‘Wired differently:’ Researchers are diagnosing more ADHD in girls and women
By Grace Claxon/Kent State NewsLab
Caitlyn O’Brien grew up convinced she was lazy.
Each day after high school in the Columbus suburbs, she followed the same routine: putting off her homework for hours, desperately searching for the energy or motivation to begin. Upon finally starting, she stared at the first question or read the same paragraph over and over, unable to focus or understand the material.
She could eventually get “in the zone,” but her mother or sister talking in the living room would distract her again, and the process would restart.
“My homework wasn’t getting done, so I was falling behind and my grades slipped,” said O’Brien, now a cosmetology student at the Paul Mitchell School in Cleveland. “It feels like, technically, you can put your hand on a hot stove, but you won’t because your brain physically stops you. It’s the same thing, like there’s something stopping me in my brain.”
O’Brien did not understand her struggles until her mother read through an ADHD questionnaire for O’Brien’s younger sibling. Many of the symptoms matched O’Brien’s behavior. At 17, she received a diagnosis.
For decades, researchers and the public have associated ADHD with the image of a young boy who cannot sit still in class. Today, experts think that norm misrepresents the experience of many people with ADHD, particularly girls and women.
In childhood, the ratio of males with diagnosed ADHD to females is about 3:1 on average. However, the ratio is closer to 1:1 in adulthood, leading many to believe that females with ADHD are underdiagnosed in childhood.
“Boys show it by getting up and running around — they’re the squeaky wheels in the classroom, and they get the grease,” said Dr. Emma Climie, a child and wellness researcher at Alberta Children’s Hospital Research Institute and associate professor at Werklund School of Education. “But the girls who are twirling their hair or bouncing their legs or chatting with their friends are still showing hyperactivity, just in a way that’s more socially acceptable.”
Climie had been researching child development and psychology for a decade when one of her graduate students, Darby Attoe, presented to her the idea of writing a research article about women with ADHD. Climie had previously focused on boys because there were simply more of them.
Climie and Attoe published a research article in the Journal of Attention Disorders titled “Miss. Diagnosis: A Systematic Review of ADHD in Adult Women” in March 2023. People across the globe reached out to say the researchers had described their experiences in a new and useful way.
“I thought, ‘Huh, how have we missed such a big section of the population? How is this one little review article hitting home with so many different people?’” Climie said. “There’s just very little research on women with ADHD, and there’s any number of reasons for it.”
Males with ADHD generally exhibit greater levels of hyperactivity, aggression and impulsivity, which are more disruptive in social and classroom settings. Females who don’t display those symptoms are more likely to be overlooked in the diagnostic process.
“Girls and women often fail to give close attention to details or make careless mistakes,” said Jacqueline Winter, a Kent-based licensed professional counselor based with specialized training in ADHD assessment. “They’re maybe a little disorganized, lose things easily, easily distracted, forgetful of daily activities. Some may seem to daydream, but their thoughts are going a million miles a minute.”
Additionally, girls and women often seek treatment for mental health disorders such as depression or anxiety before an ADHD diagnosis because their symptoms do not match the stereotypical expectations of ADHD.
“Women in their 30s and 40s are being diagnosed [with ADHD] at the highest rates,” Climie said. “Oftentimes, they were misdiagnosed with depression or anxiety or medicated for something else — not to say that couldn’t have been a challenge for them as well, but ADHD is often that underlying difficulty.”
Females with ADHD are at a “very high risk for antisocial, mood, anxiety and addictive disorders,” according to Climie and Attoe’s 2023 article.
Given these differences, girls and women with ADHD may need to present more severe symptoms than males in order to gain recognition or treatment. At the same time, social norms for girls and women encourage empathy, organization and obedience. When females with ADHD display symptoms such as disorganization, forgetfulness and hyperactivity, they are more likely to face social repercussions. As a result, they may put considerable time and effort toward “masking” their symptoms.
“There’s a lot of conversation about social norms that come into this as well,” Climie said. “Girls are expected to sit nicely, and they’re expected to listen — you know, sugar and spice and all that.”
The inadvertent masking of symptoms may cause failure to recognize ADHD, even within oneself, for years.
Rylee Durbak did not suspect they had ADHD until the end of high school.
“My friends with ADHD would have crazy trouble completing their work in general, whereas I would get all of mine done during school because I knew I couldn’t do it after,” the sophomore environmental studies major at Kent State said. “I’d always heard that ADHD was a hyperactive disorder, and I’ve never really had the hyperactivity bit.”
Durbak decided to be tested for ADHD when their grades began to slip and they had more difficulty focusing on daily tasks. They found their ADHD assessment tedious and frustrating but don’t regret it.
“I had to take a lot of tests, and I hated every second of it,” Durbak said. Their ADHD diagnosis “made me feel like there was a reason behind all the problems I was having, like procrastinating and my emotions.”
Emotional regulation is a common challenge for people with ADHD. It may be a result of difficulties with executive functioning.
“Executive functioning includes our working memory, our time management skills, regulating our emotions … so a lot of emotional dysregulation happens,” Winter said. “You can’t teach executive functions. You just learn adaptive skills to navigate the deficits.”
An ADHD diagnosis can also bring relief from shame and guilt, Climie said.
“There’s a sense of relief. ‘Okay, it’s neurological; my brain is just wired differently,’” Climie said. “Living in a neurotypical world doesn’t always mesh with the things that people with ADHD need.”
Not only does an ADHD diagnosis allow females to take a breath of relief, but it also allows them to find tools to manage and cope with their ADHD symptoms.
“I approach things from a different perspective now that I know that my brain is completely wired differently,” O’Brien said. For example, she puts a bead in a jar every time she goes to the gym, helping her visualize her progress. “It’s still changing every day.”
Medication, therapy or ADHD coaching can help people with ADHD manage and cope with their symptoms.
O’Brien and Durbak both take a stimulant medication called Vyvanse.
“Being medicated has helped a lot, especially with school,” Durbak said. “I feel like now I can do things like a normal person does.”
Winter, the therapist, also works with her patients to target executive function deficits.
“I sit with a lot of people and parse out their biggest challenge,” Winter said. “I’m a huge advocate for green therapy — getting outside, fresh air, moving our bodies — but for some people, that’s not their thing. So, it becomes finding something else that helps them ground and regulate themselves, and accommodations at work and school are important too.”
Researchers and mental health professionals like Climie and Winter remain determined to end stigmas and misunderstandings about female ADHD.
“I say to parents, ‘I don’t have to make this diagnosis, but it doesn’t change your child at all,’” Climie said. “The label is very minor in the grand scheme of things, but what it does is say, ‘These are the challenges that might happen, and here are some ways to mitigate it.’”
For those who might suspect they have ADHD, Winter recommends research and professional evaluations.
“People seeking an ADHD diagnosis, especially in their adulthood, can face a lot of pushback, but I think self-advocacy is extremely important,” Winter said. “You are an expert on yourself, right? If something feels off, then it’s important to look into that for yourself. Trust your gut and know that if these diagnoses aren’t fitting you, keep pushing.”
This story was originally published by the Kent State NewsLab, a collaborative news outlet publishing journalism by Kent State students.