ADHD: Why are women under-diagnosed?
GENDER AS A SPECTRUM
In order to honor our transgender and gender non-conforming community, I would like to preface by stating that this article will view gender though a binary, dualistic form. This is done largely in part to demonstrate how patriarchal, psychological diagnoses have often overlooked symptoms in patients who are not cis-heterosexual males. Furthermore, we hope to challenge current paradigms surrounding expectations of health and performance surrounding gender, especially as our upcoming generations (particularly Gen-Z) perceive and operate with the mindset that gender is a spectrum to be experienced, rather than an assignment given at birth. As our audience is multigenerational, we feel this discussion is necessary, and we ask for your grace as we bring this topic to the table for discussion. After all, we are an ADHD community, and it is important that we honor each other’s journey, despite how different it might be from our own.
BEING A BAD WOMAN
In her book A Radical Guide for Women with ADHD: Embrace Neurodiversity, Live Boldly, and Break Through Barriers, Sari Solden writes, “The hardest part of your journey is dismantling the toxic effect of the insidious, damaging messages of shame and stigma that you, as a woman with invisible differences, have received and internalized during the course of your lifetime.” ADHD’s symptoms, in women, are difficult to accept and ask for help with as to do so would be an admittance that you are not a good woman in society. Good women, according to social conditioning, pay attention, listen, are clean and organized, do not disrupt, are polite, and can be calm, kind and cordial no matter the circumstance. Let’s analyze these qualities in relationship to the neurobiological impacts of ADHD.
ADHD, then, impacts women differently than it does men. If a girl were to express similar hyperactive traits that we see boys do, there would be more severe social consequences not only from adults but also from peers. This explains why inattentive ADHD is almost an introverted form of hyperactive ADHD. I would argue that girls learn to repress their symptoms in efforts to blend in with their societal expectations. A girl can daydream, but she cannot yell in a classroom the way a boy can. A girl is allowed to take color-coded, word-for-word, intricate notes in a classroom to help her maintain focus. If a girl were to have a calendar noted and dated with every chore, phone call, text message, appointment, etc. that needs to be executed, this would only be seen as her efforts to be a clean and organized woman, not as a coping mechanism for a deeper, neurobiological disorder that impacts her day to day life.
BEING A GOOD WOMAN
This is why many women do not discover that they have lived with ADHD until they approach their late twenties to early thirties. Even though many women with ADHD do blend in with societal expectations surrounding gender performance, eventually, there does come a breaking point. For many women, this begins to manifest itself when they have left college and no longer feel they need their intricate, organizational system to complete coursework and lifework. Surely, now that academics are off of the table, life should be more manageable. However, this is not the case. They begin to realize that it was this intricate organizational system flooded with various colors, post-it notes, stickers, reminders, etc. that had been keeping their functionality in tact. This, then, confirms their darkest fears, that all along they were an imposter, somehow functioning as a good woman, when in reality they were a bad woman.
For others, it is during the journey of motherhood that they begin to make the discovery that their inability to execute tasks, organize their lives with ease, and maintain emotional regularity might be a little more pervasive than they had been able to manage in the past. However, it is due to the perspective that we maintain of women and their gender performance that makes it difficult for women to discern whether they are experiencing a personal failure or the impacts of a neurobiological disorder. The complexity of these feelings may spur women to seek help, however, research finds that most women with ADHD are often misdiagnosed with depression and anxiety. To the untrained clinician, it might seem that the woman before them is just struggling to adapt to the realities of life and cannot manage her fears around doing so. After all, she is a good woman. She is polite, calm, and seems to have kept her life organized up until this point. Right?
Mental health, in general, carries with it various layers of stigma. ADHD in particular contains a special breed of stigma given that one of the primary methods of treatment is to be prescribed a controlled substance. When seeking consolation, possibly even some advice regarding an ADHD diagnosis, women are less likely to do so than men. If we take into consideration social factors such as: (a.) Who might see them in a psychiatrist’s office? (b.) What if they are told that they do not have ADHD? How will they manage this shame of the reality that they are just a bad woman after all? (c.) What is wrong with them for believing that they have ADHD? Etc. then we are given a clear view around how our ethics as a society creates barriers for treatment and healing for women.
At Done, over 60% of our patients are women. This is not a coincidence when we take into consideration societal factors that might otherwise prevent our patients from seeking help in their direct communities. Telehealth provides a solution to various layers of social stigma that are present within doctor’s offices. Arguably, it helps to reduce shame, maintain dignity, and give access to women who might be in an environment that doesn’t support their wellness. Finally, women who have struggled privately with their ADHD can now have access to a private method of treatment. We encourage everyone, in this day and age, to no longer suffer in silence and to seek the treatment that they deserve. No one deserves to shoulder this mental health journey alone, especially not when there are solutions available now that might not have been available a decade ago.