ADHD & women: the story you haven't been told

Express Tribune

09-03-2025

I sat in the clinic's waiting room staring at the walls. Fear and anxiety crept in but I was ready to seek help. This moment came after a long struggle with concentration and self-discipline. What I accepted as a character flaw got a new name when a friend shared a similar experience and it rang a bell. Scouring the internet for my symptoms pointed out it could be ADHD (Attention deficit hyperactivity disorder).
I signed up for therapy despite hearing terrible stories from my circle. Part of me was happy for finally taking this step, part of me dreaded the imminent outcome.
After giving my history, finally saw the psychiatrist. A male, in his 60s, I could sense where it was headed but I resisted stereotyping.
'What's your qualification?' he asked.
'Masters,' I replied.
Psychiatrist: Masters ki hui larki ko ADHD hota hai? Aise bachay panchwi pass nahi kar patay [Can a girl who has done her Masters have ADHD? Such kids cannot go past grade 5].
The session progressed dismissing the concerns and ended with a prescription for antidepressants.
Fuelled with curiosity, I dug the internet and it showed this isn't an isolated case, women all over the globe are in this together. We are misunderstood, misdiagnosed and perceived to be a creature too good to have ADHD.
My personal journey leaned into learning coping mechanisms and to make do without medication until I hit the point where medical intervention became inevitable. So, I began reaching out to women with the same predicament to be fully aware of what comes with the territory.
My 20s went by being distracted, inattentive and impulsive, on the surface what looked like a lack of discipline or bad memory was just a manifestation of one of the symptoms. With my head always up in the cloud, halfway through the movie, I'd forget the plot or the protagonist's name. It was troublesome but my inner monologue screamed 'You're the issue'' because who asks for the hero's name mid-movie?
Wanting to get things done the neurotypical way, my neurodivergent self would make a to-do list hoping to check off the list item by item. The activity would get me pumped up but my impulsive nature looked for a little inconvenience to get off the track. Building a habit was another nightmare, I turned to productivity apps and soon would be back to square one.
Beating myself for zoning out frequently, what I got wrong was, it's not inattention but dysregulated attention. In girls, the signs of ADHD are subtle, and internalised such having trouble focusing, staying organised, anxiety and depression, but merely because they aren't physically disruptive doesn't absolve them from the probability of being affected.
Later, I connected with Saba who's in the same boat and has been struggling to get screened for ADHD for the past two years.
'Typically, women who exhibit ADHD symptoms are prescribed medicine for anxiety and depression. Mine was mislabelled as OCD (Obsessive-Compusive disorder), though I knew it was ADHD because one, it's genetic and runs in our family. Two, I'm a doctor and understand better.
'Let down by one therapist, I went to see two more but had the same misfortune every time,' Saba shared, expressing her sheer disappointment. 'Though I had glaring symptoms of a stereotypical ADHD-er, I was shut down, even told I'm acting up to score medicine for myself.'
The stories of exhaustion continued. Maria, a close friend, shared the hardships she faced looking for validation of her feelings.
Recounting her experiences, she explained, "That journey of mental health was a trainwreck.
'I signed up for therapy to understand why I swung between dull moments to intense concentration only to hear, 'You can't have ADHD, that happens to kids only'. I requested psych evaluations, but was told to try therapy as well. In the three sessions I took, the psychiatrist talked more than I did. When I emphasised getting assessed for ADHD, the psychiatrist dismissed the possibility stating ADHD only happens to kids and people grow out of it in adulthood. Keep in mind that no evaluation tools (tests and such) were used for any of these diagnoses.'
As prevalent in such cases, he assumed she had BPD (Bipolar disorder) which was appalling as she has something one can refer to as textbook ADHD.
'In my personal life, I often overcommit to multiple social events and exhaust myself keeping up with them,' she adds. 'I also am horrible at time management at work, school, and housework, and my sleep suffers as a consequence. I also struggle with personal hygiene because the task is so daunting. In my professional life, I am often unable to concentrate and often in need of deadline extensions both at work and at school.'
Both the ladies withdrew from therapy after a short while.
While talking to ladies navigating their lives with ADHD, the questionable demeanour of mental health professionals show how stigmatised and gendered mental health is in Pakistani culture where being born in a female body means you can have cancer but not ADHD.
Untreated ADHD
'My ADHD almost landed me in a psych ward,' recalled Areeba, a married professional with teenage kids discovering having ADHD at 40. 'I had a major breakdown two and a half years ago. My clueless husband ringed a close relative (related to my dad) who's a doctor and a well-wisher for help. She revealed, this breakdown was due to the fact that I have had ADHD just like my dad ever since I was kid, and the pieces started to fall together. My long list of always seen as attitude problems growing up and that no one cared to probe into were symptoms of ADHD. Results? Always shamed for my slow reflexes, focus was a nightmare. Science and maths weren't impossible to get, they were not just not taught in a way my brain would understand. Now diagnosed with clinical depression, I have given up trying to blend in. Despite flagging my ADHD, I still get treated for depression only. A little awareness back then and much more inclusive/accommodating medical help now could have done the trick.'
In Asian cultures, women have this silent expectation to be super. Anything less is unacceptable.
When we hear the word ADHD most of us think of it as a guy's thing because society boxes us as compliant and competent beings. The research skewed heavily towards boys adds insult to injury. What this stigma perpetuates is a culture of denying diagnosis to women.
The popular myths about ADHD have an equally negative impact just as the condition itself and are very damaging, especially for women. Disorders aren't gendered. When it comes to ADHD, girls are as likely to have it as boys. But because it doesn't resonate with the fallacy of 'unruly schoolboy' women are subjected to a point-blank refusal in therapy.
ADHD is a reality not a gendered disorder
'This bias is implicit not only in Asia but all over the world that ADHD is a man's disorder because of how it manifests in men and women', said Dr Samiya Iqbal, Adult and Child and adolescent Psychiatrist.
'The precursors of ADHD in childhood are inattention, hyperactivity and impulsivity. Inattention is a prevalent behaviour in girls as compared to externally observable attributes of hyperactivity and impulsivity in boys.'
'Hyperactivity includes cutting people, inability to sit in peace while inattentiveness is careless mistakes, say, losing things, appearing forgetful, or zoning out. Symptoms in boys are more noticeable as they're bothersome to people around and hence get on the radar. Girls aren't typically that unruly or show such symptoms and there's not much scientific basis to understand why this happens.' She said, talking about how ADHD manifests in men and women.
'If the teacher to student ratio in a class gets high the kids are more likely to get an assessment of ADHD and this diagnostic criteria of picking only externally observable behaviour is a challenging situation.'
Unfortunately this explicit difference in manifestation of ADHD and the diagnostic criteria favouring the boys makes the assessment process discriminatory for young girls.
'Another factor is the way we raise girls is that they conform to social norms which masks the hyperactivity or impulsivity in girls and consequently they're misdiagnosed a lot of times. This bias in the screening process can be addressed by configuring the early childhood diagnosis criteria and making it more considerate of internal feelings.'
'In adulthood, untreated ADHD triggers behavioural problems which become the major contributor to misdiagnosis of ADHD as personality issues.'
'When one grows up with untreated ADHD, they are predisposed to esteem issues. For instance, if we internalise the problem and think of the struggles as our own fault it gives rise to anxiety and depression which eventually becomes the point of focus in treatment not ADHD.'
This is the reason girls are put on schizophrenic medicine instead of given treatment for ADHD.
Boys on the other hand are likely to get into substance abuse or risky behaviours which again prompts the people around to point them to help.
ADHD manifests in all aspects of life, personally and professionally
Discussing the consequences of ADHD Dr Samiya said, 'As humans we typically have an idea about how capable or intelligent we are as humans. What ADHD does is despite our capabilities it impairs our ability to initiate, prioritise or organise any task, complimented by a warped perception of time, also called 'time blindness' that leads to punctuality and planning issues.'
'The consequences of this can be underachievement in childhood but they're more detrimental in adulthood/professional life leading to high personal and societal cost. An example could be a barrier to equal opportunity to work. In most of the cases the symptoms are presumed to be personal shortcomings instead of any underlying condition inciting esteem issues. That's why adults with ADHD come up with issues in emotional regulation and managing relationships.'
Adult life and ADHD
'Navigating life with ADHD as an adult is tricky, the dopamine ebbs and flows, distraction is a constant and consistency is an uphill battle. Even an ad during an important video draws my attention,' shared Hafsa. 'I grew up doing great in studies, my only gripe was with time management and although I worked at prestigious places my career trajectory never went up. My peers progressed but I didn't progress much, pitting myself against them I started beating myself up. Our work was the same but what was special about them? I always wondered. My output was meticulous but procrastination was my biggest hurdle, report writing gave me chills making extensions in deadlines my permanent ask. When I moved continents the pressure to prove myself intensified. Again, it was me against the superficial standards I set for myself. Seeing my anxiety about falling short sneaking in, my husband suggested therapy to me. After taking sessions for 1.5 years my therapist suspected ADHD. I went for an assessment and the results affirmed ADHD.' She recalled her experience of getting diagnosed at the age of 32. When asked if having a female therapist on board helped her in the diagnosis? She replied, 'Having a therapist with ADHD helped me, I had seen other therapists and was always told I had anxiety, depression. Only she was able to identify the loop of repeated patterns I was stuck in. Rejection sensitivity, time blindness, sluggish cognitive tempo, she put a finger on what felt like mere emotions and kept me in the perpetual phase of self-shame. It was relieving to know my condition was pathological and not a personal issue.'
This case might not be a norm but it's evident to demonstrate that psychologists and therapists have a key role in providing support to adults with ADHD. A heightened awareness about adult ADHD and administering the skills and resources needed to facilitate proper diagnosis of ADHD in adults can decrease the subjectivity in evaluation and break the cycle.
In our side of the hemisphere where the masses grapple with the concept of equal pay and equal rights this health disparity is yet another man-made calamity inflicted upon women. The criminal discrimination is surprising but nothing new. You might have encountered one or more females with (diagnosed/undiagnosed) ADHD in your circle, given the prevalence the number could be high.
Here's the thing to understand, women are underdiagnosed/misdiagnosed because of their ability to mask the symptoms. But putting a bandage on the wound conceals the wound but doesn't heal the pain. Early intervention can do wonders for us otherwise the symptoms get worse with time translating into low self-esteem, troubled relationships and greater healthcare costs for women.
Ayesha Aslam is a freelance contributor
All facts and information are the sole responsibility of the writer