The objective of this research paper is to increase understanding and raise awareness of women’s experiences of having Attention-Deficit Hyperactivity Disorder (ADHD) with special consideration to gender specific issues. Symptoms for females are different than males because they are less overt. Male symptoms include restlessness, fidgetiness and squirminess, whereas the symptoms in females include forgetfulness, disorganization, low self esteem and demoralization. (Whitbourne, 2014). Women and girls with ADHD have a distinct symptom presentation, with internalizing symptoms being more prominent than externalizing symptoms. Their symptoms are more likely to be missed and less likely to be referred for diagnosis and treatment.
Lack of recognition of ADHD in females can be partly explained because their symptoms, such as forgetfulness, disorganization, low self-esteem, anxiety, and demoralization, are all considerably less overt than the disruptive behaviors typically seen among males. Furthermore, hyperactivity in females is more likely to manifest as hyper talkativeness or emotional reactivity than excessive motor activity. (Quinn, 2005). In this research paper, I will be using a scholarly research article titled ‘Experiences of employed women with attention-deficit/hyperactive disorder: A phenomenological study’, and I will review the research article’s hypothesis, how the study was conducted, who the participants were, what measurements were used to collect the data and finally discuss the results of the study. I will also discuss the common traits of ADHD as it pertains to women and occasionally use myself as an example being recently diagnosed with ADHD “combined type”, I will also discuss the known treatments being used by clinicians.
ADHD is a neurodevelopmental disorder that begins in childhood and has a major impact on social and cognitive functioning involving serious deficits in social interaction and communication skills (Whitbourne, 2014). Most ADHD research points to genetics and heredity for developing ADHD. Having a genetic predisposition for ADHD makes a person more vulnerable to their environment and it can play a role of increasing the severity of a person’s symptoms, such as exposure to maternal stress and traumatic events. Adults and children who meet the DSM – 5 diagnostic criteria for ADHD have, to an extreme degree, behavior patterns in which they are inattentive and hyperactive/impulsive. There are 3 types of diagnoses for ADHD: “predominately hyperactive-impulsive”, “predominately inattentive”, or “combined type”. To be diagnosed with ADHD you must show six or more of the symptoms in either of the categories and these behaviors must be present for at least 6 months to a degree that is maladaptive and inconsistent with the persons developmental level. In addition symptoms must be present prior to the age of 12 years (American Psychiatric Association, 2010). However, it is interesting to note that ADHD materializes much later in females. Many women are diagnosed when they are in college and they have trouble with self regulation and self management. Some women are diagnosed even later in life, when they are over 50 as menopause makes symptoms worse.
The hypothesis of the research study of ‘Experiences of employed women with attention-deficit hyperactive/disorder: A phenomenological study’ was “Employees with ADHD face various risks in the workplace”. This hypothesis was put forward because little is known of the specific challenges women with ADHD encounter in the workplace. Today, most of what is known about women who have ADHD is based on clinical experience of mental health professionals who specialize in treating females with the disorder. For instance, Dr Kathleen Nadeau PhD, Dr Ellen Littman PhD, and Patricia Quinn MD co wrote a book titled Understanding Girls with ADHD based on treating females with the disorder in their clinics.
Clinical research is also vital, in an article on www.apa.org titled ‘ADHD A Woman’s Issue’ stressors how important clinical research is on gender issues in ADHD. Women with ADHD are not being diagnosed due to current diagnostic criteria–which remain more appropriate for males than females. Julia J Rucklidge who is quoted in the article says, ‘We can’t make assumptions that what applies to males will apply to females–females have different hormonal influences to start with that can greatly affect their behavior.’ Also, Rucklidge says, “females are socialized differently and therefore tend to express themselves in a different manner, and are more susceptible to such problems as depression or anxiety that again influence behavior. This suggests that ADHD ‘will manifest and express itself differently in females. But only research can tell us this definitively. Until then, these are assumptions that we make.” (Crawford, 2003)
The method used for the study was the qualitative phenomenological approach. In-depth interviews were conducted with eleven tertiary-educated employed women (average age around 33 years) who were diagnosed with ADHD. Participants had to have a documented diagnosis of ADHD from a neurologist or psychiatrist and without any other self-reported disability or health issues to prevent confusion from comorbidity. Most of the participants, except for one, were born in Israel. The study was conducted using a qualitative study design based on the thematic analysis of interviews. This approach has strengths and limitations. It can provide a rich and detailed view of a human experience. However, it depends upon how well a participant can express themselves and it requires that the researcher be objective and free of bias when interpreting the data. This is why it is beneficial for this study that the transcripts were analyzed by three researchers as it ensures neutrality and objectivity.
Data was collected by means of semi-structured interviews conducted in accordance with an interview guide established by three researchers, following the methodology of Bryman. The research guidelines aim to be conducted in order to understand the social world through examining the interpretation of its participants, it focuses on words rather than quantification in collection of data and it is about depth not breadth (Bryman, 2012). Participants could choose the time and place for an approximately two hour meeting. After completing a short demographic questionnaire, in-depth interviews were conducted by an occupational therapist who specializes in vocational rehabilitation and who also took reflective field notes (Schreuer et al., 2015).
The results confirmed the expected outcomes and the hypothesis. Employees with ADHD face various risks and challenges in the workplace. They have difficulties entering the labor market and have a high occurrence of going from job to job. I can definitely relate to this, I would joke about jumping from job to job and would say “I was a jack of all trades but master of none’, but inside I felt completely lost and chronically insecure. The participants also reported working overtime to try to handle their challenges and increase their productivity, and they experienced behavioral issues, such as irritability and low frustration tolerance, chronic forgetfulness, lateness, disorganization, and impulsivity that lead to conflicts with their managers. As a result, adult women with ADHD are less likely to be promoted and typically earn less than other workers. Compared to their non-ADHD counterparts, employees with ADHD are also prone to higher rates of work-related accidents, trauma, and health-related work impairment, and decreased work productivity. and are three times more likely to have their employment terminated (Schreuer et al., 2015).
One of the main themes that came out of the research paper was the challenges women with ADHD face in coping with job demands and the workplace. Women with ADHD have trouble with identifying the unspoken hierarchy rules and expectations of the workplace. I was fired from several jobs because I did not adhere to the unspoken rules. My friends and family called me a “rebel” but I know my behavior was not rebellious I just did not go about communicating in the way the hierarchy governed because I did not see or understand the social cues. Another aspect that was consistent with the participants experience was challenges in filtering and regulating their reactions to stimuli. The woman reported that stimuli such as noise or bright lights overwhelmed them in a way that interrupted their focus on required tasks. Such oversensitivity to stimuli, like the presence of others in the room or discussions in the corridors, sometimes led to conflicts with supervisors and peers (Schreuer et al., 2015).
The next symptom women in the study shared in regards to coping with job expectations and the workplace was regulating emotions and behavior. The women described intense overreactive emotional outbursts which occurred in inappropriate situations or at inappropriate times. In one of my jobs, I remember coming back from inspecting a nursing home and crying hysterically to my manager that my work colleague would not let me take the lead with the inspection. A non-ADHD person might have discussed it in a rational manner with their work colleague and then to their manager if necessary. As a child growing up, I cried all the time and I was called a “sooky baby” however a symptom of females with ADHD is over-sensitivity. The last aspect relating to the theme of coping with job demands and in the workplace is the challenge of regulating time and boundaries. The women talked about activities taking them much longer than other people require, being late and having a different perception of the dimension of time and the difficulty of discipline and boundaries (Schreuer et al., 2015).
As we can see by this research study women with ADHD suffer psychological distress, feelings of inadequacy, low self-esteem and chronic stress. Women with ADHD feel that their lives are out of control or chaotic and daily tasks may seem to big to tackle. They face feelings of being overwhelmed and exhausted. Also, many women are expected to be caretakers and this role is very difficult for a woman with ADHD and in addition to being employed, this role may greatly increase feelings of inadequacy. In addition to the findings of the study ADHD shows up in behavior in the following ways: the desk where you work is piled high with papers, your mind drifts during conversation or work meetings, friendships can be difficult because social rules seem complicated, women with ADHD do not feel organized with money and often over spend to compensate for other problems and they spend a lot of time, money on research on products to help them be more organized and they do not use them, and they are impulsive when it comes to food and have trouble stopping even when they are full.
Treating ADHD in adults requires a multi-pronged approach. Symptoms are generally treated with medicine. Stimulants such as Adderall, Concerta, Focalin, Vyvanse, Quillivant, and Ritalin in long-acting form are often prescribed for symptoms. The medication should be used in a treatment plan along with psychological such as getting coaching or cognitive therapy for organization and time management and psychosocial like attending an ADHD support group for women. I myself have chosen not to take stimulants and prefer naturopathic methods to treat ADHD “combined type” I take vitamins such as lithium orotate to treat my symptoms of impulsivity, lack of focus and hyperactivity. 5-Hydroxytryptophan (5HTP) is a naturally occurring amino acid and chemical precursor as well as a metabolic intermediate in the biosynthesis of the neurotransmitter serotonin and I use it to help build up serotonin levels. I take grape seed extract to help build up dopamine levels, omega threes such as Krill oil and a lot of minerals for my brain in the form of a protein shake. I have given up sugar and I am also trying out nuerofeedback as a treatment which provides the brain with information it needs to correct itself and function at its most optimal.
In this paper I outlined the symptoms for women with ADHD and I analyzed a study of the difficulties women with ADHD face in the workplace. I endeavored to demonstrate how gender issues can make a difference on how a women can be misdiagnosed and fall through the cracks. It is estimated that 4 million women are living with ADHD (Howden, 2010). As we have seen it affects women at work, at home, at school and in social settings. I believe my life would be different today if I were diagnosed 10 years ago and there are women who have it today and who do not know and who are suffering. Even though the etiology is hereditary most people associate ADHD as a childhood disorder for boys and the common knowledge of treatment is Ritalin and Adderall, again stimulants not associated with treating women. For women this is not just about homework and paying attention in class, this is about our self esteem, our self worth, our creativity and self – expression. Women with ADHD are more likely to suffer from major depression, anxiety and eating disorders. Since my diagnosis I have felt a lot of relief to learn that a lot of my behaviors I have been struggling with for so long are due to having ADHD. I am going to get the conversation started and I have been inspired to create a Youtube channel to help and empower women with ADHD and to raise awareness.