10 responses to “Women with ADHD — Practice Tips”

  1. Thanks great article. I can think of a patient who ticks all these boxes but unfortunately I know she occasionally uses cocaine. I’m worried about starting stimulant drugs knowing her drug use. Any ideas how to tackle these patients?

  2. Thank you, I personally learned a lot from this article. I was wondering if Indigenous girls and boys statistics differ? If so how? Does historical traumas etc play a role? How can a trauma-informed len be used or is used?

  3. Thank you for the helpful article. As a GP who practices primarily in a university health setting, it’s very common that I see young women/female-identifying students who have been dealing with all sorts of mental health issues as they transition from high school to post-secondary education. The majority of them come with an “anxiety/depression” label but I often do wonder about ADHD, especially given the high prevalence of mood dysregulation issues that I see, and I have started doing more in-depth assessments to ensure that this treatable condition is not being missed. Unfortunately, there seems to be a very ingrained attitude among certain colleagues in psychiatry that ADHD is being over-diagnosed and that in order to properly diagnose ADHD, patients must undergo extensive and expensive psychological testing; some won’t even discuss ADHD in any great detail with patients unless they have had this kind of testing done. Do you have any advice for how we can best advocate with colleagues about taking a more holistic view of ADHD in university-age and adult folks?

  4. Great article. I see many patients self-diagnosing with ADHD – perhaps because it is less stigmatizing label than other mental health diagnosis. Often they are more interested in the label than addressing the symptoms. I know Dr Allen Frances says ADHD is over-diagnosed but this piece made me re-think the issue. And really dig deep to help these patients obtain a correct diagnosis and obtain treatment.

  5. Thanks so much Dr Hall for all your work in this area and for working so hard to spread the word and advance treatment options for our patients and our colleagues. I also appreciate your attentiveness to ‘the story’ as opposed to relying on the questionnaires only. So many of us high functioning women are getting diagnosed late, as up until now we have been the last to consider this diagnosis because of gender bias in information regarding the subtleties of ADHD in women through the lifespan. We are not the 9 year old boy disrupting the classroom. Up until 1 year ago I only had 3 patients in my panel of 1000 who carried this diagnosis. Spending the time to identify and treat many women in my practice has been life changing for them and so rewarding as some of these patients I have known for most of their lives. These assessments are no fancier or more complicated most times than diagnosis of MDD or GAD, and can rest in the hands of GPs. Especially in these times of very limited access to MH resources. Re: self diagnosis – I hear this a lot from my colleagues as being a ‘problem’, and is often accompanied by an eye roll . Honestly, I now use this in my practice as being a high predictor of an eventual clinical diagnosis. Why should we criticize patients for taking the time and energy to learn about how their brains work ?

  6. Excellent article. This really sheds a new light on the presentation of ADHD in women. I am sure I have missed this on many occasions in practice both in the clinic and ED. Thank you for this enlightening description and explanation of inherent biases in diagnostic tools.

  7. Interesting article raising differences in presentation of ADHD between males and females. Self-diagnosis via rating scales (in combination with clinical assessment) is used for other conditions, so it’s not a big leap to include this in assessing patients for ADHD.

  8. As with everyone else, Dr. Hall, I want to thank you for this article. As a psychologist who works with adults with ADHD, and as a woman with ADHD myself, I know how desperately we need voices in the medical community who look beyond the basic DSM-5 criteria to see below to the deeper dynamics. I would like to add one thing that wasn’t included in your information – when you talked about the impulsive behaviours, you didn’t include shopping and eating, both of which are problematic in many of my clients.

    I’ve been specializing in ADHD and ASD for two decades now in my practice in Edmonton. Over time I’ve come to view some of the common issues, like anxiety, low self-esteem, and “creating chaos”, as representing neurophysiological processes beyond just poor executive skills or co-morbid symptoms. I think that people with ADHD may unconsciously be using these processes as a form of self-stimulation, to increase dopamine levels in the brain. I have developed a comprehensive bio-psycho-social model related to this, and in the last two years I have developed a series of videos to explain this model to clients, as well as a training program for mental health workers. If you are interested, you can go to https://aaa.cambiumed.ca/ to watch the introductory video. I want to spread this information, because my clients find it very helpful.

    Thanks again!

  9. largely misdiagnosed

  10. I appreciate your paper very much. This sentence was not clear for me with Family Medicine background.
    “ When females are diagnosed at a young age, there are often neurodevelopmental comorbidities like intellectual impairment.”

    When the child/student does not fit the normative templates, I hesitate to use “intellectual impairment” in the symptom list while establishing ADHD as a diagnosis. If there is a comorbid condition, such as ASD, CP, childhood Bipolar then the intellectual impairment should be assigned to those conditions.

    Instead, I say to the child seated on the table and the parent – I can see the teachers report, behavior, Vanderbilt, reading is off, etc, – I think this is ADHD.
    Then with excited voice i postulate that people who have this are usually bright; just busy juggling multiple ideas from different paradigms in the head at once and can miss some social cues.
    However, when something new comes into the world, it will come from someone like this who can take an idea from over there and one from over here and put them together and create something new that nobody has thought of before.
    (Whereas the linear thinkers, can be reliable, but nothing new comes of it. )
    The thing is you need to get through school, and you need to be more organized, turn work in and other symptoms, plus usually a stimulant med (light switch).

    At this point there are four wide-eyes looking back at me, so I know it’s the first time they’ve heard that ADHD is a positive attribute.
    I am guessing it’s the same for the 50ish women I treat. The lack of confidence and shame over the years. The Doc’s (always) put on SRIs – helps a little, wears off, higher doses, no sex life, more depressed, ETOH, muscle tightness, fibromyalgia, more meds, divorced etc. i’m grateful that TikTok is improving awareness – I have several women come-in and correctly declare themselves.

    Back to the child and parent and the concept of birthing great new idea for society:
    Steve Jobs dropped out of College and went to India, stayed in an Ashram and studied calligraphy (to the chagrin of his parents?). The calligraphy and emphasis on fonts was a differentiating concept of the early Macintosh computers.
    However dear student, you’re in grade school, you need to learn to read, do your homework, finish assignments so you can get to college and develop your great ideas and study whatever you want.
    Of course, there are negative examples of the untreated student who could not stay in the guard rails.
    Then there’s the extreme relief of the 50ish woman who learns the diagnosis for the first time – so that’s what was wrong with me. I don’t think she sees herself as intellectually impaired.

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