For a long time, neurodivergent diagnoses for conditions such as attention-deficit hyperactive disorder (ADHD) were mostly for boys who couldn’t sit still in class due to hyperactivity and a tendency to be distracted.
However, this has changed in doctors’ rooms and online, with many female social media content creators posting content about how neurodivergence presents differently in them. Diagnoses in adulthood are also becoming more frequent.
According to a study published in the Journal of Attention Disorders in 2023, the assumption that ADHD was only a male disorder left many girls and women to suffer in silence. “In childhood, the ratio of boys to girls with ADHD is about 3:1 whereas in adulthood it is closer to 1:1, suggesting that women and girls are underdiagnosed in childhood. ADHD is one of the most common psychiatric disorders in childhood and can result in cognitive difficulties and functional impairments.”
The study states that the reason for this is that symptoms appear differently in boys than girls, who are more likely to internalise behaviour and mask their symptoms due to societal norms around femininity.
“Girls are more often diagnosed with ADHD-inattentive (ADHD-I), exhibiting symptoms such as distraction, disorganisation and forgetfulness. Boys more frequently present with ADHD-hyperactivity impulsivity (ADHD-HI), exhibiting greater levels of hyperactivity, impulsivity and aggression. These symptoms are often more disruptive in the classroom setting, leading to higher rates of referral for assessment in boys than girls.”
Like ADHD, autism is also harder to spot in girls and women than in boys and men. According to Harvard’s Adult Autism Health Resources, girls and women may have fewer social difficulties and, like with ADHD, learn to mask their autistic traits — girls in school have stronger social imitation skills and they can compensate for or “camouflage” their social difficulties. Additionally, restricted interests for autistic boys and men are often displayed as enthusiastic hobbies in autistic girls and women.
Caitlin* was diagnosed with autism only last year but learnt how to mask her traits early on. “I grew up in the 1980s and they didn’t have the diagnoses that they have now. I got all of these much later on in life, so it’s often quite hard and sad to look back at five-year-old Caitlin knowing what I know about myself now and understanding why I just had this sense of not fitting in and not belonging. I was embarrassed by myself and so I internalised and made it a physical thing like, I physically embarrass people because I’m ugly.”
Tessa Otten is a social worker who has worked with clients who have struggled with neurodivergence that was misdiagnosed. “What [they have] experienced is this sense of obviously not fitting in but feeling like they are the problem because their brains don’t work the same as other people and I think it has a huge impact on self-esteem. It’s hugely traumatic and I think that’s why we see that substance-use disorders are so commonplace and developing with people where this diagnosis has been missed.”
Gabriela* who is an occupational therapist based in Australia, received her autism diagnosis recently. She said that receiving the diagnosis as someone who works with autistic people has been interesting. “It’s very, very expensive to get [the testing] done, which is unfortunate. And I think being in the health profession makes it that much harder because you know why they’re asking certain questions and what the correct answer should be.”
Gabriela said most autistic research was still centred on men and how autism presents in them.
“So autism and even ADHD, especially in girls, looks completely different... For me, in school, I didn’t have much of a filter and I could be very blunt and very harsh, but I didn’t think that I was like that. It was only as I got older that friends would tell me, ‘Gabriela, just be careful how you say [certain things].’ But if anything, as I’ve got older, I’ve become even more empathetic and hyper-aware because of the masking. Whereas boys, it kind of goes the opposite way. They become more direct. So the consensus when it comes to autism is that there’s a lack of empathy and a lack of social awareness and there is a lack of social skills. Whereas autism in girls, and particularly me, [involves overanalysing] everything.”
Ivanna* was diagnosed with ADHD when she was in grade 1. At the time, she was at Roedean, a highly academic girls’ school, where she matriculated, despite professionals telling her mother that she would be unable to finish her schooling at a mainstream institution. Ivanna said she did, however, feel that there was a stigma attached to ADHD growing up.
“I felt like it meant I was stupid. And there were a lot of comments from eight-year-olds saying, ‘ADHD medication is like cheating. It’s like taking steroids or enhancing drugs’. It was a deep source of shame and I tried to keep it a secret. At one point I needed to take [medication] in the middle of the day and the teachers would give that to me. I would try my hardest to not let my classmates see that I was taking medication.”
She carried a sense of shame with her as she proceeded through her schooling years. “It was very stressful. I think that feeling of shame and not being smart enough definitely carried through ... to high school.”
Kendyll* says that teaching styles had affected how she interacted with her schooling material when she was in school battling with ADHD. “In maths, if I had a good teacher, I’d get straight As, and if I had a bad teacher, I’d get Es. If I was nurtured by the right teacher who had the patience to teach me in a way that I understood, I could keep my concentration throughout that learning.”
She said that as an adult and business owner, she’s able to cultivate a life that suits her ways of working and learning.
“I own my own business now and it’s made things so much easier, because I can go for a walk every hour and listen to music. Corporate life was an absolute nightmare and my bosses used to get cross with me, because I just used to fidget and the chairs would squeak. There was a huge amount of shame around it because of my constant need for movement, but then I get these bursts of creative brilliance, and I have to work in that time... I just don’t feel like I’m made for a normal institution because I can’t work in the same environment that somebody without ADHD can, in an office environment with a 9-5 [job].”
ADHD has affected many aspects of Mbali’s* adult life. “It feels like I’m stuck in that phase of being in my potential but never truly reaching my full capability ... and dating is so difficult... I wish I was normal in the ways in which I processed [things]. I wish my brain could adjust accordingly. Just be OK with the way the world works. I have to work 10 times as hard.”
She said that if she had a daughter who struggled with ADHD, she would ensure that they knew that nothing was wrong with them, just that they process the world differently.
“I think I would equip my child with every coping mechanism known to man, because I want them to win in this world. I would tell them how to consider ADHD in her love life, ADHD in her sex life, ADHD in how she studies, ADHD in the kind of life she makes. If you’re messy, what are the telling signs when you’re about to spiral and how to come back from that in every context, whether it’s work, family or relationships.”
Ivanna said society and institutions also need to do more to ensure that all children are accommodated.
“I honestly think that a lot of work needs to happen in the education system to be more accommodating to different abilities. If I had a daughter one day, that’s something I would pay very careful attention to, in terms of the school that I selected for them. It’s quite crazy how you have the option to send them to a proper remedial school or a normal school but there’s [nothing] in between. Because not all children need special schools, they can thrive in mainstream schools. It’s just that teachers [and] the mainstream schools need to do a better job.”
* Names have been changed.
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