The Daydreamer: Why ADHD in Females Is Underdiagnosed

Maybe you can relate to this: I find my phone in the fridge after 20 minutes of searching because I set it there while I was looking for eggs because I decided I should boil some for my salad on my way to start the laundry that I didn’t actually start until hours later because after getting the eggs going, I then remembered I needed to do research for a story, which I did while the eggs overcooked because I forgot to set a timer.

This has always been my life. Stopping and starting, forgetting and remembering, sporadic periods of laser-beam focus. But more often, getting distracted by anything and everything that flits through my mind or range of vision. The thing is, no one — least of all me — had any idea until about seven years ago that my real problem was ADHD.

When a friend began discussing her newfound inattentive ADHD diagnosis, I was flabbergasted to find that I had exactly the same symptoms — and exactly the same life difficulties as a result. I had always thought of ADHD as something that only affected children — and only excitable, twitchy boys prone to outbursts, at that. So it was unfathomable that it could apply to me, a mom in her 30s.

It turns out there was a good reason for my knowledge gaps. In childhood, nearly three males for every one female are diagnosed with ADHD. That gap closes a bit to almost two males per one female in adulthood, probably because more females are diagnosed as adults.

But why are females less likely than males to be diagnosed with ADHD? There are several reasons.

Inattentive ADHD Is Less Obvious

There are three types of ADHD: impulsive, hyperactive/impulsive, and combined. ADHD is usually associated with hyperactive/impulsive behavior, symptoms males typically display. Many people don’t even realize there is an inattentive type, the most common ADHD presentation in females. The symptoms of inattentive ADHD are not as noticeable and young females may fade into the background of their classrooms as they daydream and doodle.

Males tend to be diagnosed more often and sooner because their symptoms are usually more physical and obvious. Inattentive ADHD tends to be mental rather than physical and includes symptoms such as:

  • Disorganization
  • Losing or misplacing objects
  • Difficulty focusing on a specific task or activity
  • Becoming easily distracted
  • Problems with time management
  • Not paying attention to details
  • Forgetfulness
  • Reluctance and/or avoidance of tasks that take an extended amount of concentration
  • Difficulty following conversations

Since many of these symptoms take place inside the mind, they can be easy for parents, patients and mental health professionals to miss. This means there are now more adult women than ever realizing that they have had undiagnosed ADHD since childhood.

“With females, it tends to be a lot harder because you are seeing someone who is probably daydreaming. They come across as being a little bit flakier, a little more in their own head, so the teacher isn’t necessarily thinking they have ADHD,” says Nikki Kinzer, a Professional Certified Coach, an ADHD coach and the founder of TakeControlADHD.com. “If parents and teachers look at other symptoms of ADHD and not just the hyperactivity, they would probably catch it a lot sooner.”

Other Mental Health Disorders Can Mask ADHD

Depression or anxiety, or both, are often diagnosed in females before ADHD is. This is especially true if, like me, you were in K-12 school in the 1980s and early 1990s, when ADHD wasn’t as well-known. The trouble is, the symptoms of all three can be interchangeable. Depression or anxiety may look like — or possibly result from — untreated ADHD. That can cause ADHD to be overlooked.

These similarities in symptoms can lead to the whole chicken-egg conundrum when an ADHD diagnosis is given: Which came first, the ADHD or the depression and/or anxiety? Did one cause the other? Or was it actually just ADHD misdiagnosed as anxiety or depression? The answers to these questions depend on the person.

“Your ADHD can cause anxiety and depression,” Kinzer says. “Many times, women are diagnosed with depression first. But if the ADHD isn’t being treated, it isn’t going to be managed. You’re still likely to have challenges and you may not feel better. Women can mask their ADHD very well and hide it from others, even if they don’t know that’s what they are doing.”

Every female ADHD client Kinzer has coached has also had an anxiety or depression diagnosis. “If you think about all of the things that probably happened before you get the diagnosis of ADHD, it’s not that surprising that you would feel anxious or depressed, and that’s probably why those get diagnosed first,” she says.

Kinzer has recently gone through this phenomenon with her own daughter. “Because the teachers who filled out the ADHD evaluation forms did not see any symptoms of ADHD and because she had good grades, her doctor told us that she didn’t think that ADHD was the issue and depression and anxiety seemed to make more sense,” says Kinzer. Though her daughter also showed signs of depression and anxiety, Kinzer knew she had multiple symptoms of ADHD. A second opinion confirmed the ADHD diagnosis.

Women Tend to Develop Compensating Strategies

With groceries to buy, appointments to remember, dinner to put on the table every night, kids to shuttle to and from activities, and the heaps of dirty laundry that never seem to dwindle, women have many demands on their attention and time. Even with a partner’s help, they usually end up with the majority of day-to-day responsibilities on their shoulders. Their expectations of themselves are high.

Many adult females who weren’t diagnosed with ADHD in childhood have learned over the years to at least partially compensate for their struggles. At the very least, they’ve learned to cover up their symptoms fairly well, often not even realizing that what they’re going through is abnormal. This ability to hide symptoms or compensate for the fallout ADHD causes is likely another reason women tend to slip through the cracks when it comes to an ADHD diagnosis.

High expectations usually come with a price. Guilt, frustration, shame and anxiety may become constant companions as women try to manage their lives as well as they see other women managing theirs. These feelings may cause women to be ashamed of a potential ADHD diagnosis.

“It’s not to say that you can’t be at a very high functioning level,” says Kinzer. “What happens is women tend to set their goals too high and they are almost self-sabotaging because they can’t possibly make those. It’s hard to hear because that kind of self-loathing and low self-esteem and shame have been built up for years.”

Kinzer helps her clients focus on realistic goals and reframing their expectations. “I talk a lot about perfection not being real. It’s going to sabotage you if that’s what you’re aiming for,” she explains.

If you think you might have ADHD, talk to a mental health professional. A diagnosis can help your life make more sense. “When you understand how your ADHD affects you and that it’s not your fault and you don’t need to be fixed, then you can start working with it by finding ADHD-friendly strategies and systems that work best for you,” says Kinzer.

CTA: Do you think you might have ADHD? We can help.

Sources:

Centers for Disease Control and Prevention (CDC)

National Institute of Mental Health

3 thoughts on “The Daydreamer: Why ADHD in Females Is Underdiagnosed”

  1. That is a perfect example of my life and I wish I was diagnosed WAY EARLIER SO I COULD OF MAYBE HAD A GOOD LIFE BUT NOW NIM JUST TRYING TO PICK UP THE PIECES TO MAYBE HAVE A DECENT 40’S AND 50’S!!

  2. Wow – this is 100 percent me my whole life. I’m 44 and just took an assessment because I’m so tired of riding the struggle bus.

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