Sexism Affects the Way People Are Diagnosed With ADHD
Female stereotypes like the “chatty Cathy” or the ditzy girl who’s disorganized and forgetful can dissuade proper diagnosis.
Joselito Briones / Stocksy
I’d never call myself hyper. Extremely distractible? Yes. Disorganized? Absolutely. Always late? Bad at prioritizing tasks? Check and check.
This was typical for an overcommitted yet driven 20-something—or so I thought. I’d always associated attention deficit hyperactivity disorder with rambunctious tween boys who were out of control in the classroom. So during a recent psychiatric evaluation, it was a shock to fill out a lengthy questionnaire and hear my doctor say that I definitely have ADHD.
The same week I saw my doctor, the Centers for Disease Control and Prevention published the results of a study that reported that between 2003 and 2015, the number of US women filling a prescription for ADHD medication increased for all ages. I was one of a huge surge in women ages 25-29 who were diagnosed with it, increasing prescriptions by 700 percent.
A key reason for the uptick is that doctors have become significantly better at diagnosing ADHD in adults and specifically in women, according to the physicians I spoke to. There are still skeptics, but the medical community is starting to accept the idea that ADHD isn’t necessarily a situation children outgrow after they turn 18. Professionals also stress that ADHD medication—particularly stimulants—shouldn’t be taken lightly.
After going down a rabbit hole of research, my skepticism about the diagnosis thawed. I zone out at the 20-minute mark of anything. Everything from my closet to the silverware drawer is in constant disarray. My parents—with good reason—gifted me Bluetooth trackers for my keys, phone and suitcase. All these little hints started to form the shape of an arrow pointing to ADHD.
Doctors now know that ADHD can manifest differently in men and women. Traditional behavioral symptoms, such as lack of restraint, are more common in males. For women, indicators can be less obvious. According to the ADHD resource, ADDitude magazine, types of ADHD include inattentive, hyperactive-impulsive (very much what it sounds like), and combination. Mine is textbook inattentive, which explains why my symptoms don’t align with the characteristics of a rowdy 11-year-old.
“The inattentive [type of ADHD] seems to be a little bit more common in girls,” says Saira Kalia, assistant professor of clinical psychiatry at University of Arizona. “You see daydreaming, tapping, zoning out in class—and as long as they’re not failing, there’s no attention paid to it.” Kalia also says female stereotypes like the “chatty Cathy” or the “ditzy” girl who’s disorganized and forgetful can dissuade proper diagnosis. Women often face questioning about whether or not they’re genuinely struggling.
Societal norms influence the boy/girl divide, but also adult diagnoses. Even though it’s becoming more accepted, people still question if adult ADHD is a thing. However, sometimes the reason it’s not diagnosed until adulthood is because of the structure and safety parents provide. Packing lunches, homework check-ins, scheduling, and reminders can all mask symptoms in youth.
“There’s such a scaffolding that parents provide,” Kalia says. “Kids may have struggles; however, it doesn’t get discovered until they hit college.” This is another slam dunk in understanding my adult diagnosis. My parents were—and still are—undoubtedly worthy of “#1 Mom & Dad” mugs. They knew my teachers, my grades, my friends, and they never missed a soccer game or choir concert. When I had scary-low SAT scores, my mom got me a tutor. When I forgot to unplug my hair straightener in the morning—yet again—my dad was annoyed, but still went back to the house to make sure it didn’t burn down.
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At 18, I moved 300 miles away for college and my ADHD symptoms flared—I just didn’t recognize what it was at the time. Most prominently, I didn’t have the attention span for hours-long lectures. I’d get hysterical feeling that it’d be impossible to pass my classes, despite using every study technique in my toolbox. I assumed it was just a difficult adjustment to college and life on my own. The disconnect between effort and performance continued after graduation, followed me through two jobs and then to graduate school. That’s when the ADHD epiphany and doctor’s appointment happened.
Timothy Wilens, a professor of psychiatry at Harvard Medical School, says that young women are aware that being an organized and efficient multitasker is crucial to surviving millennial adulthood and that undiagnosed ADHD can hinder success. I certainly struggled with thinking that I was supposed to be great at everything. “For years, this age group of women would underachieve, and now they’re identifying things that get in the way of functioning properly and they’re getting treated,” Wilens says. He’s noticed the rise in female ADHD diagnoses firsthand.
Even those who are diagnosed as children face fresh challenges in adulthood. Unstructured time can be a shock and impossible to master—especially in college. “It used to be a common folklore that we’d stop treatment as kids got older and now we realize no, in fact you have to continue the treatment,” Wilens says. “This is a time when they will often have serious difficulties engaging, initiating projects and following through.”
Alex Maldonado, from Massachusetts, can attest to this too; she was diagnosed in second grade. It was clear she had ADHD between her hyperactivity and difficulties concentrating. Now in her 20s, working and gearing up for grad school, she still takes medication to manage it. She says could get by without medication on a chill day if necessary. “I know I definitely still function better with it,” she says.
Luz Martin, a psychiatrist who used to treat Maldonado, started giving her ADHD patients urine tests and random pill counts to ensure they weren’t misusing or selling their meds. Maldonado was never a patient of concern, but eventually Martin stopped prescribing prescription stimulants altogether in favor of alternative methods. “Some of them were abusing or misusing stimulants,” Martin says. “Because I can’t cherry-pick patients, I have to do it as a practice.”
Alternatives may take more time to work, but there are non-stimulant drugs available such as Strattera, Kapvay, and Intuniv. Cognitive therapy also proves to be effective and often is used in combination with medication to ease ADHD symptoms. Martin’s choice to nix stimulants allude to the bad reputation ADHD meds have developed over the years. The “study drug” was certainly a hot commodity at Maldonado’s college, as well as my own. Even after undergrad, I knew many people who continued to buy Adderall on the street as “performance enhancers” for work.
When I initially saw the CDC release, my first thought was that large-scale abuse must be at play, as societal pressure on women to “have it all” grows exponentially. But every professional I spoke with says my mega-black-market Adderall conspiracy was false. “If you look at this population and you were to do a biopsy of it and study that group, I bet you would find that most of them were legitimate prescriptions,” Wilens says.
I squashed my theory after talking with other women, experts, and seeing my own success with treatment. Now I just wish I had been part of this statistic sooner, because feeling capable of reaching my potential is a relief. I have the energy to weigh what tasks should come first. I can read more than 800 words in one sitting. Adderall isn’t a cure-all, though. I still never know where my keys are.
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