As people, we have our own responsibilities we need to juggle, whether it is work, school, or family, and admittedly at times, these responsibilities can be kind of challenging. Now, imagine doing exactly that, but needing to carry a dozen balloons with you all day, every day, on top of everything. But each balloon is actually your thoughts and tasks you need to complete. Sure, you go about your day, holding tightly on the strings, trying not to let any go, constantly checking that they’re all still with you. But then the wind blows a little harder than you were accustomed to, you’re hit with a distraction, and a balloon slips out of your hand. Naturally, you try to get it back, but in reaching for it, you accidentally lose hold of even more. But if you look around, most people seem to be managing just one balloon, one thought or task at a time. From the outside, they see you as a little scattered or distracted, without knowing what it’s like to carry twelve. They don’t see the constant mental effort it takes to hold onto everything at once, because they’ve never had to manage more than one.
For many women with undiagnosed inattentive ADHD, life feels like trying to carry all those balloons at once when others think you’ve got it handled. Most people don’t realize how much energy it takes to keep everything under control and keep up with others whose thoughts don’t all come rushing all at once. They also don’t see the harboring guilt and anxiety that build from feeling constantly held back from one’s potential. However, Undiagnosed ADHD doesn’t make life a zero-sum game where struggling automatically means you’re destined to fail. Many women with the condition achieve incredible things, but with awareness and the right support, that success can come with less struggle.
Types of ADHD
ADHD is divided into three types: Primarily Hyperactive, Primarily Inattentive, and Combined Type. The hyperactive-impulsive type is often the most noticeable, identified by visible behaviors like constant fidgeting, excessive talking, and difficulty staying seated. These are traits that tend to stand out more in a classroom/social setting. Hyperactive type ADHD is also more prevalently diagnosed in males. The inattentive type, more often seen in females and adults, involves struggles with focus, following directions, organization, forgetfulness, and mental fatigue. The combined type is characterized as exhibiting a mix of inattentive and hyperactive-impulsive symptoms.
When exploring the topic, one may come across the term ADD (Attention-Deficit Disorder), an outdated term for ADHD, which was commonly used in the 1980s. At the time, diagnoses of ADD were often classified as either with or without hyperactivity. However, in 1987, the American Psychiatric Association (APA) released a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a handbook listing all identified mental disorders, where ADD was renamed ADHD (Attention-Deficit/Hyperactivity Disorder). This change was due to research showing that the inattentive and hyperactive forms of the disorder shared many overlapping symptoms and were not distinct enough to need separate labels. In the 1990s revision of the DSM (DSM-IV), the diagnostic criteria for ADHD were added to better tell how the disorder presents in adults. This helped challenge the earlier belief that ADHD only occurs in childhood and goes away in adulthood.
Male Research
Early research on ADHD almost exclusively involved males, and for decades, ADHD was considered a “boys disorder.” As a result, studies done on the basis of diagnosing ADHD and its criteria were done so based on male behavior, and that of females was overlooked. By the late 1990s, studies confirmed that girls with ADHD were just as impaired as boys but often went undetected. To this day, clinical referrals show far more males than females, indicating many girls were simply never diagnosed, or were very late in life, being known as “the lost girls.” However, despite the scientific confirmation, a gender bias in terms of the likelihood of diagnosis continues.
Since females with ADHD are more likely to have internalized symptoms, and by extension to go untreated, many young females go through life feeling misunderstood. Instead of receiving support, they’re frequently labeled as “lazy,” “spacey,” or told they just need to try harder, when in reality, they’re struggling with a neurodevelopmental condition that could need specific care.
Another reason why girls get away with going under the radar is because of masking, or intentionally acting in a certain way in order not to come across as ‘different’. This includes going out of their way to be extremely organized, mimicking the behavior of peers without ADHD, or working harder to meet expectations. After a point, this attempt to come across as “normal” can be exhausting and often leads to increased anxiety and depression.
The Toll
When being undiagnosed when having ADHD, it can also be misdiagnosed as anxiety or depression. While these conditions can and do often occur with ADHD, they have been treated as the main issue rather than as symptoms of an underlying issue. Because women with ADHD often keep their struggles to themselves, they might seem anxious or overwhelmed. These ways of presenting are more similar to what clinicians are trained to recognize as anxiety or mood disorders, especially in female patients. As a result, many women are prescribed medication for anxiety or depression without much improvement because the actual cause is not being addressed. This not only delays proper treatment but can increase feelings of frustration and self-blame.
Rejection Sensitive Dysphoria (RSD), while not an official symptom of ADHD, but rather a common experience tied with emotional dysregulation, is an impactful condition often involving extreme emotional sensitivity to what is considered or actual rejection and criticism. For females with ADHD, RSD can be especially intense due to societal pressures to be composed and succeed socially and academically. Without proper diagnosis and support, the emotional toll of RSD can become overwhelming and result in burnout and feelings of failure.
ADHD can also have an impact on relationships, such as friendships, family, and those in the workplace, due to ADHD-related symptoms since a combination of these traits often leads to misunderstandings/difficulties in communication. For instance, about 50–60% of children with ADHD struggle with peer relationships, a challenge that often continues into adulthood. Adults with ADHD may also experience social rejection and conflicts due to impulsive behaviors while the emotional aspect associated with ADHD also causes mood swings.
Considering how significant the negative effects can be, treatment for ADHD should be more accepted. Medication, such as stimulants and non-stimulants, can be highly effective in managing the main symptoms like inattention and impulsivity. However, therapy such as Cognitive Behavioral Therapy (CBT) is also important in helping women develop coping strategies and rebuild self-esteem. Many women can also benefit from ADHD coaching by lending g a hand with time management and staying organized. Peer support groups can also improve feelings of isolation felt before and after a diagnosis by offering validation and an understanding community.
It’s also important that treatment takes anxiety and depression into account and recognizes the impact of hormonal changes, that may occur during menstruation, pregnancy, or menopause, which can affect symptoms. With the right combination of support, women with ADHD can improve their quality of life and minimize levels of stress.
To summarize, a lack of recognition for women with inattentive ADHD can result in significant impacts on their mental health, relationships, and overall quality of life. As awareness grows and research is conducted, healthcare providers can begin to consider the unique ways ADHD can be displayed in women. By creating a more inclusive understanding of ADHD, we can empower women to seek the support they need and improve their well-being.
A lack of recognition for women with inattentive ADHD can result in significant impacts on their mental health, relationships, and overall quality of life.