Gendering ADHD – the mental illness undetected in women

Amanda only got diagnosed with ADHD because a friend recognized the signs and encouraged her to seek help. Why is ADHD only diagnosed in one woman for every five males?

ADHD (or Attention Deficit Hyperactivity Disorder) brings to mind an unruly schoolboy being peeled off the ceiling by a frustrated teacher. He squirms in his seat and blurts out in class, gaining a reputation as a ‘problem child.’ He will likely be referred for the extra help he needs. Perhaps he’ll receive the diagnosis of ADHD. His struggles have been given a name. They are now a tangible thing that can be treated.

What about the shy girl at the back of the classroom? The one doodling stars in the margin or captivated by a bird on the windowsill?

ADHD in girls might look a bit like this.

Picture it. She is contentious, eager to please and struggling just as much as the unruly schoolboy. She spends twice as long completing projects as her peers. Compensating for her difficulties, she’s desperate to please and remains undetected.

When she reaches high school she’s handed a school planner and becomes responsible for her own organisation. She becomes anxious as she cannot keep up the charade. Over-compensating becomes impossible when she has six or seven teachers to contend with rather than one.

By her teenage years she may well have low self-esteem as she struggles to organise her life. Her procrastination is chronic and her only fuel for urgency is anxiety. Her impulsiveness is likely to draw her towards a world of risky decisions. By her late teens she’s in danger of anxiety gaining a vice-like grip. She may feel a need to find solace in self-medication, the adrenaline from risk acting as a substitute Ritalin.

By her early twenties she may find that she cannot sleep at night, fails at tedious life admin and quits her job bi-annually.

Burnt out, she’ll seek help. After a ten minute appointment, her GP might send her off with a prescription for anti-depressants. A diagnosis outside depression is not even likely to be on the radar.

Her home might be littered with the debris of whatever hobby she hoped would act as a natural anti-depressant to help her gain control of her life; a yoga mat, a juicer, a sewing machine, a Mandarin for Beginners book.

She is in a constant state of overwhelm, surrounded by unopened credit card bills and empty pizza boxes. She feels a fraud merely pretending to be an adult.

This is the textbook experience of ADHD. Except it isn’t.

Why are so few women diagnosed with ADHD?

For every five males diagnosed there is only one female. Yet there is no evidence that males are more likely to have ADHD, so how can we explain such a large gender disparity in diagnosis?

Those with ADHD are between 60 and 80% more likely to develop other mental health conditions – most commonly, anxiety and depression. Undetected women will often seek treatment for these, yet without treating the root of the problem they will continue to suffer.

Hyperactivity is one of the most obvious symptoms of the disorder that allow it to be detected, yet it’s not always present. Girls often internalise their hyperactivity, leading to racing thoughts with nothing to show except a slight fidget.

Teachers bear the brunt of the responsibility to detect the disorder, yet in one survey 82% of teachers believed ADHD was more common in boys.

If a girl is lucky enough for her symptoms to be detected she may find it difficult to reach the diagnostic criteria. That’s because the scientific literature is based almost exclusively on males. The disorder also makes it difficult for someone to regulate their emotions, yet for women this is written off as hormonal or even good old Freudian hysteria. For men, their struggle to control emotions is considered so abnormal that the first response is to seek treatment.

ADHD is very much a (wrongly) gendered disorder where women have the cards stacked against them in receiving help and many suffer unnecessarily.

My own ADHD diagnosis

I didn’t receive a diagnosis until I was 22. My experience wasn’t all that unique. It followed a pattern that’s almost inevitable when ADHD is left untreated.

Once I was diagnosed, my GP asked me if I “really needed” medication whilst not studying. It was an unsettling sign of ignorance in someone who’s usually the first port of call for mental health.

The separation of mental health from physical health is dangerous – it allows for mental health treatment to be seen as non-urgent or lower in the hierarchy of health.

If you Google ‘ADHD’ it wouldn’t take you long to find many articles debating whether or not it’s even real, or simply an excuse for bad parenting.

In places without free healthcare, ADHD is often cited as a creation thought up by ‘Big Pharma’ that serves as a cash cow.

It’s even a television trope with a character’s exaggerated symptoms being the punchline. With attitudes like these so prevalent, is it any wonder so many people with ADHD are slipping through the net?

Combined with the view of ADHD as a ‘male’ disorder, women stand little chance of being detected. The stigma and stereotypes surrounding the disorder need to be actively fought, and women’s experiences need to be brought into the discussion.

The power of awareness should not be underestimated. If it wasn’t for a friend of mine recognising it in me, urging me to get assessed, I’d still be muddling through my twenties and wondering how everyone around me seemed to manage to be an adult better than I could.

We cannot allow another generation of women to suffer at the hands of gender bias in mental health care.

Useful ADHD links and resources

• NHS Choices – ADHD info (UK)
• ADHD Institute – Educational ADHD resources for healthcare professionals outside the US
• ADD Association (US)