“Women Need Better, More Accurate Diagnostic Tools for ADHD”
“Women are raising their voices against long-established male-centric thinking about ADHD and demanding diagnostic criteria that reflect the female experience.”
There is a revolution underway.
Women are raising their voices against long-established male-centric thinking about ADHD and demanding diagnostic criteria that reflect the female experience of ADHD. Most diagnostic tools have been developed by men and screen for symptoms seen in boys with ADHD, a huge impediment to proper care and treatment for girls and women with the condition. Even the questionnaires that are considered gender normed — meaning adjusted to ensure equal rates across genders — ask male-centric questions but require fewer points for a female to meet the threshold for a clinical diagnosis.
For example, the Adult ADHD Self-Report Scale (ASRS) is widely accepted as a standard screener for identifying adults with ADHD. This questionnaire, like many others, was developed by males to identify traits consistent with the male-centric Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria.
How Screeners Fail Women
All six of the most salient items on the ASRS describe most men with ADHD, while only three pertain to most females. Individuals must respond with “sometimes,” “often,” or “very often” to at least four of the questions to warrant further assessment for an ADHD diagnosis, causing an obvious problem for women.
[Get This Free Guide: ADHD Diagnosis for Women]
Here’s my analysis of the three problematic questions:
1. How often do you have trouble wrapping up the final details of a project once the challenging parts have been done?
This question implies that an intellectually challenging project becomes difficult to complete after it’s no longer interesting. The “projects” many women face are mountains of laundry, dishes piled in the sink, managing kids’ schedules, and grocery shopping. Completing these tasks is not related to losing interest; these projects were never interesting to begin with.
2. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
Because many women fall into the predominantly inattentive category, they are less likely to routinely fidget or squirm.
3. How often do you feel overly active and compelled to do things, like you were driven by a motor?
Again, because women are predominantly inattentive, they are not “driven by a motor.”
Due to the working of these questions, few women with ADHD would ever reach the “four or more” requirement to indicate that further ADHD investigation is warranted. Even when follow-up does take place, no clear guidelines exist to tell clinicians how ADHD impacts females. When ADHD is misdiagnosed or undiagnosed and untreated, the consequences can be extremely serious.
[Get This Free Download: Hormones and ADHD in Women]
Better Training = Accurate Diagnoses
Clinicians need better training to recognize the unique ways that ADHD impacts and manifests in women. For example, women are more likely than men to experience:
- co-occurring anxiety and depression that can be viewed inaccurately as the primary cause for their inattention and feelings of overwhelm
- feelings of overwhelm and failure in response to unreasonable societal expectations that they are unable to meet
- intense reactions to social rejection
- social isolation
- hidden symptoms due to masking and strong efforts to compensate
- emotional regulation problems
- hormone-related symptom variation
- self-harm, psychiatric hospitalization, and suicidality
- domestic abuse
One of the most urgent needs in the ADHD community is more gender-appropriate diagnostic criteria and treatment approaches for females. We must continue to speak out until the medical community responds appropriately and effectively.
Diagnostic Criteria for ADHD: Next Steps
- Learn: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.
- Symptom Test: Signs of ADHD in Girls and Women
- Understand:Why We Need U.S. Guidelines for Adults with ADHD
Kathleen Nadeau, Ph.D., is the author of more than a dozen ADHD-related books, including her most recent, Still Distracted After All These Years: Help and Support for Older Adults with ADHD. (#CommissionsEarned)
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