For many years, ADHD was believed to impact only males — and the research reflects that. It wasn’t until 1993 that NIH-funded clinical studies on ADHD were required to include women. We’ve come a long way, but missed ADHD symptoms and underdiagnosis are still common among females with the condition.

“Because of stigma as well as thoughts related to gender role presentations, ADHD symptoms in females can be thought of as more likely due to anxiety or depression,” says Dave Anderson, Ph.D., of the Child Mind Institute, in the video above. “Those are conditions that people are more used to seeing in females.”

The presentation of ADHD in males and females is distinct, and not fully understood or valued. On average, females experience a later age of symptom onset and a different level of severity. While males are commonly hyperactive and impulsive, females are better known for symptoms of inattention and distractibility. (Inattentive ADHD was introduced to the DSM in 1980.)

“People will say, ‘Oh, she’s distracted because she’s anxious,’ or ‘She’s distracted because she’s sad,’ not because she has ADHD. And that is something we’re actively trying to fight even in clinician bias,” Anderson says. “If a female is presenting these symptoms, we want to consider whether or not to include ADHD.”

Other factors that cause females with ADHD to slip through the cracks include referral bias, lower symptom severity, internalizing symptoms, and outdated diagnostic criteria.

For more information about the evolution of ADHD understanding, watch Dr. Anderson’s free ADDitude webinar, “ADHD Then and Now: How Our Understanding Has Evolved.” Dr. Anderson is Vice President of School and Community Programs and former Senior Director of the ADHD & Behavior Disorders Center at the Child Mind Institute.

ADHD Symptoms in Women Vs. Men: Next Steps

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• Female ADHD Test: Symptoms of ADHD in Women
• Read: 5 Overlooked Signs of ADHD – the Inattentive Type
• Sign Up: Essential Support for Women with ADHD

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Our environments and experiences play an important role in our wellbeing. Of particular interest to researchers is the link between exposure to adverse childhood experiences (ACEs) and risk for an array of mental health conditions, including depression and ADHD.

“We don’t talk enough about the importance of adverse life events in patients who have ADHD,” said Nelson M. Handal, M.D., DFAPA, in an ADDitude webinar.

Compared to those without ADHD, individuals with the condition are more likely to have experienced adverse life events — an association that may explain, according to researchers, why individuals with ADHD are also at greater risk for depression.¹

“Adverse life events on adults who have depression and ADHD are extremely, extremely significant,” Handal said, referencing research that found that the ADHD-depression connection was substantially stronger in individuals who experienced serious conflicts and more adverse life events.¹

What counts as an adverse life event? Researchers are working to confirm the definition, however Handal offered the following examples:

• losing a parent (which happened to so many children during COVID, in itself an adverse event)
• witnessing domestic violence
• experiencing an unstable home environment (due to financial difficulties or other problems)
• experiencing parental neglect

The rule of thumb for identifying an adverse life event, according to Handal, may be “anything that can alter your normal functioning.”

To learn more about adverse childhood experiences and their role in ADHD and depression, watch the full replay of Dr. Handal’s free ADDitude webinar, “New Insights Into and Treatments for Comorbid Depression.”

Depression and ADHD: Next Steps

• Free Email Class: Living with Depression — 5 Weeks to Healthier Habits
• Get This Free Guide: Signs of Depression That May Surprise You
• Take This Self-Test: Depression in Adults
• Read: Does Trauma Cause ADHD? And Vice Versa?

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Sources

¹ Semeijn, E. J., Comijs, H. C., Kooij, J. J., Michielsen, M., Beekman, A. T., & Deeg, D. J. (2015). The role of adverse life events on depression in older adults with ADHD. Journal of Affective Disorders, 174, 574–579. https://doi.org/10.1016/j.jad.2014.11.048