ADHD Symptoms in Women
Women with ADHD are often overlooked, misdiagnosed, or undiagnosed all together. After working with Kaitlin* over the past year, I have been able to witness the long-term effects of this oversight and the journey it can take to receive an accurate diagnosis. Kaitlin has lived the majority of her life with various mental health symptoms that never quite fit into any one diagnosis. She has spent years testing out various medications and treatment methods with only limited success. This year, at age 34, she received an ADHD diagnosis and finally felt everything click into place. As I celebrated this feeling of relief and progress with Kaitlin, I started thinking more seriously about why and how this diagnosis took so long to figure out. Looking at my own caseload, I realized that almost all of my female clients with ADHD or ADD were diagnosed later in life. This pattern within my client base is representative of the current statistics regarding ADHD: 50-75% of women with ADHD go completely undiagnosed. Using Kaitlin as my inspiration, I started learning more about what has been missing in ADHD research and diagnosis and what is finally improving now. Here’s what I’ve been learning:
ADHD is diagnosed using three major subtypes: inattentive, hyperactive, or combined. Inattentive subtype can result in a limited attention span, distractibility, forgetfulness, or procrastination. Hyperactive subtype can result in constant movement, fidgeting, or impulsivity. The percentage of individuals who fall into each subtype is mostly equal.
However, the majority of children diagnosed with ADHD show hyperactive symptoms, leaving those with more inattentive or combined symptoms to be easily ignored. Though the exact rate is difficult to measure, it is understood that males are assessed for and diagnosed with ADHD more frequently than females despite the male to female prevalence of ADHD leveling out in adulthood. To better understand this inconsistency, we must look at the differences in presentation, the gender roles at play, and the comorbidities and implications.
ADHD symptoms can present differently in men and women. This presentation may be the result of differing symptoms/presentation as a whole combined with the behavioral model ADHD diagnosis was based on. Women and girls tend to display more inattentiveness than the hyperactivity that was so typically thought of in the past. And which presentation is going to get noticed first in a classroom? You guessed it: the child that seems to be “disrupting” the other students rather than the child who is doodling and daydreaming in the corner.
This variance was seen in Kaitlin’s own family: Kaitlin’s younger brother was diagnosed with ADHD in 4th grade while Kaitlin received the same diagnosis at 34. Kaitlin’s parents became worried about her brother in elementary school when his grades started slipping and he started getting in trouble in class. A couple of months later, he received a diagnosis. When Kaitlin eventually shared her diagnosis with her parents at 34, her mother challenged it with, “But you always did so well in school!” Kaitlin’s intelligence and natural love of learning paired with the gendered expectations set by her parents and her teachers helped her compensate. However, this didn’t come without its own set of challenges. Kaitlin experienced trouble focusing, reactivity, forgetfulness, overwhelm, and overall emotional distress.
Societal gender expectations of women greatly impact this inconsistency as well. Since the research focused so heavily on the “disruptive boy model,” there wasn’t language for young girls to understand their distress. Because Kaitlin lived much of her life without an understanding of her symptoms, she began to internalize these so-called ‘deficits’ that led to compensatory strategies and low self-esteem. In college, she experienced significant shame around her poor time management skills and difficulty paying attention in lectures. She’d often feel unable to start assignments until late the night before, all the while experiencing crippling anxiety every day until she finally pushed through the paralysis and began her mountain of work with a couple of hours until the deadline. Like Kaitlin, there are countless other stories of women internalizing this shame as a character defect such as “lazy” or “stupid,” believing that they just aren’t trying hard enough. As her shame and anxiety grew, the less she wanted to ask for help.
Kaitlin only began seriously considering the diagnosis of ADHD when her own young child was diagnosed. “I feel proud that I can give my daughter the experience I never had, the experience of understanding the way her brain works and feeling like she’s not alone,” Kaitlin shared in session one day. She went on to describe the ways in which her self-esteem, anxiety, depression, romantic relationships, and substance use were all significantly and negatively impacted by her ADHD being ignored for many years. Since her diagnosis was not acknowledged until recently, she never received appropriate care, treatment, or support.
The good news is that the conversation is shifting and changing! There are many great resources out there for learning more, such as the groundbreaking book A Radical Guide for Women with ADHD: Embrace Neurodiversity, Live Boldly, and Break Through Barriers by Sari Solden. It’s never too late to begin the treatment process and receive the support you deserve. I have experience with the late diagnosis of ADHD in women both professionally and personally, and I can help you learn to manage symptoms, decrease shame, and gain a greater understanding of the unique and special ways in which your brain works. Though Kaitlin’s fight for an accurate diagnosis is admirable and brave, we must collectively make it easier for EVERYONE to receive the acknowledgement and treatment they need.
If any of Kaitlin’s story rings true for you, consult with a therapist today to see how they might be of help!
Warmly,
Jessica Leader, AMFT
*Name and specific details have been changed to protect confidentiality.
A Radical Guide for Women with ADHD: Embrace Neurodiversity, Live Boldly, and Break Through Barriers
The Strives, Struggles, and Successes of Women Diagnosed With ADHD as Adults
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