On a quiet, lazy Sunday afternoon, I was scrolling my Instagram feed when something caught my attention. It was a post, from the official account of The Times. A picture with two women staring at me was followed by a caption that started like this: “Impulsive? Disorganised? Easily distracted?”. I was immediately hooked because - even if it sucks to admit - I have been all those things recently. I kept reading the following sentences that reported the stories of Charlotte and Jess, the two women from the picture, who were recently diagnosed with ADHD - a condition often associated with boys but that is now a hidden epidemic for women.
Since the beginning of the Covid-19 pandemic, many women have experienced first-hand the intensification of certain ailments such as being always distracted, having difficulty concentrating or forgetting things. Probably the first reaction of all was to blame the infamous brain fog that has been talked about so much since the rise of Covid. But when studies showed that hundreds of thousands more women tested themselves and (some) got diagnosed for attention deficit hyperactivity disorder (ADHD) it was a bit of a shock.
According to exclusive data gathered from The Independent, around 7,700 women took an online test verified by health professionals to see if they have ADHD in 2019, but this figure soared to around 254,400 women last year (2021). Data from Clinical Partners, one of the UK’s leading mental health care providers which works closely with the NHS, shows women made up 60% of those using their ADHD tests - a number substantially higher than in past years.
ADHD is a condition that was traditionally thought to affect mostly men. We all know the stereotype of the young boy being hyperactive and disrupting classes with their fidgeting. Truth is that boys are five times more likely to be diagnosed with ADHD than girls, although later in life, case numbers of ADHD are roughly similar for men and women. This happens because females have different, and often unrecognised, symptoms.
ADHD affects women differently compared to men. Symptoms tend to be less obvious or less socially disruptive compared to the classic stereotype. As clearly expressed in this study, men tend to have hyperactive/impulsive ADHD, causing them to be disruptive, restless, impulsive and impatient, while women have a tendency to exhibit inattentive ADHD, which - unlike for men - makes it hard to focus, pay attention to details, stay organised, listen, and remember things. Girls' ADHD is often seen as a typical trait of their personality and therefore neglected and not recognised/diagnosed. However, it can affect women’s physical and mental health, as well as a lot of other aspects of their lives, both in adolescence and in adult life.
The Centers for Disease Control and Prevention (CDC) reports that boys are more likely (12.9%) to be diagnosed with ADHD than girls (5.6%). However, this disparity is not because boys are more susceptible but instead because girls are consistently under-diagnosed. Consultant psychiatrist and ADHD specialist Dr. Pablo Jeczmienm said: “ADHD is under-recognised in girls and in women because the symptoms we associate with hyperactivity and impulsivity are usually not present in girls and women, as there is a cultural expectation that women should behave in a certain way.”
The lack of diagnosis of ADHD in women happens because most of the studies on the topic are done with boys. Historically, in medicine, it has been assumed that there wasn’t any fundamental difference between men and women (other than their reproductive system), and so for years, medical education has been focused on a ‘male norm’, with everything that falls outside that designated as ‘atypical’ or ‘abnormal’. We can see the consequences of this male-centric approach in almost every aspect of medicine, especially when it comes to diseases presenting differently in women that are often missed or misdiagnosed, and sometimes even a mystery for many doctors. As a result, women who are misdiagnosed often continue looking for answers in the wrong places and receive treatments that don’t work for their ADHD symptoms.
Under-studied, under-treated and frequently misdiagnosed, women suffer from this societal lack of sex-disaggregated data, and that affects doctors' ability to give them sound medical advice. This has major knock-on effects for both medical practice and women's health.
Written by Miriam Tagini