Why Are Women Frequently Misdiagnosed When it Comes to ADHD?
“Olivia’s effort and concentration in class have been variable. At times she has participated well, but at other times, has been off-task. In her future studies, I would like to see Olivia ask more questions and seek help if she is unsure. Her absences have unfortunately hindered her progress quite significantly.”
That was my maths report in year 12. My teachers constantly told me, “You don’t try hard enough!” or “Why weren’t you listening?” and eventually, “Why are you still here?”
The bulk of my high school years were spent in meetings with the Dean trying to decipher why I didn’t appear to care for my education, why I found it impossible to complete any task that was presented to me, and why I had a ridiculous amount of absences from class. She came to the conclusion that I was just lazy, and threatened me with expulsion even though, when I gathered the courage to come to school, I wasn’t disobedient.
I had Inattentive ADHD, but it hadn’t been diagnosed yet.
I was forced to attend classes out of fear of ruining my chances of gaining the prerequisites to get into university. This sent my mental health into turmoil and my brain ran into overdrive trying to achieve my personal goals. I constantly copped anxiety-inducing judgments and negative reception from my teachers and parents. I was constantly fighting to prove that I did care about my education and that I was not lazy.
That word, even now, looms over me every second of my waking day.
I knew that deep down there was more going on than what my authoritative figures could see, which makes me wish that my diagnosis of Inattentive ADHD had come sooner.
ADHD, or Attention Deficit Hyperactivity Disorder, is a common neurobehavioral disorder that is identified by patterns of hyperactivity and impulsivity. Common symptoms include disorganisation, poor focus, irregular moods, amplified emotions and trouble coping with stress. It comes in three types: Inattentive (also known as ADD), Hyperactive and the combination of both.
Stereotypically, ADHD is associated with the five-year-old boy in your class at primary school who can’t sit still to save his life. He calls out in class, fidgets, misbehaves, and wreaks havoc. Although this representation is widely understood, it fails to represent the broad spectrum of those who live with ADHD.
In particular, it’s women like myself who are left undiagnosed and struggling because of this common misconception. In an attempt to understand why there is such a significant gap in childhood diagnosis between genders, I spoke with my friend Kate.
Like me, Kate wasn’t diagnosed with inattentive ADHD until early adulthood. I came to her childhood home and asked her about her schooling experience. She gave an answer that sounded all too familiar.
“I was above average academically in primary school but in high school, I felt the pressure and really began to struggle. I was always compared to my sister, who is an academic and made my parents very happy by going on to university and gaining a degree, and I felt as though I could never live up to that standard.”
In a paper by Patricia O. Quinn, it was uncovered that the physical display of ADHD behaviour is gender-specific and that women predominantly suffer from the inattentive subtype.
We internalise our symptoms as opposed to expressing them like our male counterparts. In comparison, Males with ADHD tend to come under the hyperactive subtype and often physically display their symptoms by behaving in a disruptive, loud and impulsive manner, which can be accompanied by physical aggression. This behaviour is intolerable and unbearable in the learning environment, but at least this overt behaviour is a gateway to an early diagnosis for boys.
Males have set the tone for what ADHD should like, which causes female symptoms to be overlooked as females fail to disrupt the classroom. Schoolwork is often completed to an adequate level due to coping mechanisms such as perfectionism that are commonly formed by ADHD students. It is because of this that the idea of a female student having ADHD is eliminated — making our struggle lonely and silent.
For Kate, one day she just realised she wasn’t taking anything in.
“I would read a page or a chapter of a book and I’d skip through the words to make it to the end. I then realised that I had interpreted the meaning of the text completely wrong because I would have skipped over key parts of the story, and then I’d forget everything I had read within seconds.
“Teachers would then call on me to answer their questions in front of the class, knowing I didn’t know the answer, just to prove that I didn’t read it properly or didn’t follow their instructions’ as they called it. This made me feel a bit stupid, so I’d do anything to forget about my school work and wag.
“The thought of going to school, not understanding anything and being embarrassed in front of my mates kept me up at night. Looking back, this was the trigger for my depression and the cause of huge panic attacks.”
Child and adolescent psychiatrist Timothy Wilens has highlighted that in females with ADHD, the prevalence of depression in girls aged 6 to 16 years old, compared to those with healthy controls, is 17 per cent verses 1 per cent, and the prevalence of anxiety disorders is 34 per cent verses 5 per cent. Women with ADHD who are not diagnosed until adulthood were also found more likely to have a history of depression and anxiety than those without ADHD.
Like me, Kate fell short of support and sympathy from her teachers.
“Over a few months, everything just built up and I ended up seeing the leader of my year group. The best they could do for me was sort out a plan to get me through two more years of school, so I could leave as soon as I could and with some sort of qualification.”
It is only when the lives of those with ADHD begin to spiral out of control during adolescence that a diagnosis is formed, which was the reality for Kate.
“On the weekends, I was going to house parties and getting wasted to forget about what happened the week before and the shit that was coming Monday. I was pretty reckless and, to be honest, I didn’t really care how I acted when I was drunk or who I got with. I just did whatever to forget. I’d then lay in bed all day Sunday hungover, which made it even less likely for me to try to catch up on school work.
None of what I did made my parents happy, but they weren’t the ones struggling.”
This reminded me of myself during high school and university. I was referred to by peers as a “bit of a loose bitch”: a persona I would use to mask my deeply embedded anxiety towards education, but really just reflected the demoralisation, substance abuse and promiscuity that comes with undiagnosed ADHD.
I was relieved, to say the least, when I fell over and fractured my wrist at a house party and had to take time off school. My friends thought it was a pretty classic story, but when I returned to class, my design teacher did not and asked me if alcohol was involved in my fracture. It was clear that she had overheard my friends talking, but I sheepishly denied her claim, as I’m not one for serious conversations. She took my denial, but by the look on her face, she knew I was lying, although this didn’t affect us continuing as normal. This was one of the classes I struggled with significantly.
By the time I reached university, I went clubbing three or four times a week. I’d hit the D-floor, hook-up with some very questionable men and always come back to the halls with a good story.
This temporarily distracted me from my traumas, but only until I failed a semester. This was when I knew I truly needed help. Due to my previous attempts at seeking help being rejected, I downplayed my own misery and moved campus to start again on my own. This failed miserably, and the year was riddled with not only my existing educational anxiety, but I felt so overwhelmed by the self-deprecative acts that were haunting me from the previous year. This then lead me to fall further behind in my education and further bad habits I had established, which included hefty substance abuse mixed with living in pyjamas and rarely leaving my bedroom.
I contemplated the worth of my existence. I began to ask myself daily, “What is the point of continuing if I can’t even gather the courage to leave the house or complete an assignment?” I couldn’t stand that I was proving my Dean from school right. I felt so lazy and useless.
I knew I couldn’t live like this anymore; I just wanted to wake up one day normal – but I knew that wasn’t ever going to happen. I ended up having to go see a counsellor from a crisis team, who then referred me to a psychiatrist. They told me I was depressed, had anxiety and, after a few sessions, diagnosed me with inattentive ADHD.
This is the reality for women with inattentive ADHD. We are stripped of what would be considered by most a ‘normal’ childhood and education, and rebated with traumas that follow us into our adult lives. No matter how great we attempt to forget them, they always catch up. Our cries for help are ignored by those who aren’t suffering, by those who we are taught to trust and seek guidance from.
Why is it that to be heard, we have to hit absolute rock bottom?
Even after diagnosis, we are plagued with comments like “You don’t seem like you have ADHD”, “I couldn’t even tell you have ADHD when I met you” and my favourite, “Isn’t that what the naughty kids have?” Some just laugh at the idea of it.
I can’t speak for anyone who falls under the hyperactive or combination subtype, and I acknowledge that they have their separate struggles. But I can speak for myself. I can say that from my own experience, there is nothing, absolutely nothing, comical about living with ADHD of any subtype, being generalised, being deprived of a sense of normality or any of the bullshit that comes with the label.
The way people see ADHD isn’t going to change anytime soon, but it needs to. Teachers need to be educated further to understand the students that are coming into their classrooms, stigmas need to be diminished and most importantly, every cry for help in the classroom needs to be heard. No matter how quiet.
Cover by Siora Photography