ADD and ADHD: Not Just a Boy Thing
I was almost 30 when I was diagnosed with ADHD, and even then the diagnosis was almost accidental–a stowaway in my search for answers for my chronic fatigue.
My reaction was skepticism. ADHD, I thought, was psychology’s way of attaching a pathology to kids who couldn’t sit still all day. Sure, I figured, maybe there was a real condition here and there, but those were the trouble students, the ones consistently being removed from class.
I was wrong.
As far back as the 1700s, researchers have focused the study of attention primarily on school-age boys.1 Not until the late 20th century did scientists begin to study women specifically, and it was 2013 before the Diagnostic and Statistical Manual of Mental Disorders (DSM) was updated to include adults. The resulting stereotype regarding what ADD/ADHD looks like and who it affects means many women are going mis- or undiagnosed.
Writing in 2012, psychologist Ellen Littman summed up the phenomenon this way: “Early referrals to psychiatric clinics were motivated by the difficulty of managing hyperactive, impulsive, willful children, the great majority of whom were young white boys…Only the minority of girls exhibiting behavior most similar to hyperactive boys could potentially be diagnosed.”2
Julia Rucklidge was one of the first to study women with ADHD. She began in the mid-1990s while working on her doctorate in psychology at the University of Calgary in Alberta, Canada. She, along with her colleague Bonnie Kaplan, looked at 102 women, half of whom had ADHD and half of whom did not. The results–which pointed to greater depression, anxiety, stress and lower self-esteem in women with ADHD–were among the first concrete evidence the condition went beyond making it difficult for six-year-old boys to sit still in class.3
The response to work like Rucklidge’s and Kaplan’s can only be described as slow. As of 2003, most women were not diagnosed until their late 30s and 40s. Psychologist Stephen P. Hinshaw also blames this on the fact that “their ADHD symptoms bear little resemblance to those of boys.” In its place, says psychologist Kathleen Nadeau, women are given diagnoses of depression and anxiety.4
Making matters even more confusing is the fact that while hyperactive boys with ADHD “grow out” of the “H” part of the diagnosis, female symptoms frequently increase with time. This is because the hormone estrogen fuels them, which increases with age.5
As late as 2013, an estimated four million women living in the United States were still undiagnosed–a number that represents anywhere from half to three-fourths of all the women living with the condition.6
As far as the effects of misdiagnosis or lack of diagnosis go, I consider myself lucky. True, I can’t sit through a game of Monopoly, and my personal record for the number of times I’ve gotten up during a movie is seven (in my defense, it was Boyhood). But I was also raised in a home defined by order, with strict bedtimes and chore assignments. Despite being years since I’ve lived at home, this training has given me something to fall back on, helping me assign a specific pocket for keys and avoid the buildup of clutter. It can be exhausting, the constant reminders, and OCD-inducing as I check again and again for the same object in the same place as if my wallet might have somehow leapt from my backpack when I wasn’t looking. But at this point in my life, it stops at being a nuisance–nothing more.
For those with more severe cases, journeying into adulthood with untreated ADHD/ADD can mean a lot more than embarrassment at once again finding that one has hogged the conversation. It can mean substance abuse, teenage pregnancy, alienation from peers, eating disorders, unemployment or underemployment, low self-esteem7 and, in the most extreme cases, self-injury and suicide.8
“These are people significantly underachieving and [who] end up going the depression route, mostly the result of life failure,” says Mitchell Clionsky, a clinical and neuropsychologist. “It’s like they’re running life’s race with lead weights on their ankles.9
How then do we identify ADHD/ADD in girls and women before the situation becomes dire?
Generally speaking, girls with the condition are more likely than their male counterparts to be inattentive than hyperactive.10 When told to perform an assignment they will often daydream quietly at their desk. They struggle with organization, are forgetful, and overall seem to “operate at a slower pace” than their peers. Says Kathleen Nadeau, “Some of these girls are anxious or depressed, and are often mistakenly seen as less bright than they actually are.11
Those girls who do display signs of hyperactivity are often labeled undisciplined. “Their handwriting may be messy, they are often disorganized, and they may rush out the door for their next activity leaving their room a huge mess,” says Nadeau.12
In some cases, the hyperactivity and inattentiveness work in conjunction, resulting in a “Chatty Kathy.” Active and talkative, they often have trouble organizing their thoughts and are frequently disruptive in settings such as a classrooms.13
Common in each of these is a struggle with school, whether due to daydreaming, hyperactivity, or constant chattering. But as Nadeau points out, some girls with ADHD/ADD do well in school, making it especially difficult to spot them. Frequently the issues don’t come to the fore until later–middle school or high school, at which point “their problems with concentration, organization and follow-through are more likely to reveal themselves.”14
It’s been less than a month now since I was diagnosed, but already I’ve felt the weight of shame lift off my shoulders. Without absolving myself of all responsibility, I’ve come to see what used to feel like a stack of character flaws a mile high as instead something that extends far beyond me. With that understanding has come more patience and forgiveness for myself, and with that hope.
Written by Tamarra Kemsley