Note: This post is part of Blog Action Day 2014. Please click here to check out the live stream of posts about inequality!

ADHD may not be the first thing that comes to mind when you hear the word “inequality.” Likewise, a teacher isn’t thinking about it when she recommends a female student repeat the second grade instead of undergoing an ADHD assessment.

I suspect my own second grade teacher didn’t have ADHD in mind when she sent home notes about my poor behavior. On my report card, she wrote that I “often [did] not ‘feel like’ working and staying on task.” No one mentioned ADHD.

Unfortunately, the gender gap in effective diagnosis and treatment has improved little since my elementary school days. Girls are still consistently less likely to be diagnosed and treated for ADHD than boys.

This is not just a tragedy of wasted potential — it’s damaging our mental health. Women and girls with ADHD self-report more issues with anxiety, depression, and low self-esteem than their male counterparts. The effects of missed diagnoses are compounded by the fact that female friendships can require more skill in reading social cues and interpreting others’ feelings. Women and girls are especially prone to social isolation and rejection as a result of their ADHD.

The other side of ADHD

ADHD often looks different in girls, making timely diagnosis more challenging. Society drives us to please others more than it does boys, so girls’ academic performance suffers less often. Like many girls with both high IQ and ADHD, I had no trouble coasting through school. It was only in adult life that everything began to fall apart in earnest. Because girls are also less prone to disrupt classroom activities, their struggles often go unnoticed by educators.

Your brain (and meds) on estrogen

Adding another layer of complication is estrogen, which studies have shown to improve memory and cognitive functioning. It stands to reason, then, that during periods of lower estrogen — before the menstrual period, postpartum, and at the onset of menopause — we would experience more severe ADHD symptoms.

I’ve experienced this firsthand. I dreaded stopping my stimulant medication for my pregnancy, but my doctor told me, “wait and see, you may find you feel great.”

To my surprise, I did feel great. I continued to feel great for six months after my son was born. Then, as he began exploring solid food and gradually decreased his intake of breast milk, my symptoms came back with a vengeance. By the time he weaned at 14 months, I felt like I was witnessing the final moments of a slow-motion collapse.

Don’t assume medication will insulate you from the estrogen roller coaster, either. While estrogen is believed to render stimulants more effective, the converse is also true: you may find your meds don’t work as well during those low-estrogen periods. Additionally, progesterone — found in higher levels during puberty — dampens the effect of stimulants. Women entering puberty and menopause should be prepared to make dramatic changes to how they manage ADHD symptoms.

Seeing past the stereotypes

If you’re still picturing a hyperactive little boy when you think of ADHD, you’re part of the problem. Undiagnosed ADHD can have crippling effects on girls’ self-esteem, social relationships, and mental health. The good news is, you can change for the better today by educating yourself on ADHD in all its forms: male and female, hyperactive and inattentive.

What you can do

  • Educate yourself on the unique challenges of women with ADHD
  • Know the common symptoms of ADHD in women, and how they differ from most men
  • If you’re a woman with ADHD, make sure your mental health care provider is familiar with treating ADHD in women; if your meds don’t feel right, say something
  • To help make the most of your treatment plan, keep a daily log of your symptoms throughout your monthly cycle; look for patterns in how your symptoms fluctuate
  • If you have a daughter with ADHD — or you suspect she has ADHD but she hasn’t been evaluated — be prepared to advocate for her and push for a diagnosis and reasonable accommodations; also, look out for changes in her symptoms or the effectiveness of her medication as she enters puberty

Further reading