Lecture Notes: Women and ADHD by Dr. Ellen Littman

Introduction

• Speaker: Dr. Ellen Littman, clinical psychologist
• Topic: How and why ADHD is different for women
• Presented by: Attitude Magazine's ADHD Experts Broadcast
• Housekeeping: Slides downloadable, certificate of attendance available

ADHD in Women vs. Men

• ADHD has a greater psychological toll on women than men
• Women experience more troubling long-term outcomes
• Psychological distress affects self-worth and quality of life
• Holistic treatment plans tailored to women are being developed

Historical Context

• Early ADHD studies focused on young, white, hyperactive boys
• Misconception that ADHD was a disorder only affecting boys persisted into the 20th century
• Diagnosis originally required hyperactive symptoms by age 7
• Until 2013, ADHD classified as a disruptive disorder of childhood

Diagnostic Challenges for Women

• ADHD in women often overlooked and under-researched
• Studies primarily focus on boys, fewer on adults and women
• DSM-5 includes minimal references to gender differences
• Different symptom presentation: internalizing symptoms, less hyperactivity
• Gender bias in diagnosis and treatment

Hormonal Influences

• Estrogen impacts neurotransmitter activity, executive functions, attention, and mood
• Symptoms vary with hormone fluctuations, affecting ADHD symptoms
• Decrease in estrogen associated with increase in ADHD symptoms
• Treatment considerations include stimulants, SSRIs, oral contraceptives, hormone replacement therapy

Gender Role Expectations

• Women are expected to manage multiple roles efficiently – often unrealistic
• ADHD women camouflage symptoms, leading to underdiagnosis
• High emotional reactivity, lower self-esteem, more anxiety and depression
• Social acceptance challenges, rejection sensitivity, and risky behaviors

Socialization and Relationships

• ADHD women struggle with relationship demands and maintenance
• Early sexual activity and higher risks of STIs and unplanned pregnancies
• Tend to withdraw from social situations, leading to isolation

Sensory Hypersensitivities

• Tactile sensitivities: discomfort with certain types of touch and clothing
• Somatic complaints: headaches, nausea, insomnia
• Sensitivity to sounds, light changes, and odors

Comorbidities

• Emotional dysregulation, anxiety, depression, eating disorders, externalizing disorders
• Personality disorders (e.g., borderline personality disorder)
• Self-harm and suicidality more common in ADHD women

Treatment Considerations

• Find a knowledgeable therapist who understands ADHD in women
• Family psychoeducation to provide support
• Medication management considering hormonal influences
• Coaching and online support groups for practical and emotional support

Outcomes and Implications

• Poor self-care, higher risk of depression, suicide attempts, intimate partner violence
• Increased risk of early mortality due to accidents, substance abuse, and health issues
• Importance of being well-informed and advocating for oneself

Q&A Highlights

• Studies Participation: Contact university settings studying ADHD (e.g., Mount Sinai, NYU, Mass General)
• Adult Onset ADHD: Controversial; symptoms often triggered at menopause or perimenopause
• Assessment Scales: Limited, with some functional impairment scales available
• Thyroid Issues: Correlation with ADHD symptoms, recommend evaluation by an endocrinologist
• Career Impact: Hormonal influences can affect concentration, mood, and memory
• Doctor Education: Provide articles and research to clinicians to raise awareness about hormonal impacts on ADHD

Conclusion

• Emphasis on self-advocacy and finding appropriate support
• Importance of addressing hormonal factors in ADHD treatment for women
• Upcoming webinar on mindfulness and ADHD management