The hidden struggles of women with ADHD: how overlooked symptoms can lead to problems later in life

This year, my boyfriend was diagnosed with attention deficit hyperactivity disorder.

Having struggled with symptoms for the majority of his life after suggestions of him having the condition were shrugged off when he was a child, he was finally able to seek out proper treatment and support.

His diagnosis, coupled with the accumulating number of videos on my TikTok “For You” page about ADHD in adults, redirected my attention to a number of symptoms I’ve experienced since I was a teenager.

My yo-yoing moods, the constant “noise” in my head — among the other laundry list of signs I’ve experienced — were continuously labelled as depression and anxiety by doctors.

My embarrassment over the traits that have made me feel less intelligent, capable and worthy has waned in my recent endeavour to receive potential treatment for ADHD, which is not an easy task as an adult woman.

ADHD occurs in at least four per cent of adults worldwide.

October was ADHD Awareness Month, and people across Canada continue to grapple with the stigmatization and misconceptions associated with it.

There are barriers that already exist with diagnosing ADHD in adulthood, but women can face even more obstacles in receiving a diagnosis and proper treatment.

Stereotypes and myths surrounding ADHD often contribute to its skewed and frequently inaccurate public perception.

High-strung little boys disrupting classrooms are over-generalized examples that commonly come to mind when identifying ADHD. However, the disorder is not limited to boys or children and presents differently depending on the individual.

While speaking with Heidi Bernhardt, founder and director of education and advocacy at the Centre for ADHD Awareness Canada, it’s clear more needs to be done for girls and women who are living with this condition.

“We know girls get referred for assessments far less often by teachers and parents,” Bernhardt said.

“We also know that girls try very hard to fit in, to appear competent at school … So a lot of times parents will say, ‘Oh, my daughter can’t have ADHD, she’s not failing in school.’ But when you dig deeper, she’s spending three and four hours every night doing homework to make sure everything is done and perfect.”

Masking ADHD symptoms is common with girls especially, which adds to prolonged and complicated periods of diagnosis.

“Since girls don’t present in this classic way, they often get missed. And let’s face it, our medical professionals are not very well trained in ADHD, period, let alone in these different, subtle presentations,” she said.

“But unfortunately, we know it’s primarily that attention regulation and emotional dysregulation, and in the executive functioning that is impairing lifelong and it’s just as impairing for girls and women, if not more so, than males.”

Gender bias and gaps in education within the medical community play a large role in delayed treatment.

“We see an awful lot of coexisting anxiety, depression, eating disorders. I mean, recent research has shown one in four women with ADHD has attempted suicide. We see more chronic pain, insomnia, unwanted pregnancies,” Bernhardt said.

“Let alone the [typical] things we see with ADHD: less post-secondary education, more unemployment, relationship problems, poverty. It just goes on and on.”

Women with ADHD have three times the prevalence of chronic pain, suicidal ideation, insomnia, childhood sexual abuse and generalized anxiety disorder.

“The other thing we see a lot happening is the misdiagnosis. So not only do we totally miss diagnosing, we often misdiagnose it as other disorders like anxiety and depression. Because family physicians and adult psychiatrists are very well trained in anxiety and depression. Sometimes it comes with ADHD, sometimes the ADHD causes it,” she said.

“We see women who are unsuccessfully treated for decades because their underlying ADHD has never been diagnosed. We did a survey of Canadian women and 46 per cent said they were first misdiagnosed with another disorder. And 60 per cent of those women said they were untreated for their ADHD for more than two decades.”

An article published by CBC News recently highlighted a woman’s diagnosis of ADHD in her 50s. A story from BBC News featured a woman who wasn’t diagnosed with ADHD until she was 34. This trend of women receiving later-term diagnoses and being disbelieved is unfortunately common for those who have the condition.

“We are really doing a disservice to these women by not assessing and diagnosing and treating successfully,” Bernhardt said.

College-aged students face numerous barriers if they’re entering post-secondary education with ADHD or wish to get tested for it.

Bernhardt has worked to address the difficulties young people face when seeking accommodations and support from their universities.

“I did a review of 50 schools that we looked at in 2015, again in [the] fall of 2019, and they have all stopped asking for psych assessments and clearly stated students with ADHD had the right to accommodations [and] support from accessibility centre[s]. But then again, it still takes ongoing advocacy,” Bernhardt said.

“I’d say what we need more [from] post-secondary [schools] is to educate our professors so they understand that ADHD is truly a medical and neurodevelopmental disorder, very similar in impairment to learning disabilities and autism.”

“A lot of students still talk about having to advocate for themselves on a daily basis. We’re never going to build awareness, decrease stigma and be able to do more advocacy around this unless those with ADHD start opening up and really feel free about sharing their struggles their entire life,” she said.

Laurier’s Waterloo campus offers “registered social workers and psychotherapists who work within a short-term, goal-directed model for all registered Laurier students.” As well, the Accessible Learning Centre aims to provide students with disabilities and learning impairments the tools they need to succeed.

“Most often students talk about having to put in two and three times the amount of hours and work than their peers to be able to be successful. So they really need that help. But they need both the school and their peers to understand that they actually have the right to those accommodations.”

For students who suspect they may have ADHD and have yet to receive a formal diagnosis, the process can become complicated.

Bernhardt advised people in this position to start with their school’s health services.

“I’d say go to their health student services. Also going to see their family physician who can refer them [to a specialist]. The difficulty is, in Canada, we have a lack of adult psychiatrists, period. And then we have a super lack of adult psychiatrists who specialize in ADHD.”

“I would highly recommend, they make sure who they see, whether it’s a psychiatrist or a psychologist, they specialize in ADHD.”

“The uphill battle for students in those environments is huge. They can also contact [the Centre for ADHD Awareness Canada], we have resource lists. Psychologists generally are much easier to get in [to see], but they’re not covered by provincial health care plans,” she said.

People who are looking to receive formal ADHD assessments will discover those aren’t cheap either. According Bernhardt, “these tests [can] cost $3,500 to $4,000.”

Focusing on equitable access to resources and pushing for comprehensive, widespread education are important in providing sufficient support for individuals, especially women, with ADHD.

“[Women are] very, very hard on themselves. It really, really chips away on their self-esteem,” Bernhardt said. 

“They don’t see themselves as being good students and good daughters and good mothers and good friends because their ADHD symptoms get in the way. We end up with a lot of mental health problems with a lot of suffering that really doesn’t need to be there if we could get better at this.”