The Overlooked Challenges of ADHD in Women and Girls

### The Overlooked Challenges of ADHD in Women and Girls

Attention-deficit/hyperactivity disorder (ADHD) is often discussed as a condition affecting children, primarily boys. However, a growing body of evidence highlights the unique and complex challenges faced by women and girls with ADHD. From misdiagnosis to the impact of hormonal changes, the experiences of women with ADHD have long been overlooked. Recent discussions at APSARD shed light on this critical issue, offering insights into research gaps and practical approaches to better care.

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#### **A Life of Letters: Navigating Overlapping Diagnoses**

Dr. Lotta Skoglund emphasized that many women with ADHD feel isolated, gaslighted, and discounted. They often live with overlapping diagnoses such as PTSD and ASD, which complicate their experiences. Dr. Skoglund’s initiative to form a supportive community has demonstrated the power of safe spaces. Within this community, women share their experiences and seek expert guidance without fear of judgment. Dr. Skoglund also uses short articles and visual aids, like whiteboards, to address common questions and empower women with ADHD to navigate their challenges.

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#### **The Impact of Hormonal Changes**

Hormones play a significant role in how ADHD symptoms manifest in women. Dr. Sandra Kooij explained that estrogen—not progesterone—is the primary hormone influencing dopamine, a critical neurotransmitter in ADHD. This interaction means that hormonal changes during menstruation, pregnancy, and menopause can profoundly affect ADHD symptoms.

Jeremy Didier shared her personal experience of being diagnosed at 36, only after years of struggling with ADHD symptoms that worsened during perimenopause. She noted that higher doses of stimulants, particularly premenstrually, helped alleviate her symptoms.

Dr. Kooij’s research highlights the importance of including hormonal cycles in ADHD diagnoses and treatment plans. Adjusting medication doses based on menstrual cycles has shown promise, as demonstrated by data from ADHD 360, a UK-based clinic.

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#### **Expanding Mental Health Programs for Women**

Dr. Ritika Bawja’s work at Penn State Medical Center focuses on integrating ADHD care into broader women’s mental health programs. Her journey began when a close friend, despite being a medical professional with strong social support, was misdiagnosed with postpartum depression instead of ADHD. Dr. Bawja’s program initially targeted postpartum women but has since expanded to include endometriosis, pelvic pain, trauma, and substance use disorders. Collaborations with OBGYNs have enabled these complex patients to receive comprehensive care, fostering a sense of ease and trust.

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#### **The Unique Presentation of ADHD in Women**

Women with ADHD often present differently than men. Dr. Skoglund noted that perfectionism and constant busyness are common coping mechanisms for women with ADHD. These traits can mask symptoms, making diagnosis even more challenging. Unstructured time, however, often reveals the underlying struggles of ADHD.

Moreover, Dr. Skoglund pointed out the overlap between symptoms of ADHD and PMDD (premenstrual dysphoric disorder). She noted that the PMDD symptom severity scale closely resembles the ADHD scale, underscoring the need for a nuanced approach to diagnosis.

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#### **ADHD and Cardiac Health in Women**

ADHD doesn’t just affect mental health—it also has implications for physical health. Dr. Kooij stressed the importance of screening women with ADHD for cardiac risk factors by age 40. Treating comorbid conditions like hyperlipidemia and hypertension is critical, as is encouraging smoking cessation. Dr. Skoglund highlighted that untreated ADHD poses greater risks than the potential side effects of treatment, making timely intervention essential.

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#### **Pregnancy and ADHD Treatment**

For pregnant women with ADHD, continuing treatment is often safer than discontinuing it. The risk of decompensated ADHD—leading to increased stress and functional impairment—outweighs the potential risks of medication. This perspective represents a significant shift toward prioritizing mental health during pregnancy.

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#### **A Call for Research and Advocacy**

The discussions at APSARD underscored the urgent need for more research on ADHD in women and girls. Dr. Kooij advocated for adjusting diagnostic criteria to reflect the unique female presentation of ADHD, particularly considering hormonal influences. For instance, the DIVA 5.0 diagnostic tool will soon include examples specific to women, taking into account symptoms during different phases of their menstrual cycle.

Dr. Skoglund’s observation that adolescent girls with ADHD respond well to higher doses of depot progesterone highlights the importance of personalized treatment. Additionally, ongoing research from ADHD 360 and other institutions offers valuable data on dose adjustments and treatment efficacy in women.

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#### **Real Stories, Real Impact**

The stories shared at APSARD illustrate the transformative power of accurate diagnosis and tailored treatment. One psychiatrist recounted a female patient who failed her medical boards six times. After receiving ADHD treatment, she passed with flying colors. Similarly, Dr. Didier’s account of her struggles during perimenopause emphasizes the need for awareness and advocacy for women with ADHD.

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#### **Moving Forward**

The conversations at APSARD revealed a clear consensus: women with ADHD need tailored care and greater recognition. From adjusting medication doses to addressing hormonal influences and comorbid conditions, clinicians must adopt a holistic approach. Meanwhile, researchers must continue to expand our understanding of how ADHD manifests in women and girls.

By fostering supportive communities, advocating for comprehensive diagnostic tools, and promoting awareness, we can empower women with ADHD to thrive at every stage of life.