Misogyny and the Underdiagnosis of ADHD in Girls
Disclaimer: The writer of this article is neither a doctor nor a mental health professional. Any opinions expressed in this article are the writer’s own, based on the knowledge available.
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder which is estimated to affect 5.29 percent of the population worldwide. Symptoms of this condition fall under the umbrella of hyperactivity and inattentiveness, such as having trouble concentrating, sitting still and acting without thinking. ADHD is said to impact all genders equally, however outdated stereotypes about the condition have left many women going undiagnosed until much later in life in comparison to their male counterparts. This has been shown to lead to a whole host of other mental health issues and general difficulties in life as they are not provided with the necessary treatment or support.
Ever since ADHD has been recognised as a disorder, there has been a clear gap between the number of girls and boys diagnosed, particularly at the early stages. Research indicates that the ratio of boys to girls diagnosed could be anywhere between 2:1 and 10:1 in the population as a whole. In an article for BBC Future, Florence Mowlem (an associate at healthcare consultancy Aquarius Population Health) suggested that although there is no specific reason why males should be more predisposed to the condition than females, “they don’t seem to be getting the same clinical diagnosis as often.” Gap in diagnoses have steadily narrowed over the last thirty years, however across the board most parents and teachers still tend to see ADHD as young boy’s issue.
There are many theories as to why this is the case. It is widely believed that the roots of under-diagnosis lie in childhood. As a result of social conditioning, girls are more likely to be raised as ‘people pleasers’ and so tend to try harder than their male counterparts to compensate for or cover up their symptoms. The symptoms of hyperactive ADHD in childhood - talking excessively, getting up constantly and therefore being generally disruptive in class - are at odds with the societal expectations placed on girls to be polite and accommodating and not take up too much space. Girls tend to show inattentive symptoms more frequently, such as daydreaming, being disorganised and making careless mistakes in schoolwork. The NHS states that most ADHD diagnoses take place between the ages of 6 and 12, meaning it is parents and primary school teachers who are usually the ones to suggest a child gets tested. However, as the hyperactive symptoms are more outward and noticeable to others, people exhibiting more inattentive symptoms, primarily girls, are able to slip through the net when they are young.
Failing to get an effective diagnosis and the right treatment can lead to underperformance at school and missed work opportunities. Studies in the U.S suggest that on average, adults with ADHD earn $4,300 less per year than their peers as they often struggle with being on time, organising their work schedule and maintaining good relationships with colleagues. This does not have to be the case though. A diagnosis can lead to special considerations and attention at school and university as well as the diagnosed people themselves learning effective coping mechanisms and how to adapt to their disability.
This lack of recognition can also have more severe consequences for young girls as they move through their lives. For instance, they often end up internalising their ADHD symptoms and blaming themselves for not being able to go about their daily tasks with the same ease as their peers. This can lead to general feelings of self-hatred and anxiety. The evidence corroborates this theory, as the most common diagnosis of a woman before ADHD is depression, which is often also accompanied by severe anxiety. As girls are often left untreated for a long time, they can end up self-medicating with alcohol or caffeine which can end up worsening symptoms. Even with a diagnosis, it is clear that the societal pressure to mask certain symptoms of the disorder from the outside world can also be detrimental to someone’s mental health. This was confirmed by a key study led by Harvard psychiatrist and scientist Joseph Bidderman, who found that teen girls with ADHD are more than twice as likely to suffer major depression than girls without the disorder. The study also showed that as a group, girls with ADHD are much more likely to self-harm and attempt suicide than boys with ADHD and girls without the disorder. This is the case in both diagnosed and undiagnosed cases, depicting that societal pressures still heavily impact girls, whether there is early intervention or not.
These statistics regarding ADHD link into an alarming pattern of how the burdens placed on women to act a certain well can lead to a lower satisfaction in life overall. In this case, the pressure on women to be on top of everything is an expectation is deeply ingrained into them from a young age. This is, however, not limited to ADHD. For example, the emphasis placed on women to fit a certain appearance is a leading cause of the rise in eating disorders and overall feelings of self-hatred and low self-esteem. It is also, of course, not just something that affects women, as the prevailing high suicide rates among men show – which are arguably often related to their fear of being seen as week and emotional for speaking out about mental health struggles.
It is clear that in almost every way, ridding our society of toxic gendered stereotypes can only improve everyone’s quality of life. In terms of ADHD, this greater fluidity in gendered expectations could ultimately lead to earlier intervention and therefore greater care for girls who are suffering. This could mean they could navigate the world with a greater understanding of their strengths and weaknesses and know not to blame themselves for the struggles they may face as a neurodivergent in a neurotypical world.
Words: Caroline Rauch
Art: Fempower Art