‘Nobody realizes that some people expend tremendous energy merely to be normal.’
A diagnosis of Attention Deficit Hyperactivity Disorder, (ADHD), may be given when an individual experiences ongoing difficulties with self-regulation, concentration, attention, planning, impulse control and memory over an extended period of time.
Historically, research into ADHD focused exclusively on boys and men, and a gender bias in diagnosis still exists. Boys are three to four times more likely to be diagnosed with ADHD than girls. This may be because boys are more likely to display disruptive behaviours in school, so their difficulties are obvious. Girls are more likely to be quiet, inattentive daydreamers, with their symptoms viewed as personality traits. As girls tend to create less of a problem for teaching staff, many will remain undiagnosed.
Research would suggest that up to 50 – 70% of women with ADHD are undiagnosed. One of the reasons for this relates to the hormonal changes that all women experience throughout life. Puberty in girls begins at around ten years of age, and the menopause finishes when women are in their late 50s, so women may experience hormonal swings for up to 50 years. Pregnant women may complain of exhaustion and poor memory, women in their thirties and forties may experience pre-menstrual tension, adolescent girls can suffer from mood swings and low self-esteem, menopausal women may be emotional and aggressive. It is easy for professionals to confuse symptoms of ADHD with so called ‘women’s problems’ and, as a result, many women are misdiagnosed with anxiety or depression and prescribed inappropriate medication.
Symptoms of ADHD vary between women, but common traits would include: –
- Being distractable. Everyone with ADHD has a problem with concentration and focus, continually being distracted by external and internal factors. Their thoughts constantly interrupt their attention. They may be having a job interview, when they suddenly realise that they’re not sure if they locked the car; where they parked the car; whether they paid for parking. Then the interviewer asks a question and it’s obvious they haven’t been concentrating.
- Being accident prone. Pranging the car, leaving an empty pan on the hot plate, falling over something that has been put down seconds earlier.
- Being easily overwhelmed. Women are expected to manage work commitments as well as caring for children or elderly relatives, coping with domestic responsibilities, keeping fit and looking good. Women with ADHD have to expend considerable amounts of energy on tasks that others manage on automatic pilot. Such conscious effort is achievable, but exhausting.
- Underperforming. The woman will know that she has potential, and feel frustrated that her ADHD traits block her way to realising that potential.
- Being forgetful. Forgotten medical appointments, birthdays, play dates, bills and meetings. Misplaced house or car keys, purses, glasses, iPads, phones, bank cards, pieces of work, (the importance or value of the item does not guarantee its safety) Umbrellas, handbags, coats and shopping left on buses. Forgetting to put petrol in the car or to buy a key ingredient for a special meal. The list will be endless.
- Having a poor sense of time. Women with ADHD will have poor time management. They fail to appreciate how long it will take to do a task or to drive somewhere. Schedules will be approximations.
- Feelings of incompetence. Difficulties with focus and concentration will mean that the individual never grasps all of the facts or information. They may try to fill in gaps, but are often left feeling stupid.
- Feelings of ‘Why is it always me? Why is it me who buys theatre tickets, but goes on the wrong day? Why is it always my child who goes in school uniform on Mufti days? With ADHD, it can feel as if every day is spent in damage limitation rather than in progression of personal goals.
- Experiencing imposter syndrome. When the individual is constantly covering up for errors, striving to be something they’re not, they know that the persona on public display is not the real them. As well as it being exhausting to maintain such a pretence, there is the ever-present fear that they will be ‘found out’.
- An inability to regulate emotions. ADHD individuals can be volatile and respond explosively to situations without thinking. This can lead to problems in personal relationships.
- Impulsivity. Impulsive purchases they can’t afford: buying an expensive pair of shoes because they feel a bit down, or even a flat and leaving worries about the paying the mortgage till later. Eating a packet of biscuits or cake on Day 1 of their diet.
- Being disorganised. The ADHD woman will constantly ask herself why she is unable to manage and organise things that other people do easily. Her desk will be piled with paperwork: even when she makes an effort to clear it, it will only stay tidy for a day or two.
- Job hopping. These women often start a career, but never manage to stay in post long enough to progress. Their CVs will never fit on to a single page.
- Finding routine tasks challenging. Completing boring, repetitive tasks is almost impossible, and will be avoided or delayed. Procrastination is the name of the game.
- An ability to hyperfocus. If an activity captures the individual’s interest, they are able to block out everything else in order to concentrate. When others see this behaviour, they assume the individual is selective about what they want and do not want to focus on.
- An inability to relax. The individual finds it hard to unwind. Relaxation must involve activity, as if the person is driven by a motor.
- Appearing selfish. At social gatherings the individual will talk over people because of nervousness, but interrupting conversations and failing to listen will make them appear self-centred. Their minds will drift during conversations unless they’re talking, or it’s a topic they find interesting. Any difficulty remembering people’s names will add to the impression of a lack of concern for others.
- Appearing thoughtless. The woman with ADHD will often say what first comes to mind, and inadvertently hurt other people’s feelings.
- Experiencing sleep disorders. Most women with ADHD suffer from difficulties with sleep.
- Having poor long-term commitment to work. Although an individual may be fascinated by anything novel and new, and start tasks with great enthusiasm; following through on the project will be difficult when the need for detailed or mundane work arises.
The lack of a diagnosis or a misdiagnosis is devastating for many women leading to underachievement, unnecessary medication, poor self-esteem, self-doubt, anxiety, frustration and confusion.
An accurate diagnosis will lead to an understanding of problems, advice and support, self-help strategies and appropriate medication. A treatment plan will allow relief from symptoms and a greatly improved quality of life.