Why Are Women Only Just Receiving ADHD Diagnoses?
By Alice Hargreaves
Picture the scene: it’s a warm summer’s day and I’m sitting in a psychiatrist’s office. The office is extra, to say the least. Byzantine art replicas are all over the walls and there are way more leather sofas than you could need. It’s taken me a long time to get here. I’ve been exploring diagnosis online for months. After hours of deep diving into my childhood, education, work life, and medical history, I was diagnosed with inattentive type ADHD. I was 32.
Throughout the entire experience, I was told time and time again that my ADHD was “textbook.” So why did it take 32 years for this to be diagnosed? As I outed myself in my personal life and publicly on my personal LinkedIn, it became clear that I was not alone in my experience.
What’s ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that affects people of all ages. Depending on where you live, it’s estimated to affect between three and five per cent of the adult population.
ADHD is characterised by three main features: inattention, hyperactivity, and impulsivity. Not all of us experience all three, most experience one or two. Some of these traits are experienced in neurotypical people from time to time, but for ADHDers these experiences are more pronounced and are constant.
Why are women like me going so long undiagnosed?
Historically, the diagnosis of ADHD has been skewed towards male individuals, with at least three times more boys receiving the diagnosis than girls.
Most of us can picture what ADHD looks like in young boys. They’re disruptive in classroom settings, can’t sit still and tend to have very externalised traits. From a diagnosis point of view, their symptoms are picked up by teachers and parents because they’re making themselves seen and heard.
Girls tend to be inattentive just like me, a more internalised trait. I was a class clown sure (I definitely enjoyed speaking back to teachers from time to time), but I was far from disruptive and achieved exceptionally high grades throughout my education. From a teacher’s point of view, there was little to pick up on, my grades were good, and I was always getting work in on time. The challenges were mainly going on inside.
This gender disparity has led to many women going undiagnosed or misdiagnosed throughout their lives. I was diagnosed with anxiety and depression for over a decade.
However, with the internet has come an increased understanding of what ADHD can look like, with more public figures coming forward about their late-in-life diagnoses.
What does ADHD look like in women?
Often ADHD presents in a less outwardly disruptive way than it does in men. For me, my inattentive qualities mean that I struggle to focus for long periods. This can mean that as soon as I’m tired, mistakes happen. It also means that I’m very forgetful, often forgetting where I should be and when and losing things, and being terrible with names and faces.
On the flip side, I can also hyper-fixate on things that I find interesting, spending hours researching something or working on creative projects. Luckily, as an entrepreneur, I have more control over what I spend my time on than others.
Rejection Sensitive Dysphoria
A common comorbidity that a lot of people with ADHD experience is Rejection Sensitive Dysphoria (RSD). It’s not an official medical diagnosis, but it is widely used by doctors and therapists to refer to the heightened emotional responses that ADHDers experience following rejection, or perceived rejection.
I often use the following anecdote to share my own experience of RSD. When myself and my partner first started dating, I’d been burned before in relationships. I’d spent nearly a year out of the workplace following a nervous breakdown after an abusive relationship ended. I immediately associated all that pain with the new feelings of being in a relationship. For over six months, this fear was all-consuming. I regularly ended things after the smallest disagreement because I was so scared of rejection.
Sure, nobody likes rejection, but for someone who has RSD, rejection is a deep-rooted fear, and experiencing it can be physically painful.
How can we have more equitable access to diagnosis?
Education is vital. Education providers and employers need to broaden their understanding of neurodivergence to support and nurture those who are currently without a diagnosis.
The pathway to diagnosis also needs significant improvements. Where I’m based in the UK, the wait lists for a diagnosis can be upwards of three to five years, and in many educational institutions the diagnosis is the key to unlocking support.
If you suspect you could have ADHD…
The best thing to do is to speak to your health practitioner to understand what a diagnosis pathway would look like. For most, the evaluation will include interviews, questionnaires and a detailed and in-depth assessment with a psychiatrist.
While waiting for this process to begin, take steps to seek adjustments in work and education. Self-diagnosis may not always be recognised by others, but it is valid. For many of us, we know what the results of the professional assessment will be before we walk through the door.
Treatment and coping mechanisms
Living with ADHD can be challenging, but there are various ways to manage the condition. Medication is one of the primary treatments for ADHD and is often prescribed to help manage symptoms. However, depending on where you live, this medication is in short supply.
Luckily, medication is not the only solution. Time management techniques, workplace and educational adjustments, and stress reduction strategies can have a significant impact on the quality of life of an ADHDer.
If you’re employed, explore what support is available to you. In the UK, Access to Work can unlock a whole range of support including free-to-access software, individual support (support workers), coaching, and technology.
The underdiagnosis of women with ADHD is a long-standing issue, with recent developments highlighting the importance of recognising and addressing the condition in both young and adult women. If you find yourself sitting in a plush psychiatrist’s office, wondering if you’ve chosen the right sofa out of seven options to sit on, know that this isn’t part of the assessment, I asked!
About the author
Alice Hargreaves (she/her) is the founder of SIC, a social enterprise in the UK that works to close the disability employment gap through education, training, and support. Alice was born with a variety of respiratory conditions and has acquired a few more chronic conditions more recently. She was diagnosed with ADHD in 2022.
