Understanding the Underdiagnosis of ADHD in Women and Girls
ADHD, or Attention Deficit Hyperactivity Disorder, was historically thought of as a condition that affects hyperactive boys. However, more people are starting to understand that ADHD can look very different in girls and women. The differences in traits leads to many girls and women not being diagnosed and missing out on the help they need.
Public Awareness
One big reason for the underdiagnosis of ADHD in girls and women is the lack of public awareness. People have not talked much about female ADHD, so girls and women often do not realise they are neurodivergent. They might think their struggles are just personal flaws instead of a neurological difference.
Trait Presentation
ADHD traits in girls are often different from those in boys. Girls with ADHD tend to be more inattentive, meaning they might daydream, get easily distracted, and have trouble staying organised. These behaviours are less noticeable than the hyperactivity and impulsiveness often seen in boys, so they are less likely to be flagged by teachers and parents.
Social Masking
Many women with ADHD learn to hide their hyperactive and impulsive behaviours to fit in better with their peers. They try hard to follow social rules and not stand out. This makes it difficult for doctors and others to see the signs of ADHD, as these behaviours are often hidden.
Brain Structure and Social Adaptation
Differences in brain structure between boys and girls might make it easier for girls to hide their ADHD traits. These differences allow girls to adapt and blend in, making their ADHD less obvious (Borg Skoglund, 2020). While this helps them fit in, it also means their struggles are less likely to be noticed and treated.
Hormonal Fluctuations
Hormonal changes can make ADHD traits vary a lot in women. Puberty, menstrual cycles, pregnancy, and menopause can all affect presentations of ADHD. Because of these changes, it can be hard to see a clear pattern of behaviour that points to ADHD, leading to many women not being diagnosed correctly.
Perfectionism and Pressure
Girls with ADHD often strive for perfectionism to cope with their struggles. They might wait until the last minute to do their work and push themselves very hard to get it done. This can make it seem like they are doing fine, and their ADHD may go unnoticed.
Moving Forward
To help more girls and women get diagnosed with ADHD, we need to raise awareness and understand how it looks different in them. This means:
- Education and Training: Teaching teachers, parents, and doctors about the gender differences in signs of ADHD.
- Encouraging Self-Recognition: Helping girls and women recognise ADHD traits in themselves and seek help.
- Research and Advocacy: Supporting studies on gender differences in ADHD and pushing for policies that ensure everyone can get diagnosed and access to support.
By recognising and addressing how ADHD presents in girls and women, we can help them get the support they need to thrive.
Attention Deficit Hyperactivity Disorder (ADHD)
ADHD is characterised by a predominance of either inattentive or hyperactive-impulsive symptoms, or a combination of both. The condition involves challenges in managing attention, with considerable variability in how individuals focus on tasks based on their relevance. ADHD individuals often seek sensory stimulation and may have a strong need for movement, which can aid in concentration, anxiety regulation, or serve as a form of release. Organisational tasks can be particularly challenging, and there may be difficulties in retaining information in working memory. Written instructions or note-taking can be beneficial. Support in breaking down tasks and managing organisation is often needed.
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Neurodiversity
Neurodiversity acknowledges the natural variations in human brain function and behavioural traits as integral to human diversity, viewing conditions like autism, ADHD, dyslexia, dyspraxia, and dyscalculia not as disorders but as different aspects of neurocognitive functioning. It advocates for societal shifts towards greater acceptance, rights, and accommodations for those with neurological differences, emphasizing inclusion and support. The concept of a "spiky profile" integrates with this view, illustrating how individuals may exhibit significant strengths in certain areas while facing challenges in others, further highlighting the diverse spectrum of human abilities and the need for tailored support.
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Dyspraxia
Dyspraxia affects both fine and gross motor skills, significantly impacting writing, typing, and self-care activities. Dyspraxic individuals may also face challenges with memory, attention, perception, and processing, leading to difficulties in planning, organisation, executing actions, or following instructions in the correct order.
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Dyscalculia
Individuals with dyscalculia struggle with mastering arithmetic skills, calculations, number sense, and mathematical reasoning. Challenges often extend to understanding quantities, time, and abstract numerical concepts. Dyscalculia is frequently accompanied by working memory difficulties. Approximately 50% of individuals with dyscalculia also face reading challenges, and many experience significant maths anxiety.
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Dyslexia
Dyslexia is a learning difficulty that affects the ability to develop automatic and fluent word reading and spelling skills. It is often associated with challenges in phonological awareness, which involves understanding and manipulating the sounds in words, and may also impact orthographic processing—the recognition of whole words, letter strings, or spelling patterns. Dyslexic individuals might be self-conscious about reading aloud, which can also hinder comprehension, and may avoid using complex vocabulary in writing to prevent spelling errors. Though not officially part of the diagnostic criteria, dyslexic individuals often struggle with organisation, sequencing, and may have low academic self-esteem. A notable discrepancy exists between their confidence in verbal tasks versus written tasks.
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Autism
According to current diagnostic criteria, autistic individuals face challenges primarily in social communication and exhibit restricted, repetitive patterns of behaviour. The severity of these challenges can vary significantly. Many autistic individuals have sensory sensitivities that are particularly challenging in new and unfamiliar environments. Furthermore, they often prefer structured and predictable settings, benefiting from ample time to process information and adapt to changes. Social anxiety can pose a significant challenge in unstructured and unpredictable social situations. While the challenges of autism might be less visible in certain settings, they can still have a profound, cumulative effect on mental health, well-being, and may lead to burnout.
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