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Who tells the story of females with ADHD?

Internalising. Low grades. Can’t seem to focus. Just not putting in the work. Validation seeking. Loosing track of time, again. Panic. Loosing my job. Depression is settling in. Panic again. Medical leave. Anxiety peaking.

Someone is losing their minds.

The Attention-Deficit Hyperactive Disorder condition, popularly known as ADHD is predominantly characterised by inattentiveness, impulsivity and hyperactivity. This neurodevelopmental condition is known to affect both males and females from childhood even into their adulthood. While it has further been described in the words of psychologist, John Fleming as ‘having a good engine and lousy brakes,’ in his article on ADHD and Impulsive Eating, Martha Bernard Ray has said that the problem is in its name. In her TEDx speech on ADHD in Girls and Women in 2022, she goes on to explain: “People with ADHD don’t have a deficit of attention, we have too much attention and less ability to control it.”

Dr Michelle Marie Martel, a clinical psychologist, professor researching in ADHD and an acting chair in the department of psychology, for the University of Kentucky agrees to this, saying: “ADHD is misnamed because there really is no attention deficit per se. People with ADHD struggle with appropriately focusing their attention. Sometimes, they struggle with regulating emotions and regulating behaviour. It’s really more kind of a higher level than just like simple attention. The simple attention stuff is all intact.”

A study by Quinn MD, and Madhoo MD, in 2014 on the review of ADHD in women and girls, reveals that underdiagnosis of girls with ADHD is largely due to the type of ADHD they in most cases present which is inattentiveness as opposed to the hyper activeness, which is often associated with boys as an ADHD trait. There is also a higher rate of diagnosis of boys with ADHD compared to girls. Martha Barnard-Rae in her speech further goes on to say that the underdiagnosis of ADHD in females is a feminist issue. A study by some scholars in the United States, published in the Journal of Psychiatry, on the prevalence and correlates of adult ADHD in the United States shows the rate of men diagnosis with ADHD compared to women being 5.4 per cent and per cent respectively. This study further reveals that women tend to be older when diagnosed with ADHD and also have less ADHD medication use but more of internalising their ADHD symptoms, which will materialise in conditions like depression, inattentiveness, anxiety, low self-esteem, shame among many others.

Sunshyne Bruton, a 43-year-old certified coach talks about her experience of late diagnosis with ADHD at the age of 38. She shares what life was like for her as a child. “In school, I was the one to have A in citizenship, everything else was like Cs, Ds and Fs. My teachers said, ‘She’s a good kid, she’s smart, but she is lazy. She is not getting the work done’,” Sunshyne said. She did not see anything particularly wrong with herself. “To me, I just thought that was life,” she said.

Females with ADHD often grow to mask their symptoms or traits. Masking, meaning to conceal (something from view). Dr Michelle agreed to this saying: “Girls are a little quicker to develop for a variety of reasons. I think they’re more able to mask than boys, especially at the younger ages, and that’s true for all adults. It can be more difficult to diagnose ADHD in adults because most adults are not like climbing on the furniture. It is however more true for girls than boys because girls are usually quicker to develop verbal skills. They’re more regulated. A message they get through socialisation that it’s important that they be a certain way, like ‘boys will be boys’, but girls need to be quiet. I think they’ve had more practice doing that, and that’s another thing that makes it more difficult to identify ADHD in girls.”

Sunshyne further expresses the journey of using medications after her ADHD diagnosis. “While I am grateful for the ADHD medication, I am disappointed in our mental health system and their inability to provide individuals with cognitive disorders the tools to live, without being dependent on this medication,” she says.

Dr Michelle starts by describing the ADHD medication as possibly even a bit more effective than talk or behavioural therapies. “There is obviously a lot of individual variability and side effects to ADHD medications are no exception.” Dr Michelle further highlights the possible reasons ADHD medications might be less effective in females ADHDers. “We find this very interesting hormonal effects on ADHD symptoms and women who are naturally menstruating and not taking hormonal contraceptives.  That suggests that their symptoms vary across their menstrual cycle and potentially also across different reproductive periods like adolescents.”

An escape from all of the mind chaos and irregular emotions and energy might mean to find temporary pleasure, like binge eating. Rebecca King, a dietician based in Charlotte North Carolina in the United States says that binge eating does not necessarily result from impulsiveness in females but will be more from a mindless kind of eating. “Binge eating can also be a treat and a coping mechanism. It can be a way to get stimulation or get our brain the dopamine it’s looking for. It can also be a trait of ADHD in itself but you can have ADHD and not struggle with binge eating.”

She further explains that eating healthy can be relative as it depends on what an ADHDer’s executive function permits them to do. Sharing a tip to healthier eating as an alternative to binge eating, Rebecca says to “connect with how food feels in your body after eating a nourishing food.” Making an analysis of that and being flexible in incorporating a healthier diet is one of the keys to stop binge eating  and also, not being obsessively strict with the healthy diet as “there might be some rebellion” against this new diet.

The climax to this condition can be a burnout, ADHD burnout, which Martha Barnard Rae, a neurodivergent business owner describes as an ADHD bonus in her article on ADHD burnout. She describes it as experiencing “a lack of motivation, exhaustion, pain, irritability, negativity, and even more emotional dysregulation than usual”.

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