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Who do you picture when you think of someone with ADHD?

If you’re like most of us, your first thought is probably of a hyperactive, impulsive boy. A boy whose behavior is much more noticeable than that of a withdrawn girl.

Yes, girls with ADHD are much more likely to have “inattentive-type” ADHD—they are not fidgety and aggressive but distracted, forgetful, and inattentive. And because of this difference, mental health providers can be “inattentive” too—not diagnosing and not treating ADHD.

A quick look at the research makes it clear that gender-bias in the diagnosis and treatment of ADHD is very real…

ADHD Statistics Don’t Lie

Boys are twice as likely to be diagnosed with ADHD as girls—13% of boys compared to 6% of girls. (CDC data)

On average, girls are diagnosed four years later than boys. In a recent study of more than 85,000 people, girls got diagnosed with ADHD at the average age of 23, compared to 19 for boys.

And that’s a “failure” for women and society, conclude the authors of the study, who write:

“To prevent long-term adverse consequences for females with ADHD, methods, and tools for early diagnosis and treatments that mitigate personal suffering and societal burden are warranted.” (The Journal of Child Psychiatry and Psychology, November 28, 2023)

There are other reasons why girls are under-diagnosed aside from the fact that inattentive-predominant ADHD is more noticeable than hyperactive-predominant ADHD…

Girls with ADHD might be missed because they’re trying to be missed—they’re masking or hiding their symptoms to conform to social expectations for girls.

Or a girl might be diagnosed with depression or anxiety—which often co-occur in girls with ADHD—and the ADHD is overlooked.

But even when they’re diagnosed, girls are likely to be under-treated.

In an analysis of more than 20 studies, only 25% of adolescent girls diagnosed with ADHD received a prescription for ADHD medication, compared to 75% of adolescent boys. (PLOS ONE, September 18, 2020)

And when a child, adolescent or adult with ADHD isn’t diagnosed and treated, they end up dealing with symptoms on their own—and they may not deal very well. Not at school. Not at work. Not in their relationships.

As I wrote in my book Finally Focused, an adult woman with ADHD might find it next to impossible to meet life’s relentless demands for attention to detail, organization, and planning. She might start every day vowing to “get organized”—and then spend the rest of the day looking for things amid a mess of papers and stuff, catching up, trying to cope…and feeling overwhelmed.

Female-Specific ADHD Treatment

Fortunately, there’s a measurable shift away from gender bias in ADHD…

The percentage of adult women (ages of 23 to 49) newly diagnosed with ADHD doubled from 2020 to 2022. (Epic Research, March 20, 2023)

The number of U.S. women ages 15 to 44 who filled a prescription for ADHD medicine increased more than three-fold (344%) between 2003 and 2015. (CDC data)

And a growing body of scientific literature makes clear that when women are treated with ADHD, they need to be treated as women—because there are many issues unique to women with ADHD. For example:

Hormones

The mind- and mood-influencing fluctuation of reproductive hormones during the menstrual cycle, the perinatal period (pregnancy to a year after giving birth), perimenopause, and menopause call for “female-specific” treatment regimens for ADHD. (Journal of Clinical Medicine, April 4, 2024)

Medications

There’s a need for female-specific pharmacotherapy in ADHD, with research showing that increased doses of ADHD medication during the premenstrual period improve symptoms like inattention, irritability and fatigue. (Frontiers in Psychiatry, December 12, 2023)

Pregnancy care

Pregnancy care for women with ADHD should take into account their higher incidence of maternal and neonatal complications. (BMC Pregnancy and Childbirth, May 15, 2024)

Comorbidities

Practitioners must acknowledge the influence of psychiatric comorbidities like depression in women with ADHD. (The Journal of Sexual Medicine, April 16, 2024)

Low self-esteem

Low self-esteem must be addressed. According to a study published in Sage Choice (August 2023), “…girls and women with ADHD are more likely to experience low self-esteem in comparison to males with ADHD and non-ADHD females.” Further, “Low self-esteem predicts negative real-world consequences, such as unemployment, low socioeconomic status, and poor mental and physical health.”

The same study concludes:

“Overall, the research identifies the pressing need for greater understanding and appreciation of ADHD in females, particularly amongst health professionals.”

I would add to that conclusion and say the research also identifies the pressing need for greater biological understanding and appreciation of ADHD—in girls and boys, in women and men.

We need both gender-specific and individual-specific medicine. Precision medicine that takes into account the underlying causes of mental disorders—the unique biochemical deficiencies and imbalances in each person.

Psychiatry Redefined

Addressing these underlying causes is exactly the Functional Psychiatric treatment approach that we teach here at Psychiatry Redefined. For years we have been showing what’s possible, training health-care providers in the functional and integrative management of mental health conditions, including ADHD.

Health care professionals often overlook nutrients; yet imbalances in many minerals are frequently seen with ADHD. Fortunately, replenishing and balancing nutrients – like copper, zinc, and magnesium – with an integrative treatment plan has proven to be an effective treatment for the symptoms of ADHD, and many other mental health disorders.

By addressing the unique imbalances of each patient and using a more comprehensive, whole-person approach, symptom resolution and recovery is more often attainable than with medications alone.

If you’re interested in learning more, consider our Functional Medicine for Psychiatry Fellowship, which begins in July 2024. Schedule a call to determine if our Fellowship is the right catalyst to help you build your practice and your wellness toolkit and help more patients seeking root cause recovery.

Want to learn more functional medicine approaches to help your patients? Enroll in our certified Fellowship for professionals. Book a private call with Dr. Greenblatt to learn more and inquire about scholarships!

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