The Science Behind ADHD and Women
The following is an excerpt from my upcoming e-book, Dancing with ADHD, Demystifying ADHD for Women. Watch here for the publication announcement.
The experience of ADHD and learning to navigate it is like a dance, with each of us finding our rhythm amidst the ebbs and flows of life. Today, let's dance deeper into the realm of ADHD, specifically, how it manifests and plays out in the extraordinary lives of women!
The Brain's Elegant Ballet: The Science Behind ADHD
Attention-Deficit/Hyperactivity Disorder is more than just a series of symptoms or behaviours. It's rooted in the very structure and function of the brain. Let's start by looking at the brain of an individual with ADHD. Have you ever wondered what's orchestrating the dance of our thoughts, emotions, and behaviours? It's the magical choreography happening within our brains!
Neurotransmitters: Neurotransmitters are chemical messengers responsible for transmitting signals in the brain. Two of them, dopamine and norepinephrine, play pivotal roles in attention, planning, impulse control, and mood regulation. There's often an imbalance of these neurotransmitters in people with ADHD, leading to challenges in these areas.
Dopamine plays a crucial role in the brain’s reward system. It’s associated with pleasure and satisfaction derived from achieving specific goals. When dopamine levels are low, motivation can dwindle, and individuals might struggle to start or complete tasks.
Norepinephrine is tied to alertness and attention. It affects how the brain responds to events, especially those that are novel or punishing. An imbalance in norepinephrine can impact attention span and impulse control.
As stated, in ADHD, there can be an imbalance or dysfunction in the pathways of these neurotransmitters. This dysfunction could lead to challenges in sustaining attention, impulsivity, and hyperactivity. Think of neurotransmitters like dopamine and norepinephrine as the lead dancers in our brain's ballet. An imbalance in their performance can lead to a few missteps, like challenges in attention or impulse control.
Prefrontal Cortex: The prefrontal cortex sits at the front of the brain, behind our forehead and is a part of the brain's frontal lobes. It's often called the "executive part" of the brain due to its role in complex cognitive processes. This part of our brain is like the choreographer of our mental ballet, directing our impulse control, decision-making, and attention. The prefrontal cortex tends to be less active and may develop more slowly in individuals with ADHD. In other words, sometimes, this choreographer may be a tad off-beat in ADHD, which offers insight into some of our unique moves.
Impulse Control: The prefrontal cortex helps inhibit inappropriate behaviours, allowing for reasoned responses. An underactive prefrontal cortex in those experiencing ADHD can result in difficulty withholding a response, leading to impulsive actions.
Decision Making: Weighing the pros and cons and making decisions based on past experiences or predicting future outcomes are primarily essentially of the prefrontal cortex. Dysfunction here can result in hasty decisions without considering long-term consequences.
Attention: The prefrontal cortex helps in focusing on tasks, shifting attention when needed, and organizing tasks. In ADHD, the efficiency of these functions can be compromised, causing distractibility and difficulty in managing tasks.
Brain Connectivity: Our brain is an intricate network of interconnected neurons with different regions communicating continuously. In ADHD, some studies have shown altered connectivity, especially in networks associated with attention and impulse control. Studies using functional MRI (fMRI) have shown that in ADHD, there's less coordination among different brain areas, particularly those linked with attention and visual processing.
Default Mode Network (DMN): Typically, it is more active when the brain is at rest and not focused on the external world. In ADHD, DMN might be overactive when attention is required, leading to distractibility and missing cues, especially in areas tied to attention.
Task-Positive Network (TPN): Activated during tasks requiring attention. In ADHD, this network might not be as active or coordinate as well with the DMN, leading to difficulties in sustained attention.
The ADHD Dance Variations in Women: The Diagnosis
While ADHD is a single diagnosis, it can manifest in multiple ways. The diagnostic criteria for ADHD are the same regardless of gender or age. However, the way ADHD presents itself can vary among individuals, and there are some trends in symptom presentation and challenges that are more common in women; the dance of ADHD isn't one-size-fits-all; there are variations. Diagnosing ADHD can be a bit like identifying specific dance styles. With societal norms and other coexisting conditions (like anxiety), our unique ADHD symptoms might sometimes be mistaken for other diagnoses. Recognizing our dance and giving it the correct name is vital to owning our moves and finding the best ways to shine. Traditionally, it's categorized into three main subtypes:
Inattentive Type: This type is dominated by symptoms of inattention like forgetfulness, difficulty in organizing tasks, or missing details. It can be characterized by drifting thoughts or difficulty in keeping up with the tasks and symptoms like forgetfulness or difficulty in organizing tasks.
Hyperactive-Impulsive Type: Characterized by fidgeting, difficulty remaining seated, rushing through tasks, or excessive talking. This type is marked by restlessness or spontaneous actions.
Combined Type: A mix of both inattentive and hyperactive-impulsive symptoms.
ADHD in women often remains underdiagnosed or misdiagnosed for various reasons:
Internalized Symptoms: Unlike the external, hyperactive symptoms, internalized symptoms like inattentiveness or daydreaming can go unnoticed.
Societal Expectations: Women are often expected to be caregivers, organized, and attentive, leading to a lot of undiagnosed women developing coping strategies that mask their ADHD.
Comorbid Conditions: ADHD in women often coexists with other conditions like anxiety or depression, which can overshadow ADHD symptoms.
Women with ADHD are more likely to be diagnosed with inattentive subtypes. They may present with symptoms like forgetfulness, difficulty organizing tasks, or being easily distracted. Additionally, women with ADHD might also be more likely to have coexisting conditions like anxiety, depression, or eating disorders.
The Ebb and Flow: Hormones and ADHD
The rhythms of our hormones further influence the dance of ADHD. Just as in dance, where the music's tempo can change, our hormonal levels can shift our ADHD moves. This dance is not only vital for maintaining our health and well-being, but it also plays a significant role in how our cognitive and emotional systems function. Particularly for women, the rhythm of hormones across different stages of life can have a considerable impact on ADHD symptoms. For women with ADHD, the hormonal fluctuations can reshape the contours of their ADHD experience.
Premenstrual Phase: Estrogen governs many cognitive and emotional processes. When this hormone recedes during the premenstrual phase, ADHD symptoms often become more evident. This can lead to heightened inattention, impulsivity, or emotional reactivity. The backdrop of other premenstrual symptoms like mood swings or physical discomfort can further amplify these ADHD characteristics.
Pregnancy: Pregnancy is like an elaborate performance with multiple acts. Estrogen levels rise significantly, especially into the final trimester. For some women, this surge in estrogen can act to counteract ADHD symptoms, leading to a temporary alleviation or a different experience of these symptoms. The tranquillity of this can sometimes be disrupted postpartum when hormonal levels drop, possibly leading to a resurgence or amplification of ADHD symptoms.
Menopause: As the reproductive years decline, estrogen also begins to decline. With the gradual exit of estrogen, ADHD symptoms often come under the spotlight, making them more noticeable or intensified for some women. Menopause brings with it several other changes – both physical and emotional – and these can also interplay with ADHD in complex ways.
Recognizing these hormonal shifts is akin to understanding the rhythm and nuances of a dance performance. By being aware of the potential crescendos and decrescendos in ADHD symptoms due to hormonal changes, women can better anticipate, manage, and adapt to these shifts. This knowledge, paired with appropriate medical and therapeutic interventions, can help navigate the dance of life with grace, resilience, and empowerment.
A Graceful Bow: Conclusion
ADHD is not just about neurobiology; it's a dance of the soul. By understanding the intricate choreography of brain functions and hormonal shifts that shape our ADHD, we’re better equipped to twirl, leap, and glide gracefully.
So, here's to every ADHD woman: Keep dancing, keep shining, and remember, understanding your dance is the first step to empowerment. Every dance has its unique rhythm and beauty. Embrace yours with all its nuances and complexities!
To endless twirls and leaps of understanding in this world of ADHD,
Lisa
References:
Arnsten, Amy F.T. Ph.D. (2010) The Emerging Neurobiology of Attention Deficit Hyperactivity Disorder: The Key Role of the Prefrontal Association Cortex
Castellanos, F.X., & Proal, E. (2012). Large-scale brain systems in ADHD. Brain Imaging and Behavior.
Hantsoo, L., & Epperson, C.N. (2020). Premenstrual Dysphoric Disorder: Epidemiology and Treatment.
Rubia, K. (2018). Neuroanatomic abnormalities in ADHD.* Journal of Clinical Psychiatry.