There has been a misconception in comprehending ADHD in women. The typical image associated with ADHD is often that of a boy unable to sit still and constantly engaging in disruptive behavior. However, a recent systematic review indicates that despite available evidence, women are still frequently misdiagnosed.

Role of Social Expectations

Social expectations, as elucidated by Holthe (2013), play a pivotal role in shaping acceptable behavior, and these expectations vary significantly based on gender norms. In particular, girls are frequently steered toward embodying traits traditionally categorized as “feminine.” However, when these young girls display behaviors associated with Attention Deficit Hyperactivity Disorder (ADHD), they encounter the risk of societal judgment, as underscored by Holthe (2013). Consequently, in navigating these societal expectations and the potential for negative perceptions, many girls grappling with ADHD engage in a purposeful concealment of their symptoms. This strategic effort to mask their ADHD-related behaviors, highlighted by Waite (2010), becomes a coping mechanism adopted by numerous girls to mitigate potential stigmatization or societal disapproval. In delving into this complex interplay between gender expectations and neurodevelopmental conditions, it becomes evident that the societal lens through which ADHD in girls is viewed contributes significantly to the challenges these individuals face in expressing their authentic selves.

Disparity in Healthcare for ADHD in Women

Mowlem et al. (2018) discovered that among children diagnosed with ADHD, 72% were boys. Additionally, 12.9% of children exhibited symptoms without a formal diagnosis, with 64% being boys and 36% girls. These findings suggest potential disparities in both diagnosis rates and criteria applied between genders.

Overdiagnosis of Emotional Issues

Boys are frequently referred for behavioral issues such as ADHD, while girls are more commonly referred for emotional concerns like anxiety and depression, according to Klefsjö et al. (2021). Girls tend to have more pre-diagnosis psychiatric care visits, and they are often prescribed non-ADHD drugs like antidepressants both before and after diagnosis at higher rates. Girls are generally older than boys at the time of referral and diagnosis, and they require higher levels of emotional distress for referral. Symptoms in girls may go unnoticed until there is a significant disruption (Klefsjö et al., 2021).

Other Instances of Gender Bias in Healthcare

This pattern of underdiagnosis transcends the realm of ADHD and extends to other conditions. In the case of disorders such as Autism Spectrum Disorder (ASD), women encounter underdiagnosis, primarily attributed to diagnostic criteria that are historically based on male behavior (Green et al., 2019). Additionally, when considering cardiovascular disease, a prominent cause of female mortality, there is a documented trend of delayed diagnosis and subsequently poorer outcomes for women (DeMarvao et al., 2021). This underscores the pervasive challenge of gender-biased diagnostic practices and the need for a more inclusive and nuanced approach across various medical domains. The implications of such underdiagnoses are substantial, highlighting the importance of addressing gender-specific manifestations and considerations in the medical diagnostic framework.

Why Fixate on Labels?

The emphasis on labels is not arbitrary. Diagnosis not only shapes identity but also influences hope and self-esteem (Yanos et al., 2010). It provides a framework for self-comparison and aids in identity formation, helping individuals make sense of their history (Schmitz et al., 2003).

Regrettably, many women and girls silently grapple with ADHD, often excluded from conversations. A timely diagnosis can bring about significant positive changes for women and girls dealing with ADHD.

The Twisted Diagnostic Curve of ADHD in Women

Recognizing that ADHD symptoms in women may differ from traditional male presentations, healthcare professionals should consider gender-specific manifestations, including emotional dysregulation and internal struggles

Story of Moira Dela Torre

In a recent interview with @inquirerdotnet, Moira Dela Torre shared that her ADHD diagnosis marked the beginning of a self-learning journey. Before the diagnosis, she described herself as self-critical, not fitting the stereotypical notion of being hyper, easily triggered, and experiencing certain sounds disappearing from her train of thought. The diagnosis is seen as a new chapter in her life.

I express gratitude to her for sharing her personal struggle, and I extend heartfelt wishes for a wonderful journey of healing ahead.

References:

Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of Attention Disorders, 27(7), 645–657. https://doi.org/10.1177/10870547231161533

de Marvao, A., Alexander, D., Bucciarelli-Ducci, C., & Price, S. (2021). Heart disease in women: a narrative review. Anaesthesia, 76 Suppl 4, 118–130. https://doi.org/10.1111/anae.15376

Green, R. M., Travers, A. M., Howe, Y., & McDougle, C. J. (2019). Women and Autism Spectrum Disorder: Diagnosis and Implications for Treatment of Adolescents and Adults. Current psychiatry reports, 21(4), 22. https://doi.org/10.1007/s11920-019-1006-3

Holthe, M. E. G. (2013). ADHD in women: Effects on everyday functioning and the role of stigma (Master’s thesis, Norges teknisk-naturvitenskapelige universitet, Fakultet for samfunnsvitenskap og teknologiledelse, Psykologisk institutt).

Klefsjö, U., Kantzer, A. K., Gillberg, C., & Billstedt, E. (2021). The road to diagnosis and treatment in girls and boys with ADHD – gender differences in the diagnostic process. Nordic journal of psychiatry, 75(4), 301–305. https://doi.org/10.1080/08039488.2020.1850859

Mallorca, H. (2023, September 18). Moira Dela Torre after ADHD diagnosis. INQUIRER.net. https://entertainment.inquirer.net/518924/moira-dela-torre-says-adhd-diagnosis-set-her-on-a-self-learning-process

Mowlem FD, Rosenqvist MA, Martin J, Lichtenstein P, Asherson P, Larsson H. Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. Eur Child Adolesc Psychiatry. 2019;28(4):481-489. doi:10.1007/s00787-018-1211-3

Schmitz, M. F., Filippone, P., & Edelman, E. M. (2003). Social Representations of Attention Deficit/Hyperactivity Disorder, 1988–1997. Culture & Psychology, 9(4), 383–406. https://doi.org/10.1177/1354067×0394004

Waite R. (2010). Women with ADHD: it is an explanation, not the excuse du jour. Perspectives in psychiatric care, 46(3), 182–196. https://doi.org/10.1111/j.1744-6163.2010.00254.x

Yanos, P. T., Roe, D., & Lysaker, P. H. (2010). The Impact of Illness Identity on Recovery from Severe Mental Illness. American Journal of Psychiatric Rehabilitation, 13(2), 73–93. https://doi.org/10.1080/15487761003756860