoria,’ meaning “I feel God awful when I think people don’t like me.” You don’t read about rejection sensitive dysphoria in males. It’s a female reaction to feeling like I don’t belong, I don’t fit in, and I’m being judged by other women because I can’t meet these impossible expectations.

And the last super important is emotional dysregulation that women, and girls for that matter, with ADHD feel so much stress and anxiety just trying to meet the expectations that our families, society, and our employers place on us that we, of course, respond with emotional dysregulation of just “I can’t take it anymore.” And again, that is not a set of traits complained about or written about in relationship to men; it is we women because we want to be more connected and we want to be accepted, and so this whole suite of issues impacts women much, much more than men. 

Announcer:
That was Dr. Kathleen Nadeau talking about the different ways ADHD affects women. To access this and other episodes in our series, visit NeuroFrontiers on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening.