Traditionally, when little boys were naughty they were often diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and given medication to calm them down. Little girls with similar symptoms - lack of concentration, fidgety and disruptive behaviour - were likely just to be labelled lazy and disobedient and left to get on with it, frequently having unhappy, chaotic and confused lives as a result.
Today, however, adult women of varying ages are far more commonly being diagnosed with the condition which is a relief for some but extremely upsetting for others. It does mean that various medications can be prescribed which, along with therapy, can help them get their lives back on track.
March marks Women's History Month and last Wednesday was International Women's Day (IWD) and it should be a time to celebrate women being increasingly given the often crucial diagnosis. But, just as progress is being made in this area, some critics are suggesting that the condition is being over diagnosed which is threatening to set back scientific advances.
Euronews Culture spoke to ADHD expert Dr Beth Sennett of Falmouth University, who has the condition and studies it. She says many women initially find it hard to get a correct diagnosis, as she did, “The first question I was asked was '‘how was my mood?'‘, the implication being that I must be ‘'depressed'’. I had to be able to deflect comments about how ADHD rarely affects women. I imagine there are many women who take the first step towards being diagnosed, only to be convinced by medical professionals that it's all in their head or they are ’depressed'.”
Sennett feels that teachers in junior and senior schools alike ideally need to be trained to be far more aware of the problem in girls to avoid them suffering more issues later in life.
“Getting diagnosed early would enable people to understand their ADHD” she says. “I think this goes a long way to preventing people from seeing this as a problem with themselves (e.g. they are useless, disorganised, a bad parent, etc.) to recognising this as a difference in how their brain functions. I often hear people with ADHD talk about their 'brains' as if they are a separate entity… but I think it does help to differentiate between the ADHD and you as a person. 'You' are not rubbish. Your brain just reacts differently to situations and that's OK, in the right circumstances, it can be amazing!"
The academic, whose work aims to support neurodiverse adults, also feels that domestic challenges where women are expected to multi-task could add to feelings of failure among the undiagnosed.
Social media and, interestingly, the COVID-19 pandemic have both played their part in bringing the condition to the fore. It is now widely discussed on the internet with countless TikTok videos on the subject and, when many people started working from home, they lost their routines and structure.
“This change meant that many of us lost the strategies that we have in place to help us manage or mask our ADHD so our symptoms became much more noticeable”, Sennett explains. “This combined with social media raising awareness, led to many women recognising the symptoms of ADHD in themselves. The sudden upsurge of diagnosis is a result of the extreme under diagnosis of women over many years."
Sennett believes that the impact of undiagnosed ADHD is underestimated and that more funding for diagnosis, training and support is vital. Many adults with ADHD have a history of job insecurity, leading to underemployment and economic insecurity. They also often have a history of long-term mental illness and can be more susceptible to addiction.
Despite recent criticism of alleged ‘overdiagnosis’ by some media outlets, Sennett says despite the progress in women getting help more frequently than before, more needs to be done - “ADHD is not trivial and we really need to be looking at better support”.
Alongside psychiatrist-prescribed medicine including Ritalin, which can help improve symptoms, many sufferers can benefit from coaching to give them more structure in their lives.
Masking the truth
Hester Grainger is an ADHD Coach and co-founder of Perfectly Autistic and believes, as the condition manifests differently in girls, that the diagnostic criteria needs to be updated accordingly. She was diagnosed herself with ADHD at the age of 43 and says, “A lot of women sadly are misdiagnosed with everything from BPD [Borderline Personality Disorder] to bi-polar, generalised anxiety and more. Women mask a lot so it’s hard to actually see the ADHD traits”.
The background of ‘masking’ is interesting and it’s perhaps unsurprising in patriarchal societies that females are forced to do it. Often, girls and women are accused of being ‘opinionated’ or ‘bossy’ and told, especially as children, to be quiet and listen better, so they are forced to put on a front, figuratively masking their overactive brains so the neurodiversity becomes less visible to others.
Grainger agrees that the benefits of early diagnosis in women are extremely beneficial. “It helps you understand who you are and that it’s OK to have a neurodivergent brain. Executive function and Rejection Sensitive Dysphoria (RSD) are huge parts of having ADHD and can hinder women’s day to day lives, with everything from memory, to organising tasks and essentially feeling unable to ‘adult’. Adults with ADHD can also be incredibly sensitive to perceived or real criticism which can [feel like] physical pain via RSD.”
Early detection efforts
In the UK, managing to get a diagnosis from the National Health Service (NHS) seems to be somewhat of a lottery. Through the country’s ‘Right to Choose’ scheme patients are able to go to their GP and then be referred to a place of their choosing to be assessed, which is often government-funded. However, this practice isn’t widely known or talked about by some doctors, so many of those with ADHD are forced to pay privately themselves or suffer by waiting on a long list for years.
Waiting time varies widely depending on location and in some areas it can take over five years to be assessed.
Grainger explains this situation needs to change - and fast, “Everyone should have equal treatment and many women who are less well-off are getting into debt or borrowing the money to try to get a diagnosis more quickly.”
The picture across Europe is similarly bleak, with the ADHD diagnosis ratio for boys to girls is 5 to 1, chiefly because young females are forced to mask their symptoms due to lack of understanding across schools and medical fields. The German and Belgian project ‘ADHD and Women’ alongside many other organisations, is aiming to change this long-established issue and get women help far earlier.
They say women are far more likely to be diagnosed with ADHD and related comorbidities, including depression, anxiety and eating disorders, emotional dysregulation and addictive behaviours and, if given help earlier in life, these can be eased and lives improved.
Despite increased research and understanding into ADHD, including a number of female celebrities such as actress Zooey Deschanel, Olympic gymnast champion Simone Biles and model Erin O’Connor - who was diagnosed at the age of 43 - there is still a long way to go. Even after an official diagnosis, a whole wave of women are now having to come to terms with not being diagnosed until later in life, which can lead to many ‘what if’s?’ and fears it’s too late to get back on a ‘neurotypical’ path.