Women with undiagnosed ADHD at risk of suicide, says US psychologist

Girls less likely to be hyperactive in class but suffer ‘internal chaos and restlessness’

Girls and women with undiagnosed Attention Deficit Hyperactivity Disorder (ADHD) are at risk of anxiety, depression and suicide, a leading American clinical psychologist has said.

Dr Ellen B Littman said because of societal expectations, girls with the condition tend to try to conform in class, so are less likely to demonstrate the hyperactivity seen in boys with the condition, but still have “internal chaos and restlessness”.

“Since they are not disruptive, they are more likely to be the girls in class that either are daydreamers . . . or they would be the chatty giggling girls,” she said.

“But in either case there would still be the issue of inattentiveness; they weren’t focused on the topic at hand, they would be forgetful and have to be told things many times.”


She said society has expectations for girls and women that involve listening, organising, co-operating and caring for others’ needs.

“Those are all things that girls with ADHD are not good at, so there is a lot of shame,” she said.

“What ends up being observable are feelings of anxiety and depression . . . so they often get misdiagnosed.”

Other red flags that could indicate the condition include constantly picking at cuticles, nails and scabs, and inconsistent achievement at school, despite ability.

ADHD is a neurodevelopmental disorder that affects approximately 5 per cent of children and 3 per cent of adults, according to support group HADD Ireland. It is estimated to affect 200,000 people here, and is the most common condition diagnosed by Child and Adolescent Mental Health Services.

Dr Littman said women with the condition may lose things, their home may be in chaos and they may be poor at managing finances

Dr Littman described it as a difference in brain wiring. She said for the ADHD brain to focus optimally, it has to be very stimulated and when it is, people with the condition focus as well as anyone and are as smart as anyone else.

Most people in a boring meeting or class will “power through”, she said, but people with ADHD cannot engage with things that are not stimulating.

“As a result you have a very inconsistent picture of achievement; in the things that they like, they are fabulous and in the things that don’t interest them, they cannot motivate themselves,” she said.

Managing finances

Dr Littman said women with the condition may lose things, their home may be in chaos and they may be poor at managing finances. They feel compelled to present a good facade, she said, but their internal experience is “I’ve left the water running at home and I forgot to pick up my child and I didn’t return those calls”.

They feel worse and worse about not being able to conform to basic feminine ideals, such as managing a family and children and organising a house.

“Their brains are just not wired to do that really well and they are struggling all the time and they are further ashamed,” she said.

Research shows women with ADHD are more likely to self-harm or attempt suicide, she said, and are also much more likely to die early of unnatural causes related to inattentiveness.

“Those are pretty scary public health statistics that none of us can ignore,” Dr Littman said.

The condition is also “one of the most heritable disorders there is”, she said, so if a child has it, at least one parent will have had it.

There are medications to treat the condition, though Dr Littman does not prescribe them. She said psychological education is needed for the whole family and once people know what is going on, they can find out what makes things easier or more difficult.

Dr Littman addressed a conference at Trinity last week as part of ADHD Girls and Women’s event, for ADHD Month, organised by HADD Ireland.

Also speaking at the event were Margo Wrigley, clinical lead for the National Clinical Programme on ADHD in Adults and Dr Hanni Kiiski, researcher at Trinity’s Institute of Neuroscience.

Fiona Gartland

Fiona Gartland

Fiona Gartland is a crime writer and former Irish Times journalist