When psychologist Stephen P. Hinshaw, PhD, published two studies on attention-deficit hyperactivity disorder (ADHD) in girls last October, psychologist Kathleen Nadeau, PhD, was heartened that females with ADHD were finally beginning to receive long overdue attention from researchers.

It was also a signal for her to push even harder to raise the awareness of the needs of women with the disorder. Through advocacy and groundbreaking research and writing, Nadeau and a small group of psychologists are fighting to bring the issues of ADHD in women from the fringes of research to center stage.

"Historically, research on ADHD has focused almost exclusively on hyperactive little boys, and only in the past six or seven years has any research focused on adult ADHD," says Nadeau, an expert on the disorder in women and director of Chesapeake Psychological Services of Maryland in Silver Spring.

But for advocates, the bottom line is this: Girls with undiagnosed ADHD will most likely carry their problems into adulthood, and left untreated, their lives often fall apart.

As adults, they're at risk for "divorce, financial crises, single-parenting a child with ADHD, never completing college, underemployment, substance abuse, eating disorders and constant stress due to difficulty in managing the demands of daily life--which overflow into the difficulties of their children, 50 percent of whom are likely to have ADHD as well," Nadeau adds.

More research on gender issues in ADHD is needed for several reasons, says Julia J. Rucklidge, PhD, assistant psychology professor at the University of Canterbury in Christchurch, New Zealand, who has studied ADHD in Canadian women. "We can't make assumptions that what applies to males will apply to females--females have different hormonal influences to start with that can greatly affect their behavior." Also, Rucklidge says, females are socialized differently and therefore tend to express themselves in a different manner, and are more susceptible to such problems as depression or anxiety that again influence behavior.

The mommy factor

Many women are in their late 30s or early 40s before they are diagnosed with ADHD. "One of the most common pathways to a woman being diagnosed is that one of her children is diagnosed. She begins to educate herself and recognizes traits in herself," says Nadeau.

Women with ADHD typically present with tremendous time management challenges, chronic disorganization, longstanding feelings of stress and being overwhelmed, difficulties with money management, children or siblings with ADHD, and a history of anxiety and depression, says Nadeau, who didn't recognize her own ADHD until middle age and has a daughter and a brother with the condition.

Pioneering research

Some psychologists are building up the literature on ADHD among women. Julia Rucklidge began studying the area while working on her doctorate in psychology at the University of Calgary in Alberta, Canada. Rucklidge's findings, published in the Journal of Attention Disorders (Vol. 2, No. 3) and the Journal of Clinical Psychology (Vol. 56, No. 6), shed light on the experiences of women diagnosed in adulthood:

• Women with ADHD were more likely to have a "learned helpless style" of responding to negative situations than were women without the disorder and tended to blame themselves when bad things happened.
• Women with ADHD were likely to believe that they couldn't control the outcomes of life events, resulting in a vicious cycle, reports Rucklidge. "A woman with ADHD is less likely to make efforts to finish challenging tasks due to her belief that she has no power to change the negative outcome. By giving up, she further reinforces the belief that she is unable to accomplish things in life," she says.
• Women with ADHD were also more likely to report a history of depression and anxiety. They had also been in psychological treatment more often and had received more prescriptions for psychotropic medications than had women without ADHD.

Jane Adelizzi's research explored a rarely mined area of ADHD: its similarity to post-traumatic stress disorder (PTSD). Three of her studies looked at women diagnosed with attention and learning problems who also showed PTSD symptoms as a result of experiencing classroom trauma--which she defines as a significantly unpleasant external event or stressor occurring within the confines of an educational environment that is of a psychological nature.

It's not always clear which comes first, the post-traumatic stress symptoms, the ADHD symptoms or the trauma, says Adelizzi. But, she argues, these women's ADHD symptoms can't be helped without looking into the coexisting panic and anxiety that can be triggered many years later--if, for example, they decide to return to school.

'Cutting-edge advocacy'

In addition to pushing for more studies on gender issues, these psychologists use a range of forums to raise awareness of ADHD in women.

"I hope that psychologists, especially those who specialize in adult ADD issues, will play an active role in advocating for more appropriate diagnostic criteria--for adults, and especially for women--before DSM-V comes out," says Nadeau. "I hope that such issues are dealt with at the [next] APA convention in a vocal fashion--the lives of many people are at stake."

Click here to read the entire article

Source: Crawford, N. (2003). ADHD: A women’s issue, Monitor on Psychology, 34 (2), p.28