Daily life is pretty frantic. You’ve lost your keys – for the third time this week. Plus, you found yourself spacing out while the boss was talking to you and you’re way behind on that project. Feeling a bit stupid?
The problem may not be your intelligence. It could be Attention Deficit Hyperactivity Disorder (ADHD), which affects 8%-10% of the world’s population. More than four million women have ADHD and don’t know it, says Patricia Quinn, M.D., a developmental pediatrician and co-founder and director of the National Center for Girls and Women with ADHD in Washington D.C.
So why are women in the dark about ADHD, a brain disorder that can make them more distractible, inattentive or impulsive?
“Women are very good at compensating, coping, staying up late and working very hard. They really suffer silently,” says Quinn, who has authored 20 books on the disorder, including the award-winning Attention, Girls! A Guide to Learning about Your ADHD (Magination Press) and the upcoming 100 Questions and Answers About ADHD in Women and Girls (Jones & Bartlett Learning), which is scheduled for release in October.
In fact, most women don’t find out they have ADHD until 38, about the same time their children are diagnosed.
“They usually get diagnosed when the [stresses in their lives] outweigh their ability to compensate,” Quinn adds.
There’s good news, though: It’s controllable through a combination of behavioral therapies and medication, she says.
In this exclusive Lifescript interview, Quinn discusses her own ADHD, how you can tell if you have it and the best ways for managing life with the disorder.
What’s the difference between ADHD and Attention Deficit Disorder (ADD)?
Unfortunately, the names are a real issue. They’re used interchangeably and a debate is going on about whether there are two [disorders]. ADHD is the most common.
The AD part is the inattentiveness, daydreaming and not being able to focus on one thing or finish something you started. It affects organization and time management and leads to losing things and being forgetful. Then, there’s hyperactivity.
Many people occasionally have those traits, like forgetfulness. How do you know if they’re severe enough to be ADHD?
Everybody loses their keys once in a while. But when you never can find your keys, that’s the problem. I lock my keys in the car all the time.
I had a policeman at the Washington Monument break into my car because my keys were in there with the car running. I was in Baltimore – where I gave a lecture on ADHD – and I locked my keys in the car. It was ridiculous.
We finally had to buy a car that I couldn’t lock the keys in.
How else do you know if you have ADHD?
The basic symptoms are the same for men and women: inattentiveness, impulsivity and hyperactivity. You have to have them for at least six months.
They’re usually pervasive and affect you throughout the day. We also look for family history.
Is ADHD genetic?
Yes. There’s a 17%-34% chance the mom [has] ADHD and an 18%-38% chance that it’s the dad.
Adults have just been getting diagnosed since the 1990s. Most likely, they don’t know about grandparents with the disorder.
In our family, we all have ADHD. My dad did. He was in a private school and was asked to leave. He could never sit still. He was never diagnosed, but we knew he had it.
In school, my sister was always in trouble – jumping off desks in the principal’s office while wearing the nun’s capes.
I had all these issues, but I didn’t realize there was a problem until medical school. I’m more distractible and hyper-talkative, but I can hyper-focus.
Do ADHD symptoms show up the same way in women and men?
Women and girls with ADHD are more likely to internalize symptoms and become anxious. Symptoms most often reported by women are dysphoria [unhappiness], inattention, organization problems and impulsive behaviors.
By contrast, men report more problems with conduct, learning and attention, greater stress intolerance and poor social skills.
The hyperactivity component in women may be very different from that in boys and men.
For men, it tends to be external motor activity; for girls it’s more fidgeting and twirling their hair. With females [you see more] hyper-talkativeness. They’re out of control emotionally.
Why are symptoms different in women?
Women have fluctuating estrogen levels. As they head into menopause in their early 40s, we see estrogen levels start to go down. This affects neurotransmitters [chemicals that transmit signals between nerve cells and other cells] in the brain, such as dopamine, serotonin and noradrenaline.
Lower estrogen [means] lower dopamine, [which affects reasoning and concentration], making ADHD symptoms worse. If you lower serotonin, you’re going to get depressed and if you raise noradrenaline levels, you’re going to get very agitated.
This is often why a woman will seek help for ADHD for the first time in her late 30s, 40s and early 50s.
What's ADHD often misdiagnosed as?
People think you’re not very smart. When I diagnose women with ADHD, they often say, “Oh, that’s it – I’m not stupid.”
A lot of women get labeled incorrectly as depressed.
Is there a link between ADHD and intelligence?
We have a whole spectrum of intelligence with ADHD.
We have gifted people with ADHD and that delays the diagnosis because they continue to do well. I had a patient with Down syndrome, and he had it as well.
We have the whole gamut of intelligence around the world. This goes to [it being hereditary] – the fact that we see ADHD in every country in about the same ratios as in the U.S.
Are women with ADHD more likely to have depression or anxiety?
Women with ADHD are five times more likely to be depressed. People see the depression and treat it, but they don’t get any better.
A lot of women diagnosed with depression really have ADHD. If we treat the ADHD, the anxiety and depression go away in about 60% of the cases.
What kind of doctor treats the disorder? How can I find a specialist?
Usually, it’s a whole team. If you have co-existing conditions, such as depression, anxiety or issues with self-esteem, it’s more complicated.
I would recommend [that adults] find a psychiatrist who sees children and adolescents.
I’ve found a trick for helping people find doctors: Call the local university and ask where they send their students for an evaluation or assessment. They can find experts within the community.
What treatments work best?
A multimodal [multiple elements] treatment program. We use cognitive behavior therapy, where we work on internal scripts: You talk to yourself and say, “I’m not going to do anything else until I get this done.”
We also use coaches who help people set short- and long-term goals.
And we talk about ADHD-friendly lifestyles. If someone makes life choices that [accommodate the disorder], they may be able to come off meds.
ADHD doesn’t go away. You still may have symptoms, but those may not impair you. You learn how to manage it and make good choices.
Is it possible to treat ADHD with only behavior modification?
It depends on the person’s problems. In some studies, behavior management has worked very well.
But a lot of parents have ADHD and it’s very hard for them to effectively conduct a behavioral program for their kids.
Medications improve ADHD’s core symptoms – inattention, distractibility, impulsivity and hyperactivity – but they don’t teach you new skills.
So while you’re able to pay attention long enough to clean your room, you still may not know how to clean your room. I still may need to teach you those organizational skills.
What medications help?
Two types of medications are used. Stimulants (methylphenidate and amphetamine preparations) are the most effective first-line ADHD treatment. Most are at least 70%-80% effective when prescribed at appropriate dosages in adults.
Non-stimulants (including atomoxetine or guanfacine) are also quite effective.
Can pregnant women take the medications?
There’s no prospective long-term study where we’ve given pregnant women these meds and seen what happens to them.
Right now, stimulants aren’t recommended during pregnancy. Many women do a little bit better [with ADHD] when they’re pregnant anyway because of higher estrogen levels.
I recommend pregnant women get more rest, eat well and get more support if they’re not taking their meds.
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