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Amanda Moses

Psychologist and Director of Amanda Moses Psychology and Divergent Assessments.

Email:

Website:

www.amandamosespsychology.com.au 

For clinical training, supervision, and resources.

www.divergentassessments.com.au 

For information about my adult Autism and ADHD assessment services.

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A Bit About Me

I am a senior psychologist and board approved supervisor. My area of interests are ADHD, Autism, and complex psychological assessments. I have been practicing as a psychologist for over 12 years and have recently commenced a PhD with La Trobe University. I supervise and train psychologists and other allied health professionals, and also offer a range of clinical and educational resources. In my clinical work, I conduct adult Autism and ADHD assessments specifically focusing on those with highly internalised or 'high masking' presentations. You can learn more about me here.

Identification of ADHD in Girls and Women: A Critical Look at Sex-Specific Symptoms and Diagnosis

Epidemiological Overview

Diagnostic Disparities and Challenges

Nuances of the Internalised Presentation & Compensatory Strategies

Limitations of Psychological Assessments

Key Takeaways

  • ADHD is more frequently diagnosed in boys during childhood, but the gap closes in adulthood, suggesting significant under-diagnosis in girls.

  • Boys are often diagnosed at younger ages, while many women receive their diagnosis in their 30s or 40s.

  • Research has identified being female as a barrier to timely clinical care, affecting identification, assessment, diagnosis, and treatment of ADHD. 

  • Long-term studies show that ADHD symptoms persist into adulthood for many women, but the manifestations often change over time.

  • High intelligence can mask ADHD symptoms, leading to under-diagnosis. Individuals may excel in specific areas while struggling with routine tasks.

  • Executive Functioning (EF) deficits are central to ADHD and include issues with inhibition, working memory, emotional regulation, and planning. These are often missed in standard cognitive assessments. EF-specific tools like the BRIEF and D-KEFS provide more accurate information relevant to ADHD.

  • Standard psychological assessments focus on externalising behaviours and may overlook internalising symptoms common in females. Rating Scale norms predominantly derive from male or mixed samples, impacting the accurate diagnosis of ADHD in females. 

  • Conditions like anxiety, depression, and eating disorders often overshadow ADHD symptoms, complicating diagnosis and treatment.

  • Females often exhibit inattentiveness, daydreaming, and mental restlessness, rather than observable hyperactivity.

  • Emotional dysregulation and overwhelm are common in females with ADHD. Emotional instability can significantly impact daily functioning and mental health, leading to mood swings and stress management issues.

  • ADHD has also been linked to academic under-achievement, decreased self-esteem and self-concept and the use of dysfunctional strategies such as drinking, using illicit substances to cope with the emotional turmoil.

  • Girls and women frequently develop compensatory strategies, which can mask ADHD and hinder diagnosis. While these strategies can be adaptive, they often conceal the underlying challenges and toll which can be significant. 

  • The diagnostic classification of ADHD was developed from a sample comprising 79% males. Therefore, standard assessments and diagnostic tools often fail to capture the full range of ADHD symptoms in females, focusing more on behaviours typically seen in males.

  • Gathering detailed personal, educational, and social histories are crucial for accurate diagnosis. Particularly focusing on inattentive traits and internalised symptoms. 

  • Tools designed to evaluate executive functioning are necessary to address the limitations of standard cognitive assessments.

  • Interpret psychometric assessments with caution unless there are female-normed samples available. 

  • A comprehensive, multimodal approach is essential for diagnosing ADHD in females, incorporating detailed histories and EF evaluations. This includes incorporating comprehensive histories, executive functioning evaluations, and considering internalised symptoms that may not be immediately apparent.

  • Increasing awareness and training among professionals about sex-specific ADHD symptoms is paramount.

  • Further, acknowledging the bias and historic under-diagnosis of ADHD in females is important. 

  • Further research is needed to understand and improve the diagnosis and treatment of ADHD in females.

  • Tailored assessments and interventions for girls and women with ADHD are necessary.

  • Diagnostic criteria should be applied flexibly, considering the broader context of each individual’s symptoms and history.

Interested in Upskilling?

Check out my next training.

Attention Please! A Hyperfocus on ADHD.
Attention Please! A Hyperfocus on ADHD.
61 DAYS TO THE EVENT
Working with or curious about evidence-based and affirming methods to work with ADHD'ers? This workshop is for you!
When
20 Sept 2024, 12:30 pm – 2:30 pm AEST
Where
Online via Zoom

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