Women with Attention Deficit Disorder

Sari Solden is a psychotherapist working in Ann Arbor, Michigan. For years she has worked with adults with ADHD, especially women.

This book was first published in 1995 by Underwood Books. The subtitle of the first edition pointed to how disorganization is lived at home and at work. In the updated 2005 edition the subtitle changed, and the emphasis shifted to accepting difference and transforming your life.

It is cited as the first book to put ADHD in women at its center.

I could not reach a verified Turkish edition; I am writing with the English title. The book of Solden's that has been translated into Turkish is her later guide, written together with Michelle Frank.

What was on the table in 1995

To understand the book's value, you have to remember the day it was written.

In those years the picture that came to mind with ADHD was still the boy who could not stay in his seat in the classroom. That symptoms could continue into adulthood was only just beginning to be accepted. Hallowell and Ratey's book, which also described adults, had come out a year before.

In an interview given later, Solden explains why she wrote the book. At the counseling center where she worked she noticed that women with similar difficulties carried a much heavier shame than men. In the first writings on adult ADHD, women could not find themselves either.

This book was written for that gap.

The real subject: the distance between expectation and brain

At the center of the book there is a single observation, and I think it is still its strongest side.

Society expects a certain kind of order work from a woman: managing the flow of the home, remembering birthdays, planning meals, keeping up the children's things, the family's calendar, the social relationships. Almost all of this work requires planning, sequencing and remembering. That is, the very skills ADHD strains most.

When a man struggles with these tasks, it is often not seen as a deficiency, and someone else takes the work on. When a woman struggles, she counts herself as failing as a woman.

This is the shame Solden describes. It was also the place where I stopped while reading. Most of the moments in my own life when I asked "why can't I manage something this simple" were about the tasks on this list.

The book does not think of depression, anxiety and falling below one's potential, which are common in women, as separate from ADHD. It treats them as the visible face or the result of the picture.

Today's literature largely proves Solden right on this point. The review by Quinn and Madhoo published in 2014 explains that ADHD in women is often missed and that these women are first followed with a diagnosis of anxiety or depression. The consensus statement by Young and colleagues published in 2020 in BMC Psychiatry also stresses that symptoms in girls and women take a more inward course, and that diagnosis is therefore delayed.

Solden was saying this in 1995, based on clinical observation.

Surviving, hiding, emerging, embracing

The updated edition is built around four sections, and these four follow an order.

Surviving. The state before diagnosis. Living with an unnamed difficulty, trying to get through the day.

Hiding. The most important part of the book, I think. The labor spent so that nobody sees you struggling. The counterparts in my life are familiar: not inviting guests, not letting anyone into the house, pulling everything together at the last minute to look put together on the outside, saying "yes" and then being crushed under it.

Today we call this masking. I went into detail in the article on masking in ADHD. Solden describes this behavior long before the concept became so widespread, and clearly shows its cost, that is, constant tiredness and not being able to ask for help. The consensus statement by Young and colleagues also notes separately that the compensation strategies women develop delay diagnosis.

Emerging. Diagnosis, giving it a name, and slowly letting go of hiding.

Embracing. Accepting difference and rebuilding life accordingly.

Reading these four headings I saw myself as someone who had stayed in the second stage, hiding, for a very long time. It was the first time a book defined this stage as a separate period.

Three steps

The change the book proposes comes together in three steps.

Restructuring life. Stopping forcing an order that fights your brain and building outside structure. Seeing what is really hard for you and dividing, handing off or reducing the work accordingly.

Renegotiating relationships. For 1995 I think this is the boldest step. Putting on the table the roles you have taken on in the family, marriage and friendships. You do not have to be the one who always keeps the calendar; saying this feels like a confession but the book sets it up as a negotiation.

Redefining self-image. Letting go of the story of the woman who cannot meet expectations and beginning to see yourself as someone living with a brain that works differently.

These three steps are valid today too. Only on how to do the first step does the book stay superficial; I will open that below.

What changed in the 2005 edition

If you are going to read it, read the updated edition.

In this edition there is a new chapter devoted to women's friendships. When the effect of ADHD on relationships is discussed, friendship always stays in the shadow of the partner relationship; this chapter is a rare thing. For me the counterpart of this heading is clear: replying to messages late, forgetting meetings, not being able to invite, and over time the circle quietly narrowing.

Women's accounts compiled from Solden's online question-and-answer column have also been added. The parts on medication, hormones, diagnosis and treatment have been expanded. There is a decision tree that helps with deciding, and a strategy table.

In her interview Solden points to one more change: the first edition did not have the language of "executive functions," because at that time ADHD was not described with this concept. This framework was added in later editions.

Where it has aged

Some pages of the book should not be read as they stand today.

Diagnostic information. The first edition was written in the DSM-IV period, and the updated edition is also from before the DSM-5. Criteria such as the number of symptoms required in adults and the age by which symptoms must begin were later changed. The diagnosis-related parts need to be read together with a current source.

Medication information. Since 2005 the options and ways of use have changed. It is best to read this section to get an idea and make the decision with a physician.

The female-male ratio. In the book's introduction it is said that ADHD affects women as much as men. Today's data do not support this equality as it stands. In childhood boys are diagnosed markedly more often, and in adulthood the gap narrows. Part of this narrowing is thought to come from girls missed in childhood. So Solden's intuition is right in direction but exaggerated in the certainty of its claim.

Hormones. The updated edition touches on the relationship of estrogen to ADHD symptoms. This area has been discussed a good deal since then, but solid data is still limited. After reading the book it is good to look at the current picture in the article ADHD, hormones and the menstrual cycle.

The matter of sources

This book should not be read as a research review.

The bibliography of the first edition is about five pages. Most of the narrative rests on case stories and Solden's own clinical observation. Most of the time you cannot tell which sentence came from a study and which from the therapy room.

Counting this as a flaw would also be a little unfair. The book was describing a group about which almost no research had been done. There were few studies to cite. Clinical observation was the most honest thing that could be done in this situation.

But today's reader should know this difference. Some of Solden's findings were later supported by research, some are still open questions today.

Is there a superpower tone

On this site I am wary of books that present ADHD as a superiority. This book does not fall into that category.

Solden speaks of embracing difference but does not lighten the difficulties while doing so. Most of the book is a description of difficulty, shame and tiredness anyway. Acceptance here is not set up as a claim of advantage; it is set up as the precondition for stopping hiding the difficulty and asking for support accordingly.

I know that in later years Solden leaned more on the language of neurodiversity. In this book that language is not yet this prominent.

What came after the book

To understand the book's place in the field, you need to look at what came after.

Shortly after its publication, the clinical psychologist Kathleen Nadeau, who works on ADHD in women, reviewed the book in Journal of Attention Disorders. Names such as Nadeau and Patricia Quinn carried out a significant part of the work that brought ADHD in women onto the clinical and academic agenda in the following years. Solden's book stands at the head of this line.

Where we have arrived today largely confirms the picture the book describes but changes the detail. The consensus statement by Young and colleagues explains that inattentive symptoms can be more prominent in girls and women, that co-occurring anxiety and depression can overshadow diagnosis, and that symptoms take different forms across life stages. What Solden saw with intuition and from the therapy room is now being written down systematically.

For a more current framework on this subject, see the article ADHD in women across the lifespan on the site.

Solden's voice today

In an interview held for the twentieth year of the book, Solden also explains how her view has changed.

She now thinks of ADHD more within the framework of neurodiversity. She uses sharp language against the stigma attached to invisible neurological differences and points to the contribution of people who think differently.

It is interesting to follow this change. The 1995 book described shame. In later years Solden began to look for the source of shame less inside the individual and more in society's view of difference. The guide she wrote with Michelle Frank is a product of this new view.

I found it useful to read the two books one after the other. The first gave me the name of what I was living through, the second made me think about what to do with that name.

What it leaves out

The book explained very well why I struggle. It explained what to do only to a limited degree.

The step of restructuring life is strong on paper. But when it comes to how to concretely set up a home, a calendar, a work day, the book stays in general advice. Additions like the strategy table make up for this a little but not enough.

That is why I would not recommend reading this book alone. It works better to take the shame part from here and the system part from a more practical source such as Kolberg and Nadeau's organizing book.

For whom, at what stage

For women diagnosed late. Especially those who spent their childhood with an unnamed difficulty and for years thought of themselves as lazy or clumsy. This book helps you reread those years.

For the period right after diagnosis. For the period when you need someone to understand you before you look for information.

For those whose shame weighs more than their disorganization. For those who feel the problem is less the state of the house than what they think about themselves because of the state of the house.

Whom I would not recommend it to: someone looking for current diagnosis and medication information, someone who wants to build a system, someone who expects a book that cites sources. These readers will be disappointed.

How I read it, how to read it

You do not have to read it from beginning to end.

My suggestion is to begin with the hiding section. If you find yourself there, the rest of the book will pull you in anyway. If you do not, this book is probably not for you.

It makes sense to go quickly through the diagnosis and medication parts and turn to current sources on these subjects. The friendship chapter and the women's accounts suit reading in intervals very well; short, independent pieces.

The updated edition is around three hundred and fifty pages. Because the case stories are dense it is not a heavy read but it can be emotionally tiring. I put it down several times and came back a few days later, and that was not a problem.