Written by: Arin Lee
Edited by: Holly Paik
Attention Deficit Hyperactivity Disorder, more commonly known as ADHD, is often characterized by fidgetiness, an inability to pay attention, and poor time management among several other things. There are many misconceptions regarding the representation of ADHD, with one being that ADHD presents in the same way in every person, regardless of gender. There is empirical evidence against this, with several studies indicating that there are different types of ADHD, general differences in how ADHD symptoms manifest, as well as specific differences in ADHD representation between males and females.
In order to properly understand the various ways in which ADHD presents itself, it’s important to note the three different categories of ADHD that exist: hyperactivity/impulsivity type, inattentive type, and combination type (American Psychiatric Association, 2013; Centre, 2023; “Types of ADHD”, 2023). Those living with the hyperactivity/impulsivity type of ADHD are characterized by both hyperactive and impulsive behaviors. Hyperactivity can look like fidgeting/being unable to sit still, inability to take part in leisure activities quietly, feeling or being perceived as restless, and/or having a tendency to talk excessively. On the other hand, impulsive behaviors can present as interrupting or intruding on others or finding difficulty in waiting their turn (“Types of ADHD”, 2023). The inattentive type, formerly referred to as a completely separate diagnosis of Attention Deficit Disorder (ADD), is moreso characterized by behaviors such as losing/misplacing important items, being distracted by unrelated thoughts, an inability to finish tasks, and difficulty organizing things like time and money (“Types of ADHD”, 2023). A person is usually diagnosed with the combination type of ADHD when their symptoms take from both the hyperactive/impulsive type and the inattentive type or if their symptoms generally don’t fall under one exclusive category (“Types of ADHD”, 2023).
While there is extensive research on the different types of ADHD, there has only recently been an increase in research done on women/girls with ADHD, much less the gender differences in ADHD representation. With that being said, all research that has been conducted up until now has found notable differences between males and females in two aspects of ADHD: the symptoms and the type.
The majority of female patients with ADHD have “internalized” symptoms whereas the majority of male patients with ADHD have “externalized” symptoms (Centre, 2023; Stibbe et al., 2020). Internalized symptoms are those that are mainly self-afflicting and are not easily observable from the outside, whereas externalized symptoms are those that can affect others and are easily observable from an outside perspective. Most females with ADHD often struggle with internalizing issues such as persistent perfectionism, feelings of despair or inadequacy, impatience, hypersexuality, sensory sensitivities, difficulty maintaining attention, and troubles with sleep among several others (Centre, 2023). On the other hand, most males with ADHD deal with a range of externalizing problems such as anger outbursts, insensitivity, interrupting others in conversation, and high-risk behaviors such as substance misuse (Centre, 2023).
Based on symptoms alone, it was assumed (and has since been confirmed) that most women live with the inattentive type of ADHD whereas the majority of men live with the hyperactive and impulsive form of ADHD; however, this distinction has led to the underdiagnosis of several women and girls with inattentive ADHD. Women and girls with ADHD were, and still are, misdiagnosed with internalizing disorders such as depression or anxiety based on the inattentive type’s more easily observable symptoms such as feelings of despair and troubles with sleep (Littman, 2022). This isn’t to say that women with ADHD cannot also have depression or anxiety; in fact, it is actually more likely for those with ADHD to struggle with another psychiatric disorder, a term that is referred to as comorbidity. As many as 80% of adults living with ADHD also live with another psychiatric disorder, with the most common comorbid psychiatric disorders being depression, anxiety, and personality disorders (Katzman et al., 2017). This can make it difficult for women to be diagnosed with ADHD especially if they already suffer from a commonly comorbid disorder such as depression or anxiety; this is because quite a few symptoms from each disorder overlap with one another.
Despite the majority of men with ADHD exhibiting hyperactive/impulsive behaviors and the majority of women with ADHD having inattentive symptoms, each type is not exclusive to one gender or the other. It’s important to note that there are several nuances in how ADHD represents itself between each gender, but it’s equally as important to note that each type is not entirely mutually exclusive in regards to gender. With more research, the inconsistencies in ADHD diagnoses and disparities in ADHD prevalences found between genders will continue to decrease, and the proper diagnoses and securing of effective treatment for any gender with ADHD will soon become a more likely reality.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Centre, A. (2023, January 13). Female vs Male ADHD. The ADHD Centre. https://www.adhdcentre.co.uk/female-vs-male-adhd/
Katzman, M. A., Bilkey, T. S., Chokka, P., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry, 17(1). https://doi.org/10.1186/s12888-017-1463-3
Littman, E. Gender Myths & ADHD - CHADD. (2021, September 30). CHADD. https://chadd.org/adhd-news/adhd-news-educators/gender-myths-adhd/
Stibbe, T., Huang, J., Paucke, M., Ulke, C., & Strauß, M. (2020). Gender differences in adult ADHD: Cognitive function assessed by the test of attentional performance. PLOS ONE, 15(10), e0240810. https://doi.org/10.1371/journal.pone.0240810
Types of ADHD in adults: Understanding the differences. (2023, January 6). ADDA - Attention Deficit Disorder Association. https://add.org/adhd-types/
Comments