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Suffering in Silence: Women With Adult ADHD

Posted Aug 30 2011 9:46am

“Adult ADHD is a sly condition that can secretly affect people for years without their knowledge. Lori-Lynn Dale knows first hand. In her senior year in college, she not only completed her studies, but also managed three jobs and cared for a new baby boy. Dale seemed to handle herself beautifully, but inside the young mother felt alone, tired, and overwhelmed.

Besides staying awake for days to finish projects, Dale admits to alcohol and drug abuse to ease frustration, and to using “underhanded tactics” to get her way. Her manipulative behavior and fear that someone would find out that “something was really wrong” with her made it difficult to make and keep friends. She did not want anyone to know about her shortcomings. “I was out to prove that I was just like everybody else,” says Dale. “It was a huge cost to my personal development and my self-esteem.” Dale did not feel relief until she was in her 30s. That’s when she became sober and was diagnosed with adult attention deficit hyperactivity disorder (ADHD).

In many ways, Dale’s story illustrates the significant impact of adult ADHD on women. Women with the disorder tend to suffer in silence compared with their male counterparts, says Patricia Quinn, MD, director of the National Center for Gender Issues and ADHD, a nonprofit group. She says women often develop strategies to hide their deficiencies, but in the process, feel ashamed and have low self-esteem. They frequently find it difficult to make social connections. And, even when things are going well, they feel frustrated and besieged.

The burden is especially noteworthy given at least 4 million women have adult ADHD and many of them don’t know it, says Quinn. “Women have tended to be underdiagnosed with the disorder,” she explains. “We have probably not diagnosed one-half to three-quarters of the women with ADHD.” Women are apparently missed early on. “If you go to [children's] clinics and see who’s getting treated [for ADHD], the ratio of males to females is as high as nine males for every one girl,” says F. Xavier Castellanos, MD, director of the Institute for Pediatric Neuroscience at the New York University Child Study Center. Research of school-aged children indicates there are actually about 2.5 boys to one girl with ADHD. Yet even this estimate may not be completely realistic, says Castellanos, citing anecdotal reports that there are an equal number of males and females with the disorder. There are many theories as to why fewer females are diagnosed and treated with ADHD. Quinn points to the history of the disorder itself. “We’ve studied the disorder in males — usually elementary school-aged males — and that’s how we’ve defined the disorder,” she says, noting that boys with ADHD have traditionally been known for their hyperactivity and disruptive behavior. Teachers and parents, who refer kids to the doctor, notice these symptoms.

Instead of recognizing the adult ADHD factor, however, many women and their families see their difficulties as merely a part of the stress of modern-day living. Other factors that can aggravate ADHD symptoms and potentially throw women off the ADHD trail include •    Hormonal fluctuations. Symptoms of adult ADHD could tax already challenged minds and bodies. Women with PMS, for example, can already be oversensitive and irritable. For women with perimenopause, Matlen says it’s not unusual to already have some trouble with memory, cognitive skills, and word retrieval. Then there’s also the emotional rollercoaster that often accompanies pregnancy and post-partum depression. The drastic changes in hormone levels could certainly wreak havoc with mental health and well-being. Add ADHD to the mix, and the burden could certainly become greater.
•    Iron deficiency due to menstruation. Research has shown that mild iron deficiency, as experienced by some females, could affect cognitive skills, says L. Eugene Arnold, MD, a child psychiatrist and author of A Family Guide to ADHD. Coupled with the symptoms of ADHD, iron deficiency could become a significant challenge.
•    Other mental disorders. As many as two-thirds of children with ADHD have at least one co-existing condition, according to Children and Adults With Attention Deficit Hyperactivity Disorder (CHADD), an advocacy group. Depression and anxiety are common ailments experienced by people with ADHD. They also tend to be more prevalent in women in general.
•    Personal problems. Girls and women who have been physically abused, or those who have not had good role models for things such as motherhood and organization could exhibit ADHD-like symptoms. These, and other personal factors, could complicate the identification of the disorder.”
Original article at MidicineNet.com

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