1	Women and AD/HD Carol E. Watkins, M.D. www.baltimorepsych.com
2	Where are Women with AD/HD?
3	Criteria for AD/HD Inattention often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities often has difficulty sustaining attention in tasks or play activities often does not seem to listen when spoken to directly often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) often has difficulty organizing tasks and activities often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) is often easily distracted by extraneous stimuli is often forgetful in daily activities
4	Criteria for AD/HD II Hyperactivity often fidgets with hands or feet or squirms in seat often leaves seat in classroom or in other situations in which remaining seated is expected often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) often has difficulty playing or engaging in leisure activities quietly is often "on the go" or often acts as if "driven by a motor" often talks excessively
5	Criteria for AD/HD III Impulsivity often blurts out answers before questions have been completed often has difficulty awaiting turn often interrupts or intrudes on others (e.g., butts into conversations or games) (Impulsive spending, multiple romantic liaisons, dangerous driving, anger outbursts my additions)
6	Criteria for AD/HD Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home). There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
7	Types of AD/HD Inattentive AD/HD (classic female kind) Combined Type AD/HD (more common in boys but can be seen in girls and women) Hyperactive/Impulsive AD/HD (rarer)
8	Male-Female Ratio DSM-IV suggests 3-5% of children have AD/HD. Male:female ratio of 4:1 to 9:1 was suggested in the DSM IV. This has been questioned in more recent work. Recent data suggests 2-4% of adults have symptoms of AD/HD Adult male female ratio unknown. Quinn and Nadeau, using a very broad criteria, suggest 1:1 male-female ratio. Children are usually parent referred. Adults more likely to be self referred.
9	How Many Women Have AD/HD? Changing criteria for AD/HD Women are better at hiding “externalizing disorders” Women have less physical hyperactivity
10	Same Disorder, Different Look Less physical hyperactivity and aggression More co-morbid depression and anxiety Social pressures to conform Self blame “It’s my fault”
11	Women are diagnosed later Boys are often the “squeaky wheel” Now we do more screening for inattentive subtype Girls are more likely to be diagnosed during or after puberty Mothers are often diagnosed when their children come for treatment More self-diagnosis in adolescents and adults
12	Differential Diagnosis Inattention is a nonspecific symptom Anxiety women>men Depression women>men Substance Abuse men>women Thyroid disorder women> men Bipolar Disorder Learning Differences Sleep disorders Sleep deprivation (trying to do too much) Situational stress
13	Fewer published studies “Expanded” criteria for AD/HD in women are not subjected to rigorous research More studies on men and boys, fewer on women and girls Research subjects are often different from patients in the clinical office. (Less co-morbidity)
14	How AD/HD Affects Daily Life Women are expected to provide structure for others “Female” tasks may not have clear beginning and end Homemakers often have to multi-task
15	Motherhood and AD/HD Impulsivity can lead to arguments Mothers are expected to keep track of children’s complex schedules More difficult with larger families Children often have AD/HD too. Mothers of children with AD/HD are at risk for depression
16	Relationships AD/HD wife and non-AD/HD husband Dual AD/HD couple Importance of understanding each other’s strengths and weaknesses AD/HD predicts higher divorce rate Higher incidence of unplanned parenthood Greater chance of being a single parent
17	Treatment begins at diagnosis
18	Medication Women and men respond to stimulants 70-80% Appetite suppression may not translate into weight loss Some medications for mood disorders may interfere with attention Medications and pregnancy—stimulants are not recommended during pregnancy
19	AD/HD and Hormones Quinn believes that that women with AD/HD have more PMDD Symptoms are often worse before menses Symptoms may worsen at peri-menopause Some women report reduced AD/HD symptoms during pregnancy Controversial: jury is still out
20	Does estrogen help AD/HD? Anecdotal reports that estrogen patches or BCP help some women Early data showing estrogen to be helpful in slowing cognitive decline not supported by WHIMS
21	Psychosocial Treatments Individual therapy Couples therapy Groups Coaching Day Planners Professional Home Organizers Assertiveness training Treatment of co-morbid conditions
22	Coping Mechanisms Flexibility Graceful apologies Humor
23	Published Studies Hinshaw SP, et al. (2002). Preadolescent girls with ADHD. II. Neuropsychological performance in relation to subtypes and individual classification. Journal of Consulting and Clinical Psychology, 70, 1099-1111. Rucklidge JJ, Kaplan BJ. (1997). Psychological functioning in women identified in adulthood with attention deficit/hyperactivitydisorder. Journal of Attention Disorders, 2, 167-176. Rucklidge JJ, Kaplan BJ. (2000) Attributions and perceptions of childhood in women with ADHD symptomatology. J Clin Psychology, 56(6): 711-722 Span SA, Earleywine M. (2004) Cognitive functioning moderates the relation between Attention Deficit Hyperactivity Disorder symptoms and alcohol use in women. Addict Behav. 2004 Nov;29(8):1605-13