Women Are Still Alienated on Planet ADHD

All my life, I’ve felt like I’ve been living on a different planet than everyone else. My parents, my teachers, my friends — no one could understand me. I used to drink 400 milligrams of caffeine, take two naps, and have several mental breakdowns to find the motivation to get through each day and still seem ordinary to everyone else. How did I pull off this performance? Masking. No one ever knew the real me: a girl with ADHD.

ADHD can make you feel like an alien to society and yourself. Being a woman with ADHD can feel even more difficult. Societal pressures placed on young girls to conform to certain behaviors and act more “lady-like” leads to more women being undiagnosed with ADHD. Boys are more likely to be diagnosed with ADHD than girls because boys with ADHD tend to exhibit more hyperactive symptoms such as aggression and rule-breaking that can be easy to spot in childhood. Young girls, however, tend to exhibit anxiety, depression, and other internalized symptoms, which are harder to recognize.

It is not a coincidence that women are more likely than men to internalize their symptoms. Women are still pressured to have qualities such as being empathetic, delicate, organized, and following instructions easily, and many girls mask symptoms that break with these expectations to avoid social judgment and conform to society’s expectations.

Though girls are more likely to make their struggles invisible to fit society’s expectations, they are not less likely to have ADHD than men; they are simply underdiagnosed. And underdiagnosing women with ADHD poses a risk to their futures. Not only is having ADHD associated with poor academic performance, but women with ADHD experience higher rates of health challenges, struggle to maintain healthy relationships, and face an increased risk of suicide. Women with ADHD are also associated with having lower socioeconomic status, higher rates of unemployment, and poorer mental health.

Young women with ADHD can only mask their symptoms for so long before they reach their breaking point, though. For me, it was my freshman year chemistry class in college. It always felt like I had to work two to three times harder than my peers to grasp basic concepts. I’m not the only young woman with ADHD for whom my struggle became more apparent in a higher educational setting. College students with ADHD tend to struggle to maintain healthy friendships and relationships, manage academics, and preserve their self-esteem, and the increased academic stress and responsibilities can push some (like me) to their breaking point.

Young women with ADHD should not feel forced to mask the struggles of their everyday lives just to fit a stereotype. It should not be the norm to suffer from the effects of ADHD until a breaking point is reached. Reducing the stereotypes placed on young girls to conform to stereotypically feminine behaviors is necessary in addressing the gender gap present in ADHD diagnoses.

However, realistically, changing the beliefs of our entire society is nearly impossible; thus, young girls must have better access to early interventions in schools to reduce the long-term effects of ADHD. Teachers and school counselors should receive training to recognize ADHD symptoms present in both boys and girls. This should include both inattentive and internalized behaviors displayed by young girls, such as having trouble maintaining friendships, daydreaming in class, feeling anxious and sad, being a perfectionist, and more. Additionally, schools and parents should prioritize mental health evaluations for all children to address potential ADHD symptoms in early childhood. Only three U.S. states — Colorado, Illinois, and New Jersey — have passed laws to provide funding to implement mental health screenings for children and young adults in schools. A nationwide law requiring all students to receive mental health screening would benefit not just young girls with ADHD but all children struggling with mental health disorders.

Of course, it is not the responsibility of just parents and teachers to advocate for girls displaying symptoms of ADHD; healthcare professionals also play a critical role. Pediatricians and doctors should conduct early mental health screening for all children, specifically looking for ADHD symptoms. However, to properly diagnose ADHD in young girls and reduce the number being underdiagnosed, the DSM-5 — the guidelines for diagnosing mental disorders — needs to be updated to account for symptoms of ADHD commonly reflected in young girls and women. The DSM-5 criteria currently focus on hyperactive symptoms, which are primarily reflected in boys. It needs to be updated to include symptoms of inattentiveness and impulsivity, which are most common in women. Specifically, having trouble regulating emotions, finding motivation, and seeming impatient should be included, as these are commonly reported ADHD symptoms in women. It is time for modern diagnostic tools to include symptoms present in women to ensure more accurate diagnoses.

To the young girls and women who believe that something is wrong with them because they are showing signs of ADHD: nothing is wrong with you. You are smart. You are strong. You can do anything you set your mind to. Having ADHD as a woman is hard, but nothing you can’t handle. The unrealistic expectations placed on young girls often have long-lasting negative effects on self-esteem and can lead to worse outcomes. It is our job, as women, to advocate for closing the gender gap, especially in clinical settings, because we are all aliens on the same planet, united in our shared experiences, and together, we can change the narrative.