Women Left Behind in Mental Health: The Late Diagnosis of ADHD

How generations of women have been let down by sexist views of psychology and behaviour

Have you noticed a boom in women talking about being diagnosed with ADHD?

No, it’s not the new mental health buzzword of the 2020s. It’s a result of an incredible step forward in psychology. The result of a realisation that…

…ADHD diagnosis is sexist.

And it’s pretty obvious why.

The ADHD symptoms most females typically exhibit are socially acceptable. Many women have internalised their ADHD. Instead of being hyperactive on the outside, it’s directed within. So they don’t cause disruption. And if you’re not causing problems, no one cares about your symptoms.

I should know.

I grew up with ADHD….but I never knew it. Not until last year. You’d think after 29 years at least one therapist would have picked up on it. Or an educator. But the misogyny runs deep in the world of ADHD.

It’s funny. The moment I was first diagnosed, my entire life started making so much sense. My battles with perfectionism, my HSP, my extreme overactive daydreaming, my mastery of procrastination… Honestly, I’m surprised no one caught it when I was a kid!

But my story isn’t unusual. All you have to do is search ADHD in women and you’ll see stories from thousands of women, just like me, who were let down by the education and mental health system and are only now getting the support they need!

The question is, how did we go so long missing and ignoring the signs of ADHD in females?

From how ADHD presents itself in most women to the reasons mental health and education professionals are biased in their recognition, here’s the story behind the late diagnosis of ADHD and the women mental health experts left behind.

The Building Blocks of the ADHD Woman

When trying to understand why so many women with ADHD go undetected in mental health diagnoses, it’s a good idea to start with understanding how it manifests.

While not every woman* falls into these categories, the majority of late diagnosed ADHD’ers have at least some of the following traits in common:

• Overly talkative
• Daydreams a lot
• Has two or three streams of thought going on at any one moment
• People pleaser
• Chronic procrastinator
• Finds it hard to follow conversations in loud environments (eg with other people talking in the background)
• Suffers from perfectionism
• High achiever in school (doing what it takes to be #1)
• Feels things incredibly intensely
• Can easily spend hours sat concentrating on something (even if they need to eat or pee)
• Difficulty with time management
• “Out of sight, out of mind” mentality
• Fear of rejection

*It’s important to note that these symptoms aren’t exclusive to females with ADHD but are more often associated with female cases of ADHD than male ones.

When you put this list of symptoms together they seem like a pretty obvious warning sign that someone has ADHD, right? Well…… that’s not what actually happens.

And so, we have floods of girls left behind by the mental health support they need during their most formative years.

Why women aren’t diagnosed with ADHD until later in life

Women are just as likely to have ADHD as men. And yet males are up to 16x more likely to be diagnosed with ADHD than females. There are many reasons why women and girls are so under-diagnosed, here are some of the biggest.

1. Females with ADHD tend to be less disruptive than males

When it comes to recognising ADHD, teachers are usually one of the first to do so (after parents). They spend all day with their students, communicating with them and challenging their brains during lesson times.

However, teachers can only do so much. In a classroom of 30 students, it’s very difficult to have a good grasp of each student at all times. The ratio gets even worse at the secondary school level with teachers seeing an average of 150 students a week. So it makes sense that the students who grab their attention and set off alarm bells are the ones causing disruption and problems instead of those who are sat quietly doing their work.

Plus, unlike the stereotypes, many girls with ADHD are hardworking and quietly get their work done. They appear to be model students. And even if they spend half the class daydreaming (I know I did!) it doesn’t affect their performance.

With the overwhelming amount of work and responsibilities teachers have, it turns into an “if it ain’t broke, don’t fix it” mentality.

Especially when you factor in the fact ADHD is so misunderstood that even mental health professionals have historically missed the signs in females. What chance do teachers have?

And because young girls often slip through detection nets throughout their school years, it can put them on the back foot for university. And that’s a time they’ll never get back.

One way to solve this is to improve the continuous professional development (CPD) teachers go through to learn to recognise it.

When I was going through teacher training, we were taught how to recognise and cater to students with a variety of mental health and learning needs, including ADHD. But again, these were often tailored towards the historically narrow view of hyperactive ADHD. So more needs to be done to enhance understanding in school.

2. Scientific studies on ADHD are historically sexist

We know that females are vastly underdiagnosed compared to their male counterparts. And we know that females often present symptoms differently from males. In fact, some psychologists believe it’s harder to diagnose females with ADHD due to the more internalised nature of their symptoms.

But we also know ADHD affects everyone equally. So why do we have so much difficulty observing more inattentive ADHD traits seen more commonly in females?

If you look at scientific journals over the past 100 years, you’ll find the answer. The overwhelming majority of literature is based solely on males with ADHD. And even when studies include females, they only make up a small minority of the sample size.

Interestingly, males with the same symptoms also tend to go undiagnosed until later in life. The problem is, the externally hyperactive view of ADHD is more typical in males than females and so, without proper analysis of ADHD in all genders, it negatively impacts some males with ADHD, too.

It just goes to show, sexism affects everyone, not just women.

If we don’t research the effects of ADHD in females, how can we hope to learn more about diagnosing and treating them in the future?

3. Societal norms force females to conform more than males

“Little girls should be seen and not heard.”

Hands up if you were told this as a child.

While these days it’s more often said as a joke, the sentiment still runs deep in society. There are many phrases we throw around that double down on the idea males and females should act differently…

“It’s not ladylike.”

“Boys will be boys.”

Historically, little girls were expected to do as they were told. They should play with dolls, be nurturing, and above all, be obedient. And while the girls sat quietly in their dresses, trying their absolute best not to make a mess, boys were allowed outside to run and play and jump in the mud. Should a girl so much as raise her voice, she would be in serious trouble. But a boy screaming and running around was absolutely fine.

It was almost uncomfortable for women to have any sign of a personality. They were just part of the furniture. And just like your sofa shouldn’t be doing laps around the sitting room, neither should a little girl.

Thankfully this disgusting, sexist mentality is becoming extinct, now only found in the darkest fringes of society.

But its legacy has left a misogynistic footprint that we’re still trying to scrub clean. (It’s getting cleaner every day but it’s still visible).

So what has this got to do with ADHD?

Well, many people with ADHD have the tendency to fear rejection and also fear being told off. And if, as a young girl, you’re being scolded for being too talkative, or too fidgety… well you’re going to do everything in your power to stop yourself. You can’t get rid of your symptoms so you internalise those ADHD qualities. That way everyone’s happy and people will like you again.

Don’t worry, though. It’s a very *healthy* coping mechanism. Most girls with undiagnosed ADHD who internalise their symptoms only develop depression, anxiety, OCD, eating disorders, substance abuse and perfectionism. No big deal, right?

4. Females with ADHD are better at wearing “masks”

If you’ve spent enough time in the mental health community, you may have come across the term “wearing a mask.” It basically means pretending to be “normal” on the outside even when you’re struggling on the inside. In the same way that a swan appears elegant above water but their legs are thrashing wildly beneath the surface.

Most children, regardless of gender, have a lot of pressure put on them to behave “well” from an early age. But it’s fair to say that when you examine like-for-like behaviour, females are told off more often for doing the same thing a male is doing. Again, this is a direct result of the historical and somewhat internalised misogyny of society.

And so, to ensure self-preservation, little girls are more likely to mask their symptoms to avoid punishment.

5. Female ADHD symptoms tend to get worse in adulthood

What happens when there are no teachers to give you detention or parents to ground you for your misunderstood ADHD symptoms?

The mask drops.

It doesn’t just drop. It crashes to the floor, smashing into a million pieces. Irreparable.

The cracks you filled with sunshine and rainbows begin to show and you start to struggle. And who can blame you? You were never taught how to cope with your symptoms.

Many women with undiagnosed ADHD are diagnosed with anxiety, depression, eating disorders, or OCD first. Partly as a result of not being taught effective coping mechanisms for your ADHD symptoms. But mostly because after 18+ years of hiding your true self and overcompensating to seem “normal” you’ve done some pretty intense damage to your self-esteem. I mean, if you convince yourself you have to hide your true self, you’re gonna believe you’re not good enough as yourself.

The fluctuation of female hormones doesn’t help, either. As women age, their oestrogen levels change. This change can directly impact ADHD, making it worse.

Between the mask falling and hormone changes, women are more likely to seek mental health help from a professional. And with the right therapist who has a deep understanding of ADHD in women, they might finally get the diagnosis they need (even if it wasn’t the one they were expecting!).

The future looks brighter for women with ADHD…

…but we still have a long journey ahead of us.

It’s a challenging feat to reprogram the fundamental beliefs most people have that ADHD is a boy’s problem for disruptive behaviour. Especially when it’s a belief that runs deep in many health professionals’ communities… the people whose job it is to diagnose and support women with ADHD.

And it’s a misconception that hurts everyone who doesn’t fit into the small subsection of ADHD symptoms seen mostly in males.

But with the overwhelming progression in education on how women present ADHD symptoms and what professionals need to look out for, we should see an end to a mass late diagnosis of ADHD in women in the next 20 years.

And finally, girls with ADHD will be given the tools they need so they can stop surviving and start thriving, just as every child on this planet deserves.

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