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Attention deficit disorder in women: from symptoms to difficulty of diagnosis

Since the beginning of the Covid-19 pandemic, many women have experienced first-hand the intensification of certain ailments such as always being distracted, having difficulty concentrating or forgetting things. Probably the first reaction of many was to blame the infamous brain fog that has been talked about so much during these two years. However, the real underlying cause of these ailments may be something else entirely (and have nothing to do with the pandemic).

The British tabloid The Independent has reported a notable increase in curiosity about the attention deficit hyperactivity disorder (ADHD): Hundreds of thousands of women have taken an NHS-approved online test to find out if they have ADHD. More than 254,400 women tested themselves in 2021, up from 7,700 in 2019. Furthermore, the data shows that women made up the 60% of those applying for ADHD testinga substantially higher number than in past years – and compared to the male counterpart.

This happens because women are rarely diagnosed with ADHD. Attention deficit disorder is a condition traditionally thought to primarily affect men. We all know the stereotype of the hyperactive child who interrupts lessons with his fidgeting. The truth is, boys are more likely to be diagnosed with ADHD than girls (12.9% vs. 5.6%). However, this disparity does not mean that the male gender is more susceptible to ADHD, but is due to the fact that girls are often misdiagnosed. In fact, later in life, the number of ADHD cases is roughly similar for men and women.

What is ADHD?

ADHD (Attention Deficit Hyperactivity Disorder – in Italian Attention Deficit Hyperactivity Disorder) is defined as a neurodevelopmental disorder characterized by specific symptoms such as iinability to maintain attention for an extended period of time, impulsivity and hyperactivity.

It is usually first diagnosed in childhood, especially in the early school years when impulsive or overly active behaviors are reported. However ADHD also extends into adulthood. According to one research dating back to 2009, an estimated 8.4% of children and 2.5% of adults have ADHD.

What are the symptoms of ADHD?

Many symptoms of ADHD, such as high activity levels, difficulty sitting still for long periods of time, and short attention spans, are common to many children in general. The difference for ADHD sufferers is that hyperactivity and inattention are significantly greater than expected and cause distress and/or problems functioning at home, school, or with friends.

According to various researches then, 72% of children with ADHD are affected by other psychiatric pathologiessuch as autism spectrum disorders, dyslexia and oppositional defiant disorder (self-control problems, anger and irritation).

Clinicians believe that many of these symptoms can continue throughout the life cycle, from infancy to adulthood. However, the symptoms of ADHD in adults also have other characteristics, including disorganization (chaos and randomness in thought and action planning), poor social skills and mentalization, immediate frustration faced with problematic circumstances e emotional lability.

Woman rubbing her eyes in front of laptop. Working in home office during Covid-19 lockdown.Kathrin Ziegler

Symptoms of ADHD in women

ADHD affects women differently than men. Symptoms tend to be less obvious or less socially disruptive than the classic stereotype of the child disrupting class. The searches show that males tend to have hyperactive/impulsive ADHD (which makes them restless, impulsive and impatient) while females tend to show a ADHD with predominant inattention.

Therefore, among the most common symptoms in girls are being easily distracted, having a poor memory, being disorganized and daydreaming. But also slowness and difficulty completing tasks (procrastination), difficulty coping with stress and mood swings. But it often happens that girls’ ADHD is seen and interpreted as a typical trait of their personality and therefore overlooked and unrecognized/diagnosed. However, misdiagnosis can affect women’s physical and mental health, as well as many other aspects of their lives, both in childhood and in adulthood.

How is the diagnosis made?

Unfortunately, there is no official medical test that tells you with certainty whether you have ADHD. The diagnosis must be made by psychologists or neuropsychiatrists using the criteria indicated by the DSM-IV (the most important and widespread international diagnostic manual of psychiatry on mental disorders). To diagnose ADHD, doctors do detailed interviews regarding the patient’s medical history and behavior, neurological tests to evaluate the patient’s mental and motor status, and an assessment of cognitive abilities.

Why is it difficult for women to get diagnosed with ADHD?

The lack of ADHD diagnosis in women occurs because most of the studies on the subject are conducted on male subjects. Historically, in medicine, it was assumed that there was no fundamental difference between men and women (aside from their reproductive systems), and therefore medical education has for years focused on a “male norm.” The consequences of this approach can be seen in almost every aspect of medicine, especially when it comes to diseases that present differently in women and are often misdiagnosed.

This is exactly the case with ADHD: symptoms are different between men and women, both for gender differences in neurodevelopment (such as faster maturation of the female brain), and for differences in neuroanatomical characteristics (such as differences in the size of brain structures). Even differences at the hormonal level and in the social expectations related to the role can have an impact on the symptomatological manifestation of the disorder in the female population.

Unfortunately, however, the “official” symptoms required to obtain a diagnosis of ADHD are based on the description of white male children. This is why it happens that ADHD symptoms in girls are often viewed as character traits rather than a medical condition. For example, a girl might be described as offhanded, forgetful, or talkative. Later in adulthood, problems may increase with increased responsibilities, but more often than not, a woman who seeks help for these symptoms ends up being misdiagnosed with chronic stress, anxiety, or depression.

The difference in rates of diagnosis and subsequent access to treatment can have a major impact on the health of women with ADHD: it affects how they live their lives, develop their self-esteem and build relationships, increasing the likelihood of suffering and occurrence of severe psychiatric symptoms.

Source: Vanity Fair

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