Women, like myself, my clients, and more famously Em Rusciano and Hannah Gadsby, are reaching middle age, and finally discovering nothing is ‘wrong’; they are not a failure. There is a reason for the overwhelm they feel, that their friends do not. A reason that life can seem so hard. That reason is ADHD. Unfortunately, the path to diagnosis is rarely easy due to stereotypes of who has ADHD and how it presents itself.
Mention ADHD in most circles, and you will hear about young boys who can’t sit still, don’t focus, and struggle at school. We would now describe this as ‘hyperactive’ or ‘combination’ ADHD. However, women often present with slightly different ‘inattentive’ ADHD symptoms which can be much harder to see from the outside. As to how we define ADHD, I like the definition Solden and Frank use, describing ADHD as a genetic, chronic, brain-based condition that impacts the management functions of the brain, including:
- Ability to activate yourself enough to begin a task,
- Sustaining focus once you start a task, and
- Sticking with it when your energy or interest wanes.
Many of my clients can relate to this. However, many have learnt to show the outside world a different face in order to fit in. This ‘masking’ contributes to the difficulty in obtaining a diagnosis. Luckily, even while you await a diagnosis, or are unable to attain one, there are a few steps you can take to support yourself in managing your symptoms.
Why is it so hard for women with ADHD to get a diagnosis?
Women’s ADHD symptoms are different
Teachers and parents of a hyperactive young boy may remember a child who was constantly bouncing around, couldn’t sit still or would have been a high achiever if they only focussed. They may recall a loud child who was impulsive. Such traits often refuse to be ignored. This helps young boys get the correct diagnosis at an early age.
On the other hand, women and girls are often less hyperactive in their ADHD. Instead, they may experience challenges sustaining attention, following through on larger tasks, and organising themselves on tasks and activities. They might be easily distracted and avoid or dislike tasks that require sustained mental effort. Unless clearly ‘off with the fairies’, these traits can be much more complex for the outside world to see, especially if a girl or woman has learnt to mask them.
Masking is a coping skill that many of my clients have learned, either consciously or inadvertently, through life experiences, to ensure they appear normal. They may only be able to keep it on for limited periods, like work or school, or they may have adopted it so strongly that not even their immediate family know the difference anymore. Some of these learned behaviours can be helpful, but they can also come with an energy cost that takes a toll at the end of the day. Masking can include:
- Mimicking or copying others
- Consciously suppressing more obvious movements, but the desire will remain
- Learning to react the way society expects rather than as you feel
- Withdrawing inward and being overly careful about everything you say
- Perfectionism or obsessively checking and organisation
- Overcompensating to appear in control, even if struggling
These strategies may have kept us from being socially cast out, but they can often leave women with depression or anxiety because it is so difficult to hide or because it delays a diagnosis that may provide healthy support for moving forward.
The impacts of a delayed diagnosis
“We diagnose ADHD based on the DSM-5 diagnostic criteria, which requires evidence of ADHD prior to the age of 12 as it is a neurodevelopmental disorder. Without this evidence we are unable to provide a diagnosis of ADHD.”
– an all too common response from medical professionals and diagnostic clinics.
The DSM-5 (the rule book for mental health diagnosis) classifies ADHD as a ‘Child Mental Disorder’ and requires evidence of the ‘disorder’ prior to 12 years of age.
Often it is not until women have children of their own that the scaffolds that supported them, school routines, work routines, masking and checklists, cease to be enough. These women can end up diagnosed with depression or anxiety, when really, they are overwhelmed with executive functioning challenges. Sometimes, the diagnosis of a child prompts a woman to investigate her own symptoms. (Not that having children is the only reason midlife can prompt diagnosis.)
By this time parents and those who ‘knew us when we were younger’ may have passed on, left our lives, or simply not be able to recall the details necessary to see through younger masks and assist with diagnosis. For some of us, we won’t even remember ourselves.
What can you do if you think you have symptoms of ADHD?
Know your support network
Being diagnosed with ADHD as a woman can be challenging, long and expensive. I wish it were otherwise. It really helps if you have one or two people in your corner that you can talk to about what is happening so that you know you are not alone. Try and find that person in your network who has been there themselves, or the close friend or family member who always has your back no matter what, and don’t be afraid to be honest with them about your journey. Having support will make it so much easier for you.
Talk to your GP
In Australia, your GP will usually run through a few questions to determine whether you have enough symptoms to warrant a referral to a psychologist or a psychiatrist for a potential diagnosis.
Whilst GPs are getting better at understanding the nuances of women with ADHD and how we may present, some are still hesitant to make the referral. If you feel strongly that you may have ADHD seek a second opinion. Remember, at this point, all you are doing is asking for a referral to a specialist who can assist with your symptoms whether it’s ADHD or something else. Once you have a referral, your specialist will advise their diagnosis process as these may differ.
While you wait to see the specialist or find the GP who understands you, while you save the money or even if you receive a negative result after testing, you can take some matters into your own hands.
Many ADHD resources are available to support women with symptoms, including podcasts, books, YouTube videos and websites. You may also find a counsellor or coach (like myself), who cannot medically diagnose you, but has more immediate availability to work with you to put in place systems and plans to help manage your symptoms (regardless of their cause).
After all, the diagnosis is only part of the process. What we are all really after is an easier life, and a little understanding. Understanding yourself and supporting yourself just as you are can be done without diagnosis so don’t be afraid to start now.
 Solden, Sari & Frank, Michelle, A radical guide for women with ADHD, 2019, New Harbinger Publications.