Russell A. Barkley, PhD, clinical professor of psychiatry at the Medical University of South Carolina, and author of “Taking Charge of Adult A.D.H.D.,” responds to a New York Times reader’s question about attention deficit hyperactivity disorder (ADHD).
Q. Can you talk about the way A.D.H.D. manifests in adult women as opposed to men? My wife has a whopping case of it, but even people close to her don’t see it because they don’t live with her and she’s developed some basic coping mechanisms — and because they presume the male hyperactive version instead of the female dreamy and distractible version. — J, Washington, D.C.
A. First, it is important to note that attention deficit hyperactivity disorder does not present all that much differently in women from the way it does in men. Most research on this issue has confirmed this. While symptoms may vary somewhat among children, they are virtually the same by adulthood.
In childhood, boys are three times as likely as girls to have A.D.H.D. Boys with the disorder tend to be more hyperactive and impulsive and are more likely to develop oppositional behavior, conduct problems and later delinquency than girls, though girls, too, can develop these problems. Girls, on the other hand, may be more prone to develop anxiety, depression and eating disorders — bulimia, in particular.
By adulthood, the proportion of men to women with the disorder is nearly even, and there are few differences in the symptoms. Both men and women have significant problems with executive functioning, which involves skills like time management, self-organization and problem-solving, as well as self-restraint, self-motivation and self-regulation of emotions. All of these problems can have a major effect on daily life activities, like family relations, child-rearing, managing money, functioning at work or driving.
Where men and women may differ is in the amount of time they engage in these activities – and the subsequent impact on daily life. A woman who works full time outside the home, for instance, would have more work-related difficulties, whereas a stay-at-home mother might have more problems related to home life. To the extent that women may opt for certain roles, those roles will be more greatly affected by the disorder, and vice versa for men.
In the general population, men and women may be more likely to have certain problems. For example, women may be more prone to depression and anxiety or have more emotional control problems than men, whereas antisocial behavior and problems with drug use tend to be more common in men. Men also tend to drive more than women, and hence may have more traffic accidents. These same differences in the general population are also applicable to men and women with A.D.H.D., but the disorder cannot be blamed for them.
The symptom of daydreaming, which you describe in relation to your wife, can certainly occur in A.D.H.D., but daydreaming is no more common in women than in men. But the presence of behavior does raise the possibility that the person you describe may have the inattentive type of A.D.H.D., with no hyperactivity or impulsiveness. Some clinicians and others refer to this condition as attention deficit disorder, or A.D.D., leaving out the H.
But increasingly, researchers are now referring to this condition as “sluggish cognitive tempo,” or S.C.T. The term refers to a constellation of symptoms that include daydreaming, being “spacey” or easily confused, mental fogginess, or being slow-moving, lethargic or less active than usual. My own recent research shows that S.C.T. is a separate and distinct disorder from A.D.H.D. that may have different causes and may not respond as well to the same treatments. It is less impairing than A.D.H.D. but can still be a troublesome attention disorder to have. The two disorders, A.D.H.D. and S.C.T., also overlap in about 20 percent of cases. Most of the time, though, they occur separately.
For more information, see Dr. Barkley’s responses in the Related Posts section, below, and The Times Health Guide: A.D.H.D.