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Struggling in silence: Underdiagnosis of ADHD in women

If you were to look at my high school transcript, it would be easy to assume that I was a bright kid who breezed through my time there—I got all As, took honors and AP classes and was involved in multiple extra-curriculars. Yet if you were to look at my day-today-reality, a different story would unfold.

My transition into high school presented me with a new set of struggles: I had to pull frequent all-nighters just to get assignments done on time, I could never keep track of my personal belongings, I was always running late in the mornings, I could never finish tests within the allotted time period, my room was forever a disaster and I found it difficult to even get started on schoolwork. I never felt like a bright kid or an A student, but I would always tell myself that things would get better if I could just try harder, if I would just be more disciplined.

Undiagnosed ADHD often leads to women struggling with their schoolwork. 

Things might have never changed if one of my good friend’s mothers, who happened to be a psychologist, pulled my mom aside during my junior year and suggested that I might try getting tested for Attention Deficit Hyperactivity Disorder (ADHD). Thanks to this, I was diagnosed with the inattentive version of the disorder—but otherwise I probably would have gone years before I got tested or the thought of having ADHD even crossed my mind. Unfortunately, my story is common among women with ADHD—and I could even be considered one of the ones who caught it early.

According to the 2014 study “A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis,” “attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity. In the majority of cases, symptoms begin in childhood and continue to affect a person’s functioning well into adulthood.”

The prevailing image of ADHD continues to be the hyperactive young boy. Because of this, young girls with ADHD are critically underdiagnosed and misdiagnosed, continuing to fly under the radar of teachers, parents and professionals. There are multiple reasons for this disparity, but it is ultimately rooted in sexist stereotypes and has tangible negative affects on the lives of girls and women.

“Women and girls with ADHD have a distinct symptom presentation, with internalizing symptoms (e.g., inattentiveness) being more prominent than externalizing symptoms (e.g., impulsiveness and hyperactivity). Their symptoms are more likely to be overlooked by knowledgeable informants, and they are less likely to be referred for diagnosis and treatment,” the 2014 study said.

Additionally, the study explained that women with ADHD may not be diagnosed because of a high frequency of co-existing diagnoses of anxiety and depression, which can sometimes mask or misallocate ADHD symptoms. Women may also be better at developing coping mechanisms than men with ADHD. Because of these coping strategies, many women only realize they might have ADHD when faced with the full responsibilities of adult life, having to juggle work, home and family responsibilities.

“The pressure on women to be organized, self-controlled, to be the one who’s keeping everybody else organized, is a societal expectation that’s very deeply ingrained,” an article by ADDitude said. “There is a tremendous toll of having to keep up appearances, struggling, having embarrassing moments. Things like, ‘I forgot to pick my kids up after soccer practice, and they were the only ones left standing out there.’ It’s a very public failure, and women are often not forgiven for these types of things. With a man, they’ll say, ‘oh he’s so busy, of course he forgot.’”

Even after I was finally diagnosed with ADHD, I struggled to accept the ways that it affected my life. Damage had already been done, as I had spent years telling myself that my struggles were because I wasn’t smart enough and that I just needed to work harder. It took going to therapy to fully accept that I had the disorder, and longer to overcome feeling shame every time I used my accommodations.

Almost four years after being diagnosed, I am still on a journey to manage my symptoms—yet I am supremely grateful that I learned about my ADHD when I did, fortunate enough to be provided education and resources far earlier than many other women. In order to overcome the ADHD gap between men and women, it is crucial to understand and address the sexism that it stems from.