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Share on Pinterest<\/a>Why does ADHD take years to identify in women? This podcast episode explores the question. Illustration by Andrew Nguyen for Medical News Today.<\/p>\nThe following text is a full, minimally edited transcript of the MNT In Conversation podcast episode titled: \u201cADHD in women: Breaking the stereotypes.\u201d<\/p>\n
Often they receive a misdiagnosis<\/a>, such as anxiety<\/a> or other mental health conditions, before a specialist accurately identifies ADHD. Many women with ADHD are missed altogether. Why exactly is that? And how can we improve our understanding of this often misrepresented condition?<\/p>\n I am Maria Cohut, Features Editor at Medical News Today.<\/p>\n And I am Yasemin Nicola Sakay, Global News Editor at Medical News Today.<\/p>\n Today we will delve into these and other questions around the difficulty of receiving an ADHD diagnosis as a woman<\/a> on our latest podcast episode In Conversation.<\/p>\n You can listen to this episode in full below or on your preferred streaming platform.<\/p>\n<\/p>\n Yasemin Sakay: So Maria, I know this is a topic you\u2019ve been very keen to tackle on the podcast. Do you feel comfortable sharing why that is?<\/p>\n Maria Cohut: Yeah, that\u2019s basically because to be completely honest, full disclosure, I\u2019m one of the many women who received an ADHD identification as adults.<\/p>\n Yasemin Sakay: Did that come as a surprise to you?<\/p>\n Maria Cohut: Not really. I think I\u2019d always realized that my way of being in the world of interacting with things was a little bit different. Plus, I\u2019ve had people make comments about the way in which I do things that have really struck me. For instance, working in an office, we had this little snack table and I remember, I very specifically remember this moment when I got up from my desk carrying my laptop with one hand, typing with another, walking towards the snack table and talking to one of my colleagues.<\/p>\n And my colleague was like, how can you do that? I was like, do what? How can you do five things at the same time? How can you walk and type and talk at the same time? To me, I realized that is just how my brain works. That is just how I function normally.<\/p>\n Yasemin Sakay: So why would you say you only received your diagnosis so late in life?<\/p>\n Maria Cohut: Well, first of all, think when I was growing up, say ADHD or neurodiversity wasn\u2019t really a thing. People weren\u2019t very aware of what that might be and how it might manifest. And on top of that, I had this image of being a quiet, a shy kid. I did very well in school.<\/p>\n Insofar as the people around me were concerned, I guess I didn\u2019t really fit that hyperactive jumping off the wall profile that people might expect with something like ADHD or that would catch somebody\u2019s eye. That\u2019s why probably because I didn\u2019t fit the template. People weren\u2019t necessarily aware of the hyperactivity that was going on inside my brain.<\/p>\n Yasemin Sakay: Interesting. So do you feel like you learned to hide this very early on?<\/p>\n Maria Cohut: For sure I did, because I think really early on I managed to get an understanding of what was deemed socially acceptable and what wasn\u2019t socially acceptable, or what would get me in trouble, for instance.<\/p>\n So I wouldn\u2019t, I was a daydreamer, I was struggling to pay attention in class, but I would never own up to that, right? Because I figured out that people would just think that I\u2019m being a bad student. I would like perform focus, which is a very weird thing to say, but that\u2019s what I did.<\/p>\n Yasemin Sakay: Yeah, and they will present differently. So on that note, I think it\u2019s time to welcome our special guest who will help us unpick some of these issues further.<\/p>\n Joining us today In Conversation is Professor Davida Hartman<\/a>, Chartered Educational and Child Psychologist with the Psychological Society of Ireland, Adjunct Professor in the University College Dublin School of Psychology, as well as Clinical Director at The Adult Autism and ADHD Practice, and Co-director and Principal Psychologist at The Children\u2019s Clinic.<\/p>\n Prof. Davida Hartman: Thank you so much!<\/p>\n Maria Cohut: Do you mind if we start by asking you what got you interested in specializing in ADHD in the first place? Is it okay if you talk to us a little bit about that?<\/p>\n Prof. Davida Hartman: You know, it\u2019s very interesting. It\u2019s just, I often talk to a lot of my friends and colleagues who are working in this area and a lot of us that are currently working in this area have now discovered our own neurodivergence, have partners who are neurodivergent and children who are neurodivergent but when we started off at the beginning of our careers that wasn\u2019t the case. None of us knew we were neurodivergent or had children at that stage.<\/p>\n And it really was just honestly, it started off by chance in that one of the jobs that I got was with, was supporting autistic children. Well, now I would know they were autistic and ADHD in schools and I really loved the work and then it flowed from there that I loved that work and then I sought out more experience in that area and then I focused on that in my college years. So it led on to that.<\/p>\n But what I would say is I think for a lot of us, what we realized was, well: Why were we drawn to that area? Why were we drawn to those children? And I always found that I really enjoyed their company. It never occurred to me at the time that I might be ADHD myself, but really enjoyed their company and I really enjoyed the, what I would say, the honesty in the interactions. And now I think, because what you see, I mean, what you see with neurodivergent people is, you know, they flock together, you know, once you see.<\/p>\n You know, there\u2019ll be groups of friends and they\u2019re all neurodivergent and neurodivergent people marry each other and all of this kind of thing. So I don\u2019t think it was coincidence, but that\u2019s how it happened. It was mostly my early career was very much in the area of autism<\/a> and autistic children and then later autistic adults with the Adult Autism and ADHD Practice.<\/p>\n For years I\u2019ve been working with ADHD children, but without realizing it because a huge amount of the kids that I look back now, I wouldn\u2019t even know. And that\u2019s part of one of the issues around ADHD experience and people not being identified as ADHD is that we don\u2019t recognize it, we\u2019re not identifying it enough as professionals. Like it wasn\u2019t even until 2013<\/a> that you could be recognized officially as both autistic and ADHD, which really isn\u2019t that. It\u2019s so, so recent history. So ADHD is relatively new for me.<\/p>\n I mean, I was late identified as ADHD myself maybe 4 or 5 years ago. So I think my real interest started then. And also just seeing because my work was so much in the area of autism or autistic experience, more and more realizing that these kind of binaries between autism, ADHD and various different types of neurodivergence are so unhelpful.<\/p>\n It\u2019s helpful to recognize these things as individuals so that people can understand themselves. But actually, there\u2019s massive overlap between all these things and realising that, you know what, this is something I actually really need to understand both personally and professionally.<\/p>\n Maria Cohut: That makes a lot of sense and we\u2019ll come back to some of what you said just now as well. But I also just wanted to say, first of all, you took the words right out of my mouth with the birds of a feather flock together. And I\u2019m so glad you said it because that\u2019s also been my experience. And I\u2019m also somebody who got a late diagnosis of ADHD. In fact, mine came last year. I\u2019m not going to give you my age.<\/p>\n Prof. Davida Hartman: Congratulations!<\/p>\n Maria Cohut: Thank you! But it came last year and it took me\u2026 literal decades to obtain a, well, first of all, I guess, to think about asking for a diagnosis and then again, to obtain a diagnosis. And so that brings me to, I guess, the topic at hand. And I find it very striking that it takes so long for people to get a diagnosis of ADHD in adulthood and particularly for women, a diagnosis of ADHD. And my question to you is, why do you think, or why would you say, based on your experience, that is, why does it take so long for women to receive a correct diagnosis of ADHD?<\/p>\n Prof. Davida Hartman: You know, I think that there\u2019s so many factors going on there from the very, very broad that our systems are medical systems, because unfortunately, I mean, we see like in our practice, we see ADHD as we\u2019re neurodiversity affirmative. So we don\u2019t see it as a disorder. We see it as a natural brain variation part of neurodivergence, not that it comes without its difficulties, of course, like every different neurology does.<\/p>\n But what I would say is that, unfortunately, ADHD is kind of housed and owned within this very medicalized, very medical model, disease disorder that was developed by white middle-aged cis men. And the DSM<\/a> [Diagnostic Statistical Manual of Mental Disorders] and the ICD-11<\/a> [International Classification of Diseases 11th Revision] are based on white cisgendered children, young boys.<\/p>\n And so it looks at this very small, narrow way of being ADHD, which doesn\u2019t encapsulate all the different ways that people can be ADHD and that people assigned female at birth and nonbinary people can experience being ADHD.<\/p>\n So we have this system that only thinks that\u2019s hyperactive boys who can\u2019t stay in their seat. And so there\u2019s these kind of perceptions of being ADHD that didn\u2019t fit how many people, not just women but many people were presenting and experiencing life. So people just literally weren\u2019t thinking of it. Professionals weren\u2019t thinking of it and women and girls weren\u2019t thinking of it.<\/p>\n There\u2019s also a huge amount of, I mean, listen, this is a whole other podcast, but there\u2019s a huge amount of misogyny and distrust of women\u2019s experiences. And so within the medical system, not just around ADHD, with anything, so that when women bring certain things to doctors or psychologists or any of that kind of thing, that their experiences would have been invalidated as, you know, and a lot of stuff would have put down to, you know, women issues and anxiety and all that kind of stuff.<\/p>\n And we see that across the board, not just with ADHD. So, but I think that the reason that it took decades, but I\u2019m not sure that starting from now, it\u2019s going to take decades because now, because the good part, I mean, there\u2019s so many negatives about social media, but now with social media, there\u2019s so many people talking out about their experiences.<\/p>\n There\u2019s a lot more research from a personal perspective of this is me, I\u2019m ADHD, this is how I experience the world. And so women are seeing that and are seeing other people and they\u2019re recognising themselves, I experienced that, maybe I\u2019m ADHD. And we\u2019re talking more vocally, we\u2019re going to the professionals and we\u2019re saying, no, I think that I might be this, I want this looked at.<\/p>\n Yasemin Sakay: Yeah, no, you\u2019ve touched on a great point there. You were about to come to how it presents differently maybe in women and girls. And I thought, how about let\u2019s talk about the symptom differences? Like how does ADHD present in girls and women versus boys and men?<\/p>\n Prof. Davida Hartman: So the way that we approach ADHD, we come out from a neurodiversity-affirmative a perspective. So we don\u2019t actually use the language of symptoms. Now I know everybody does. ADHD is very much owned by most of the researchers coming from the medical community. So it\u2019s very much symptoms, diagnosis, all that kind of thing. But we don\u2019t actually use symptoms because if you think about it, symptoms is the language of disorder and disease. So we use traits instead. And it\u2019s a really helpful way of, yeah, it\u2019s really helpful.<\/p>\n We don\u2019t even use diagnosis. If you hear me saying identified and that I\u2019m formally identified because diagnosis again we diagnose disease and disorder and look the thing is we are like officially you know people are like well you are diagnosing you are making a formal identification but you know language matters and we\u2019re trying to shape the future and all that kind of thing.<\/p>\n But anyway so what I would say about the I know I talked about how it can present differently but actually I don\u2019t know personally that it does actually present differently because I think that what we\u2019re getting into there is, and people would have said that about being autistic also as well as ADHD, that it\u2019s kind of buying into this idea that there are two different ways, that there is one way of being ADHD, but actually ADHD can look so, different whether, depending on where you live, depending on your culture, depending on your personality, depending on what\u2019s going on in your life.<\/p>\n And I don\u2019t necessarily think that there is, I don\u2019t think ADHD itself presents differently in men and women. I think that men and women can be different and see we have to take into account nonbinary people as well of course and trans people and how does that fit then if you\u2019re trans or nonbinary into that. So I think that notion that it can look different stops people from receiving the correct identification if you know what mean because I think there\u2019s lots of women that do actually present in that how people would say a typical boys presentation but that it\u2019s just not picked up because we\u2019re not expecting it to be ADHD.<\/p>\n And then also you can\u2019t get away from the societal expectations put on women to be good and to sit and be nice and to not say what we\u2019re thinking and to manage everybody\u2019s feelings and all that kind of stuff. And so we don\u2019t even know how much of that cultural conditioning is going on in terms of how much. Possibly because of cultural conditioning it can look different.<\/p>\n Yasemin Sakay: You touched on a great point again, speaking of cultural conditioning and hiding. So a term that I\u2019ve come across is masking<\/a>. So do you think people who have lived with ADHD for longer, but they haven\u2019t known it, do they learn to mask this better? And does this kind of further impact the likelihood of them seeking out medical help or like a diagnosis?<\/p>\n Prof. Davida Hartman: There is emerging research around masking, but a lot of is it within the autistic community, not as much within the ADHD community, because there\u2019s a much more organized autistic community that are doing a lot more advocacy work in this area, whereas the ADHD advocacy community is smaller. It\u2019s getting bigger, but it\u2019s smaller and a bit less vocal around stuff like language and things like that, whereas with the autistic community, it\u2019s a lot stronger. But again, it\u2019s because ADHD is so significantly linked to medication. And so again, it\u2019s housed within the medical community.<\/p>\n Okay, so masking is a huge issue. So for example, an example might be talking less, for example, you know, and again, there\u2019ll be some situations, I mean, as you can tell already, I am a talker, so, you know, an example of me masking would be in some situations where I would have to really be working on talking less, you know, not saying every thought that came into my head, all of that kind of stuff.<\/p>\n And in some situations that\u2019s actually helpful and I need to do that. But in other situations where someone might do that in social situations, so they might be around friends, like it\u2019s supposed to be a situation where they\u2019re enjoying themselves and getting support from their community of friends, but instead they\u2019re working really hard on acting a certain way, communicating in a certain way, and actually that just causes significant stress on the person.<\/p>\n And also that leads to feelings of shame because usually they get it wrong or they might say things, blurt out and then they\u2019re going home and they\u2019re thinking about the things that they said and they wish they hadn\u2019t said that. But there\u2019s a lot of emerging research that masking is really significantly negatively impacts people\u2019s mental health. And it gets to a kind of breaking point where people don\u2019t even really know themselves because some masking is conscious and a lot of masking is unconscious. Like we were talking about how women learn to be nice and manage feelings and all that kind of stuff. A lot of that is unconscious.<\/p>\n I think that sometimes it just gets harder as we get older and then if we\u2019re talking about women here, when perimenopause<\/a> hits and when the demands increase, that it becomes harder and harder for people to mask and that\u2019s when they start to think, okay, this is actually becoming a little bit untenable and what\u2019s going on here.<\/p>\n Maria Cohut: Hold that thought, let\u2019s come back to that because we have some questions about that as well. I just wanted to be very vulnerable here and interject and say this is genuinely bringing tears to my eyes. I think that is so true, the emotional and mental health toll that forcing yourself to fit a certain image when that is not the way in which you naturally interact with people and I think you know there\u2019s obviously value in being a socially conscious person and knowing when to take space and when to give somebody else space to talk and talk about their experiences and whatnot.<\/p>\n If it crosses a certain line where you feel like you\u2019re constantly holding back, that\u2019s when it becomes really hard on the individual. I love what you said about how people assigned female at birth or people who, you know, have an experience of girlhood like me perhaps learn how to mask really early on because thinking very far back into my past, to my childhood, I am very aware that I was very conscious very early on that there were certain things I shouldn\u2019t do and I shouldn\u2019t say because people expected me to behave a certain way.<\/p>\n And so I learned very quickly not to do and not to say those things. But you mentioned perimenopause, making it harder to mask, to pretend that you don\u2019t have these traits and this way of interacting with the world. I\u2019m going to start broad and then maybe zoom in a little bit.<\/p>\n When you\u2019re thinking of perhaps women who seek a diagnosis later in their adulthood, in their thirties, in their forties, maybe later, why do you think that is? And obviously perimenopause appears to be a factor. So how does that specifically affect how ADHD presents and how we\u2019re able to manage it? And are there, you think, other factors, maybe?<\/p>\n Prof. Davida Hartman: There\u2019s a bit of emerging research, again, we\u2019re very early days in terms of research in this area, there\u2019s very small studies, and very small studies in perimenopause as well as ADHD, you know, a lot of the research into ADHD is very deficit-focused and not focusing on women also.<\/p>\n There is research<\/a> that\u2019s kind of indicating that it\u2019s possible that ADHD people, experience perimenopause earlier and certainly have more significant perimenopausal symptoms than people who are not ADHD. And I also think on top of that, and even anecdotally, what I would say is anecdotally and from a personal perspective, for me, I am ADHD, it did affect me. I didn\u2019t realize. Looking back, it was very clear, but I had very scaffolded\u2026 So I think this is also the thing.<\/p>\n People who are very supported in earlier life, who have supportive parents, they\u2019re able to manage that because ADHD, while it\u2019s described at the moment in the DSM as this very deficit-based problem with attention, what we know is that there\u2019s no\u2026 ADHD people have loads of attention. It\u2019s just a difference in the way that we attend. So it\u2019s very much based on novelty and it\u2019s based on interest and it\u2019s based on all of those kind of things. So there\u2019s this abundance of attention that we can give to things. And creativity.<\/p>\n I had friends. I did fine in school. But it was only later in life when I had children. And then really it was when perimenopause hit that I thought, actually, I can see, I actually received my identification before I went through perimenopause. But that was only because colleagues of mine, friends and colleagues would say to me, you know, you\u2019re very ADHD. And then I went to a psychiatrist and did the assessment and he was like, yeah, you\u2019re ADHD.<\/p>\n And honestly, I was surprised at the time. I didn\u2019t even, I had worked in the area for years. I was like, really? I am. Oh, okay. And again, not to go too broad with this, but where we are in society at the moment in terms of we\u2019re losing our communities. We\u2019re talking about women here, but middle-aged women previously would have had a community of support and even and would have been able, a lot of women would have been able for example to not be working two jobs now with the state of the economy.<\/p>\n Yasemin Sakay: So what I\u2019ve kind of understood from what you\u2019ve been telling me basically perimenopause dialed up a lot of your ADHD traits or made them more apparent. Is that correct?<\/p>\n Prof. Davida Hartman: Did it dial up or was it, do know what, was more, I don\u2019t think, no, I don\u2019t think that they dialed up, but it was more the difficult, because as I said, there\u2019s massive strengths to being ADHD. And I wouldn\u2019t say that my strengths are dialed up as in I don\u2019t think I talk more than I used to, or I don\u2019t think when I hyper focus, I hyper focus more than I used to.<\/p>\n But I would say in terms of my forgetfulness and in terms of say executive functioning, it\u2019s just too many tasks. I think with perimenopause, as well your emotions are all over the place. It\u2019s more your emotional reaction, your kind of emotional bandwidth to handle stress I would say gets harder.<\/p>\n Yasemin Sakay: So yeah, okay, so I\u2019m gonna draw on something else you said. So you were talking about executive dysfunction and I\u2019m thinking of brain fog, for instance. These perimenopause symptoms can look a lot like ADHD. How can we actually tell them apart if they\u2019re perimenopause symptoms or ADHD?<\/p>\n Prof. Davida Hartman: Oh yeah, they\u2019re very similar. But the thing is that to be ADHD, you have to have shown traits before the age of 12. To do an assessment, it has to be a really rigorous, in-depth assessment. And I know that there\u2019s a lot of talk on social media, oh, everybody\u2019s being diagnosed as ADHD and\u2026 ADHD and private companies.<\/p>\n