Houston ADHD Coach

with Michael Martin

Girls and Women With ADHD


My first reaction to tackling the challenge of noting the gender differences in ADHD was to feel overwhelmed.  The real challenge of this task is to take all the cargo on a supertanker and somehow put it in the back of a pickup truck.  Daunting to say the least.

To begin with, how do I distill the myriad of learning styles into something remotely “succinct” for want of a better word.  And then what do we do with the almost infinite complexity of human personality?   If we take just these two factors, let’s say we can boil learning styles down to a dozen types.  What about personality?  While typologies such as the Myers-Briggs Type Inventory(MBTI) distill personality down to a handful of neat types, modern research shows clearly that personality is far more complex than anything developed before the advent of computers and mathematical and statistical models.

So, just working with learning styles and personality and without much effort we get a matrix of twelve learning styles by, oh, let’s say sixteen personality traits.  And we have to cross multiply every personality trait by every personality trait to get to all the combinations.  Twelve by sixteen by sixteen is a pretty big number.  And each and every cell in that matrix is unique and has special characteristics.  Makes you want to quit before you even get started.  Remember, we haven’t even added in the various types or presentations of ADHD.  Then we’re going to suggest multiplying our already 12 x 16 x 16 matrix by two, assuming there are two primary gender types.  And there are those who will even challenge that assumption.  The point is we now have a 12 x 16 x 16 x 2 matrix, without considering they various ways of categorizing ADHD.  And that’s a simple model!

I say all that as preamble, not just to dump a bunch of words on a page, but to prepare you for the enormous complexity of dealing with human behavior in general and ADHD in particular.  You see, the major diagnostic tool used by treatment professionals (the DSM-whatever) presents only three types of ADHD, and that’s not even subdivided by gender.  This can lead the casual inquirer to assume that this is a relatively simple topic.  Moreover, too many treatment professionals who are not soundly versed in the complexity of ADHD will tend to take the easy way out and rely on the descriptions and recommendations of the current DSM as though it were the final word in the matter.  And it emphatically is not.  My editorial opinion is that the DSM-X is basically a convenient tool to appease insurance companies and HMO’s in order to get paid for providing services.  And, it’s about to get much, much worse, but that’s another post. (See DSM-5.)    Yep, it is a basic as that!

What I want to say in response to all this is, well, it’s not simple or easy.  And neither is the treatment or intervention or, or whatever we want to do to help people with this disorder to lead more effective lives.  OK?  So let’s just set all those considerations aside and see what we can come up with.

The basic question we want to consider is whether young girls and mature women with ADHD are somehow different from their male peers with the “same” condition.  Let me cut to the bottom line and state that based upon my experience and the current understanding of this condition the answer is, emphatically, YES!  Women and girls with ADHD comprise a unique and distinctive group, and should not be diagnosed or treated in the same manner as boys and men with the condition.  That is the simple answer.  And from here on out I will try to keep the information as basic and uncomplicated as I can.

As Kelly and Ramundo (You Mean I’m Not Lazy, Stupid or Crazy?!) note in their chapter on gender differences, indeed there are differences between how males and females both experience and express ADHD.  Just for openers, far more males are diagnosed with this condition and this alone ought to make all data coming out of the DSM suspect.  Put another way, girls tend to be significantly under diagnosed compared to their male peers, and here, I’m afraid, is where the water gets a bit deeper.  Current research indicates that the numbers between males and females with ADHD are about equal.  Unfortunately the diagnostic experience is not.  As Kelly and Ramundo note:

One of the most striking ways in which ADD [they use the older convention, ADD, versus the more contemporary ADHD, when referring to the disorder] presents itself has to do with gender.  In the history of ADD awareness, the focus has been almost exclusively on males.  This was because women and girls tend to have a more hidden, subtler form of the disorder (2006, p. 230).

Note that they just come right at the reader with the bold statement that gender is one of the “most striking ways in which ADD presents itself.”  Let that sink in.  Gender is not trivial and it’s not insignificant.  Put another way, gender needs to be one of the primary considerations the professional makes when putting forth a diagnosis which will have such a significant impact on the patient’s life.  Sadly, all too often gender is not part, or at least not a significant part, of the diagnostic picture.

OK, that will do for an opener.  Let this sink in and we’ll continue this thread in a few days.

Michael Martin, M.Ed.

5 Responses

  1. Julie says:

    Looking forward to more on this series. I could never pinpoint what issues I dealt with but when I sought help for my son, I learned what ADD/ADHD truly was and it blew me over how much I recognized in myself. Now being aware is only half the battle…but it helps in moving forward to work on your issues. I agree, Houston is a large city and I too am surprised not to see more professionals listed who are more in tuned to ADHD. Keep us updated when you discover quality professionals. In the mean time, back to my little library of books and frustrated self help :)

    • Mike says:

      Julie, thanks for sharing a bit of your story. One of the ironies of this condition is that so very many adults find out they have ADHD only after they begin to seek help for their children. I love this little story: Someone asked the fish, “how’s the water?” The fish replied, “What’s water?”

      If you have lived with ADHD all your life you may have absolutely no idea that you are in fact struggling with what is basically a neurological disorder that has kept you from functioning at your optimal level. Perhaps, like myself and so many others, you just learned to deal with your perceived limitations and to make the best of the situation that was “you”. And, truth be told, many people go on to succeed with never coming to awareness that they are living with ADHD.

      I relate it to having a visual problem 1000 years ago, long before there was prescriptive eye care, let alone lasic surgery. People with poor vision just learned to cope. They probably learned that there was little or no sympathy from others with “normal” vision who just saw them as somehow limited or clumsy, or whatever described the “limited” you. This has been true with ADHD since the beginning of time.

      Now, to be honest, in ancient times ADHD was probably adaptive in a culture where food was scarce and risk taking meant you succeed in your role as a hunter and a warrior. But those skills are in limited demand in modern society, which is about “learning”, acquiring information and behaving with self control.

      You have made a great leap forward just in being able to identify an issue and begin to learn how to deal with it. You will also model coping behaviors for your son. He’s very lucky to have you as a role model. Many parents cannot bring themselves to accept the reality of having an ADHD child.

      As for professionals, I am working with what time I have available to locate those professionals who really do understand the condition of ADHD. One of the problems is that every psychiatrist I have spoken with assures me that they are fully prepared to deal with ADHD patients, whether adult or child. I know from personal experience that is not the case. I cannot make referrals on this blog, but I’ll figure out how to get this handled for the benefit of those who follow the blog. Thanks again for sharing.

  2. [...] Read more at Girls and Women With ADHD. [...]

  3. Just Me says:

    How does one get diagnosed with ADHD? I’ve got a brother with it, and have suspected that my daughter and I both have it—mine being worse than my daughter’s.

    • Mike says:

      That is an excellent question. The accurate diagnosis of ADHD is definitely a low-tech process and is based upon your personal history. As you might already suspect, it is important to find a doctor or psychologist who is well versed in the nuances of this disorder because the symptoms attributed to ADHD can be found in a large number of other medical and psychological conditions.

      Step one is to learn as much about the condition as you can. In the post I tried to emphasize how multifaceted this condition is. One size definitely does not fit all.

      There are two very good resources for you to follow up with to get you started. The first is the CHADD web site (http://www.chadd.org/Content/CHADD/Understanding/Evaluation/default.htm). In addition this web site has a ton of useful information for learning about ADHD, its many forms, diagnosis and treatment. It also offers various kinds of support. I just checked the Professional Directory under Finding Support and to my surprise I am the only “professional” listed in the Houston Area. I know there are a bunch of practitioners in this area, including a number of psychiatrists who are well versed in the diagnosis and treatment of ADHD. Let me check into this and see why they are no longer listed.

      The second resource is the now classic book, Driven to Distraction, by Hallowell and Ratey. Ed Hallowell, M.D. and John Ratey, M.D. are two psychiatrists who are themselves ADHD. In one sense this is a relief to know, because you can have this condition and still function at a very high level. Chapter 7, How Do I Know If I Have It, is a very comprehensive but readable discussion of the “discovery process” to an accurate diagnosis of the condition.

      To address your question more directly, in order to determine whether you or your daughter has this condition a very careful personal history needs to be taken. Having family members with ADHD is very useful information, as this condition is genetic and runs in families. Driven to Distraction has some very good information to help you with this, as does the CHADD web site. Traditionally, this condition must first present in a significant way in childhood. In other words, it doesn’t show up suddenly in adulthood.

      Moreover, a differential diagnosis is critical because ADHD often occurs with other conditions such as anxiety or depression. In addition there is the problem of misdiagnosis, which is more common than might seem reasonable. I recently started working with a young man who was diagnosed manic depressive and was prescribed lithium, which is a common medication for treating manic depression. But as I worked with him I began to suspect that he was really ADHD and the lithium being prescribed to him was having a negative effect.

      Doctors can be “funny” about that. If the medication doesn’t work, double it and see what happens. This can be dangerous. I referred him for a second opinion and low and behold it was determined he was indeed ADHD and that the symptoms he originally reported were not related to manic-depression. As we switched the treatment to ADHD he began to show a rather remarkable improvement. I wish this were a rare situation, but my experience is otherwise. Again, it is important to work with a professional who is well versed in the nuances of ADHD.

      It is fortunate that you are seeking help for your daughter. Many women do not seek help for attention issues in childhood. And of those who do, many are diagnosed with other conditions, including psychological, medical and educational. This becomes critical later in life as, for example, a high school student seeking needed accommodations. And that is why I’m doing a series of posts on the challenges of women and girls with ADHD. It is a seriously under-diagnosed condition with this population, particularly among those with the passive or inattentive type. Again, ADHD might appear in very different forms or behaviors in a young female child as opposed to a male child.

      Good luck. You are about to embark on a journey. It is indeed fortunate that your daughter has an opportunity to be evaluated at a young age. As with so many conditions the earlier you get started in learning to live with it, the better the long term outcomes tend to be. Again, best of luck. Please keep us posted as you move forward on this journey.