Distracted and dismissed: Let’s talk about women and ADHD
For women, and particularly women of color, accessing healthcare experiences where our needs are listened to, respected, and effectively addressed can be a challenge. Women’s health needs can be misunderstood or dangerously overlooked.
If you feel frustrated that you miss deadlines, lose track of time, worry that you might have problems with focus or concentration, or have asked yourself “why can’t I do this small thing when it seems like everyone else can?” - you’re not alone. Executive functioning weaknesses can be a result of depression, anxiety, chronic illness, chronic pain, grief, or, other sources.
Attention-deficit/hyperactivity disorder is a neurodevelopmental disorder that first emerges in childhood and has been shown to be substantially heritable. Despite this genetic connection, cultural stereotypes about gender can act as a barrier to diagnosis and treatment: boys are twice as likely to be diagnosed as girls with ADHD in childhood in the US.
Where does gender fit in ADHD in Women?
Symptoms of ADHD in women include patterns of inattentive, hyperactive, or impulsive behaviors that interfere with day-to-day goals and that have existed since childhood. Some common experiences include:
Inattention:
Overlooking or missing details in written or spoken instructions
Challenges maintaining focus or concentration during meetings, readings, or class
Starting tasks but then losing steam or being distracted by other items on your to-do list, leaving behind unfinished projects
Even in settings without obvious distractions, the mind wanders and may not stay focused on one thing or conversation
Hyperactivity and Impulsivity:
Fidgeting, tapping, and other challenges with sitting still
Excessive talking or interrupting of others’ conversations
Challenges with waiting in line or for their turn in a game or activity
Feelings of restlessness, getting up and moving around at inappropriate times in school or work settings
Based on their individual experiences with these symptoms, a person with ADHD may fit into one of three categories:
Predominantly inattentive subtype → only experiences inattentive symptoms
Predominantly hyperactive/impulsive subtype → only experiences hyperactive or impulsive symptoms
The combined subtype → experiences a combination of both inattentive and hyperactive or impulsive symptoms
One of the unique features of ADHD in women, unlike some other chronic health concerns, is that the first person to notice these symptoms rarely is the child themselves. Often diagnosis follows after parents, teachers, or other health professionals notice that the child may be experiencing hyperactive, impulsive, or inattentive symptoms after those behaviors interfere with classroom learning, mealtime or bedtime routines, or other activities.
Clarity of Symptoms Effect the Likelihood of an Early Diagnosis
The more visible the symptoms, like external interruptions or classroom disturbances caused by hyperactive and impulsive behaviors, the more likely a child will be identified for further testing for ADHD. If a child only experiences internal inattentive behaviors and is too young to recognize these behaviors as internally disruptive or to verbalize these experiences of internal disruption, they may go under the radar.
So we know that a child is more likely to receive a diagnosis and appropriate treatment if they are identified early, often through externally disruptive behaviors.
Where does gender step in as a barrier to treatment for ADHD in Women?
According to some studies, girls are twice as likely as boys to only experience internal, inattentive symptoms of ADHD. Culturally, girls in the US are often pressured to be quiet, sit still, and avoid external disruptions to activities, class, and other routines. When a girl interrupts or speaks over others, she may face more social shaming than boys might for the same interruptions - boys are leaders who show initiative, and girls are bossy micromanagers, and naggy. Girls may receive cultural messaging that inadvertently teaches them to mask external symptoms of ADHD.
Going under the radar
In addition to differences in symptom presentation by gender, there are other myths about ADHD in women and stereotypes that may delay diagnosis.
Myth #1: If you have good grades, you can’t have ADHD.
Regardless of gender, this simply is not the case. Hyperactive or inattentive symptoms may make it more difficult for folks with ADHD to absorb new content in class or perform well on assignments and tests. However, that layer of difficulty does not always translate into failure at school.
If a student has enough access to extra help, such as
accommodating teachers
1-on-1 instruction
encouragement from friends and family
and also has strong intellectual skills
Therefore, it may take years before that student reaches a level of education that places enough demands on their attention which are beyond their abilities even with undiagnosed ADHD.
How does this show up in women?
For girls and women, in particular, cultural pressures to be conscientious, follow instructions, and diligently focus on their studies may result in average or above-average performance in school, masking the internal difficulties that come with such performance. Some women are able to handle the executive functioning demands of their classes even through their 20s, when they may hit a wall during undergraduate or graduate study when their coping skills for inattentive or hyperactive symptoms are overwhelmed not only by needing to manage day-to-day tasks of completing school or work tasks but also being implicitly put in charge of household management activities too.
Myth #2: Women aren’t usually interested in or good at STEM subjects. Poor grades in some classes are to be expected for girls and aren’t a sign of ADHD.
ADHD in women often have variable attention and are able to focus or even hyperfocus on topics that interest them. Going through school, sometimes girls who succeed academically in some subjects but not others can have their academic weaknesses explained away by gendered stereotypes instead of approaching this discrepancy with curiosity about what barriers may exist in one class but not another.
Additionally, a girl who takes twice as long to complete her assignments as her peers yet earns average grades in all her classes might be thought of as having the decent ability “for a girl” or labeled a hard worker, and not have teachers or parents pause to question why she needs extra time to complete the same tasks.
We also have to consider the historical impact of this.
Historically, American culture has been steeped in gendered expectations that women’s abilities are lower than men’s, which can result in implicit bias which ties a girl’s lower academic achievement to her innate ability rather than the presence of attentional barriers.
Whether the cause is implicit bias, poor understanding of ADHD, or other factors, the fact is that many girls and women fly under the radar and cope with their symptoms undiagnosed, or, if they are identified as having ADHD do so later in life than their male peers.
Why do we care about the early diagnosis of ADHD in women anyway?
So women might go longer without knowing their experiences meet the criteria for a diagnosis of ADHD. If they can see academic or professional successes without a diagnosis, why do we care?
1) Growing up without awareness of our neurodivergence can negatively influence our mental health.
Even for folks with a diagnosis of ADHD, more than two-thirds have at least one other coexisting condition. Common coexisting conditions include sleep disorders, anxiety, depression, learning disorders, and other behavioral disorders like oppositional defiant disorder or conduct disorder.
When one goes without access to appropriate diagnosis and treatment, regardless of gender, men and women may misinterpret their symptoms in ways that can be detrimental to their mental health.
When we don’t understand what is happening, it can lower our self-esteem
Inconsistent control of attention or executive functioning can lead to low self-esteem. When one notices that they’re struggling with day-to-day tasks, they may interpret that behavior as being lazy, and engage in critical self-talk: “I’m so lazy, I can’t do anything right. I’m such a failure.” Low self-esteem and critical self-talk, over time, can feed into symptoms of depression or anxiety.
Misunderstanding symptoms of ADHD in women also impact our ability to form a confident, strong sense of self. A person who knows that they’re inconsistent or sometimes has trouble with memory or following instructions might, over time, learn to dismiss or distrust their own internal cues. Ignoring internal cues, like when our bodies or minds are telling us something dangerous is happening, can be a risk factor for staying in abusive relationships or hostile work environments. Their internal voice might suggest: “I feel like this isn’t a good fit for me, but I don’t know if I can trust myself. Other people say that this is normal or that I can handle it. Maybe what’s wrong is me.”
2) Women pay a “pink tax” when they access diagnosis and treatment.
When schoolchildren are identified by a parent or teacher as potentially having barriers to learning like ADHD or other learning differences, public schools are mobilized into a resource for diagnosis and treatment. Public schools are required to provide families with access to psychologists who can then evaluate their child to search for answers through testing, diagnosis, and referral resources or coping strategies tailored to that child’s needs.
Public schools provide these services to children identified as having the need for them - for free.
When a woman flies under the radar as a child and decides later in life to pursue testing for ADHD, she takes on the burden of paying for testing on her own or with insurance help if her plan covers those services.
While there are some insurance plans that can lighten the load, and some psychologists or training clinics that may offer sliding-scale fees to help make testing more affordable, it is not uncommon for the financial cost of assessment (or the executive functioning required to negotiate and know your coverage) to be a barrier.
3) Treatment can be harder to access.
Without a formal diagnosis, some psychiatrists and other health professionals may be hesitant to provide resources for medication or other forms of treatment. Some clinicians are also clouded by common misconceptions about ADHD which prevent them from understanding why a woman might be seeking treatment in adulthood:
Common Myths Around ADHD in Women:
ADHD is not real or, if it is, it’s overdiagnosed
All children grow out of ADHD, or only experience symptoms in school settings
Because symptoms need to be present in childhood, anyone who comes forward as an adult seeking treatment is more likely to be drug-seeking or looking for a school or work accommodations rather than genuinely struggling with inattention or hyperactivity
Even when one is working with a treatment team that is well trained on the difference in adult or female presentations of ADHD symptoms may run into the barrier that, when one is in their 20s, 30s, or beyond, they will be asked if they can provide corroborating evidence from childhood that these symptoms are not new as part of the assessment process. It can be challenging to find school records, teacher comments, or stories from childhood that can retroactively be used as evidence for symptoms earlier in life.
If this sounds like you, what can you do next?
For women who already have a diagnosis of ADHD and find that some of these experiences sound familiar, know that you’re not alone. Treatment for inattentive and hyperactive symptoms of ADHD may include meeting with a psychiatrist to see if medication is a good fit for you, but medication is not the only resource available.
Individual or group therapy, or support groups for folks with ADHD can be helpful to work through low self-esteem, normalize your experiences and struggles, and feel more confident in your understanding of how symptoms of ADHD in women impact their day-to-day life.
Group skill-building classes or individual executive functioning coaching can be a particularly powerful tool to increase your awareness of what your executive functioning strengths and weaknesses are and what environments put more strain on your attention and to set goals to make behavioral or environmental changes to meet your personal or professional goals.
For readers who have not been diagnosed with ADHD, but feel like parts of this post and other ADHD resources speak to them, consider reaching out for a free consultation to learn more about the steps involved in assessment for ADHD.
Regardless of what treatment options you feel work for your goals, it’s key to work with a treatment team that has a thorough understanding of the intersectionality of gender with neurodivergence. You don’t have to do this alone. Learn more about ADHD in women today!
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Other Services at Rapoport Psychological Services
We are held to such high standards in life. That can lead to anxiety, depression, trauma, stress, burnout, and more. It’s time to rewrite your narrative and become your authentic self. If you need support, we offer therapy for women, but we can help you with specific mental health issues. Additional services we provide include depression treatment, anxiety treatment, PTSD treatment, and trauma therapy, Coaching with Dr. Zoe, testing services for ADHD, professional development, therapy for new moms, life transitions, and group therapy. Lastly, we offer workshops on women’s empowerment, grief, mindfulness, and stress management. We really look forward to walking alongside you and hope you will take the next step and begin in-person or online therapy in New York!