Photo by Priscilla Du Preez / Unsplash

Undiagnosed, Misdiagnosed and Forgotten

The state of ADHD in women and girls.

In 1985, researchers warned that girls were at risk of being a “silent minority” when it came to ADHD, stating that their findings suggested an under-identification of the condition and internalisation of traits by young women.  

According to a 2020 study conducted by scientists and researchers, this hasn't changed. That's in spite of females showing higher levels of internalisation and a varying presentation of symptoms. Researchers highlighted that given it is now recognised by the key diagnostic tool, the Diagnostic and Statistical Manual, that “this (initial) omission is remarkable."

Born in 1989 and diagnosed with ADHD in 2022, my path to receiving this label spanned over 30 years. I feel like a poster child for these researchers’ warnings in 1985. 

Hearing “you have ADHD” for the first time 

The words “severe” and “combined” ADHD engulfed me when the psychiatrist moved to sit next to me after undergoing his assessments. “You’ve got full marks”, he said. After asking questions and listening to my answers, littered with many common symptoms I’ve now read are indicative of ADHD, he was confident I have the neurodevelopmental condition. 

Hyperactivity and inattention have been hallmarks of my day for as long as I can remember. Impulsivity, forgetfulness, seeking novel things and emotional dysregulation have too. I just didn’t know they were connected and that there was a reason for them.  

Accepting a new identity and letting go of an old one

Yet, despite his certainty, it reassured me as much as it confused me about the list of other diagnoses I’d accrued over the past 15 years. Labels that had formed part of my identity. Ones that I’d associated with fear, shame, trepidation when entering new relationships, embarrassment and guilt. I was 33, and for the first time, I was learning that my brain is, and has been, different from that of a person without ADHD.

There was a 3200% increase in women taking online ADHD tests between 2019 and 2021, Dr Samantha Hiew, the founder of ADHD Girls, shared in a recent workshop on ADHD and women. In it, Dr Hiew explored how women have been misunderstood, misdiagnosed and how now the industry is finding a lost generation of ADHDers moving forward for change. I spoke to Dr Hiew, who confirmed she calculated this percentage rise after The Independent UK reported a staggering jump in the number of women taking an online ADHD test rising from 7,700 in 2019 to 254,000 in 2021.

Between July and September 2022, 170,000 women were prescribed ADHD medication, Hiew relayed. I was one of them. But before that, I had to try and trust this new diagnosis after receiving others over a 15-year period. My earlier diagnosis of bipolar disorder was the one I struggled with letting go of and making sense of the most. After reflecting on my assessments, my psychiatrist confirmed he didn’t perceive my earlier diagnosis of bipolar disorder to reflect my experiences, and it was an error. 

Accepting ADHD

Reaching educational and vocational potential, impaired work performance, financial stress, childcare responsibilities, criminality and co-occurring health conditions are concerns and potential challenges for ADHDers. 

A failure to identify and treat ADHD in females goes beyond pathologisation and medication. A lack of equity stems from childhood, research continues to indicate, with the global incidence of ADHD being almost threefold for boys than for girls. In 2019, there were over four million global diagnoses of ADHD, with 74% boys and 26% girls. 

Women and girls need holistic support in understanding, recognising and managing ADHD at all life stages. The impact of hormones on the condition is under increasing scrutiny, with advocates calling for more knowledge of how the condition can affect women and girls during different life stages, such as puberty, periods, pregnancy and menopause.

While I’ve been diagnosed with ADHD, my path to understanding who I am, what those four letters mean and how I live my life going forward remains, with only one tentative foot on the step in front of me. That part of the path remains elusive. But I’m empowered to follow it. And it’s my hope that with women-centric research, understanding and trauma-informed approaches to living a full and good life with ADHD, it can be for all women and girls.