Only in recent years have a few studies begun to focus on the possibility that women have ADHD. Females with ADHD are often overlooked when they are young girls, and some believe that the symptoms present in a different manner. However, according to Michael Manos (2005), symptoms of inattention, distractibility, impulsivity, and hyperactivity in women are the same as symptoms of ADHD in men. Because ADHD is a biogenetic, the condition does not distinguish itself in symptoms that differ by sex.

In a 2004 study Biederman and colleagues compared women and men on the 18 DSM-IV symptoms of inattention, hyperactivity, and impulsivity, in which only one symptom, ''talks excessively,'' was reported to be significantly different in women.

According to Barkley (2006), in childhood boys are three times more likely to have ADHD than girls and five to nine times more likely than girls to be seen by physicians. Brown et al. (1989) found that girls were more socially withdrawn and had the internalizing symptoms of anxiety and depression than did boys but had similar evaluations on clinical measures of their symptoms. Girls probably showed fewer aggressive and impulsive symptoms and had lower rates of conduct disorders. The age at diagnosis for girls tends to be much later. However, in adulthood, just as many women are diagnosed and treated as men. The difference appears not to be in the symptoms; the varied expression of symptoms in the daily lives of men and women is quite different. Researchers suggest that the brain function is the same in both males and females but the actual behavioral expression of brain functioning is very different.

One of the areas of differing expression is in the idea of locus of control, the place from which people feel they manage their daily activities. If one has an internal locus of control, the individual believes that he or she determines the happenings and events in life and that it is under control. She operates on the premise that she makes decisions that affect her environment. External control means that the individual things happens to her and that she has no control over life and her own efforts are not effective. Personal initiative makes no difference because of a ''poor me--everything just happens to me.'' In general people with an external locus of control do not use or appreciate their talents and do not meaningfully contribute to the lives of others.

Rucklidge and Tannock (2001) found that girls with ADHD lose a sense of internal locus of control sooner than those without ADHD. In adulthood, their difficulties may be magnified in a sense of self-ineffectiveness and low self-regard. For example, a young woman with an IQ of 140 decided to work in her mother's nail salon because she thought that she was stupid and could do nothing else; years of failure in school because of inattention led her to the conclusion that she was not capable. She had come to the conclusion that in her life nothing that she could do would make the difference; she had an external locus of control.

Rucklidge observed the following in her study of women with ADHD:

- Women with ADHD are more likely to show learned helplessness. The idea, ''poor me--I can't do it begins early in school.'' They respond to negative situations with resignation and tend to blame themselves when things go wrong.

- Women with ADHD think they cannot control the outcomes of their lives and that they are unable to accomplish anything.

- Women will be more likely to report depression and anxiety and have been in psychological treatment more often than women without ADHD.

Cultural expectations of women may also bring out obvious symptoms of ADHD. It may become critical for women in their late 40s and 50s. Women need managerial skills to manage families, joggle demands of a job, and juggle multiple activities. The symptoms of ADHD increase with obvious demand; women may turn to drugs, alcohol, or other self-destructive pursuits to cope.

Nicole Crawford (2003) calls ADHD a women's issue with gender bias in research on ADHD. She describes the studies of several psychologists and researchers, including an article by psychologist Stephen B. Hinshaw, who published one of the first studies of girls with ADHD in the Journal of Consulting and Clinical Psychology. Prior studies had focused on comparing girls to boys, using boys ADHD symptoms as the marker for measurement. Hinshaw concluded that girls experience significant symptoms that are often overlooked because they bear little resemblance to those of boys. This observation also highlights the fact that current diagnostic criteria as found in DSM-IV focus on male rather than females and parent and teacher referral patterns. The new DSM hopefully will address ADHD in girls and women.

Crawford also refers to the work of educational researcher Jane Adelizzi who theorizes that researchers have neglected women with ADHD because hyperactivity is usually missing in girls and they just have the inattention. She likened the unpleasant and stressful experiences of girls with ADHD in education to post traumatic stress disorder (PTSD). However, when they are undiagnosed, they will carry their problems into adulthood, and left untreated, their lives fall apart. They are then at risk for low self-esteem, underachievement, anxiety, depression, teen pregnancy, and underage smoking and drinking.

Treating women for ADHD is often more complicated than treating for men with ADHD. Prescribing any medication must take into consideration all aspects of the women's life including treatment for coexisting conditions, including possible substance abuse and alcoholism. Considering hormonal fluctuations across the menstrual cycle and across the lifespan is imperative. According to a study by Quinn et al. (2002) reduced levels of the hormone estrogen may increase symptoms of ADHD. In some cases, hormone replacement therapy must be added to control hormonal fluctuations. Women with ADHD are usually treated with a combination of stimulant medications. ADD-focused psychotherapy, which is structured and goaloriented, must accompany the medication.

Other treatment approaches may benefit the woman with ADHD:

- Parent training. Women are generally expected to be family managers and that requires organization and parenting skills. However, if the person has high levels of ADHD symptoms, the training may less effective.

- Group therapy. Social problems for women with ADHD develop early and appear to increase with age. Because many women with ADHD feel shame and rejection, group therapy sessions can provide a place where they are safe and understood.

- ADHD coaching. Coaching is a new profession that has developed in response to the need among some adults with ADHD for structure, support, and focus. Coaching may take place by telephone or e-mail.

- Professional organizing. The organizer profession has been made popular with television programs that help people organize their space and lives. A professional organizer may provide hand-on assistance at home and office for a system that is easy to manage and maintain.

- Career guidance. Women may need specific guidance about their careers. Some of the tasks involved in office management are challenging for a person with ADHD who must pay attention to detail, scheduling, paper work, and an organized workspace.

Bibliography:

1) Biederman, J. et al. 2004. Gender effects of attention-deficit/hyperactivity disorder in adults, revisited. Biological Psychiatry 55:692-700;

2) Brown, T. E. et al. 2006. ADHD gender differences in a clinic-referred sample. In Attention-deficit hyperactive disorder: A handbook for diagnosis and treatment. 3rd ed., edited by Russell Barkley. New York: Guilford Publications;

3) Crawford, Nicole. 2003. ''ADHD: A women's issue: Psychologists are fighting gender bias in research on attention-deficit hyperactivity disorder.'';

4) Quinn, P. 2002. Hormonal fluctuations and the influence of estrogen in the treatment of women with ADHD. In Gender issues and ADHD Research, diagnosis, and treatment, edited by P. Quinn and K. Nadeau, 183-99. Silver Spring, MD: Advantage Books;

5) Rucklidge, J. J., and R. Tannock. 2001. Psychiatric, psychosocial, and cognitive functioning of female adolescents with ADHD. Journal of the American Academy of Adolescent Psychiatry 40(5):530-40.

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