by Deb Hadley, AIWC Düsseldorf and Health Team Co-Chair
“Highly intelligent, but lazy.” “Would excel if she applied herself.” “Lacks focus.”
These were all common things on my school reports growing up. I grew up thinking I was disorganized, lazy and fickle. I cared about friends and family deeply, yet I was the one constantly forgetting birthdays, dates to meet up, and other important details. I was “that girl.” Fun, but unreliable, always flaking out. If something wasn’t right in front of me, it just wasn’t on my radar. I described my life as “organized chaos.” I knew where everything was on my desk or in my purse but to anyone else, it looked like a tornado had been through. Everything was last minute: assignments, getting ready, tasks. Thankfully, as a midwife, I worked in a busy hospital with a challenging, ever-changing environment, which is the type of place I thrive. No monotony, every day different and presenting a new challenge.
When I moved to Germany in 2020 and found myself not working for the first time in a long time, I started to decline. I couldn’t do anything. I would procrastinate the simplest of tasks for days. Something that would literally take me 30 seconds and that any normal person would have done right away just seemed impossible. I mentioned this to my wonderful GP and she asked if I’d ever been assessed for Attention Deficit Hyperactivity Disorder (ADHD). That piqued my interest, but I told her I’d never been hyperactive. She said women and girls often are not hyperactive and often have the inattentive type of ADHD. So I made an appointment with a psychiatrist specializing in the condition. As I waited for the appointment I began to read other women’s stories. It was as if I was reading about myself. I took the DIVA-5 assessment1 at home and saw that I scored off the charts. When I went for my assessment, the doctor seemed surprised I had gotten as far in life as I had without realizing something wasn’t right. I was formally diagnosed with inattentive ADHD and started on medication.
Within hours of taking the first dose, I felt different. Things were getting done. The pile of stuff at the bottom of the stairs that needed to go upstairs was taken upstairs, when before I would have walked right on by not even seeing it. I cleaned up as I went along. Laundry got done and folded right away. Irrational fears melted away. Previously, I was terrified of driving in Germany and suddenly I was going 200 km/h on the Autobahn without a care in the world. I could focus better, I was able to pay attention to something without having several other tasks going at the same time. I was a better listener, my mind didn’t wander when someone was talking. In short, for me, it was life-changing. That was two years ago, and I’m still experiencing the benefits. Mind you, I have to remember to take my medication – and therein lies the joy of ADHD.
As I began to learn more about the condition, I realized that many women and girls are misdiagnosed with depression or anxiety, which can be co-occurring conditions,2 but can also be a result of long-term “masking.” Masking is a technique in which people with ADHD mask their symptoms in an effort to appear more normal. It can be exhausting, physically and mentally. They may not even realize they are doing it.3
As Neurodiversity Celebration Month comes to a close, it’s worth taking a look at ADHD and how it affects women and girls. ADHD is one of the most common neurodevelopmental disorders. It is thought to be primarily determined by genetics, but research as to other potential causes is ongoing.4 Researchers believe that ADHD occurs equally among sexes, but boys and men are three times more likely to be diagnosed.5 Like many conditions, this is because the symptoms can be very different for women and girls.
Symptoms in girls can differ from the overt hyperactivity that is often seen in boys. Girls with ADHD can be daydreamers, have difficulties with friendships, have low self-esteem and have trouble focusing or maintaining interest in a task. Hyperactivity can also occur in girls and is often displayed by fidgeting, excessive talking, interrupting, racing thoughts/overactive mind and acting impulsively.6 Hyperactivity often occurs internally for women, whereas with men it’s more external. I often describe my brain as being like a browser with 50 tabs open.
Most women are diagnosed with ADHD in their thirties as a result of the symptoms being missed or misdiagnosed in childhood. As women age, the issues don’t go away. Women often develop coping strategies to help them manage their symptoms. Some of the symptoms and issues women may face include persistent low self-esteem, poor time management and executive function skills, being easily frustrated, having difficulty relaxing, and relationship difficulties.7
A common issue for women with ADHD is Rejection Sensitive Dysphoria (RSD). This is something I have always struggled with. RSD is extreme emotional sensitivity. Perceived criticism or rejection is extremely difficult to deal with and can result in mood swings, withdrawal and in extreme cases, suicidal ideation.8 For me, this takes the form of over-analyzing people’s tone, meaning and context and often misinterpreting it entirely. I replay perceived hurtful scenarios in my head for years. It’s exhausting.
Gender role stereotypes and hormones can also impact ADHD symptoms in women. It is a complex condition that is individual to each woman. Treatment options include medication, therapy and lifestyle changes. Again, treatment is individual to each woman and her particular needs.
For me personally, having a diagnosis has helped me learn a lot about myself and how my life developed as it did. On one hand, I am delighted to be able to explain why I always felt different or that I didn’t fit in. On the other hand, it’s tinged with a sense of mourning and regret for how different things might have been if it had been caught earlier. I grew up thinking I was fickle, disorganized, unreliable and lazy, yet there had been an explanation there – and one that was potentially fixable.
If you suspect you or a loved one might have ADHD, it is worth doing some reading on the topic and approaching your doctor for a referral to an ADHD specialist. Generally, it is diagnosed by a psychiatrist or psychologist. In some areas you may be able to self-refer. ADDitude magazine is a good resource and if you prefer to settle down with a book, it offers a wonderful list of books for women who have or suspect they may have ADHD.
1https://www.divacenter.eu/DIVA.aspx
2https://chadd.org/for-adults/women-and-girls/
3https://www.webmd.com/add-adhd/mask-adult-adhd
4https://www.cdc.gov/ncbddd/adhd/facts.html
5https://www.talkwithfrida.com/learn/how-is-adhd-different-in-women/
6https://chadd.org/for-adults/symptoms-of-adhd-in-women-and-girls/
7https://psychiatry-uk.com/adhd-in-girls-and-women/
8https://www.additudemag.com/rejection-sensitive-dysphoria-and-adhd/
Photo: Canva