Pay Attention
Why are so many women just now finding out they have ADD?

By Emily A. Kane, ND, Lac

"Things are out of order at home, at work, and in my mind,” says Ursula Yeats of Juneau, Alaska, a somewhat agitated 51-year-old woman struggling to preserve her third marriage and her relationship with her 9-year-old daughter. “I have unfinished projects everywhere,” she says.

ADHD or ADD: What’s the difference?
The terms attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) are often used interchangeably and do basically refer to the same disorder. Adults usually are diagnosed as having ADD, however, because symptoms of hyperactivity tend to diminish with age, often taking the form of restlessness or fidgeting. Yeats, a patient of mine whose name has been changed here, may not seem like the obvious attention deficit hyperactivity disorder (ADHD) candidate. After all, ADHD has long been considered a boy’s disorder with symptoms including inattention, hyperactivity, and impulsivity. But according to the national nonprofit organization Children and Adults with Attention-Deficit/Hyperactivity Disorder, ADHD, also known as attention deficit disorder (ADD), is found in approximately 2 percent to 4 percent of the adult population, including some 4 million women. Adults with ADD usually don’t appear hyperactive, but rather have trouble focusing and finishing projects, are disorganized and easily distracted, often lose things, and tend to be procrastinators.

Although once considered two to three times more common in males than females, the ratio is now about equal, according to Deerfield, Illionis-based Peter Jaksa, PhD, past president of the Attention Deficit Disorder Association. In fact, more and more adult women are being diagnosed with ADD—some after their children have received an ADHD diagnosis.

Like mother, like daughter
ADHD begins in childhood, but according to the Center for Adult ADHD, only recently has it been acknowledged that approximately 40 percent of children outgrow their pattern of inattention. That means some 60 percent of children with ADHD will continue to have symptoms later in life—symptoms that may interfere with school, work, and relationships, causing pain and hardship well into adulthood. The side effects of adult ADD run the gamut, from having trouble performing numerous tasks at work, balancing a checkbook, or keeping one’s home organized, to frequently changing jobs, being unable to maintain relationships, or experiencing drug-related or psychiatric problems. In fact, research shows that teenagers with ADHD are more likely to abuse alcohol and drugs than their non-ADHD peers (Journal of Abnormal Psychology, 2003, vol. 112, no. 3). A 2002 study that followed 208 ADHD children into adulthood also revealed that women were more likely than their counterparts to be admitted for psychiatric treatment in adulthood, develop schizophrenia, have mood disorders, and abuse drugs and alcohol (The British Journal of Psychiatry, vol. 181).

Doctors believe diagnosing a female with ADD is more difficult than diagnosing a male—and therefore women are often undertreated. “Women with ADD may go undiagnosed, or misdiagnosed, at the doctor’s office and often are mistakenly put on antidepressants,” says Judyth Reichenberg-Ullman, ND, LCSW, coauthor of Ritalin-Free Kids (Prima Lifestyles, 2000) and Rage-Free Kids (Prima Lifestyles, 1999). One important reason for this underdiagnosis is that girls tend to be overlooked by doctors who more commonly notice ADHD in overly active and disruptive boys. Why this gender bias? The strongest feature of attention deficit in boys and men is hyperactivity—a very obvious, telltale symptom that girls usually don’t exhibit. “ADD goes more unnoticed in females, especially those who are inattentive and not hyperactive,” notes Reichenberg-Ullman.

Today, mothers of young girls who are being diagnosed with ADHD often become aware of similar behavior patterns that they themselves have lived with since childhood. Yeats, for example, realized she had the disorder when her daughter was diagnosed with ADHD. Indeed, more than 20 studies confirm that ADHD can be inherited. A recent study by the University of Maryland ADHD Program showed that parents of children with ADHD—specifically mothers—were found to be 24 times more likely to have ADD compared with parents of kids who don’t have the disorder (Journal of the American Academy of Child and Adolescent Psychiatry, 2003, vol. 42, no. 12). Getting an adult ADD diagnosis and proper treatment can end years of confusion and hardship.

The glucose connection
Adult women who discover they have ADD are finally in a position to seek help and get their lives in order. Although many physicians turn to the prescription drug Ritalin to treat ADHD, naturopathic physicians more often look to a woman’s diet to help manage ADD. And sugar and glucose are often found to be the culprits.

Food Culprits
It may be worth trying an elimination diet to find out whether avoiding one or more of these food groups helps reduce ADD symptoms.

  • Dairy (casein) products
  • Food additives
  • Refined sugar
  • Wheat (gluten) products
  • Yeast

According to Gina Nick, PhD, ND, a researcher in complementary and alternative medicine and chief scientific officer for the Laguna, California-based consulting firm Longevity Through Prevention, “research shows that women are far more likely [than men] to eat when they are upset,” a tendency that compromises glucose control and stress hormones, including cortisol, insulin, and noradrenaline. Although excess sugar in the bloodstream may not cause ADD, it does exacerbate the ADD symptoms of inattention and disorganization. “It is likely that women suffering with ADD would benefit greatly from nutritional measures that specifically help to regulate blood glucose levels and that help women to handle stress better,” says Nick. This is why limiting refined carbohydrates is a key part of many ADD treatment plans.
 

The sugar connection has also been confirmed in a Yale University School of Medicine study, which demonstrated strikingly divergent responses to glucose loading in ADHD children compared with non-ADHD children (Pediatric Research, 1995, vol. 38, no. 4). Because only 40 percent of ADD children outgrow their diagnoses, sugar management as these children become adults continues to be critical. Eating small high-protein, low-carb meals throughout the day helps.

Lifestyle tips to stay focused
Today’s fast-paced, multitasking lifestyle seems to promote inattention, even in those who don’t have ADD. That’s why it’s crucial that any woman suffering from ADD symptoms establishes daily patterns. I recommend the following guidelines to my ADD patients: First, don’t continually move from one city or home to another. Staying put will allow you to plant roots, establish a core of close friends, and find and commit to a fulfilling job.

Resources
ADD Resources: www.addresources.org
Attention Deficit Disorder Association: www.add.org; 484.945.2101
Children and Adults with Attention-Deficit/Hyperactivity Disorder: www.chadd.org; 800.233.4050
Driven To Distraction by Edward Hallowell and John Ratey (Touchstone Books, 1995) Other simple tools include trading TV time for reading and taking up a craft that requires concentration. Physical changes can help, too. Engage in deep breathing to settle your mind; try yoga or tai chi to enhance this practice. Go to bed early enough so that you are always sure to get eight hours of sleep. And when you’re transitioning from one situation to another, for example going home after work, begin to align your mind with the next setting. By letting go of what you’re leaving behind and tuning in to what’s ahead, you’ll be more attentive and focused when spending time with your family or housemates.

Working with me as her doctor, Ursula Yeats has set more realistic expectations about what she can accomplish in one day. She has adopted my suggestion to make a flash card for her next day’s activities before going to bed each night. The card will state what time she needs to be at work, what food she plans to eat, what exercise she’ll engage in, how she’ll work one hour of fun into her day, and what time she’ll be in bed. Creating an orderly program for the unfolding of her life has proven most helpful in treating her ADD.

Changing her diet has also been beneficial. “Giving up doughnuts and coffee in the morning was really hard but so worth it,” says Yeats. “Now I take my flaxseeds or eat fish every day and avoid the processed carb section of the grocery store.” Practicing focus creates focus. “Some weeks, it’s two steps forward and a long step back,” Yeats admits at a 12-week follow-up appointment. “But I think I’ll get through this [and be able] to help my daughter avoid years of confusion like I suffered.”

Emily A. Kane, ND, LAc, is a graduate of Harvard and Bastyr Universities. A registered yoga teacher and health writer, Kane lives in Alaska.