ADHD & Women
This week on The Slut Show Ellen Moore is joined by journalist, activist & neurodivergent feminist: Kaia Manoeli Stafford (she / her). They talk about the chronicles of being a (late diagnosed) woman with ADHD. From insecurities to medicines and from struggling to thriving, diving into the various ways in which this disability influences Kaia her life, what symptoms she struggles with, how she copes with it all and way more. This week’s Slutty Science discusses the basics of ADHD and how this neurodevelopmental disorder relates to women.
Please note: this article contains information about ADHD & sexism, which may be triggering for some readers.
Attention deficit hyperactivity disorder, more commonly known as ADHD, is a neurodevelopmental condition which impacts the growth and development of the brain and nervous system. ADHD can affect one's competence in regards to:
- Social skills;
- And learning from past mistakes.
The brain of people with ADHD (also called neurodivergent individuals), develops and functions differently from that of people who don’t have ADHD (also called neurotypical people). The key differences between individuals with ADHD and those without are found in (1) brain structure, (2) brain function and (3) brain development.
ADHD brains show disordered brain function – in comparison to neurotypical individuals, as a result of both dopamine and (to a lesser extent) noradrenaline deficiencies. These deficiencies lead to problems with emotional and mood regulation, learning abilities, self-control and memory. In order to properly understand why - and how - a deficiency in such neurotransmitters leads to those kind of complications, let’s first take a closer look at dopamine.
Dopamine is a neurotransmitter that affects several areas of the brain. One of the things dopamine does is filter the stimuli that enter the brain. Stimuli can be any of the five senses: sight, sounds, smell, touch and taste. Filtering these various stimuli allows individuals to classify them as relevant and irrelevant. The irrelevant stimuli will then proceed to be blocked or ignored, in order to leave workspace which the brain can use to manage relevant stimuli.
Relevant information is then drawn from the long-term memory, into the working memory. This allows you to come up with a plan for the scenario at hand. You then execute your plan, after which you evaluate whether or not the execution was good as is or if that plan could perhaps benefit from some improvements.
The dopamine deficiencies found in people with ADHD, result in a much less efficient stimuli filter. The poor functioning thereof inhibits irrelevant stimuli from being blocked or ignored the way they would in people with sufficient dopamine levels. This makes it harder for people with ADHD to focus and increases the prevalence of overstimulation.
This inability to filter out irrelevant stimuli forces ADHD brains to draw information from the long-term memory for stimuli that were, in fact, irrelevant. Neurotypical brains draw such information exclusively for relevant stimuli. The enormous amounts of both relevant and irrelevant information that are drawn from the long-term memory in people with ADHD, result in both turmoil and hyperactivity in the brain – which people with ADHD are unable to suppress. For that reason, dopamine deficiency can be tiring as fucking shit.
Additionally, the evaluation of past behavior – in people with ADHD – generally doesn’t take place. This is for the simple reason that chances are, the ADHD’er in question is already distracted by something else. Due to this lack of evaluation, there is no information to be stored in the long-term memory, making it less likely for those with ADHD to learn from their mistakes and making them more likely to thus repeat past missteps. This can be incredibly frustrating and have detrimental consequences on one's self esteem.
Furthermore, studies found that disruptions in the dopamine reward pathway also lead to deficits in motivation. Imaging studies observed similar findings, linking the inability to stimulate certain areas of the brain weakened motor activity and attentional competence.
Dopamine is to the brain, kind of like what the brakes are to your car: hella important to prevent getting into major trouble and just like a car without brakes, having a dopamine deficiency can be incredibly debilitating.
Brain development & brain size
Additional causes for disordered brain function are disparities (found when comparing people with ADHD, to those without) in brain development and brain size.
Studies have shown that the brains of children with ADHD tend to be smaller and develop more slowly than those of their neurotypical counterparts. This difference in volume – which, for your information: does not influence intelligence – does impact a variety of other areas of the brain, amongst which the ones responsible for emotional regulation, impulse control, social behavior, motivation, planning, attention, cognition and memory. Thus dysfunction in these areas of life might occur as a result of that impaired development.
Strikingly, there’s also an area of the brain that matures more quickly in children with ADHD – than in those without, namely the motor cortex: the region of the brain that relates to fidgeting and restlessness. Great, right?
Causes of ADHD
So why do certain people have sufficient levels of dopamine, while others don’t? Well, both genetics and environmental factors play a determining role in the occurrence – or lack – of ADHD.
A baffling 70-80% of ADHD is hereditary and although there isn’t one particular gene to blame for causing the disorder, a combination of certain genes can, in fact, determine the development thereof.
Fun fact: if one of your parents has ADHD, you have a 50% chance of having ADHD and thus most people with ADHD have a parent with the same disorder. Similarly, if one of your siblings has ADHD, that makes you five (!) times more likely to have it yourself.
Additionally, there are a variety of environmental factors that play a role in the development of ADHD. Early childhood traumas, a chaotic family life which lacks clarity and structure, abuse, neglect, premature birth, low birth weight, consumption of both alcohol and nicotine, as well as stress during the pregnancy of the infant all increase the chances for ADHD to develop.
“Everybody has ADHD nowadays”
The ongoing discourse which revolves around the notion that “everybody has ADHD nowadays,” is incredibly problematic, because it perpetuates stigma. Yes, more and more people are getting diagnosed with ADHD, however, by saying 'EvErYBodY HAs ADHD nOWaDayS' you disregard the plethora of scientific research offering an explanation for that exact development.
ADHD, like any other medical diagnosis, requires research. Ongoing research which is being conducted as we speak, because improving our understanding of this neurodevelopmental disorder, will allow for progressively better treatment of ADHD. Thus treatment strategies have adapted over recent decades and are likely to continue to change. For that reason, individuals who did not meet the diagnostic criteria two decades ago, may have had raging – yet undiagnosed – ADHD all along.
Getting an ADHD diagnosis doesn’t happen overnight. Such a diagnosis will only be made when an individual displays chronic symptoms related to attention, hyperactivity and / or impulsivity, which negatively impact their functioning and / or development, after making sure there are no other medical and / or psychiatric conditions which offer a more suitable explanation for their symptoms.
Women & ADHD
ADHD has long been thought to predominantly be a male condition, however, that is far from true. In fact, the amount of women with ADHD is thought to be nearly equal to the amount of men with ADHD, however, women with ADHD are systematically under-identified.
In many instances, ADHD in women is either not diagnosed, diagnosed only in adolescence or adulthood or the disorder is misdiagnosed as a different condition, like depression for example.
However, the presence of other medical and or psychiatric conditions, does not rule out the presence of ADHD (regardless of gender). Simultaneously suffering from more than one disorder / disease is called comorbidity and the occurrence thereof is actually more common than the lack thereof. As a matter of fact, an astonishing 70-75% of people with ADHD also have another psychiatric diagnosis. The most frequently recurring ones being:
- Anxiety disorders;
- Sleep disorders;
- Low self-esteem;
- Substance abuse.
Amongst women higher rates of anxiety, learning disabilities, as well as mood and substance disorders were found - when compared to the rates found amongst men. This elevated presence of comorbid disorders might complicate the clinical picture, however, it remains to be clinicians who bear the responsibility to disentangle symptoms of ADHD from coexisting conditions.
Migraines & Irritable Bowel Syndrome (IBS)
Noteworthy are a couple of seemingly dissimilar diseases which turn out to be recurring comorbidities to ADHD alongside the previously mentioned diagnoses. One of them being Irritable Bowel Syndrome, which finds a greater prevalence amongst children with ADHD. Another commonplace comorbidity to ADHD are migraines, with both age and the female sex increasing the probability of the occurrence thereof.
Its originator being not so much the inattentive symptoms and behaviors that occur as a result of ADHD, but rather the hyperactive-impulsive symptoms and behaviors that indicate a significant association with all types of headaches, migraine included. Additionally, a variety of other things stand out:
- Firstly, the association with ADHD was most striking in migraine patients who suffer from visual disturbances;
- Secondly, research shows that children who suffer from migraines are more likely to have ADHD, than children who don’t;
- And lastly, adults with ADHD are more likely to suffer from migraines, than their neurotypical counterparts, with a 34,4% prevalence of migraine amongst women with ADHD – in comparison to a 24,9% prevalence amongst neurotypical women. In adult men with ADHD the prevalence of migraine is 28,3%, whereas the prevalence amongst their neurotypical counterparts is only 19,2%.
In part thanks to this plethora of frequently reoccurring comorbidities underdiagnosis of ADHD is awfully prevalent. Research indicates that underdiagnosis of ADHD takes place primarily in individuals who have high intelligence, who function in a very structured environment and whose ADHD presentation is predominantly inattentive.
High intelligence can result in the ability to successfully mask your symptoms, which – in turn – may lead to satisfactory academic achievement. Although this is oftentimes wrongfully assumed to rule out the possibility for ADHD, beware that even when a person seems to excel academically, they may still very well have ADHD. Although poor academic performance can indeed be a pointer for ADHD, that train of thought does not apply the other way around.
Functioning in a particularly structured environment might also lead to underdiagnosis, as your symptoms might be surprised by external environmental factors.
Having a predominantly inattentive presentation of ADHD is another explanation for underdiagnosis, as the manifestation of such a presentation can be more subtle and when it is recognized, such a presentation is more likely to get misdiagnosed due to the variety of overlapping symptoms with other (potentially comorbid) disorders.
When analyzing the ADHD population as a whole, the predominantly inattentive presentation of ADHD occurs in only 10% of cases. However, when examining exclusively adults with ADHD this presentation occurs in 31% of cases.
It is primarily women who suffer the consequences thereof, as females are more likely to have this predominantly inattentive presentation of ADHD. Yet parents, teachers and / or caretakers often associate ADHD exclusively with that hyperactive-impulsive presentation and thus adults in the lives of these young girls showing symptoms of inattentive ADHD – might mistakenly consider there to be no reason to seek diagnosis.
As a result, they may disregard the possibility for ADHD altogether, unaware that the behavior of the girl in question is – in fact – fueled by symptoms originating from undiagnosed ADHD. This can lead to diagnosis not taking place at all or it can lead to diagnosis much later in life when symptoms of ADHD begin causing problems in one's academic and / or professional life.
Therefore, males remain to show higher rates of ADHD, but how can it be that underdiagnosis, late diagnosis and / or misdiagnosis amongst women are not exceptions, but rather the norm?
Well, hormonal factors are thought to play another important role in the way ADHD presents in women and are known to influence the way women respond to ADHD medication.
In addition to that, recent studies have indicated that female patients with ADHD are more likely to suffer from premenstrual dysphoric disorder, as well as postpartum depression. This same study suggests that women with ADHD and such conditions are likely to suffer from more severe symptoms of such disorders – than women without ADHD – as such disorders are linked to serotonin deficiency in a similar way ADHD is linked to dopamine.
However, research about sex differences in response to treatment is anywhere between scarce and non-existent. Thus it is of the utmost importance that both clinicians and scientists are made aware of these phenomena, so they can enhance their understanding of the correlation between gender and the way ADHD presents, in order to improve the quality of care women – of all ages – receive.
Did you know ADHD also impacts the way you experience sex? Click here to read the full article about it.
Another factor that contributes to the under identification of women with ADHD is social conditioning. Starting from a young age boys are told to be strong, tough leaders, whereas girls are taught to be nice, obedient and polite. This influences the way symptoms present across the sexes and is thought to force girls into masking their hyperactive-impulsive symptoms. As a result, women are more likely to internalize the psychological hardship they face, making it even more likely for ADHD symptoms to go unseen.
'Girls are raised to “internalize” – to take in and “own” negative feedback, to apologize, to accommodate, and not to fight back – in short, to take the blame. Boys, however, are typically raised to “externalize” – to fight when attacked, to see the problem as outside of them.'
Due to the manner in which social conditioning occurs and the striking gender differences that stand out across the sexes, hyperactivity in girls is more likely to be expressed through verbalization, whereas boys are more likely to express their hyperactivity through physical movement.
For that reason it should come as no surprise that clinics specialized in treating adults with ADHD report to treat relatively more women, than clinics specialized in treating children with ADHD.
It is for these reasons that with both the female sex and increase in age, the chances of ADHD diagnosis decline. But what are the other presentations of ADHD?
The presentations of ADHD
Before you ask me about ADD, it no longer exist. What was previously known to be ADD is merely a presentation of ADHD that manifests primarily as an attention deficit, without the presence of hyperactivity and or impulsivity.
With the removal of ADD from The Diagnostic and Statistical Manual of Mental Disorders, came the introduction of the three presentations of ADHD. These are:
- The predominantly Inattentive Presentation – which occurs in roughly 10% of cases and 31% of cases amongst exclusively adults with ADHD;
- The predominantly Hyperactive-Impulsive Presentation – which occurs in roughly 3-5% of cases and 7% of cases amongst exclusively adults with ADHD;
- And lastly, the combined presentation, which is both inattentive, hyperactive and impulsive. This is the presentation which unanimously occurs in most cases, in people of all shapes, sizes, genders, ages, sexualities and skin colors. Present amongst the remaining 85-87% of cases and 62% of cases amongst exclusively adults with ADHD.
Important to note is that a diagnosis with one presentation of ADHD doesn’t rule out other presentations of ADHD, as symptoms aren’t stable traits. They can change over time and thus the presentation of one’s ADHD might too.
Although ADHD is not curable, there are a variety of treatment strategies for individuals with ADHD. Cognitive behavioral therapy – combined with medicinal treatment – can improve both business and academic performance, as well as overall quality of life.
The first-line treatment strategy for ADHD is medication, which we will discuss in depth in the Slutty Science of episode 13 of season 6 of The Slut Show. Click here to read the full article!
Followed by medication is psychoeducation, in other words, learning the ins and outs of ADHD and what exactly it is you suffer from.
Lastly, is cognitive behavioral therapy. This is a type of therapy which focuses on improving ones insight into their own behavioral and thought patterns. It aims to teach you how to recognize and change negative thoughts about yourself, but also more practical things like learning to plan and organize.
Motherhood & relationships
In this society we are raised with the idea that women are supposed to take care of household chores and raise their children, while men are the main “financial providers”. However, taking care of such responsibilities can be incredibly daunting in and of itself, but even more so when ADHD comes into play.
In result, a neurotypical partner might wrongfully assume their neurodivergent counterpart simply doesn’t care enough, because 'if they would, they would have solved the issue at hand.' However, it isn’t a matter of wanting to do something badly enough. Sadly, that is not how ADHD works. If anything, such remarks aggravate poor self-image, which has been proven to exacerbate ADHD symptoms.
Due to symptoms like distractibility, being unorganized, having a hard time finishing tasks and impulsivity, learning effective coping skills can be increasingly complex for individuals with ADHD. Lacking such effective coping skills can lead to failure and underperformance, which in turn can lead to lack of self-confidence and the development of a negative self-image. This negative self-image can aggravate distractibility and avoidance behavior and cause both mood swings and depression. Breaking out of such a downward spiral can be an incredibly daunting task, especially when you lack the dopamine – and thus the motivation – to turn your thoughts into action.
We can thus conclude that social conditioning plays a variety of pivotal roles in the ways ADHD symptoms influence the lives of women, not excluding their relationships, nor children.
'If you would have wanted it badly enough, wouldn’t you have done it already? When you’re actually interested, you know how to concentrate, so do it now. Just control yourself, instead of smoking so much weed. I don’t think you actually have ADHD, you just don’t know how to let it go, do you? Just take the week off, you’ll manage to get your shit back on track! At least if you just stop being so lazy.'
Quite obviously none of those things are beneficial to say to people who suffer from ADHD. Yet, every single one of those comments have been made to me and trust me when I say: I left out the worst. Stigmatization and unfavorable attitudes can make individuals with ADHD reluctant to disclose their diagnosis and no wonder, considering the myriad of nonsense we get told from our early childhoods onwards.
Concluding, further research should be conducted studying the way ADHD presents in women, how best to treat them, what developmental differences occur in girls in comparison to boys, what the effects of female hormones are on ADHD and how both comorbidity and ethnic differences play roles in ADHD, its diagnosis or rather, the lack thereof. In addition to that, clinical education needs to be improved in order to allow for earlier diagnosis and treatment of ADHD in people of all sexes.
With an estimated 240 million people suffering from ADHD, the need to change the discourse around this disorder has never been more urgent and thus I would love to end this – not that slutty, yet incredibly scientific – piece of Slutty Science on a positive note.
Although Attention Deficit Hyper-activity Disorder is classified as a neurodevelopmental disorder and ADHD undeniably complicates right about every aspect of life, it is – perhaps even more – important to beware that these struggles can also benefit you.
Your stubbornness will likely bring you perseverance. Your impulsiveness sources your creativity. Your hyperactivity is also your energetic personality. Your restlessness brings you your tireless enthusiasm. Your distractibility is caused by your curiosity and your forgetfulness may result in spontaneity.
Yes, ADHD can absolutely fucking suck at times, but it isn’t all bad.
Interested in hearing more? Check out the full episode of The Slut Show on your favorite podcast platform, by clicking here! Or head over to our Instagram @TheSlutShowWithEllenMoore for your daily dose of intersectional feminism. Want to send in questions for our mail-segment? Want to be on the show yourself? Know someone who should or want to request an episode about a particular subject? Don’t be a stranger. Our DM’s are always open ❤
We hope to see you on our socials and for now, sluts out!
Lots of love,
The slut show is about way more than sex. It is about breaking taboos, asking questions and fucking the patriarchy, by having real, raw, uncensored and heartfelt conversations about topics that matter. In a safe space we aim to make room for the voices of marginalized folks, creating a place to listen to the pain, sorrow, hopes and dreams of those who came before us. Found in & by intersectional feminism, we believe that everybody should have the same opportunities and get treated equally - regardless of the color of their skin, the size of their body, the gender they identify with or the people they choose to love. Let it be known that the feminism we know today rests upon the foundation black, indigenous, people of color & the queer community built for us. May the battles they fought and the struggles they overcame keep the raging fire in our hearts alive, to make sure that they - nor their legacy - will ever be forgotten.
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