Why women may wait decades for an ADHD diagnosis
Gender bias is leaving many women with attention deficit
hyperactivity disorder undiagnosed, leading psychologists are warning.
The prevailing stereotype ADHD affects only "naughty boys"
means at least tens of thousands in the UK, it is estimated, are unaware they
have the condition and not receiving the help they need.
"I used to tell doctors and therapists all the time,
'You've got to make this constant noise in my head stop. I can't think. I can't
sleep. I can't get any peace,' but this was always dismissed as anxiety or
women's problems," Hester says.
Diagnosed with depression at 16, she spent much of her 20s
unsuccessfully battling to be referred to a psychiatrist.
And she constantly felt she was not reaching her true
potential.
Make mistakes
"I studied history at university and could write an
essay on an academic subject - but when I worked as a sales assistant, I
couldn't fill out an order form," Hester says.
"My mind would wander off and I would make mistakes.
"I would get a lot of criticism for that.
"I was always thinking, 'Why am I not able to manage
things that other people can do so easily - like keep their house tidy or
remember deadlines?'"
Nervous breakdown
The anti-depressants and anti-anxiety pills Hester was
encouraged to take were not helping but she learned to hide her struggle.
"You suppress who you are, so you can look like a
normal person - but it's exhausting," she says.
"Then, I had a baby - suddenly, that extra pressure,
the sleep deprivation, all the wheels fell off.
"When he was three-years-old, I had a nervous
breakdown."
Doctor's radar
Hester was finally diagnosed with ADHD in 2015, aged 34, and
only, she says, because her husband had discovered he had the condition, a year
earlier.
His diagnosis took 12 months.
"At no point did anyone say to Chris, 'This sounds like
anxiety,' or 'Have some tablets,'" Hester says.
"He was taken seriously.
"Whereas with me, I was on the doctor's radar from the
age of 16.
"Bluntly, it took so long for me to be diagnosed
because I'm a woman."
Disruptive behaviours
A late diagnosis can have a negative impact on relationships
and careers, as well as increase the risk of mental-health problems such as
anxiety, depression and eating disorders.
Clinical and forensic psychologist Dr Susan Young says
childhood is where the bias starts - with boys three to four times more likely
to be diagnosed.
Research suggests boys tend to display more disruptive
behaviours, such as rule-breaking or fighting, while girls' symptoms are likely
to be more subtle.
"It's the boisterous boys who are causing problems in
the classroom who are going to be referred for help, not the quieter girls who
are criticised for daydreaming or not paying attention - but those girls are
also struggling," Dr Young says.
"Women haven't just woken up with ADHD - there have
been signposts all the way along their life."
Twiggy, 27, says the signs she had ADHD were clear at
school.
"I loved English and drama," she says.
"If we were learning about Shakespeare, oh my gosh, I
was on fire.
"But if it was anything else, like maths, I just wasn't
interested.
"If I was a boy, I think my behaviour would have been
looked into - but I was just labelled a disruption."
Cried tears
Twiggy's struggles with focus often left her feeling
"stupid".
But, with the support of her family and friends, she went on
to study law at university and become a beauty journalist for a prominent
magazine.
Twiggy first heard about ADHD in women on social media but
then had to persuade her GP to refer her to a psychiatrist.
When her diagnosis was confirmed, last August, she cried
tears of happiness.
"It was a huge relief knowing I'm not hyperactive because I'm annoying, I don't daydream because I don't care about what the person is saying, it is just the way my brain works," she says.
Blame myself
ADHD is a neurodevelopmental condition that comes in three
types: inattentive, hyperactive/impulsive, or a combination of both, which is
what Twiggy has.
All the women say their ADHD diagnosis has improved their
lives.
For some, medication and therapy has helped.
For others, including Twiggy, all they needed were answers.
"My ADHD is part of who I am - but now, I'm able to
manage it, I don't blame myself anymore," she says.
Underlying difficulties
Experts say females often learn to "camouflage"
their symptoms.
They may be viewed as having anxiety or depression.
They may have another condition alongside their ADHD, such
as autism.
And this can lead to an incomplete or incorrect diagnosis
that masks their underlying difficulties.
Car crashes
Leading experts say the diagnosis gap between males and
females shrinks in adulthood.
But while NHS Digital data suggests diagnoses have been on
the rise for both genders in recent years in England, in 2019-20, 33,000 women
were diagnosed compared with more than 100,000 men.
Sheelagh
As a teenager, Sheelagh battled suicidal thoughts.
As an adult, she exhibited risky behaviour - including being
involved in six car crashes.
And her life was "chaos", the 66-year-old says,
until her ADHD was confirmed, three years ago.
"I do think about what it would have been like if I had
been told earlier," she says.
"My kids have turned out amazingly well - but I'm sad
they've done it in spite of me not because of me.
"I could have had a career - I trained as a dispensing
optician but I never managed to hold down a job long enough to progress.
"I would just walk out because I would get frustrated
with people not understanding me.
"I'm quite fond of who I am now.
"Before, I was like a volcano, ready to go off.
"Now I'm like a mountain - gentler, quieter,
smoother."
Mental-health services
A Department of Health and Social Care official for England
says guidance has been updated.to make it easier for doctors to diagnose ADHD
in women and girls.
There are currently no dedicated services for adults with
ADHD in Northern Ireland, according to a departmental official. Patients' needs
are met via "generic mental-health services".
The Scottish government says it is carrying out a pilot
project to improve the diagnoses of adults with neurodevelopmental disorders.
A review by the Welsh government of all-age
neurodevelopmental services is due to be completed by March.
For more information, psychologists advise completing online
ADHD questionnaires and speaking to a GP.
Source BBC
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