Why are women underdiagnosed?

ADHD doesn’t discriminate and impacts both genders equally. However, boys are three times more likely to be diagnosed as ADHD can present differently in girls or women.

“We tend to think of ADHD as small boys ricocheting off walls and not to be allowed any red cordial. And I think testing has been focussed on that side of it. But girls and women are different,” says journalist Liz Swanton, 68, who was recently diagnosed with ADHD.

In women, inactivity and difficulty paying attention are more common signs than hyperactivity, and are often dismissed as ditziness, lack of intelligence, laziness or daydreaming. “We’re quiet and we don’t cause trouble, so busy teachers are just happy that we are manageable – until it comes time to write the reports that say, “could do better; needs to focus; not working to potential”.

Liz believes women are socially programmed to be nice and quiet, and multi-task anyway, so we “mask” the symptoms well. “We can function but at a huge cost emotionally and psychologically. That’s not to say it is all bad – there are huge numbers of creative people who have ADHD and I’m sure much of my career has been because of my ADHD – getting bored easily, being prepared to take risks etc. But I weep at times when I read some of the stories on the Facebook support groups”.

Research also suggests that adult ADHD in general is vastly under-diagnosed and as few as ten to 25 percent of adults with the condition are diagnosed and properly treated.

What are the symptoms of adult ADHD in women?

While ADHD can present differently for everyone, common symptoms include;

• Impulsiveness
• Inattentiveness
• Negative self-image
• Poor time management skills
• Finances in chaos
• Inability to focus
• Difficulties in multitasking
• Frequent restlessness
• Low frustration tolerance
• Mood swings
• Difficulty in completing tasks
• Poor planning skills
• A feeling of loss of control
• Feelings of impostor syndrome
• Wandering thoughts
• Trouble coping with stressful situations

If you find some of these symptoms apply to you, visit the ADDitude Symptom Checker, which will guide you through a series of questions and compare your responses to symptoms of common psychological and learning conditions, including ADHD.

How is adult ADHD diagnosed?

There is no single medical test for ADHD, however diagnostic evaluation can be provided by a physician or mental health professional. Evaluations generally consist of a physical exam, information gathering and ADHD rating scales or psychological tests, however an official diagnosis is only available via a clinical psychologist or psychiatrist.

For Liz, the diagnosis came after a chance conversation with a male colleague who had come to suspect it of himself. As he wasn’t getting the necessary support at home, Liz started to look into it to see if she could offer him some help and encouragement.  “I still remember sitting here in front of the computer looking at the search results for ‘adult ADHD, symptoms’ and realising that I had found an explanation for my whole life,” she adds.

“It was huge. I Googled the internationally recognised Jasper Goldberg ADD assessment, which is the international standard, did the test and the result sent me off on this path. I started looking for an adult ADHD psychiatrist locally and went to my GP asking for a referral to him, and to a psychologist.”

Just a few months later her suspicions were validated.

How living with undiagnosed ADHD can impact your life

Undiagnosed ADHD in women in midlife and beyond can lead to issues of low self-esteem, poor relationships, physical and mental health problems such as anxiety and depression, social wellness, educational difficulties, and poor work performance, amongst other issues. 

For Liz the impact had been huge. “My life has been chaotic and distressing at times. The constant refrain in my brain has been “I must be lazy, crazy or stupid because I can’t do X or Y like other people do,” explains Liz, who suggests that such thoughts are a constant in undiagnosed ADHD brains, as are self-doubt and savage self-criticism.

Liz also suggests that her undiagnosed condition led to her constantly trying to juggle a gazillion balls to look ‘normal’ and that juggling all the time, then ‘masking’ the fact that you believe you are not ‘normal’ but you need to look like you function like everyone else left her in a state of constant exhaustion.

“All the things you start and don’t finish and then criticise yourself about. Over-spending, impulsivity, over-eating (chasing the dopamine hit!). The lack of focus and concentration, the struggle to remember things, the umpteen ‘hacks’ you need to create and use to do basic everyday stuff. The brain that never stops. I think when I was younger, youth and adrenaline got me through. And hormones help. Once that all starts to fade, it gets harder,” she adds.

How is adult ADHD managed?

An ADHD diagnosis in mid or later life can bring with it feelings of relief and anger, but also resolve. While there is no cure for ADHD, with the right medical team and support it can be managed. Treatment generally involves an individualised combination of medication, education and counselling. Psychotherapy can help patients to deal with the issues caused by past failures, improve self-esteem, reduce impulsive behaviour and develop problem solving skills.

Integrative medicine can also help promote health, calm, and productivity

For Liz, it is early days and she is working to create a new life structure and learn skills to manage what she calls her “miswired brain” but her diagnosis has allowed her to forgive herself and to be more gentle.

“I’m not fighting so much – and that includes no longer arguing with all the different voices in my brain. I’m processing my life with this new lens. I refuse to fall in a heap about it: the overriding emotion is relief that I have an explanation. But obviously there is anger and regret and grief too. Mainly, my processing of memories involves that understanding and forgiveness and then putting them away again – unless there is something to take out of processing those memories to make the future better. Life is still hard but it IS better.”

Liz has also begun working with a nutritionist to improve her gut health. Not only to make sure that there’s nothing in her diet that will argue with medication when the time comes but because recent medical research has suggested there is the gut-brain axis and intestinal microbiota play an important role in modulating the risk of ADHD.

Recommended Reading:

Beyond Mental Health: Women with ADHD