ADHD is diagnosed four times more often in boys than in girls, although it occurs with equal frequency in both. — MONIQUE WUSTENHAGEN/dpa
IN GIRLS and women, attention-deficit/hyperactivity disorder (ADHD) is underdiagnosed, research shows.
The reasons are manifold, and include gender stereotypes and internalised symptoms.
In fact, the neurobiological metabolic disorder is diagnosed four times more often in boys than in girls, although it occurs with equal frequency in both, according to Dr Astrid Neuy-Lobkowicz, a specialist in psychosomatic medicine and psychotherapy who has ADHD herself.
Symptoms typically start in early childhood. In many girls, she says, ADHD presents itself predominantly in inattention, a type of ADHD that was previously called attention-deficit disorder (ADD).
They tend to be dreamy, shy, slow and unobtrusive rather than hyperactive and impulsive.
Either way, ADHD is “a particularity of being human,” remarks Neuy-Lobkowicz, the title of whose latest book translates from the German as “Female ADHD”. Its sufferers, she says, are neither better nor worse than other people – just different.
Examiner bias is why far more boys are diagnosed with ADHD than girls, says Dr Matthias Rudolph, like Neuy-Lobkowicz a specialist in psychosomatic medicine and psychotherapy. Girls, too, can have ADHD with a predominantly hyperactive/impulsive presentation, however.
They’re often “typical tomboys” and are told in childhood, “It would have been better had you been born a boy,” says Neuy-Lobkowicz.
She describes them as feeling “lots of joy, lots of sorrow, lots of heartache, lots of enthusiasm. They’re always a bit over the top.”
Some girls have ADHD with a combined presentation – both inattentive and hyperactive/impulsive – and others change from one type to the other.
“A girl can begin with an attention deficit and then develop hyperactivity symptoms in puberty,” writes Neuy-Lobkowicz in her book. “The reverse can occur as well ... We don’t know yet why.”
Conform to fit in
Girls with an attention deficit are often bullied, she says. Ashamed, they try to conform and not draw attention to themselves.
They study harder in order get on well in school, but are quick to have a guilty conscience if they don’t.
“In contrast to boys, they try to display socially desirable behaviour.”
If their inattention-presentation ADHD remains unrecognised, they often develop anxiety disorders or depression that would otherwise be easy to prevent, and that become increasingly pronounced in adulthood and are then treated.
“But no one suspects inattention-type ADHD anymore,” Neuy-Lobkowicz says.
Rudolph reports treating menopausal and post-menopausal women who felt unable to handle the tasks life presented them. Fearing they suffered from dementia, they had themselves examined because their retentiveness and ability to concentrate were so poor.
Many of them said they’d always known that “something was wrong with them”, he says.
“They’re often strong women who, with 120% to 140% effort, achieved what other women do with 100%. At some point their strength gives out.”
How ADHD is diagnosed
An ADHD diagnosis can be made by a neurologist, psychiatrist, psychosomatic medicine specialist, psychotherapist or psychological psychotherapist. A standardised questionnaire must indicate presence of the disorder, beginning in childhood and continuing into adulthood.
School reports are often consulted as well, or the person’s parents are interviewed.
“(Inattention-type ADHD) in women is hard to substantiate in many cases because their behaviour (in school) was so unobtrusive that it’s not mentioned in the reports,” Neuy-Lobkowicz says.
“It depends on the environment the child grew up in,” says Rudolph, noting that many of the parents checked their homework every day and packed their schoolbag, so the disorder didn’t attract attention at first.
“If the doctor has the impression that ADHD is present even though the results of the questionnaire on the person’s childhood aren’t out of the ordinary, it’s worthwhile to dig deeper,” Rudolph says.
Should ADHD indeed be diagnosed, medication is an important element in treatment, as an ADHD brain is hypersensitive to sensory stimulation and there’s an imbalance of the neurotransmitters dopamine and noradrenaline.
Medication is often supplemented with behavioural therapy aimed at teaching the patient to better organise their life.
Further therapeutic elements can include ergotherapy, sport and self-help groups.
Relatives of the patient can do their part as well. Neuy-Lobkowicz says it’s important that they learn about the disorder so as not to misinterpret the person’s behaviour.
“They’re not, for example, inattentive during a conversation because they’re uninterested, but because their thoughts wander,” she says.
They’re also very capricious and constantly late, but not because they’re reluctant to show up – they just manage their time poorly. “Someone who doesn’t know this can be easily offended.”
Take a break
Neuy-Lobkowicz advises the relationship partner of a woman with ADHD not to argue with them when a conflict arises, but to take a break and discuss the matter when tempers have cooled. “Female ADHD sufferers are shrinking violets with a wooden club,” as she describes them.
When they blurt out something, they put the world back in order for themselves, she says – but only for themselves. “That’s why you’ve got to explain to them that this can damage the relationship.”
Rudolph, too, emphasises the importance of proper communication.
He advises partners of women with ADHD not to hold long monologues, but to speak in short, clear sentences. Sometimes, he says, it helps when they summarise what they’ve just said: “Have I understood you correctly that ...”
He also recommends setting feedback rules and making sure that important conversations are held in a quiet environment with few distractions. – dpa