Why ADHD is underdiagnosed in women

Girls with ADHD can be as energetic and hyperactive as boys, but then be conditioned out of the behaviours by being criticised for being “un-ladylike”

By Ghenwa Yehia

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Published: Thu 21 Dec 2023, 3:20 PM

When most of us hear the term attention deficit hyperactivity disorder, or ADHD, the image of loud, overactive young boys bouncing off the walls often comes to mind. But a deeper understanding of how the neurodevelopmental issue presents itself in girls and women is challenging that stereotype to give a new face to ADHD.

For RT*, a woman from the South Caucasus region living in Dubai, it has been a 36-year long journey to getting a proper diagnosis and treatment for her condition.

“I remember when I was a kid, I always thought the way my brain functions and how I engage in society is different than people around me,” she said. “Sometimes I was happy about it, but a lot of the times, I perceived that life would be easier if I was like everyone else.”

“To others, I was quiet but internally my mind was running a mile a minute. I was high achieving but if something wasn’t interesting, I would struggle to get started and leave things to the last minute. I was overly emotional and had issues with self-esteem even though externally I could mask my emotions and seemed fine.”

Working in the high-pressure world of corporate finance eventually led her to seek treatment after experiencing anxiety and burnout. “My last job was demanding with frequent, tight deadlines and repetitive tasks. I struggled with time management and got easily bored from doing the same things over and over. I felt like I was a shell of a human going through life in zombie mode. Everything seemed easier for everyone else, and I didn’t understand why it was so difficult for me to function. My journey in therapy eventually let me to an ADHD diagnosis, where it all finally clicked.”

Chaanan Kaur, a counselling psychologist and ADHD certified clinical services provider at Windsor Medical Centre in Dubai who diagnosed RT, explains how the differences in the way ADHD manifests itself in both genders can lead to a later diagnosis in women.

“The key visible difference is that there is outward expression of hyperactivity and impulsivity in males than there is, in females,” she said. “Males with ADHD will yell, shout and try to distract others or engage in risk-taking behaviours, whereas females with ADHD mostly remain in their own world — they doodle, daydream, or drop tasks before completion, for example.

“In terms of diagnosis, this can lead to boys getting an earlier diagnosis than women. If we look at the classroom setting, outward expressions will be picked up more because they impact the classroom dynamic. A boy creating major ruckus time and again impacts the teacher’s instruction more than a girl whose head is in the clouds. In this scenario, it’s more likely the boy’s behaviour will be flagged for concern leading to earlier diagnosis.”

Societal and cultural factors can also play a role when women and girls are being diagnosed. For example, hyperactivity in girls may present itself as being extremely over-talkative. But since they are stereotypically seen as chattier in general, this symptom of ADHD in girls may not be flagged as a sign of hyperactivity because it’s seen as “normal”. Conversely, if a girl seems to be inattentive — daydreaming, perhaps reading a lot of books and disengaging from activities and tasks — then the label of “shy” and “quiet” is given rather than being flagged as potential inattention.

Girls with ADHD can be as energetic and hyperactive as boys, but then be conditioned out of the behaviours by being criticised for being “un-ladylike”. These symptoms can be masked by girls and then show up in ways that are more acceptable like hair twirling, playing with their nails, skin picking, or overthinking internally as opposed to incessant talking which is more “normal” for them.

“Traditional symptomology says to look out for signs associated with ADHD that show up in boys as most studies were conducted on male children and therefore don’t consider the female ADHD experience,” said Kaur. “But by learning about how ADHD can show up differently in girls/women, educators and even parents can help with an earlier diagnosis that may lead to a better quality of life.”

For RT, her diagnosis provided validation that her lived experiences were not just in her head. “When I first got diagnosed, I went through a stage of grief. I reflected on all the years that I struggled and was so hard on myself because I didn’t understand how, as a neurodivergent, my mind worked differently than neurotypical minds. I was sad because an earlier diagnosis could have saved me a lot of difficult times.”

But now, her diagnosis has empowered her by giving her the ability to make life choices that support her personal growth and success, instead of trying to be like everyone else.

“I do have ADHD superpowers. When I’m doing something I love, I can hyperfocus and get it done quickly. I can think on my feet and I’m curious about everything — this leads to great problem-solving skills. And I also know how to take care of myself and that I need frequent breaks to function well. All of this self-awareness has been empowering because it has helped me learn to love myself, which is the greatest superpower of all.”

*Name has been changed to protect the interviewee’s privacy.



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