Attention Deficit Hyperactivity Disorder (ADHD) is underdiagnosed in women, with gender bias and cultural expectations prompting females to mask their symptoms, leading to a dismissed or delayed diagnosis. According to Frontiers in Global Women’s Health, a trend has emerged where, on average, men are diagnosed with ADHD between the ages of 11 and 22, while women typically receive a diagnosis much later, around ages 16 to 28. This is mainly due to girls not demonstrating the typical ‘naughty boy’ representation of ADHD, which is constant movement and disruptive tendencies, as, through social expectations, girls learn not to exhibit this behaviour.

Context

Historically, it was thought that ADHD is more common in males; however, according to the Australian Psychological Society, there has been a 450 per cent increase in adults being prescribed ADHD medication in the past 10 years, and 52 per cent of those were women. As a survival mechanism, girls often hide ADHD symptoms through rehearsing conversations, studying social rules, hiding sensory overwhelm and forced eye contact. This is referred to as ‘masking’. Foundational medical research centred on the male population; therefore, the ADHD diagnosis criteria present a gender bias by not considering the commonality of masking in girls, as boys often do not feel pressure to uphold similar behaviour expectations.

Symptoms

Symptoms of ADHD in women differ from those in men as they are often more internal; they include difficulty paying attention, a tendency to start but not finish tasks, having trouble remembering things, difficulty in organising tasks on time and struggling to follow instructions. These symptoms are often mistaken for anxiety or other conditions. A study involving interviews with 200 women with ADHD found that 70 per cent of participants had received a diagnosis of anxiety in childhood or adolescence and then went on to be diagnosed with ADHD as adults. Additionally, the assessment for ADHD in girls is often treated as subjective, receiving comments from doctors such as “she’s just a little bit quirky”, in contrast to the standard objective assessment that boys often receive.

Impact

There is a reported significant impact of living undiagnosed with ADHD, with it being highly consequential across all domains of life, including relationships, education and career. Additionally, an emotional cost comes with masking ADHD symptoms, which requires a high level of energy and can lead to emotional exhaustion and burnout. Women with ADHD reported that when they were undiagnosed, they felt that there was something wrong with them. Girls often receive correction comments of “you’re too sensitive and inconsistent”, resulting in high distress and negative self-judgment.

After receiving an ADHD diagnosis, people typically experience five stages:

• Grief, of missed years of not knowing they had ADHD.
• Relief, of finally finding an answer to years of confusion and distress.
• Awareness, researching about symptoms and treatment for ADHD.
• Superhero, realising you are unique and have a different way of thinking compared to neurotypical people.
• Balanced view, finding harmony with the positive and negative effects of your condition. 

Importance of Early Intervention

Early intervention is key to supporting girls with ADHD as it can significantly improve their development, well-being, functional capacity, and quality of life. The Mental Health Foundation Australia is here to help females with ADHD and for females who believe they may have ADHD. By creating an environment of safety and acceptance, where girls can feel comfortable unmasking.

How can the Wellness Hub help?

Counselling sessions can be tailored with predictability and structure to the individual’s strengths and challenges, and visual supports are available to accommodate variability in learning styles. We understand the experience of sensory overwhelm. Sessions are held in a room with limited outside light, and noise-cancelling headphones are available to assist with comfort. Services offer flexible support by adjusting conversations based on the energy and capacity that an individual is feeling that day.

We understand that asking neurodivergent individuals to talk about feelings is complex. Counsellors use a communication style that is effective in identifying problems and finding tools and solutions. Counsellors can offer referrals to assist with ADHD diagnosis, and if further support is needed.

You can use this link to book a counselling appointment at our Wellness Hub https://wellnesshub.mhfa.org.au/book-an-appointment

Blog Art & Written by Olivia Pase, Media Intern

Content Inspired by Shannan Lea, Provisional Counsellor