Treatment for ADHD in Women and Girls
The recommended approach for ADHD treatment for women and girls considers their respective needs, stage of life, and symptom intensity along with evidence-based medical and behavioral management.
Effective treatment involves a multimodal approach that often includes medication, therapy and counseling, stress management techniques, workplace and homelife accommodations. Some women and girls incorporate various lifestyle strategies to help manage their ADHD.
The challenge of receiving appropriate treatment
Women with an ADHD diagnosis often face the challenge of finding a professional who can provide appropriate treatment. While the number of clinicians experienced in treating adult ADHD is growing, it can still be difficult to find a professional who takes the challenges women face into consideration while managing treatment. Most clinicians use standard psychotherapeutic approaches, which can provide insight into emotional and interpersonal issues, but do not help a woman with ADHD learn to better manage the disorder or learn strategies to lead a more productive and satisfying life.
ADHD management needs to take a woman’s or girl’s stage of life into consideration. Each of the following factors can affect symptom levels: changes in hormone levels; responsibilities at home, in the workplace, or at school; relationships with significant others, partners, or spouses; relationships with friends, coworkers, and family members. Management of co-occurring conditions also plays a role in managing ADHD symptoms and tailoring treatment to a woman’s or girl’s specific needs.
ADHD-focused therapies address a broad range of issues, including self-esteem, interpersonal and family issues, daily health habits, daily stress levels, and life management skills. These interventions are often referred to as “neurocognitive psychotherapy,” which combines cognitive behavior therapy with cognitive rehabilitation techniques. Cognitive behavior therapy focuses on psychological issues related to ADHD (for example, self-esteem, self-acceptance, self-blame), while the cognitive rehabilitation approach focuses on life management skills for improving cognitive functions (remembering, reasoning, understanding, problem solving, evaluating, and using judgment), learning compensatory strategies, and restructuring the environment.
Recent research shows a relationship between untreated or poorly managed ADHD symptoms and overall health and life expectancy. ADHD that is poorly treated negatively affects a person’s ability to manage other chronic health conditions, such as diabetes, high blood pressure, or depression. Combined with chronic stress, this poor management of overall health can create situations for ongoing poor health and increases the risk of an early death.
Medication management for ADHD
Medication does not cure ADHD. When effective, it eases ADHD symptoms during the time it is active in a woman’s or girl’s body. There are primarily two categories of medications: stimulant and nonstimulant medications. Some clinicians will occasionally prescribe a medication off-label that was not developed to treat ADHD but has been seen to improve some ADHD symptoms.
Prescribing medications for women with ADHD can be more complicated than it is for men. Hormone fluctuations throughout the menstrual cycle, or related to birth control or assisted reproductive technology, and at different stages of life (such as during puberty, pregnancy, perimenopause, and menopause) can cause an increase in ADHD symptoms, especially during the times of decreasing estrogen level. For some women approaching or in menopause, when estrogen levels are fluctuating and dropping the most, hormone replacement therapy may be combined with medication for better symptom management.
Any medication management approach needs to consider all aspects of a woman’s life, including the treatment of coexisting conditions. Additionally, alcohol and substance use disorders are common in women with ADHD, especially if the disorder has been untreated. This requires taking a careful history of substance use before prescribing. This step is not to deter the use of medications in treatment, but to help the clinician and patient choose the medication that is most appropriate in the specific circumstances.
For more information on adult ADHD medication management, see Medication Management.
Behavior management for ADHD symptoms
For girls who have ADHD, behavioral or psychosocial treatment may be recommended along with medication management. Behavioral treatment for ADHD is important for several reasons. First, girls with ADHD face problems in daily life that go well beyond their symptoms, including poor academic performance and behavior at school, poor relationships with peers and siblings, failure to obey adult requests, and poor relationships with their parents. These problems are extremely important, because they predict how children with ADHD will do in the long run.
Behavioral treatments for ADHD should be started as soon as the girl or teen receives a diagnosis. Parents, schools, and practitioners should not postpone effective behavioral treatments for children with ADHD. Learn more about this treatment approach for girls in Psychosocial Treatments. There are behavioral interventions that work well for elementary-age students and others specifically for teenagers.
For women, behavioral management will include more lifestyle supports and possibly cognitive-behavioral therapy. Cognitive-behavioral therapy refers to a type of mental health treatment that focuses on the thoughts and behaviors that occur in the here and now. This approach differs from traditional forms of psychoanalytic or psychodynamic therapy, which involve recapturing and reprocessing the childhood experiences that may result in current emotional problems. A difference of CBT over these earlier therapies is that its goals and methods are stated clearly, and, therefore, can be measured for each individual.
There are CBT programs that were developed specifically for adults with ADHD. Some of these programs aim to help adults overcome their difficulties in everyday executive functions that are needed to effectively manage time, organize, and plan in the short term and the long term. Other programs focus on emotional self-regulation, impulse control, and stress management.
Women who are employing CBT for coexisting conditions, including depression and anxiety, may find this therapy helpful for ADHD symptoms, even though it was not designed specifically to address the symptoms and impairments associated with ADHD. Learn more about this approach at Cognitive-Behavioral Therapy.
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