ADHD is a disorder that is spoken of a lot more frequently now than it was even just a decade or two ago. It is a condition that seemingly is becoming more frequent – whether this is because it just simply went undiagnosed before or because it is actually becoming more prevalent. ADHD, or Attention-Deficit/Hyperactivity Disorder, is a neurodevelopmental disorder that affects people of all ages, though it is most often diagnosed in childhood. It is characterized by a persistent pattern of difficulty paying attention, impulsive behavior, and hyperactivity that can impact a person’s daily functioning and quality of life. What’s more, is that it tends to present itself differently in girls and women versus boys and men. This is everything that we know currently about ADHD and how to manage it.
Understanding ADHD
As already mentioned, ADHD is a neurological condition that affects a person’s ability to concentrate, make well-thought-out decisions, and stay still for long periods of time. ADHD is typically diagnosed in childhood, but symptoms can persist into adulthood. Due to the differences in expression, many girls go undiagnosed until adulthood. There are three subtypes of ADHD:
- Predominantly Inattentive Presentation
- Predominantly Hyperactive-Impulsive Presentation
- Combined Presentation
These subtypes all have to do with how the condition presents itself. Some people with ADHD have the most trouble with paying attention, even in simple one-on-one conversations. Others have more difficulty sitting still and tend to be rather impulsive with their decision making, rather than taking the time to think through the various possibilities and their outcomes. Finally, the third subgroup is those who struggle with both of these problems.
Symptoms
There are many symptoms of ADHD, however, there are few more common ones that can tip you off to this being the problem. This can be either for your child, student, or for yourself. Common symptoms of ADHD include:
- Difficulty paying attention or staying focused
- Impulsivity in decision-making and actions
- Hyperactivity or restlessness
- Forgetfulness and disorganization
- Difficulty following instructions or completing tasks
While we tend to think of these issues in more formalized settings, for example, in the classroom at school or in a long work meeting, they can affect more casual and social settings, as well. Difficulty paying attention can be simple while having a conversation with someone. That person may then, in turn, think of the person with ADHD as rude or that they don’t care about what that person is telling them. The reality is that simply their brain got caught on a tangent – something that happened in the background, or they got hooked on one word that the person said that made them think of something else, and the list goes on. As you can see, this can greatly affect interpersonal relationships, in addition to the ability to get good grades in school or do well in the workplace.
Onset and Development
ADHD symptoms usually emerge in early childhood, with many cases diagnosed by the age of 7. That being said, ADHD is often diagnosed later in girls (more on that later). While the exact cause of ADHD remains unknown, research suggests that a combination of genetic, environmental, and neurological factors contributes to its development. That is to say that while some of the factors are not within the control of the person, some factors are, primarily in the control of the people in charge of that person’s environment while they are growing up.
Differences in ADHD Presentation: Girls/Women vs Boys/Men
It has been mentioned a few times now in this article that ADHD tends to present itself differently in girls and women than in boys and men. For a long time, it was thought that ADHD was more common in boys, simply because we were diagnosing based on certain criteria that only the boys fit into. Now we know more about these gender differences and the presentation of ADHD in girls, and so we can more accurately diagnose these girls to get them help at a younger age, helping them to achieve success in school, work, and life.
Variances in Symptom Expression
Let’s first explain the differences in the expression of ADHD in girls vs boys, and then we will explain some of the reasons why this is so. ADHD often presents differently in girls and women compared to boys and men. While boys typically exhibit more overt hyperactivity and impulsivity, girls may display more internalized symptoms, such as inattention and disorganization. These symptoms have in the past been waved off as a girl simply being ‘flighty’ or ‘air-headed’, when actually she is suffering from a neurological condition.This atypical presentation in girls can lead to under-recognition and misdiagnosis of ADHD.
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Social and Behavioral Challenges
Boys with ADHD are more likely to demonstrate disruptive behaviors. They will be loud and disruptive in class, perhaps a ‘class clown’ or perhaps simply breaking the rules and misbehaving frequently. Girls, however, are more likely to experience more internalized symptoms such as anxiety and low self-esteem. This can lead to the misconception that ADHD is primarily a male-oriented condition, which has historically influenced diagnostic trends and treatment approaches.
Factors Influencing Gender Disparities in ADHD Diagnosis and Treatment
Essentially, the differences largely lie in the way that society tends to treat and raise girls vs boys. Girls and women with ADHD often develop coping mechanisms, such as increased effort to maintain focus or conform to societal expectations, which can mask their symptoms. There is a lot of pressure traditionally on girls and women ‘be more mature’, organized, more calm, and generally just ‘smile and be polite’ than boys. This adaptive behavior may inadvertently delay or impede the recognition of ADHD, as their struggles are not as readily apparent as in boys and men.
Diagnostic Bias
Unsurprisingly, the studies done on ADHD have traditionally lacked representation of girls and women. Historically, ADHD has been more frequently diagnosed in boys, leading to an underrepresentation of girls and women in clinical and research settings. Clinician bias and reliance on male-centric diagnostic criteria have thus further contributed to the underdiagnosis of ADHD in females.
Gender Stereotypes
Gender stereotypes and societal norms are harmful for both sexes, and in this case, have led to a significant underdiagnosis of girls and women with ADHD. Societal stereotypes and gender norms often influence the way ADHD symptoms are interpreted and perceived. Prevailing beliefs about gender-specific behavior can lead to the dismissal of ADHD symptoms in girls and women, hindering their access to appropriate diagnosis and intervention.
Hormonal Factors and Treatment Challenges
This misdiagnosis or late recognition of ADHD in girls and women often results in delayed access to tailored interventions and support. Many girls go through the entirety of their schooling, university, working life, and perhaps parenthood, never receiving their diagnosis and therefore never getting the support they need. Gender-specific factors, such as hormonal changes, emotional regulation, and social expectations, require unique considerations in the treatment of ADHD in females. This is something that has only recently begun to be considered. More advocacy, research, and awareness needs to be done in order to improve outcomes for girls and women with ADHD.
Causes of ADHD
The number one question that everyone has is, what actually causes people to develop ADHD in the first place? Why is it that some people develop it and not others? Is it our environment, diet, activities we are and aren’t allowed to do in our developmental years, or does it come down to something much less in our control, such as genetics? The truth is that we still don’t fully understand why some people have ADHD and others no – but we do have some clues.
Read More: Woman Diagnosed with ADHD Later in Life Reveals Three Key Traits Often Overlooked
Genetics
Family history cannot be ignored. Researchers have found that there is a strong genetic component to ADHD. Their studies indicate that those with a family history of ADHD are, undoubtedly, more likely to develop it themselves. The genetic component isn’t yet fully understood, but researchers have identified some specific genes related to neurotransmitter function and brain development that are implicated in ADHD development.
Brain Structure and Function
If you’re going to study a neurological condition, you have to study the brain. This is one of the most challenging aspects of studying ADHD. So far, researchers have found that those with the condition often have differences in brain structure and function compared to those without it. The areas normally affected, as in those that show abnormalities, are those associated with attention, impulse control, and executive function.
Environmental Factors
Nature vs nurture is often brought into question when it comes to the development of ADHD. In this case, researchers have found it to be a bit of both. Environmental factors definitely play a role. These include prenatal exposure to toxins, premature birth, and early childhood trauma increase an individual’s risk of developing ADHD. The prenatal toxin exposure include maternal smoking (or heavy exposure to second-hand smoke), exposure to lead, and other environmental toxins as some of the known risks.
Diagnosing ADHD
Diagnosing ADHD involves a comprehensive evaluation by a healthcare professional, not just a simple online Do you have ADHD quiz. This evaluation will include a review of the individual’s medical history, symptom assessment, and input from parents, teachers, and other caregivers in the case of a child. In the case of an adult, they may ask you about your childhood, your experiences at school, at work, and others. Standardized rating scales and behavioral assessments are often used in the diagnostic process. Again, it is important to advocate for your child or yourself, particularly if you have a girl or if you are a woman. Many of the standardized scales and assessments were developed based on how boys and men express the condition. If you don’t feel like you or your daughter is being properly assessed, go find another opinion. Preferably, this person will openly discuss the differences between boys and girls with ADHD and have a base of knowledge in this area already.
Criteria for Diagnosis
Diagnosing ADHD is based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), which outlines in detail the specific criteria for diagnosing ADHD. This includes the presence of symptoms in multiple settings (for example, not just at school), the persistence of the symptoms, and the functional impairment that they cause. This thorough assessment is necessary to differentiate between ADHD and other conditions that have overlapping symptoms. The criteria listed in the DSM-5-TR are as follows:
- Your child has at least six symptoms from one group (inattention or hyperactivity/impulsivity). Or they have at least six symptoms from each group (for a total of twelve or more).
- Symptoms began before age 12.
- Symptoms occur in at least two settings (for example, at home and at school).
- Symptoms disrupt your child’s daily activities and friendships.
- Another medical condition isn’t responsible for these symptoms.
An individual will receive an ADHD diagnosis if all of the points listed above are present.
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Co-Existing Conditions
It is important to be aware that receiving your ADHD diagnosis is often just the tip of the iceberg, but it is an important step towards you living a happy and fulfilling life. ADHD is commonly associated with other mental health conditions, such as anxiety disorders, depression, and learning disabilities. Identifying and addressing these co-occurring conditions is essential for effective treatment and management of ADHD.
Managing ADHD in Children
There isn’t necessarily a cure for ADHD, but there are ways to manage the condition. Treatment for ADHD in children often involves a multimodal approach that may include:
- Behavioral interventions, such as parent training, behavior therapy, and classroom accommodations.
- Medications: These can include stimulant medications or non-stimulant medications. Which one will depend on the individual’s expression of ADHD and their specific symptoms.
- Education and support: providing the child and family with resources and coping strategies to manage ADHD symptoms. This support should include providing the child with the skills overtime to be able to self-manage their condition well into adulthood.
Parental Involvement
Parents play a crucial role in managing their child’s ADHD. Parents provide structure, consistency, and emotional support for the child navigating the world with a neurodivergent brain. Understanding the challenges associated with ADHD and advocating for appropriate services and accommodations are essential for the child’s success.
Managing ADHD in Adults
In an ideal world, an adult would have received their diagnosis in childhood and would have been provided with the right support to learn how to manage it independently as an adult. Unfortunately, and especially in the case of many women, diagnosis doesn’t occur until later in life. ADHD symptoms in adults may manifest differently than in children, with challenges in time management, organization, and impulse control often being more prominent. Adults with ADHD may struggle in work settings, relationships, and daily responsibilities.
Many adults with ADHD may go undiagnosed or misdiagnosed for years, leading to ongoing difficulties and frustration. If you have found yourself struggling to adjust to the ‘adult world’ the way your friends, siblings, and colleagues seem to have, the first step is to speak to your doctor about your concerns. Seeking a comprehensive evaluation by a mental health professional experienced in adult ADHD can provide clarity and guide appropriate treatment.
Treatment Strategies
Treatment for adult ADHD doesn’t differ that wildly from children, though it will be more self-driven and directed. Treatment may involve a combination of medication, therapy, and lifestyle modifications. Cognitive-behavioral therapy (CBT) can help adults develop coping strategies for managing symptoms, improving focus, and overcoming challenges related to ADHD. From there, as an adult, you will have to open up about your condition and advocate for yourself. It is also important to do your best to surround yourself with people who understand (or are willing to learn) ADHD and who support you as you navigate the workplace, social settings, and the world in general.
Lifestyle Factors and How to Help Your Child or Yourself
While there are plenty of factors associated with ADHD that are harder to control, there are several lifestyle factors that can either make the struggle with the condition better or worse. For children, these factors include poor nutrition, inadequate physical activity, disrupted sleep or lack of regular sleep and bedtime routines, excessive screen time, and high levels of stress in their home environment. These factors all exacerbate the condition, but the child’s parents or caregivers can do quite a lot to help the child. Establishing consistent routines, promoting a balanced diet rich in nutrients and with limited processed, high sugar, additive-filled, and fast foods, limited screen time, encouraging active play and exercise, healthy sleep patterns, and fostering a supportive and calm home environment will help the child succeed.
These factors don’t actually change much for adults, the only difference is that they need to be more self-directed rather than by one’s parents or guardians. Again, these factors for adults include inconsistent routines, unhealthy eating habits, alcohol and substance use, poor sleep hygiene, too much screen time, and high levels of stress both in and out of the home. Adults can enhance their experience by implementing strategies such as creating structured schedules, utilizing organizational tools, incorporating nutritious meals and regular exercise into their routine, prioritizing sufficient rest, seeking support through therapy or coaching, and practicing mindfulness and stress-reduction techniques to manage ADHD symptoms more effectively and improve overall well-being.
Conclusion: Living with ADHD and Seeking Support
Living with ADHD can present unique challenges, but with early intervention, appropriate treatment, and support from family, friends, teachers, bosses, and healthcare providers, individuals with ADHD can lead fulfilling lives. Encouraging open communication, self-advocacy, and a proactive approach to managing ADHD can empower individuals to thrive despite the challenges presented by the disorder.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
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