Yet, the condition is not only about hyperactivity, but also can present as inattentiveness, the latter of which is commonly seen—but ignored—in girls. “Think about it, who would complain about the quiet girl sitting in her seat in the classroom—perhaps daydreaming—when you may have other students grabbing your attention with more overt and disruptive behaviors,” asks Yamalis Diaz, PhD, a clinical assistant professor of Child & Adolescent Psychiatry within the Child Study Center at Hassenfeld Children’s Hospital at NYU Langone. As of 2016, the Centers for Disease Control and Prevention (CDC) reported that about 9.4% or 6.1 million children across the United States had an ADHD diagnosis. However, the instances were much higher for boys at 12.9% compared to girls at 5.6%. Experts attribute this stark difference primarily to the varied ways girls and boys demonstrate ADHD symptoms, particularly because of gender expectations. “I think boys have historically presented as hyperactive, which tends to be more disruptive in a classroom setting. Girls tend to present with attentive features which only impact themselves. So it is possible for their diagnoses to get skipped,” says Dr. Sasha Hamdani, a Board Certified psychiatrist and ADHD specialist who also shares educational content about ADHD on social media. Symptoms can present as early as three years old, but generally they emerge between 7 and 12 years of age. Diaz adds that this difference has “almost solidified the perceived ‘prototypical’ child with ADHD as a ‘hyperactive little boy,’ leading to a perceptual bias in the way parents, teachers, and others notice possible symptoms of ADHD.” Children rely on adults to identify potential conditions, such as ADHD, but those who don’t fit the mold are left out when only one version of the disorder is discussed. As a result, women with ADHD often aren’t diagnosed until adulthood, when their symptoms may become more pronounced. According to the National Institute of Mental Health (NIMH), the estimated lifetime prevalence of ADHD is lower in adults aged 18 to 44 at 8.1%. Men are still more likely to be diagnosed with ADHD than women, 5.4% to 3.2%, though at a smaller margin. Leaving a diagnosis to adulthood can cause ADHD-related challenges and behaviors to become more firmly established. Treatment may need to be more intensive than if adults had identified the condition earlier, says Diaz.
Without an ADHD Diagnosis, Women’s Self-Esteem Can Suffer
If a woman goes through early life unaware she has ADHD, she may attribute its symptoms to a fault of their own instead of an outside disorder. “These women have long struggled in school and at work, relying on their intelligence to scrape by, overworking to compensate for difficulties with inattention or task completion, struggling with friendships or fractured interests because it can be challenging to stick with one thing at a time,” says Kate Hanselman, a psychiatric mental health nurse practitioner (PMHNP) at Thriveworks in Stamford who is also living with ADHD. “They are left wondering if they are the problem, if they are simply lazy or stupid or weird, when in truth, their brains work differently, and they’ve been doing all this extra work to cover for it for years.” Many of Hanselman’s clients exhibit symptoms of anxiety and depression, which turn out to result from an ongoing struggle with undiagnosed ADHD. Diaz blames the lack of awareness for leading many girls and women to believe that, though they work very hard, having little to show for their effort or less than others, is an indicator of poor potential—further leading to concurrent mental health conditions and poor self-esteem. The relief women can feel from finally having their inner fight validated can be overwhelming. “I cannot tell you how many women I work with who cry when I diagnose them with ADHD,” says Hanselman. “They have struggled for years, sometimes decades, thinking something is wrong with them, believing that if they just tried a little harder, it would work, and beating themselves up when it doesn’t.”
Changing The Narrative Around ADHD
Education is critical to change the long-held beliefs about who has and doesn’t have ADHD. Diaz stresses the need for continued research on ADHD’s different presentations to raise the awareness of parents, teachers, and pediatricians. This includes further work on behavioral interventions for people whose fundamental characteristic is inattentiveness, a move away from focusing solely on hyperactivity. According to Hanselman, part of the problem also stems from the number of healthcare professionals who still don’t believe ADHD is real. It’s a reminder that, when possible, seek a medical opinion for yourself or your child from more than one mental health expert, as not all professionals will treat it with the seriousness you deserve. Some women may also feel worried about being judged for having ADHD since it is often associated with men. While this is a natural reaction, there is nothing to be ashamed of with getting the care you need—it’s a strong, admirable decision. “I think it all starts with talking about symptoms more freely,” says Hamdani, on breaking down the stigma around ADHD for women. “This also means destigmatizing treatment options: medications—we have many, not just stimulants—change lives, and stigma around these medications prevents people from receiving adequate care,” says Hanselman. “As a patient, learning more about treatment options, asking your provider about the research behind it, and checking in with yourself and those who support you about what you feel is most comfortable for you can all be helpful.”
Managing ADHD
Whether you were diagnosed with ADHD as a child or discovered it as an adult, ADHD is possible to manage. Diaz suggests taking the time to clearly identify the ADHD symptoms which impact your life and how. This may be in work, relationships, or tasks around the house. Once you’ve done that, practice, without any pressure on yourself, small behavioral habits that offset these symptoms. “For example, if you’re someone who’s often late to get places or meet deadlines, work to develop specific time-management habits to help you better manage time,” says Diaz. She emphasizes the importance of only focusing on one or two points at a time as taking on too much at a quick pace can stall any progress. There’s no denying that ADHD can be frustrating, but see if you can find positives within it when possible. “It is, indeed, a superpowered brain capable of so many things—creativity, out-of-the-box thinking, problem-solving, humor, resilience,” says Diaz. “So, it’s also important to figure out the strengths associated with ADHD and maximize those to their fullest too!”
