The Science of ADHD: How it affects Women differently & tips to manage it naturally
Last year, I was diagnosed with PMDD (Pre-Menstrual Dysmorphic Disorder), which is basically a more extreme version of PMS. My endocrinologist who diagnosed me mentioned that he found that women who have PMDD also tend to have ADHD/ADD (Attention-deficit/hyperactivity disorder). At the time, I thought no, not me. Recently I have been diving deep to understand how ADHD presents in women and how to manage symptoms naturally. Basically, ADHD in females is a lot harder to detect as the symptoms often don't always manifest themselves externally as do in males, for females the symptoms are more internalised, and tend to get more severe if left untreated with age, where as it is the opposite with males.
Here are some of the key differences :
Symptom Presentation:
Hyperactivity: Traditionally, ADHD has been associated with hyperactivity, which is often more noticeable in boys. Boys with ADHD may display more physical restlessness, fidgeting, and impulsivity.
Inattention: Girls with ADHD might exhibit more inattentive symptoms rather than hyperactivity. They might struggle with maintaining focus, organisation, and task completion. These symptoms might be less noticeable but still impactful.
Social Coping:
Boys: Boys with ADHD might be more disruptive in a classroom due to hyperactivity and impulsivity. This could lead to earlier identification and intervention.
Girls: Girls with ADHD might develop coping mechanisms to mask their symptoms. They might work harder to appear attentive and organised, leading to their struggles being overlooked or misattributed to other causes.
Internalisation of Symptoms:
Girls: ADHD symptoms in girls can sometimes be internalised, leading to feelings of anxiety, depression, and low self-esteem. They might daydream or mentally "spacing out" instead of visible hyperactivity.
Diagnosis Challenges:
Girls are often underdiagnosed or diagnosed later in life due to their more subtle symptom presentation. Professionals might overlook ADHD in girls since they don't fit the classic hyperactive profile.
Women: Many women might not receive a diagnosis until adulthood. They might have developed various coping mechanisms to manage their symptoms, and as life demands increase, these mechanisms can start to fail, prompting a diagnosis.
Hormonal Influences:
Puberty: Hormonal changes during puberty can impact the presentation of ADHD symptoms in both boys and girls. Girls might experience more pronounced symptoms during hormonal fluctuations—i.e. PMS, Menopause, etc.
As the podcast went on, my mind began to blow wide open. I thought, 'This sounds a lot like me.'
THE SUBTYPES OF ADHD
According to 'Queen of Distraction' Book by Terry Matlen, MSW, there are three subtypes:
Hyperactive/ Impulsive
Inattentive
Combined
For the Hyperactive type, the book lists a series of questions:
Do you have a hard time finishing a book?
Do you fidget during meetings, tapping your fingers or swinging your feet
Do you leave a trail of 'stuff' everywhere?
Do you find it hard to relax?
Do you enjoy high-stimulation activities even if they might be dangerous?
For the Inattentive type:
Do you have a hard time paying attention to detail?
Do you make careless mistakes
Do you tend to be shy?
Do you feel sluggish most of the time?
Do you struggle with hypersensitivities?
Do you have trouble staying on task? ( unless it's an activity you have a keen interest in?)
Do you have a poor memory?
Do you see people's lips moving but not notice what they are saying?
Do you often have difficulties following or understanding instructions?
Do you avoid tasks that often involve a lot of effort?
Are you easily distracted
Do you forget where you have put things?
The combined (most common type) exhibits a combination of both, but not enough to warrant a diagnosis. After going through this introduction to ADHD…. I was left feeling somewhat shocked and also seen by it, so I spoke to my psychologist, who recommended I see a Psychiatrist to do the official test, but the waitlists for 'a good one' are over six months. In the meantime, I have been spending some time understanding the role our hormones play in ADHD, how it shows up in women, and ways to help manage ADHD symptoms naturally.
A SCIENTIFIC EXPLANATION OF ADHD
Neurotransmitter Imbalance: The neurotransmitters dopamine and norepinephrine play a crucial role in regulating attention, impulse control, and motivation, i.e. cognition faculties. In individuals with ADHD, there is often a deficiency in these neurotransmitters or difficulties in proper regulation.
Prefrontal Cortex Dysfunction: In individuals with ADHD, there's evidence of reduced activity and connectivity in the prefrontal cortex. This can lead to difficulty maintaining focus, organising tasks, and inhibiting impulsive behaviours.
Reward System Dysregulation: The brain's reward system, which involves dopamine release, is closely linked to motivation and reinforcement of behaviours. In individuals with ADHD, this system may not function optimally, leading to challenges sustaining interest and engagement in tasks that do not provide immediate rewards.
HORMONE FLUCTUATIONS AND DOPAMINE
Female hormones, specifically estrogen and progesterone, have complex interactions with dopamine, which plays a crucial role in mood regulation, reward processing, motivation, and other essential brain functions.
Estrogen and Dopamine:
Estrogen, one of the primary female sex hormones, can influence dopamine activity. It's suggested that estrogen can enhance dopamine's synthesis, release, and availability in specific brain regions.
Estrogen can increase the number and sensitivity of dopamine receptors in various brain areas, affecting mood, motivation, and cognitive function.
The fluctuations of estrogen levels across the menstrual cycle can lead to changes in dopamine-related processes. For example, some women may experience mood changes or reward sensitivity changes during different cycle phases.
Progesterone and Dopamine:
Some research suggests that progesterone might have an inhibitory effect on dopamine activity. It could reduce dopamine receptor sensitivity in specific brain regions, potentially leading to changes in mood and behaviour.
Progesterone levels rise in the second half of the menstrual cycle (luteal phase) and during pregnancy. Some women may experience mood, anxiety, or motivation changes during these times, which could be related to the interaction between progesterone and dopamine.
Pregnancy and Dopamine:
During pregnancy, there are significant hormonal changes, including elevated levels of both estrogen and progesterone. These changes can impact the dopamine system.
Some women may experience changes in mood, motivation, and reward processing during pregnancy. The interactions between hormonal changes and the dopamine system can influence these changes.
Menopause and Dopamine:
A decline in estrogen and progesterone levels characterises menopause. These hormonal changes can also influence the dopamine system.
Some women going through menopause might experience mood changes, depression, and changes in cognitive function. These changes could be related, at least in part, to the interplay between hormonal shifts and dopamine activity.
MANAGING ADHD NATURALLY
Managing ADHD naturally involves adopting strategies and lifestyle changes to support focus, organisation, and overall well-being. It's important to note that ADHD management is highly individualised, so not all items on this checklist may apply to everyone with ADHD.
PRIORITISE, ROUTINISE & ORGANISE
Use to-do lists, planners, or digital apps to organise tasks.
Break down larger tasks into smaller, manageable steps.
Create a consistent daily schedule with designated tasks, meals, and rest times.
Set alarms or reminders for important activities and transitions.
Declutter your physical space to reduce distractions.
Designate specific places for important items like keys, phone, and wallets.
DIET
Eat a balanced diet, and consider adding dopamine-rich foods such as Almonds, Apples, Avocado, Bananas, Beef liver, Cheese, Fish, Green Veggies, Lean meat, Nuts, grains, Pineapple, Poultry, and Tofu.
Avoid excessive sugar and caffeine intake, which can impact focus and mood.
Hydration! - Water helps improve cognitive function
EXERCISE
Regular physical activity has been shown to address several core symptoms of ADHD and contribute to overall well-being.
Improved Attention and Focus: Exercise has been demonstrated to enhance attention and concentration. Engaging in physical activity increases the release of neurotransmitters like dopamine, norepinephrine, and serotonin, which play a crucial role in regulating attention and focus. This can help individuals with ADHD better manage their symptoms of inattention.
Enhanced Executive Functioning: Executive functions, such as organisation, planning, and problem-solving, can be improved through regular exercise. The cognitive demands of physical activity and increased blood flow to the brain can lead to improvements in these skills.
Mood Regulation: Exercise triggers the release of endorphins, which are natural mood enhancers. Individuals with ADHD often experience mood swings, irritability, and emotional dysregulation. Regular exercise can contribute to more stable moods and reduced emotional volatility.
Stress and Anxiety Reduction: Exercise has a calming effect on the nervous system and can help reduce stress and anxiety levels. For individuals with ADHD who may experience heightened stress levels, exercise can provide a healthy coping mechanism.
Better Sleep Patterns: Regular physical activity can help regulate sleep patterns, improving sleep quality and duration. Better sleep is associated with improved cognitive functioning and reduced ADHD symptoms during the day.
Brain Plasticity and Growth: Regular exercise supports brain plasticity, the brain's ability to reorganise itself and form new connections. This can lead to improved cognitive functioning and adapting to different situations.
NATURE
Exposure to nature, also known as "green therapy" or "ecotherapy," has been studied for its potential positive effects on such as:
Improved Attention and Concentration: Spending time in natural environments, such as parks or green spaces, has been associated with improvements in attention and concentration. Nature provides a more calming and less overstimulating environment than urban settings, benefiting individuals with ADHD who often struggle with maintaining focus.
Enhanced Executive Functioning: Executive functioning refers to cognitive processes like planning, organisation, and problem-solving. Nature exposure can improve these functions in children and adults, which can be particularly beneficial for individuals with ADHD who often struggle with these skills.
Sensory Stimulation: Nature engages multiple senses and provides a rich sensory experience. This sensory stimulation can be engaging and provide a positive outlet for individuals with ADHD who might seek sensory experiences.
Regulation of Circadian Rhythms: Exposure to natural light outdoors can help regulate circadian rhythms and improve sleep patterns. Better sleep can lead to improved cognitive functioning and reduced ADHD symptoms.
In a 2015 study called "Nature Experience Reduces Rumination and Subgenual Prefrontal Cortex Activation," Published in the journal Proceedings of the National Academy of Sciences, it was found that nature exposure can reduce rumination, which could have implications for individuals with ADHD who often experience racing thoughts and overthinking. Read the study here.
ART & CREATIVE HOBBIES
A growing body of research suggests art therapy and engagement in creative activities can be beneficial and therapeutic tools for individuals with ADHD in several ways.
Self-Expression: Art provides a non-verbal means of self-expression. For individuals with ADHD who struggle with verbal communication or have racing thoughts, art allows them to convey their emotions, thoughts, and experiences in a unique and accessible way. This can promote a sense of release and understanding.
Cognitive Skills: Art involves various cognitive processes, such as planning, organising, and problem-solving. Artistic activities can help individuals with ADHD develop and strengthen these skills. For instance, they might need to plan their art project, organise materials, and find solutions if they encounter challenges during the creative process.
Emotional Regulation: Many individuals with ADHD also struggle with emotional regulation. Art can provide a constructive outlet for processing and managing emotions. Creating art can be a calming and soothing experience, helping to reduce anxiety, stress, and impulsivity.
Motor Skills: Some individuals with ADHD also have fine motor skills and coordination difficulties. Engaging in art that involves drawing, painting, or sculpting can help improve these skills over time. The repetitive and controlled movements required in art can contribute to better motor control.
Mindfulness and Relaxation: Art can be a form of mindfulness where individuals fully engage in the present moment. Providing a structured and absorbing activity can help reduce hyperactivity and impulsive behaviour.
Sensory Stimulation: Engaging in different art mediums and textures can provide sensory stimulation, soothing and grounding for individuals with ADHD. Experimenting with other materials can be both enjoyable and therapeutic. A study published in the Journal of Attention Disorders 2013 found improvements in self-regulation, social skills, and emotional expression when children with ADHD participated in school-based group art therapy. Read the study here.
It's important to note that ADHD is a spectrum disorder, and each individual's experience can vary widely. If you suspect you or someone you know has ADHD, seeking a professional diagnosis and appropriate treatment is recommended.
Zara x