Born into blame: underdiagnosing women with ADHD

In 2022, I sat across from my best friend. He stood in the kitchen, listening to me ramble as usual. Finally, he turned around and said “You know, I think you might have ADHD.” In true neurodivergent fashion, I said “What’s that?” and away I went into hyper-fixation land. Deep diving into research, I spent hours uncovering the mystery of ADHD. Like the inside of my mind, I had endless browsers with quickly-multiplying tabs. And by the end of the day, I had a list of psychiatrists and mental health centres noted to call.

Stepping into a mental healthcare centre or speaking with a psychologist was nothing new for me. However, you would think that after years of mental health care, receiving a diagnosis would not be so hard. Unfortunately, the empowerment I felt with a new understanding of myself vanished. It has become increasingly undeniable that neurodivergent women are misdiagnosed, underdiagnosed, and overall misunderstood.

Today, I write this for my teenage self: an overachiever and perfectionist who flew under the radar, masking her ADHD with burnout, social anxiety, and perfect grades. I remember sitting across from the typical representation of ADHD – a young, aggressive, angry boy who could not sit still in class. Now imagine a shy, second-generation Asian immigrant girl; that does not fit the box, does it?

I had three years of rapport with my psychiatrist before stepping into his office and asking for an ADHD assessment. He denied me, gaslit me, and quickly said, “No, you do not have ADHD. I have seen you for three years and already screened that out.” He proceeded to pull up my intake records from three years ago. He repeated, using my own words, “I had perfect grades in high school and had no problem completing assignments.” I was dismissive of myself, minimizing as I said “Okay, that is all I wanted to cover today.” Closing his DSM-5 textbook, he got up, opened the door, and watched another underdiagnosed patient walk away.

Before the session, I was full of confidence and excitement. I had gone 23 years believing “you are too much” or “you are too emotional” as ‘normal’ comments. You see, when you live in a household full of other undiagnosed neurodivergent people, your thoughts, behaviours, and emotions feel ‘healthy’ – neurotypical. It would be panic attacks, depression, and multiple burnouts until I found a family doctor ready to do their job. And although I had received the diagnosis I was fighting for, I could not shake the feeling of disappointment. A week into my diagnosis is when blame slowly creeped in; it must have snuck through the window, making itself at home.

Attention deficit disorder has three main presentations: predominantly inattentive, predominantly hyperactive-impulsive, and combined inattentive and hyperactive. Statistically, the prevalence of ADHD is more common among males: 12.9 per cent of men live with ADHD compared to 5.6 per cent of women. Mental health issues are like trying on clothes; each one will fit differently for each person. So, my biggest question is, why are men and boys receiving a diagnosis quickly compared to women and girls? Alternatively, why are more women receiving a late diagnosis of ADHD?

What is the difference? Women presenting ADHD are more likely to be inattentive, while men exhibit combined symptoms of hyperactivity and impulsivity. The challenge with socialization and gender expectations are their roles and heterogeneous characteristics. With society’s gender norms, it is almost impossible to recognize ADHD tendencies among girls, and there are few studies dedicated to learning about the gender differences of ADHD. It is challenging to be an adult woman who does not fit into the measured box resembling boys with ADHD. Psychologists have noted that girls with undiagnosed ADHD are more prone to develop internalizing disorders such as anxiety and depression.

So, why are women with ADHD born to blame? Notably, many women like me are prone to dissociation and overstimulation, masking it with overachievement and restlessness. Nevertheless, society’s gender roles have made it challenging to identify traits of ADHD as a woman. The constant need to be productive and the pressure to be successful filter the absence of motivation and the presence of impulsivity.

In other words, social institutions such as family structures, the workforce, and academia can foster a ‘perfect reality,’ enabling ADHD symptoms in women to go unseen. We are encouraged to succeed but blamed for not having the tools to achieve success. Ironically, although I am told “You talk too much,” in my attempt to receive a diagnosis, my voice is silenced simply because I am a woman. By acknowledging and validating the gender differences in children and adults with ADHD, society can move toward a collective community functioning with equality and equity. Let’s unpack the blame rather than being born into it.