It’s fair to say that many people face some sort of distractions throughout the day, and even at night when it gets quiet, and they are alone with only their thoughts. Perhaps that is when a person has time to reflect on what they accomplished or didn’t accomplish.
Was there something holding them back? Can that feeling possibly be traced back to childhood?
With advancements in recognizing, diagnosing and treating many conditions and disorders, it’s possible to find out the problem all along has been Attention Deficit/Hyperactivity Disorder.
The Centers for Disease Control and Prevention describes ADHD as one of the most common neurodevelopmental disorders of childhood. The CDC further describes that while usually initially recognized and diagnosed in childhood, ADHD can often continue into adulthood. And while we may be familiar with the signs of ADHD in youth, including trouble paying attention, fidgeting and controlling impulsive behaviors, there’s actually another layer to consider while recognizing these signs, and sometimes it comes down to our perception of genders.
“The difference in diagnosis lies entirely in gendered expectations around behavior,” said Casey Becker, LMHC, therapist and life coach with Azure Skies Counseling and Coaching.
Becker said that while diagnosing ADHD primarily happens during childhood, some individuals do not get tested and carry around these life-altering signs and symptoms into adulthood. But sometimes even diagnosing during childhood has some drawbacks when it comes to social roles between girls and boys.
“There is individual variation in symptom intensity but again, the differences that people experience and that shows up in research is better explained by social expectations,” said Becker. “For example, women typically do more unpaid domestic labor than men but do the same amount of paid labor. The difficulty organizing is harder for women but only because women typically have more to organize.”
Becker further explains that sometimes in youth, it’s more acceptable for boys to be “wild” but when girls show signs of ADHD, they are sometimes negatively labeled as “ditzy” instead of looking at diagnosing this disorder objectively.
So when should ADHD testing be done? According to Becker, it should be done as early as possible, but the focus shouldn’t be just about diagnosing ADHD, but other similar disorders that may or may not be a root cause.
“Ideally, testing would be standard at a pediatrician’s office. With my clients, I will recommend testing once we have treated or ruled out anxiety. In general, though, I would recommend testing for anyone that is concerned about their memory, attention and/or executive functioning,” said Becker.
Sometimes this anxiety is derived from these social expectations of children. As mentioned, it can be easy to label little boys as simply rambunctious or even apply the adage “boys will be boys.” But differing expectations of young girls and them being expected to act a certain way even as very young individuals in the same exact setting as boys might mean a diagnosis is missed.
“Women get diagnosed later because the typical ADHD behavior is not tolerated in girls,” said Becker. “Girls get in more trouble earlier, which leads to an anxiety disorder and then the anxiety behaviors are masking the ADHD. It is one of the many insidious types of social predetermination.”
While this “battle of the sexes” seems to start very early in life with diagnosing ADHD, regardless of gender, there are ways to treat this and other disorders. The good news for some is that medicine isn’t the only resort for treatment. The key is openness when approaching testing and treatment and, of course, doing what’s best for you or your own child, as there are undoubtedly a number of options.
“Medications are the front line because it’s easy and effective,” said Becker. “Medication isn’t the only option, but you have to actively search for someone who has the training in organizational and coping skills. Psychotherapy is typically used to help manage low self-esteem or co-occuring disorders, but there are effective behavioral treatments.”
ADHD Diagnosis and Treatment
Is it harder to diagnose this disorder in women?
While it's not always prudent to compare men and women, there certainly are some gender aspects to consider when diagnosing ADHD. Katie Perry, Psychiatric Mental Health Nurse Practitioner with Anchor Clinic, addresses questions of how to approach recognizing this disorder that often involves societal roles and expectations. It also may come as a relief to some that medication is not always the only way to treat ADHD, as there are additional therapies.
BELLA: Are there any fundamental differences in diagnosing ADHD in men vs. women?
PERRY: Historically we have been taught that ADHD was more prevalent in men versus women. However, research done in recent years actually suggests that ADHD is grossly underdiagnosed in women. It is speculated that this is due to boys/men being more likely to display the hyperactive symptoms of ADHD. Most of these symptoms (inability to sit still, difficulty waiting your turn, fidgeting, bouncing, tapping, wringing hands, impulsivity, etc.) are disruptive to the person’s environment, often to the point that others around them are noticing or perhaps annoyed. Studies suggest that women are more likely to display inattentive symptoms, such as forgetfulness, daydreaming and feeling easily distractible even in the middle of a conversation. The nature of these symptoms is generally less disruptive and in return more difficult to spot, especially in young children. Personally, I do not believe there are fundamental differences between ADHD symptoms in men and women. It is my opinion that society has presorted these symptoms through a lens of traditional gender roles; I have treated plenty of predominantly hyperactive women throughout my career.
BELLA: How does ADD/ADHD
affect women specifically?
PERRY: As women we are generally culturally responsible for more daily tasks than men: child rearing, scheduling, cooking, cleaning and simultaneous full-time jobs. ADHD often encompasses impairment in executive functioning. Executive functioning is your ability to manage your thoughts and emotions, as well as prioritize, organize, initiate and complete tasks. With a to-do list that never ends, you can see how ADHD could make the day-to-day much harder than it should be, especially if it is untreated. In this way, undiagnosed ADHD often leaves people feeling lazy, incompetent and irresponsible when this is not the case at all. In reality, our brains are just different from our neurotypical friends.
BELLA: When should someone consider getting tested/treated?
PERRY: There’s no wrong answer here. Testing would be appropriate at any age. Even getting tested and diagnosed at an older age can be incredibly validating, and that can go a long way. The earlier an accurate diagnosis can be made, the sooner you can work with a professional to develop a treatment plan that works for you. However, treatment with stimulant medications such as Adderall, Vyvanse or Ritalin is not recommended for everyone. Factors such as age, weight and cardiac health should be taken into consideration. These medications should be used as a tool, not a crutch.
BELLA: Are medications the only way treatment?
PERRY: Nope! Cognitive behavioral therapy, or CBT, aimed at ADHD symptom management can do wonders. This process is essentially working with a trained therapist to troubleshoot your brain and find out which ADHD management tips and tricks work best for you. Additionally, you can find many options for self-guided ADHD management workbooks online. There is even a video game that you can play on your mobile phone that can improve sustained and selective attention. Meditation, maintaining a structured routine and regular exercise can also be beneficial for overall ADHD management.
