The Hidden Struggle of Girls and Women with Undiagnosed ADHD | Opinion

At social gatherings, I’m not surprised when older women wonder if they could Attention Deficit Hyperactivity Disorder (ADHD) upon receiving the diagnosis of a daughter or son. It is not strange to hear them say, “At school I started an assignment and had a hard time finishing it”; “I can’t stand it after eating. I feel restless after dinner”, “I can concentrate intensely on one thing, but leave everything else unfinished” or “I make plans that do not come to fruition”. These behaviors are generally characteristic of ADHD, a common and inherited neurobiological disorder characterized by a persistent pattern of inattention and hyperactivity-impulsivity.

The literature identifies three subtypes of ADHD: predominantly inattentive, hyperactive-impulsive, and combined. These symptoms begin in childhood and continue into adulthood, even into old age. In fact, current research suggests that at least 80% of girls with ADHD will also have symptoms as females. For decades, the diagnosis was mainly given to hyperactive children, leaving many girls in the limbo of underdiagnosis.. Although they are now diagnosed, it is in a much smaller percentage and at a later age.

Although the symptoms of inattention, hyperactivity and impulsivity are the same in both sexes, inattention in general is more common in them than hyperactivity and impulsivity. As a quiet and subtle behavior, unlike hyperactivity, which is more pronounced, their inattention often goes unnoticed, especially when they perform well academically or have good social behavior. It may also be that parents, educators and health professionals underestimate the severity of hyperactive/impulsive symptoms in girls compared to boys, resulting in them not being referred in time for assessment and therefore not receiving timely support to understand them and support them.

Over time, and as a way to control ADHD, girls use coping strategies such as defense mechanisms that allow them to move on, such as “go the extra mile to maintain high grades and go above and beyond to fit into the context in which they work”masking not only the symptoms for a time or an important part of their life, but also certain problems that they may present in academic, social, work and family relations or relations between the couple.

Faced with delays in ADHD diagnosis and intervention, girls are more likely to exhibit more severe symptoms than boys, materializing dramatically differently. For example, they show more internalizing symptoms such as anxiety and/or depression (disorders that may or may not accompany ADHD), twice as high as children who, in contrast, show high levels of externalizing symptoms (conduct disorder ). Internalizing disorders in girls carry a risk of self-harm and suicide attempts that is four to five times higher than that of girls without the disorder. This means that they end up being misdiagnosed and treated with anti-anxiety or depression medications because they are misdiagnosed as primary disorders.

In fact, the most common diagnosis for a woman before being diagnosed with ADHD is an emotional disorder. There is also evidence for the coexistence of somatic symptoms such as pain and fatigue, finding that ADHD symptoms are higher in fibromyalgia clinical cohorts. Symptoms of inattention, hyperactivity, and impulsivity can be exacerbated by hormonal changes during the menstrual cycle (after the ovulation phase), pregnancy, and menopause.

The added burden of restrictive gender roles and the pressure (imposed or self-imposed) to “keep everything under control” causes many to internalize their symptoms as a “personal failure.” In the absence of a (neurobiological) explanation, they become petrified by the guilt of not being able to “get it right the first time” and end up feeling lost and emotionally overwhelmed. This is because they often also struggle with executive function (EF) difficulties, which involve a set of skills (cognitive flexibility, inhibitory control, working memory, and verbal fluency, to name a few) that the articulated form allows to perform actions aimed at the desired goal. EFs enable us to initiate and complete tasks, set goals and achieve them, focus our attention, plan and organize activities, sustain effort and persevere in the face of adversity, formulate an alternative plan when an event occurs unexpectedly or goal not achieved , goal or emotion control. When these skills are not managed, chaos is created around us by failing to cope with the demands of the context such as educational, professional, financial, family and social responsibilities, among others.

What we must not lose sight of is that people with ADHD cannot avoid certain behaviors. We should not get upset, therefore we are in the presence of a neurobiological disorder and we cannot act like an electrician to change the wiring of the brain. After all, we all have different “connectors and voltages”. Neurodiversity as a concept explains it very well: ADHD, like Autism Spectrum Disorder (ASD) and Specific Learning Disabilities (SLD), among other biological conditions, are nothing more than just neurological variations. In this sense, ADHD is neither a defect nor a flaw, it is one of the many ways in which the brain can function. It is this cognitive variability that defines our individuality as human beings. From this perspective, much of what makes life difficult for neurodivergent people has little to do with them: it’s that society isn’t designed to accept diversity of brains, ways of thinking, and being.

Loving a girl or woman with ADHD isn’t hard at all, and even though sometimes it seems like living with them is something else, your life won’t be chaotic forever when you get the diagnosis, you’ll finally be able to find answers and make sense of the problems he had to overcome up to this point. But above all, after professional assessment and with pharmacological and/or psychotherapeutic intervention options, learn to establish new priorities based on self-acceptance, choose environments where their potential is recognized and their strengths and talents are highlighted, places that provide support to differences.

In short, a timely diagnosis of ADHD is the initial step for them to overturn their belief system, which gives them, on the one hand, a neurobiological explanation for why sometimes things are so difficult and, in parallel, achieves the necessary validation that Allow yourself to own your neurodivergence.