Women with Undiagnosed ADHD
“Why can’t you ever get anything done when I ask you to?”
“Are you ever actually listening to me when I’m trying to talk to you?”
“Why can’t you ever pick up after yourself? You’re such a slob!”
“Can you ever keep track of your keys or wallet or do you just never care what happens if you lose them?”
“I just asked you to do it yesterday, have you really already forgotten?”
What … is wrong with me?
Growing up, the inside of my head was a complete catastrophe. From never being able to keep hold of the same sweater each week, that feeling of my stomach dropping each morning when my teacher asked us to pull out our homework from last night and I, of course, forgot again, and all the way to getting on the wrong bus to go home at the end of the school day. My mother even felt the need to meet with each teacher before the first day of school to prepare them that I would look the teacher in the eye, nod my head, but still would not be listening whatsoever, thus needed to be asked follow up questions to make sure I was listening.
Yet, after all of that, my mother was still never advised to have me be tested for ADHD.
This is not uncommon at all. While the DSM states that ADHD is more prominent in boys than girls with a 3:1 ratio, this has nothing to do with its prevalence in girls. This actually has more to do with an unawareness towards how ADHD looks differently in women and girls than in males, thus the female population is severely undiagnosed while males tend to be overdiagnosed. Essentially the only studies we have that delve into ADHD focus solely on elementary-school aged boys, so it makes sense why there’s very little awareness as to how it presents in girls. Interestingly, while current research suggests that the ratio of ADHD in boys to girls is 3:1, the rate in adulthood is actually almost identical - being 1:1 for females and males.
According to the National Institute of Health, while males tend to exemplify more of the hyperactivity and impulsivity (externalizing symptoms) aspects in ADHD, females lean more towards the inattention aspect (internalizing). This makes it more difficult for teachers to pinpoint and recognize, but also leads to these girls being completely misunderstood and stigmatized for their behaviors. Moreover, females have a stronger ability to develop coping strategies and skills and find ways to mask their symptoms making it less likely for teachers to recognize. This masking/hiding development is likely due to shame about their symptoms and inabilities that is brought on by criticism from families and peers for not performing to their standards.
However, regardless of binary gender differences in presentation, ADHD still negatively impacts women and girls in the same ways as boys and men, specifically with difficulty in school and lower academic performance, and behavioral issues (NIH). In terms of comorbidities, since girls with ADHD symptoms are detrimental to catering to overly restricting gender norms (such as expectations of organization/tidiness, perfectionism, taking care of younger siblings, being on top of chores/domestic work, etc), it can contribute to social rejection and isolation. This is dangerous because it ultimately poses a threat to leading to depression, anxiety and suicidal behaviors (Chronis-Tuscano, 2021). Thus, if ADHD goes unnoticed and untreated, it can pose a severe negative impact on the development and long term mental health of these girls.
A positive that may have come out of this disproportionate testing in children may be that while boys with ADHD tend to be overly medicated and become dependent at an early age in order to function, girls grow up to learn how to cope with these symptoms without the need for dependence on medications. Regardless, it is important to develop awareness over what ADHD looks like in gender differences in order for teachers to recognize it and recommend parents to get their daughters tested in order to properly provide interventions for their academic success.
In my case, my lack of interventions at an early age made my symptoms continue into high school and adulthood; while I have somewhat developed coping skills throughout the years, I still really struggled with daily basis tasks outside of the already stressful components of being a student-athlete in college, and learned many lessons the hard way. Additionally, due to the current adderall shortage, many individuals who do indeed have a diagnosis have been feeling the same or similar complications of daily functioning to those that do not have a diagnosis or prescription.
This is the case for many undiagnosed female-identifying individuals; in her book The Queen of Distraction: How Women with ADHD Can Conquer Chaos, Find Focus, and Get More Done, Terry Matlan discusses many skills and tactics that she has learned as a mother with ADHD. In her introduction, she describes the daily struggles of trying to stay on top of a million things at once as a mother; from making sure dinner doesn’t get burnt, waking up to moldy clothes because of forgetting to put them in the dryer the night before, late bill payments, and saying to herself “How can I earn two academic degrees but not be able to file ten papers? What is wrong with me?” The restricting gender roles in the typical American household make seemingly mundane tasks for others extremely difficult for women with ADHD, because not only do you have your own tasks to be on top of but also your staying on top of things for your children and spouse as well. (Matlan, 14)
Matlan shares that once she was finally diagnosed as an adult her life changed for the better exponentially, not just in organization but also with confidence within herself in ways she had never felt before. In her book, she shares many these skills she learned on how to best manage symptoms of ADHD as an adult who went untreated and/or struggling to perform tasks. On the other hand, for those that do indeed have a diagnosis, the current nationwide adderall shortage has posed serious inhibiting threats on those that depend greatly on the drug for daily functionality. Here are some key points that Matlan shares in order to best manage your symptoms without the use of medications:
Prioritizing Duties: “Should I call my grandmother back first or pay the bills? Or do I need to clean my room first or RSVP to that wedding? But I need to do the dishes and put the groceries away before I need to pick up Jack from school…but my grandmother will get mad at me if I forget to call her back before tomorrow … ” Sometimes having an extensive to-do list of the most mundane tasks can feel so overwhelming that you’ll never be able to get them done, and just the act of overthinking about getting them done distracts you from doing them even further. Moreover, a lot of times we’ll put off the mundane tasks because … well you know, they’re mundane and we just don’t feel like it. However, since they just kind of have to get done,
Make a list of priorities to make sure you get done the vital ones first. It probably is more important to grab groceries for the family first and finish paying your bills in a timely manner than calling back your grandmother, right? Moreover, a lot of times we’ll put off the mundane tasks because … well you know, they’re mundane and we just don’t feel like it. However, since they just kind of have to get done,
Keep yourself stimulated while doing them by either listening to music or having the TV on in the background so you don’t get distracted after every couple of minutes with your cell phone and it winds up taking you two hours to just put away the laundry.
Love and Relationships: With either starting a new relationship or maintaining a relatively new one, it can be a lot getting close to a potential partner that does not know you super well yet or your symptoms. Here are some tips to feel confident about yourself and in your relationships:
Managing impulsivity when going out (such as not over drinking to diminish anxiety) and in conversation. Ex. practicing “give and take” conversation strategies to not fully take over the conversation with impulsivity.
Practice focusing or grounding techniques to avoid thinking about something else while in conversation so your partner doesn’t feel ignored when talking to you.
Handling comments about your symptoms from a new partner. Such as if a partner makes a comment about your indecisiveness on what to order at a restaurant; it’s okay, they’re not criticizing you, just getting to know you by pointing out an observation!
Explaining tangents: “What I’m really trying to say here …” or “The most important thing I want you to understand is …” in a “paraphrasing out loud” sense.
Sensitivity to Stimuli: Due to being easily distracted, sometimes it can be really difficult to be out with friends at restaurants or bars in order to keep up with the conversation. This is because there are so many sounds going on and so much movement behind your friend’s head; it can get overwhelming. Even though I’ve passed every hearing exam growing up, it is well known to the people I’m closest with that I really struggle with hearing; this is due to the fact that people with ADHD tend to hear sounds that other people don’t, and thus get overstimulated and distracted.
Try ordering clothes online rather than in person at the mall to avoid the stimuli of being at the mall, can also help avoid impulsivity of binge shopping from seeing everything at all once
Person with ADHD should be choosing the table (can talk to the host about accommodations) and sit at the table to find the spot with the least amount of noise and distractions. Sometimes sitting near the service staff and kitchen door can be overly distracting when trying to catch up with friends. Feel confident when advocating for yourself and your needs.
If you walk into a restaurant or bar that you can tell upon arrival might be too overstimulating for you, it’s okay to ask your friends, “Hey, is it okay with you if we try out the spot next door? This place just feels a little too loud for me and I want to be able to catch up with you!”
Staying on Top of Workload: “Out of sight, out of mind” is known all too well for the ADHD folk, so making organizational plans to make sure that you stay on top of your tasks for each day and week is crucial.
Ask coworkers to put in writing the tasks they need you to complete, such as an email or text, rather than delivered verbally. This way you don’t have to worry about forgetting the details of what they asked you to do and instead always have something to look back to when actually completing said task.
The paper/document pile up can be so overwhelming that you’re not sure where to start when the time comes to get to it, and even then you start wasting time figuring out where to start. To mitigate this, have two separate file cabinets: one for “Do Today” and another for “Do Later” to help you prioritize the things that can get done immediately and know which ones you can breathe before doing later in the week. Also, go ahead and throw out anything that you know you’ll never do anyway, might as well right?!
Make small to-do lists that are readily visible on your desk to avoid the “out of sight out of mind” rabbit hole. Even add the most mundane tasks to it, such as “re-forward old email to boss”, because checking off even the small things can make you feel productive thus leading to increased productivity.
Emotional Sensitivity: Women with ADHD can be known for their overt sensitivity side, meaning they are very empathic but sometimes can be a bit embarrassing when in public or watching a sad movie or just simply being an ear to a friend. However, while it may feel humiliating when it happens or you even feel like you’re “not tough”, know that your empathy and intense feelings for others is a strength; embrace it! It’s what makes you who you are. At the same time, here are some tips if this feels like a relatable symptom to you:
Avoid toxic people that make comments about you being “overly” sensitive and make you feel ashamed or embarrassed as a result.
Find a supportive friend who you trust to talk to about these feelings when they get to be too overwhelming; this can help avoid emotional dysregulation which tends to happen when bottling things up.
Grounding: find good grounding, breathing or mindfulness strategies that work for you to help de-escalate and come back to a clear-mind. healthline.com/health/grounding-techniques#physical-techniques
Find creative ways to put your emotions into actions: you could either journal your thoughts and feelings, utilize your creative side through drawing or painting, or even get involved in nonprofit or NGO’s to release some of these intense emotions that you’re feeling.
Meal Prep: Meal prepping ahead of time can take a lot of stress off of your hands so you can have time to think about completing your other million tasks. And this doesn’t just mean making a lot of prepared meals beforehand, this also means purchasing foods from the store that take a lot of steps out of the question so you don’t have to worry about missing any steps or putting things off to take more time to cook. For example, buying pre-made salads or pre-chopped fruits and vegetables.
Everything Has a Home: Have one place for each item to go to, such as your wallet, keys and phone so you always know where to find them each time you leave. This way you don’t need to worry about being late because of turning the house upside down looking for your keys, and then while being focused on finding the keys you end up forgetting about your wallet and such. One thing that has helped me is having my keys, wallet and airpods all on the same keychain so they’re always together! Aside from that, “everything has a home” also pertains to other household items; always knowing which drawer to find an item makes it easier to determine what you need more of so you don’t go out and purchase the same thing multiple times.
Talk to Your Doctor: Even though you went through the first decades of your life without treatment or medications, it might not hurt to try it out. It might also open the door for workplace accommodations as well and for your supervisors and colleagues to understand you and your needs better. Consult with a doctor to see what the best course of action is for you, but only with what you’re comfortable with.
MAIN TAKEAWAYS:
It’s okay to ask for help.
It’s okay to say no if it’s out of your time commitment capacity.
Make shortcuts for yourself, whether in the kitchen cooking dinner, finding daily items in the right spots, or setting up child care when needed.
Know yourself and your limits. Feel confident taking that time out when needed and communicating to others about it.
Organization and visual calendars/detailed tasks are key to diminish the “out of sight out of mind” phenomenon.
“ADHD is not an excuse, it’s an explanation.” ♡
Works Cited
Chronis-Tuscano, A. (2022), ADHD in girls and women: a call to action – reflections on Hinshaw et al. (2021). J Child Psychol Psychiatr, 63: 497-499. https://doi.org/10.1111/jcpp.13574
Matlen, T. (2014). The queen of distraction: how women with ADHD can conquer chaos, find focus, and get more done .
Quinn PO, Madhoo M. A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01596. doi: 10.4088/PCC.13r01596. Epub 2014 Oct 13. PMID: 25317366; PMCID: PMC4195638.
Young S, Adamo N, Ásgeirsdóttir BB, Branney P, Beckett M, Colley W, Cubbin S, Deeley Q, Farrag E, Gudjonsson G, Hill P, Hollingdale J, Kilic O, Lloyd T, Mason P, Paliokosta E, Perecherla S, Sedgwick J, Skirrow C, Tierney K, van Rensburg K, Woodhouse E. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry. 2020 Aug 12;20(1):404. doi: 10.1186/s12888-020-02707-9. PMID: 32787804; PMCID: PMC7422602.
