ADHD, It's just a trend.

How many times have I heard this recently as a social comment on the numbers of people being diagnosed with ADHD or Attention Deficit Hyperactivity Disorder? It  seems society feels this is some bandwagon that everyone is jumping on now to justify bad behaviour or an inability to fit into the workplace or school.  But, what if it’s not, what if thousands of people around the world are starting to understand their own behaviour better, their emotions, responses and masking strategies.  What if this ‘new bandwagon’ helps society function more effectively, holistically and productively. What if, better understanding leads to Better.

I apologise for how long this piece is, especially if you are reading this and have inattentive or combined ADHD.  There was a lot more I wanted to say but instead opted for a brief (!) introductory overview in the hope that most people would reach the end either in one stint or in chunks and possibly gain from reading it.

The World Health organisation suggests  “ADHD affects 5-8% of children, mostly boys”, UK stats suggest a ratio of 5:1 M:F diagnoses and 3-4% of adults affected.  Here’s why I believe these known numbers do not fully encompass the issue and how it specifically affects women and girls.

First I am going to give a general overview of the science as it is currently known, but only an overview as this is not really what I am writing about today, I want to investigate how this affects women and girls specifically and how this has not been addressed.

What is ADHD? A good question that has several part answers mixed with a bit of piecing together, we are a good way further along in the understanding of the chemical process although the research is far from complete.  Gone are the days when E numbers and too much sugar were thought to be the cause and now there is recognition that people with ADHD have issues with dopamine, serotonin and norepinephrine ( neurotransmitters in the brain keeping the messages between cells flowing) and that this can be inherited from family members.

You may recognise Dopamine as it is often referred to as the pleasure chemical and we are told activities like doom scrolling give us ‘hits’ of it.  Dopamine is released when doing things that we find pleasurable so it reinforces that the thing we just did caused pleasure and we seek those same opportunities again, think opening parcels and eating.

Non ADHD brains will release dopamine in anticipation of a reward eg going through driving lessons to be able to pass the test.  ADHD brains don’t function the same way and it is more difficult to motivate for an end stage reward, instead people with ADHD need frequent rewards eg ‘passing’ each driving lesson.  Ultimately though, ADHD brains are more sensitive to the reward when it happens and will likely have a bigger emotional response.  However, once the reward is experienced the brain's reuptake of dopamine happens much faster in people with ADHD so the crash or demotivation is very real.  Humans need dopamine to help with cognitive functions like working memory, attention and problem solving, so not enough dopamine can really reduce this functional ability.

Norepinephrine has a role in executive function, attention and behavioural control.  A study looking at the role of norepinephrine in ADHD found that there is a 5.8% mortality (death) from unnatural causes in people with ADHD, (accidents and suicide) and this is higher in those diagnosed as adults.  There is a higher incidence of adults with ADHD also diagnosed with other conditions, mainly depression,  anxiety and conduct disorder, these are often diagnosed before ADHD is.  Basic level executive function as it’s being discussed here relates to things like working memory, attention control, flexibility of cognition. For example; you are involved in a task, someone talks to you, your brain has to leave the task to process what they have said and answer them. When you try to get  back to the task, refocussing, remembering where you were and being able to pick up where you left off is not easy.  

The last neurotransmitter I am going to touch on is serotonin which is needed for mood regulation, impulsivity, decision making and sleep amongst other things. Without enough Serotonin people can feel anxious, depressed, hyperactive and have insomnia.  Research has been done on the use of SSRIs, (selective serotonin reuptake inhibitors) a family of medications used to treat depression and anxiety eg Prozac (fluoxetine) and their effect on ADHD.  The preliminary results show that they help settle the symptoms of hyperactivity by making more serotonin available in the system.  

Finally a quick bust over the current three types of ADHD; hyperactive, inattentive and combined.  Hyperactive is just what the general population might associate with ADHD, the quick change, always into something new, impulsive actions without assessing the consequences, difficulty in getting a child to go to bed, difficulty in getting them to concentrate on anything, fidgeting.  It’s what, perhaps, in the past people might have excused as ‘boys will be boys’ and is the type often associated with them and perhaps why initially it was thought that only boys had ADHD.  

Inattentive is a strange label for the next type as it seems to suggest the person just isn’t paying enough attention.  Really the person struggles with focus and concentration, they may be easily distracted and have a lot of half completed tasks, they may even seem to daydream or stare off into space, often they will have multiple tasks on the go at once as the need for the next task to be done distracts them from the previous.  It doesn’t mean they cannot finish a task and often their working day is a lot longer to get the tasks done that were expected of them, they often harbour feelings of not being good enough or guilt at not being ‘better’ at their tasks/job.

The last type, combined ADHD, is a mixture of the two previous types and that is my whistlestop tour of the current basic understanding.

So why don’t I believe that women and girls are thoroughly represented in the statistics for ADHD? What makes women different?

Well there are lots of reasons, a lot stem from the way that women and girls are raised and how a patriarchal society would choose to have us behave.  We know that medicine begins with men, a condition is identified in males and this is then researched so it can be years or in the case of ADHD, decades before it is identified in women.

I was raised in a normal household where girls were expected to be sensible, nurturing and helpful but also interesting, engaging and intelligent. My mum also encouraged me to form my own opinions but supported society’s view that one shouldn’t voice those opinions unless those around us were ready to hear them.  So I grew up masking, I would organise and care for those around me until everything was done but if you looked at my personal life for example my bedroom, it was a mess.  I mean a real mess, everything I owned was all over the floor at all times.  I knew where everything was, if I was asked for a certain pen I would dive under a jumper over there on the floor and hold it aloft triumphantly.  Other people couldn’t bear to be in my room and although I wished it was tidier I didn’t have the ability to clean it, it was as though I didn’t know where to start and the feeling of starting such a huge task would overwhelm me.  If i did manage to begin (because my mum insisted), I would pick up a few items and put them away but then I would get distracted by something I had picked up, follow that down a rabbit hole then decide I needed a drink so go downstairs to get one.  I would return to my room and be overwhelmed by the size of the task again and relate that to how long, usually hours, i had already spent on getting ‘nothing’ done.  I would go to bed having tidied three things off of my bedroom floor and I would feel dispirited and lost, not understanding why I ‘couldn’t just do it’. This is reflected in my adult life in that a lot of surfaces at home are covered with ‘things’.  In more recent years I have attempted to have a place for everything and put everything back in its place, which I am better at but equally I am not the only person who lives in this house and I do not have the functioning capacity to do it immediately for everything I use, let alone what others use.

Let’s have a look at the teenage years, yay! they were easy.  Well, no they were bloody awful, pun intended.  Somewhere between 10 and 16 is where most women will start their periods (menarche).  At the same time they are finding out who they are as a person, trying to fit in with their microcosm of society (school) and more than likely dealing with the emotional lability of romantic attachments, crushes or rejections.  For those women who have had or do have periods we understand emotions and behaviour that change throughout the month depending on what our hormones are doing at any given time.  Hormones can control whether you are constipated, bloated, have diarrhoea, spots, migraines, headaches, swollen ankles or a myriad of other symptoms.  As women we generally learn to mask how our hormones are affecting how we feel day to day.  Now add to that the emotional dysregulation of ADHD.

Emotional dysregulation is not currently part of the DSM criteria for diagnosis but there has been a move recently to suggest it should be, again thought to be more of a female trait but personally I think this is just another excuse to say women are more emotional than men, after all we all know men who get frustrated easily or have trouble controlling their anger.  What is emotional dysregulation in ADHD ( I keep specifying because emotional dysregulation can be because of a number of reasons including trauma), it is overwhelming emotion or feeling, or intense fluctuations in emotions often described as a ‘dam burst’.

How would this look in people? Well there is the obvious ‘boiling over’ of frustration or short temperedness but there could also be waves of anxiety, low mood or depression as well as euphoria, happiness and excitement.  Someone might always get really emotional when watching films or their emotions may track those of the people around them, feeling sad when their partner is sad etc.  Although people without ADHD would experience extremes of emotion they might not be as frequent, could be controlled more easily or logically reasoned before breaking point is reached. Many women learn to mask, or ‘cover up’ how they are doing emotionally because society tells us it’s a weakness to be emotional and no-one wants to be labelled an emotional woman with the inference they are therefore a substandard human who is not as good as a man who thinks logically.

Instead we have women who don’t understand why they feel so low in mood when they believe their life is objectively fine, they can feel ok one minute and an hour later feel like life is over for them. Or they are anxious about going out of the house to go grocery shopping but didn’t have an issue going to the library this morning.  When they have to do something new they can be paralysed with anxiety eg driving two hours to a town they don’t go to often to stay for a two day conference, to the point where they don’t go and instead phone in sick to work.

As we have established, people with ADHD don’t produce enough of the neurotransmitters needed to stabilise and maintain mood so mix this in with the hormonal disruption of menarche and the teenage woman who is trying to fit in at the same time as finding her own path, but is learning that society is finding her opinions less valid than her male counterparts and labels her as ‘emotional’ just because she is a woman.  Combine this with burgeoning romantic relationships where neither party is particularly mature and teenage boys are trying to coerce women to engage in sexual activity that they might not choose to at this point in their relationship.  Women are raised to keep the peace, be liked, fit in and keep hold of anyone that might give them a status (boyfriend) that society will not allow them to gain for themselves.  Plus with the aspects of combined or hyperactive types leading to risky behaviours - throwing caution to the wind, and we see sexual assault and rape that teenage women do not necessarily have the language for.  Because women are expected to be the sensible ones, they know they will bear the labels (slut, easy, slag) of this risky behaviour    (whilst men are labelled with ‘boys will be boys’) so they bury it, explain it with they must have lead him on or they didn’t say no so of course they consented and they know they will be blamed for an unexpected pregnancy.   Thankfully recently this language is being turned on it’s head and we are beginning to understand sexual assault and rape for what it is as women, even if society in general is still protecting the men who perpetrate it. We should stop excusing their behaviour as ‘boys will be boys’ and hold them accountable as the men they are being in performing these acts.

As a side quest, I will touch on the fact that many women then grow into adult life with emotional and sexual trauma which can make diagnoses more complex.

Moving to the middle stage of reproductive life and women still have the emotional rollercoaster that is every month.  We have been conditioned to review our emotional standpoint on any given day, with where we are in our monthly cycle.  We know we have certain amounts of dysregulation based on where our hormones are - after all society has told us this for hundreds/thousands of years- and this is exacerbated by symptoms of ADHD.  Add to this caring for children, aging parents, spouses, because we have established that society expects us to be the caring and nurturing partner, perhaps studying or working full or part time and carrying the organisational load for the family and we can see just how brilliantly women with ADHD have had to mask their symptoms. 

This is also the formative section of life where romantic relationships are entered into in the largest number and it can be problematic for a number of reasons.  Emotional dysregulation can leave women with ADHD not feeling ‘good enough’, they are already aware that they do not keep their living area tidy and organised, they likely feel they fail at doing other things well eg college will no doubt result in a lot of procrastination and only just getting assignments in on time or not at all, exams - i remember sitting for the first 20 mins of an A-level (age 18) English literature, 90 min, exam just zoned out, not even reading the paper.  Work likely has a level of imposter syndrome no matter what the job, even other responsibilities like being a maid of honour at a friend's wedding, or simple tasks like driving someone to an appointment on time are almost impossible to get right.   I drove my friend to the airport when she visited me at university, we were so late for the domestic flight that the staff stamped her hand to say she was ‘having a go’ and she had to run to the gate (she made it), all of the above makes the person with ADHD feel ‘less than’ or berate themselves for their inadequacies (why couldn’t i just drive to the airport on time).  This can be for specific reasons like time blindness where people with ADHD can struggle to judge time or just because our organisational skills that day have gone up the spout.  

Throughout my teenage and young adult years I was always late for everything, I would try to be on time but for whatever reason I would leave late, Every. Single. Time.  This finally stopped when I found a way to mediate for it that involves alarms and building in lots of extra time and I did this when my mum angrily said to me one day ‘when you are late it says to me that you see my time as not being as valuable as yours’, bearing in mind this was the lady who offered to pick me up from my Saturday job at the shopping mall and was three hours late, she didn’t have a mobile I just had to stand and wait outside the closed mall until she got there.  Yes I do believe my mum has ADHD and yes I had thought this would make her more understanding even without the labels.  I still get disproportionately anxious when my partner is late and I am waiting to leave, I still have fear of the judgement and blame that will inevitably end up at my feet when we arrive late, because I have prior history.

I digress, unironically.  So back to women with ADHD and emotional relationships, they are more likely to get involved in abusive relationships.  This again can be for a number of reasons, alexithymia ( a difficulty in recognising, expressing, describing or feeling emotions) a symptom of some people with ADHD for example, leaves women vulnerable in their patriarchally defined role of recognising or anticipating their partner’s emotions and mediating them.  Women with ADHD are more likely to already be vulnerable with feelings of anxiety, depression, the need for others to validate them and so are more likely to stay for longer in relationships where lovebombing, coercion, manipulation, gaslighting and other emotionally negative methods of control are utilised as they are not as easily recognised by women with ADHD and may take them years longer than their non ADHD counterparts to accept.  Add to this the dysregulation of executive function and risky behaviours and they may already have children with this partner, feel they are to blame for the dysfunction (the abuser is likely already suggesting this), struggle to see a safe way out of the relationship or how to organise it.

Back to the side quest I touched on earlier.  Women are more likely to have unrecognised or recognised trauma.  If we are honest with ourselves any woman who has dated a man can usually think of a time when she ‘gave in’ to some form of sexual activity that she wasn’t really up for and likely had already tried to brush off or say no to, just to ‘keep the peace’.

We gave in and just did it either because we knew the response would be sulking or some other form of manipulative behaviour from him or we grew tired of continually saying no, not tonight, not right now etc and were fed up with demands of ‘when then’; ‘but I really love you’, ‘you could just give me a BJ’, ‘I can’t help it if i’m really attracted to you’, ‘it won’t be my fault if I have to find it elsewhere’ or any of the other statements they come out with in order to coerce and it just felt like the easiest way out at the time.  These statements in themselves have a great effect on women’s self esteem, which they are supposed to in order to make us feel like we are not fulfilling our role and will affect women with ADHD on the multiple levels that have been discussed.  Research suggests that coercion in relation to sexual activity is most likely to leave women with feelings of depression, anxiety, self blame and PTSD.

At the time we may not have seen this as sexual assault and rape because we likely feel we did consent, now with the shift of understanding for women we are beginning to stop carrying the burden of unrecognised trauma and replacing it with named trauma.  This on its own would have a huge impact on symptoms of ADHD but also contributes to misdiagnosis in women.  

If we begin from a standpoint that women are less likely to be diagnosed with ADHD than men, much less likely.  Add to this that women are much more likely to have experienced trauma.  I am not intending to minimise trauma experienced by men but in this discussion we are looking at women and ADHD and the fact is that the majority of women, yes much more than 50% have experienced some form of trauma with a large proportion of this being sexual and coercion features highly (this does not mean that men are not diagnosed with anxiety and depression or that all anxiety and depression is linked to sexual trauma or undiagnosed ADHD).  The burden we carry from this means we are much more likely to be diagnosed with anxiety and depression which would eclipse the diagnosis of ADHD.  Women are just much more likely to be diagnosed with anxiety and depression than men, partly because of the societal view that we are negatively or overly emotional.  Men are much more likely to be diagnosed with ADHD partly because it has been studied in men and is a non emotional medical condition. 

Women with ADHD understand that there is ‘something wrong’ and they shouldn’t be feeling like this and perhaps are willing to accept the diagnosis of anxiety and depression because they do feel anxious and/or depressed and/or overwhelmed at times.  SSRI antidepressants also have a positive impact on the symptoms of ADHD caused by not having enough serotonin so some relief could be gained by taking the meds prescribed.  However this is not all of the story and women with ADHD can be left disappointed that the treatment of anxiety and depression are not having as much of an effect on their daily lives as they had hoped.  If you have made it this far through this piece then hopefully by now you will be shouting ‘no because it’s the ADHD that needs treating not the symptoms of it!’ and you would be right.

The next added extra for women is peri/menopause.  As with menarche hormone imbalance is rife, although unlike with menarche it is often unexpected and the types of symptoms; insomnia, brain fog, memory loss, executive dysfunction, emotional lability, depression, anxiety, panic are very similar to the symptoms of ADHD with the added physical symptoms of hot flushes, night flushes, hair loss, ageing, irregular periods, changes in libido and many others that have to be coped with on top.  Yes there is treatment but it does not wipe out symptoms just makes them have less of an effect.  Again this is where women with ADHD as opposed to men, luck out.  Their  ADHD symptoms are made worse by their hormonal changes whilst they are still expected to carry the mental load for the family, look after younger and older relatives whilst likely working in paid employment as well, all at the same time as the patriarchal driven society is saying they are becoming irrelevant because they are now old.  

Why aren’t there mass murders or coups by menopausal women with ADHD, I suspect all that nurturing and caring forces them to reconsider. 

If you are looking at your own life and thinking any of these following statements;  I procrastinate (it took me three months to get started on this piece), sometimes I feel anxious, depressed, like I don’t belong or everything I do is wrong, I view myself with a very critical eye, I get overwhelmed with tasks or people, I have been called a people pleaser, I have been called  ditzy, air headed or forgetful, I spend more money than I have, I often buy stuff  that I don’t need, I eat more than I want to and find it difficult to stop sometimes, I get anxious and think I must have done something wrong if I don’t get a text back quickly, if my partner stops speaking to me or sulks I believe it must be my fault, I get excited about things and ‘have’ to do them, I am spontaneous about big things like moving countries, moving house, getting married or taking long trips,  then perhaps there is more to why you feel you struggle more with life than you might perceive others do.

Currently the advice is that trauma has to be resolved before a diagnosis of ADHD can be made but I wonder if this statement alone is one of the biggest let downs for women’s diagnosis with ADHD as we can experience trauma daily, weekly, monthly.  This compounded with women being more likely to be diagnosed with the symptoms of ADHD (anxiety, depression) than the condition itself and our limited but budding understanding of ADHD all gives some insight into why this condition is so under diagnosed (in my opinion) in women.

So is it a trend? I don’t believe so.  I went to a new medical school, the English government funded the founding of 5 new medical schools to open in 2002, and when I attended they were still having a vast array of ages of applicants.  Until that point the rule was you could only apply to medical school until you were 30 years old, the new medical schools didn’t have an age limit so there were people in my year of intake from age 18 to age 50.  Around 7 years after I qualified I ran into the Dean of my medical school in the wild and as we were chatting I asked if there was still such a diversity of age range, he replied that no there wasn’t, but he didn’t expect there to be because all of the older candidates had had time to apply in the last 15 years and had been ‘mopped up’.  

I believe with adults and ADHD especially women as they would not have been diagnosed as children because it was a male diagnosis, they are now being ‘mopped up’ as we are understanding more how ADHD manifests and how it affects lives which is why we are experiencing ‘so many’ new diagnoses.  If you recognise some ADHD traits in yourself you might like to do the online questionnaire that will tell you whether you have traits that are worth exploring with a professional, I would hope that most developed countries have their own but here are some links 

https://www.adhd.org.nz/resources/how-to-get-a-diagnosis-for-adhd/self-screening-assessment-tool-for-adults the one for adults in New Zealand

One in the UK https://www.clinical-partners.co.uk/for-adults/adult-adhd-add/test-for-adhd 

And one for USA https://psychology-tools.com/test/adult-adhd-self-report-scale 

They are all similar, as we would expect as the condition is the same.  If you do decide to answer the questions though please strip away all of your coping mechanisms or masking before giving your answer,  I find it helpful to think ‘how would I be if I wasn't trying and was just being’.  I found knowing I have ADHD helpful because I finally understood why to so many of my questions and behaviour.  I choose not to medicate because we have no long term data on how these medications affect the brain and because we still don’t even know what we are treating so don’t yet know if these are the effective medications.  By knowing I have ADHD I feel enlightened, I am not so hard on myself and I actively engage in coping strategies out in the open without any feeling of shame or needing to hide.  This self acceptance has made a huge difference in how successful I am with managing my symptoms and ultimately how much I enjoy my life.

If you would like to look more into ADHD you could start with the ADHD society for your country or region, there are several youtubers who have ADHD channels, I recommend How to ADHD by Jessica McCabe as one that is well researched.

Remember, as human beings we are not just the sum of our physical and emotional parts we are our own individual selves who continue throughout life to be beautifully and wonderfully made.

All art on this article was created by me with AI.