6. The Lived Experience of Women with ADHD

[22] Like many mothers with disabilities, women with ADHD (Attention Deficit Hyperactivity Disorder) face additional challenges.  An examination of these challenges reveals shared patterns in the art of mothering with disabilities; it also provides an opportunity to begin discussing the hidden advantages such disabilities can provide, including the unique knowledges generated by reflection on the experiences of such mothers. In expanding the research on motherhood and disability, it is just as important to attend to the unique knowledges and abilities such mothering can produce, as it is to recognize and address faced by mothers with disability.

[23] ADHD is an invisible disability in the sense that the behaviors and history necessary for diagnosis are often not recognized as such by non-experts. “Most of the general public (58%) and teachers (82%) think ADHD is more prevalent in boys. … An overwhelming majority of teachers (85%) and more than half the public (57%) and parents (54%) think girls with ADHD are more likely to remain undiagnosed.” (n21)  There are two responses to the significance of gender for ADHD, the dominant view claims gender is irrelevant and the marginalized view asserts the opposite.

[24] In ADHD in Adults: What the Science Says we find the dominant view: “We largely found little evidence that ADHD in females is different from that in males in any ways that are not typical of sex differences in the general population, and we found no evidence that it is qualitatively different.”(n22) But in works by and about women with ADHD we find a very different narrative:

Without a diagnostic label to help them make sense of their difficulties as children, these women developed a negative view of themselves, perceiving their problems as unchangeable. As adults, this self-perception led to more maladaptive attributional styles, elevated levels of depression and anxiety, lower self-esteem, less effective coping strategies, and more external loci of control as compared to the women without ADHD. (n23)

[25] For those who work with women with ADHD, that gender is significant is not only something women need to know, it is knowledge that changes their lives:

We have been ADD coaches for the past ten years, our clients mostly women. Almost without exception, these women talk about the book (Women with ADD) that ‘saved my life.’ They are not kidding. They are not being hyperbolic. They weep as they describe their profound sense of relief upon reading the book and finding that they are not alone; that there are sisters out there who are similarly oppressed by mountains of ‘stuff,’ both physical and psychological. (n24)

[26] In scientific, psychological and educational research, Attention Deficit Hyperactivity Disorder is understood using what disability theorists call, and critique, the medical model of disability. It is a neurological disorder diagnosable only by psychologists, psychiatrists and neurologists. It is said to exist in both children and adults who, upon rigorous testing, are found to meet the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, version IV, published by the American Psychiatric Association.  Based on such criteria, three types of ADHD are identified: ADHD, Combined Type, ADHD, Predominantly Inattentive Type and ADHD, Predominantly Hyperactive-Impulsive Type.

[27] Discussions of ADHD in public and philosophical forums are often dictated by erroneous assumptions regarding the diagnosis and behaviors of ADHD persons. In such discussions, ADHD is frequently described as a socially motivated practice of labeling normal behavior as abnormal or a genuine disability that is inappropriately used as an excuse. The ADHD literature offers a more familiar description: “Difficulty with attention/focusing… overfocusing… Difficulty with activity level (hyperactivity, hypoactivity, or restlessness)… difficulty with hypersensitivity (mood variability and reactivity)… [and] difficulty with organization of time, details, and paperwork or the breaking of projects into small segments.”(n25) As the list makes evident, ADHD can take many forms, but that it can take opposite forms in the same person at different times, and can significantly impair a person’s ability to function, is rarely discussed outside of ADHD literature.

[28] While the criteria for what constitutes an ADHD person are understood by those conducting research, providing therapy and engaging in advocacy work of behalf of ADHD persons, the role of gender in the diagnosis, treatment and lived experience of ADHD is frequently overlooked. (n26) Most studies of ADHD describe a single disorder that can take multiple forms. It is only through the pioneering work of Sari Solden, Kathleen Nadeau and Patricia Quinn that gender is being rendered visible in the ADHD community. As the three authors emphasize, there remains important work to be done in both understanding how gender impacts ADHD and in advocating for ADHD women. Because much of the treatment for ADHD involves educating oneself about the condition, in order to develop a self-awareness that promotes success rather than failure, many ADHD women unknowingly suffer from the lack of accurate and relevant literature.

[29] When studying ADHD in light of gender, certain injustices are rendered visible. Of the 3-7% identified as ADHD, significantly more than half of those diagnosed, and, through diagnosis, provided with resources for understanding and articulating their experience, are men. Hyperactivity gets attention, especially in the classroom, while inattention gets dismissed as incapacity or lack of interest. Because ADHD men are more often the predominantly hyperactive subtype, while ADHD women are more often the inattentive subtype, women are less frequently referred for diagnostic testing. As a result, they receive less treatment and are regularly left out of research trials–trials that depend heavily on clinical populations, a vicious cycle. Even when referred for diagnosis, one criterion often counts against diagnosis: girls rarely show symptoms before age seven.

[30] If a woman is diagnosed, she still faces major hurdles. The treatment regimens reflect no awareness or consideration of the significant changes in the biological mechanisms of ADHD brought on by variations in estrogen levels; monthly fluctuations in estrogen levels affect the same brain mechanisms that ADHD medications do, altering the effectiveness of treatment both monthly and over the life span. Menopause can adversely affect cognitive function and short-term memory, creating additional challenges for ADHD women who already suffer deficits in these areas. Thus there is an as yet unacknowledged need for regular re-evaluation and changes in treatment regimens for ADHD women. Finally, when the final criterion for the diagnosis of ADHD — that challenges are not better accounted for by another mental disorder– is exercised in an atmosphere of gender inequality, women are more likely to end up diagnosed as depressive or bipolar than ADHD, and subsequently medicated, but the likely cause of their mood disorder is untreated ADHD. (n27)

[31] In addition to biological sources of difference, social prejudices also impact the accuracy and age of diagnosis in women. Because of the continuing pressure to adopt traditional gender roles in contemporary society:

Women have more tasks to do, women’s lives are often more diffuse, women with children have more responsibilities, men more often have partners who organize their lives, men more often have secretaries or other assistants organizing them, men don’t feel the same sense of shame about their disorganization, and men with the same difficulties are more often seen as endearing or absent minded. (n28)

Self-esteem issues are more prevalent in ADHD women than men because these women have deficits in areas where women’s social roles require strengths. Often an ADHD woman’s femininity is called into question because of the same failures. Consequently, “girls with ADHD may have more anxiety, mood and conduct disorders than non ADHD girls. … [in research studies] ADHD females tended to have higher rates of internalizing difficulties than their male counterparts.” (n29) The challenges unique to women with ADHD are compounded when such women become mothers:  “Given that adult women with ADHD report lower levels of global self-esteem than women without ADHD, and that self-esteem has been found to be the strongest single predictor of maternal efficacy, mothers with ADHD symptoms may also have an increased risk for low parenting self-esteem.” (n30) This suspicion is confirmed in the research.

[32] There are biological challenges as well. Women with ADHD often have difficulty regulating eating behaviors, resulting in disordered patterns of eating such as bulimia and binge eating disorder. (n31)  When pregnant, such disordered eating negatively impacts the present and future health of the mother and the fetus. Due to the hereditary nature of ADHD, the biological children of women with ADHD are more likely than the average population to have ADHD. As much research has shown, parenting a child with a disability requires additional skills and resources. In the case of parents with ADHD, the very skills and resources the ADHD child needs to have provided by a caregiver are missing or impaired in the child’s primary caregiver.

Comments are closed.
%d bloggers like this: