Late to the Party: The Impact of Delayed ADHD Diagnosis on Women

A significant disparity exists in the diagnosis rates between boys and girls.

ADHD is a neurodevelopmental disorder often characterised by impulsivity, inattention, and hyperactivity. While it's commonly associated with young boys, it's a condition that can affect everyone. The CDC suggests that boys are twice as likely to receive an ADHD diagnosis compared to girls (12.9% compared to 5.6%) (What is ADHD, 2022).

For many women, the journey to an ADHD diagnosis is often a long and challenging one, marked by years of misunderstanding and misdiagnosis. This blog post delves into the world of ADHD in women, focusing on the often-overlooked impact of late diagnosis.

The Gender Gap

The stereotype of ADHD primarily affecting hyperactive boys is deeply ingrained in our society. Consequently, the condition often goes unrecognised in girls and women. Research consistently shows a significant disparity in the age at which ADHD is diagnosed between genders. While boys are more likely to receive an early diagnosis, girls tend to be diagnosed later in life, if at all. 

Girls are more likely to display inattentive symptoms and less likely to exhibit disruptive behaviours, which affects the chances of early recognition of ADHD (Hinshaw et al., 2021) while males were more likely to present with disruptive behaviours and with the combined form of ADHD (Mowlem et al., 2018) - if girls display disruptive behaviours they are more likely to be diagnosed. Traditionally, ADHD symptoms in girls have been less overt, often showing up as inattention, daydreaming, or emotional fluctuations instead of hyperactivity. These symptoms are easier to be overlook - particularly around puberty time -  or mislabelled as other issues. Additionally, society still influences how girls and women present themselves, which means we mask our symptoms to fit in.

Symptom Presentation

• Girls with ADHD often exhibit symptoms like daydreaming, forgetfulness, and difficulty staying organised, which are more internal symptoms, pretty much invisible to the eye,  than the external behaviours mostly seen in boys.
• Societal pressures for girls to be quiet and compliant, persist.They may develop coping mechanisms to hide their struggles. Referrals for ADHD assessments in childhood often depend on observations from parents and/or teachers. Therefore, the process of diagnosing ADHD can result in underdiagnosis of girls if they do not display stereotypical symptoms. Children and adolescent girls often display withdrawn, depressed behaviours which also means delays to assessment referrals (Lau et al., 2021)

Bias in Diagnosis

• The historical focus on boys means initial research and understanding of ADHD primarily focused on boys, leading to a biased view of the condition.
• ADHD symptoms in girls are often misdiagnosed as anxiety, depression, or other conditions.

Hormonal Factors

• Hormonal changes can influence ADHD symptoms in girls and women, making them more variable and difficult to recognise. This is particularly so when puberty hits.

The Impact of Late Diagnosis on Women

The consequences of a late ADHD diagnosis for women can be profound and far-reaching. Years of undiagnosed symptoms can lead to significant challenges in various aspects of life. In a large study which followed women for sixteen years (Owens et al., 2017) 74% participants continued to experience ADHD symptoms as adults. These women “experienced sizable detrimental outcomes in their 20s in fields, such as internalising problems, externalising problems, self-injury, educational underachievement, occupational attainment, health problems, social impairment, and overall impairment.”

The big issue being undiagnosed women with ADHD also face the burden of being unaware of why they experience these challenges.

Mental Health 

• Increased risk of mental health disorders: Women with undiagnosed ADHD are more likely to develop conditions like anxiety, depression, and eating disorders.
• Low self-regard: The constant struggle to meet society expectations without understanding the underlying reasons can lead to feelings of inadequacy and low self-worth.

Relationships

• Strained personal relationships: Difficulty with time management, organisation, and emotional regulation can impact friendships and romantic partnerships. Young women with ADHD experience bullying and difficulties in maintaining friendships (Young et al., 2020).
• Challenges in parenting: Undiagnosed ADHD can make parenting particularly difficult, leading to feelings of guilt and inadequacy.
• Many women with ADHD may use alcohol, cannabis, and other substances to cope with social rejection (Young et al., 2020) and some women with ADHD may engage in promiscuous and unsafe sexual activity.

Career and Education

• Academic struggles: Without appropriate support, women with undiagnosed ADHD may face difficulties in school and university, impacting their educational attainment. 
• Career challenges: Challenges with time management, organisation, and focus can hinder career progression and job satisfaction.

Daily Life

• Financial difficulties: Difficulty with financial management can lead to financial instability and stress.
• Health issues: Undiagnosed ADHD can contribute to physical health problems due to factors like poor diet, lack of exercise, and difficulty following medical advice.

It's important to emphasize that these challenges are not inevitable for all women with ADHD. With appropriate diagnosis and treatment, many women can significantly improve their quality of life.

The Challenges of Seeking a Diagnosis 

The path to an ADHD diagnosis can be fraught with obstacles, particularly for women.

• Lack of awareness: Many healthcare professionals, including primary care physicians, have limited understanding of ADHD in women. This can lead to misdiagnosis or dismissal of symptoms.
• Subtle symptoms: As mentioned earlier, ADHD often manifests differently in women, with symptoms that are more internalized and less overtly disruptive. This can make it difficult to identify and diagnose.
• Societal expectations: Women are often expected to be organized, multitasking, and emotionally stable. These expectations can lead to women downplaying or hiding their symptoms to fit societal norms.
• Self-doubt: Due to the stigma surrounding ADHD and the pressure to be perfect, many women doubt their own experiences and hesitate to seek help.
• Systemic barriers: Access to mental healthcare can be limited, and waiting times for appointments can be long,further delaying diagnosis and treatment.

These challenges can create a significant barrier to women seeking an ADHD diagnosis and receiving the support they need.

Coping with a Late Diagnosis

Receiving an ADHD diagnosis later in life can be both a relief and a challenge.

Understanding that your struggles are not personal but rather symptoms of a treatable condition is a significant step forward.

Here are some coping strategies:

Self-Acceptance and Self-Compassion

• Embrace your unique brain: Understanding that your brain works differently can be liberating.
• Practice self-compassion: Be kind to yourself and avoid self-criticism.
• Build a support system: Connect with other women with ADHD to share experiences and support.

Practical Strategies

• Time management techniques: Explore time management methods like time blocking, the Pomodoro Technique,or using digital calendars.
• Organisation systems: Implement organisational tools and systems that work for you, such as task lists, colour-coding, or digital organisers.
• Healthy lifestyle: Prioritise sleep, nutrition, and exercise, as these can significantly impact ADHD symptoms.
• Mindfulness and meditation: These practices can help manage stress and improve focus.
• Medication: If recommended by a healthcare professional, medication can be a valuable tool in managing ADHD symptoms.

Seeking Professional Help

• Therapy: Cognitive-behavioral therapy (CBT) can help develop coping skills and address emotional challenges.
• ADHD coaching: A coach can provide tailored support and guidance.
• Psychiatrist or psychologist: A mental health professional can assess symptoms and recommend appropriate treatment.

Unlocking the Potential of ADHD Women