The lie we need to stop telling women about ADHD

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Girls are less likely than boys to be diagnosed with attention-deficit hyperactivity disorder. The general consensus is this is because for boys this tends to manifest in hyperactivity, which is much more noticeable to parents and teachers than inattentiveness, the type of symptom most common in girls. Luckily, as awareness spreads (albeit sometimes at a seemingly glacial pace), more and more women are eventually finding out the distress they’ve dealt with for their whole lives has a neurological explanation, and it’s called ADHD.

The long-delayed moment of diagnosis is often held up as a new beginning for the diagnosed. But while being diagnosed may very well be the most significant event in an ADHDer’s life, it’s not the be-all, end-all everybody makes it out to be. No, ADHD diagnosis is a new beginning — just not of pure, wholesale relief forever after. Instead, it’s the beginning of a life of newfound clarity about enduring struggles, for enduring they indeed are: Even if she starts an ADHD treatment regimen, pharmacological or otherwise, post-diagnosis, the ADHD woman faces an uphill battle that will continue for the rest of her life.

Nobody ever seems to talk about the extreme fallibility of ADHD medications, at least those currently on the market. In truth, ADHD is often treatment-refractory or treatment-resistant, meaning an ADHD medication may only have potency in a given person for a limited period of time, if at all. Now, there are two primary classes of CNS stimulant medications: amphetamine, aka Adderall, and methylphenidate, aka Ritalin. Most people respond better to one type of stimulant than the other. But many people, for whatever reason, don’t get symptom relief from either.

Moreover, you can have the most positive response possible to a given medication, but still not experience complete ADHD symptom relief, even temporarily. Unfortunately, the neurotypical expect us ADHDers to perform at their neurotypical levels if we’ve been “lucky enough” to be diagnosed and treated. Promised patience tends to run dry.

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This is particularly unfortunate for women, who earn the censure of society for displaying ADHD symptoms that tend to be revered in men. For instance, a man who doesn’t follow directions is deemed an “out-of-the-box thinker,” while a woman gets a reputation for recklessness. And a man who speaks out of turn is viewed as assertive; a woman, lacking self-control.

On top of that, women are tacitly expected to assume and maintain responsibility not only for themselves but also their entire household, both in its upkeep and of its members. Many women discover their ADHD at some point during or after their child’s diagnostic process. The upshot is these women being responsible for a higher than average degree of care for children with ADHD when they, in fact, need to expend extra effort just to take care of themselves. 

Just to put it into perspective, for you, I’ve been aware of and received treatment for my ADHD since early childhood, yet even I have to strive every single day just to avoid falling behind. Getting ahead, excelling almost always feels like a pipe dream — this, despite the fact that I’m on the highest possible dosage of all of my medications; not to mention, I live with my parents, rent-free! 

All of this is to say, it’s time to infuse a little honesty into the adulthood-diagnosis narrative, especially for women. We need to stop leading these ADHDers to believe everything is going to be OK because frankly, it’s highly unlikely that will turn out to be 100 percent true. Again, this is in large part because of the tacit mandate to fulfill traditional gender roles. As Kathleen Nadeau, one of the foremost experts on women and ADHD, explains,

Society has a certain set of expectations we place on women and ADHD often makes them harder to accomplish. … They are supposed to be the organizer, planner, and primary parent at home. Women are expected to remember birthdays and anniversaries and do laundry and keep track of events. That is all hard for someone with ADHD.

Honesty, it seems to me, is what’s called for here — honesty and compassion. And in that vein, there’s also a great need to reconfigure the typical response to a newly diagnosed ADHD woman, which right now is something to the effect of, “Congratulations! You have ADHD. Good luck!”

In this day and age, that kind of MO is unrealistic, and as such, utterly unhelpful.

ADHD women: our silent struggle with the second shift (ADHD Awareness Month post #1)

October is ADHD Awareness Month. Over the next 30 days, I’ll be sharing a series of posts about attention-deficit hyperactivity disorder. Kicking off this endeavor is a piece on perhaps the least understood ADHD community: adult women. — DRD


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Women with ADHD are uniquely ill-equipped to live up to the dual demands of family and work. (Photo source: iStock)

The earliest recorded example of ADHD-like symptoms was given in 1798The first actual description of ADHD was made in 1902And the term ADHD was coined in 1980And yet, it was not until 1994 — coincidentally, the year that I was diagnosed — that an NIMH conference was held on sex differences in ADHD.

One of the major revelations from newfound attention to attention-impaired women is that we tend to take too much on and have feelings of overwhelming guilt. The general consensus among experts is that ADHD women are too enthusiastic about too many things and so foolishly overload ourselves with optional tasks and responsibilities and that the feelings of guilt we experience are pathological, not situational. But I’m here to tell you, that is patently erroneous.

In actuality, we feel a genuine need to assure our superiors and coworkers that we are valuable members of our professional team, and to throw off suspicions that we may be in any way impaired. These doubts do arise in the workplace because even the best ADHD medication doesn’t erase symptoms entirely. And we have feelings of guilt because there simply is a lot for us to feel guilty about, including the failure to fulfill regular work responsibilities, and an inability to deliver on compensatorily taken on additional tasks. 

People often counsel me, “Don’t be so hard on yourself. Give yourself a break. Learn to accept who you are.” Here’s the thing, though: I have. It took over 20 years post-ADHD diagnosis, but I’ve finally learned that (a) my ADHD isn’t my fault; (b) no one — not even I — can expect me to be able to perform at the speed and rigor of my neurotypical counterparts; but unfortunately, (c) all the self-acceptance in the world won’t change my status of adult woman living in a capitalist society.

In 1989 — the year that I was born — Arlie Hoschschild, a sociologist at Berkeley, published a book, on the modern manifestation of what is known as the gendered division of labor, titled The Second Shift: Working Families and the Revolution at Home. As one site explains,

The book and the sociological principle assert that even though Mom and Dad both have careers, it’s usually Mom who also works the second shift at home, too. The second shift includes the work performed at home, in addition to the work performed in the professional sector.

In other words, modern women are expected to bring home the bacon, cook it, and then scrub the pan when everyone’s finished eating. But while people of my sex are supposed to do both types of work (professional and quote-unquote domestic), people of my disability only have half the average amount of time to do it: The longest-acting CNS stimulant medication (the first-line ADHD treatment) lasts up to 12 hours, maximum. Meanwhile, according to results from the U.S. Bureau of Labor Statistics American Time Use Survey, last year, women in the U.S. spent an average of 14.1 hours per day in the following activities (not counting sleep):

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Average hours per day spent by persons 15 and older in selected activities in 2016. (Screencap courtesy of U.S. Bureau of Labor Statistics)

It’s an impossible standard to live up to, even temporarily. And, of course, this data does not account for the fact that even while medicated, people with ADHD tend to take longer doing, well, pretty much everything.

Many women aren’t diagnosed until well into adulthood, when their roles as ‘wife,’ and/or ‘mother’ and/or ‘professional’ are already firmly established. Meanwhile, women who are lucky enough to be diagnosed early in life (at age 5, in my case), risk being barred from starting a family or entering the workplace as a result of an ADHD diagnosis. And we know this, so we downplay or attempt to conceal altogether our struggles and limitations (see above).

In any case, it sounds virtually impossible to work an eight-hour day; drive your kids to piano lessons; cook dinner; check the kids’ homework; and then go to bed and say soothing things to your partner, whispering that all of his problems will work out while making no mention of your own. I know I find it pretty damn hard just to work as a freelancer while keeping my room clean. I’m almost 28, and I don’t really see how, at least in the current paradigm, I will ever be able to be a successful adult.

So, what’s the answer?

Maybe there isn’t one. After all, paradoxes of time and paradoxes of identity have stumped even the most learned philosophers since time immemorial, and this paradox happens to involve both time and identity. What is to be done for women who are expected to continue to fulfill traditional gender roles while simultaneously living up to so-called Modern Woman standards, and doing so with just 50 percent the usual amount of time? Well, I can think of several things:

  1. Employers need to learn that women with ADHD face real neurological obstacles and that less-than-perfect work performance results from those challenges, not subpar personal ethics.
  2. Spouses (of any gender) need to adapt their ideas of what the role of a partner is supposed to be, and what their own role should be, to the partner they actually have.
  3. Both must strive to make life easier for women with ADHD, not harder, in the form of accommodations.

Having said that, I quote Carol S. Wharton circa 1994, the year that I was diagnosed with ADHD; the year that the unique plight of ADHD women finally started the long process of coming to light:

Flexibility itself is not adequate for accommodating the demands of families and wage work. Additional changes in the organization of both types of work, as well as ideological changes in the ownership of family-related tasks are required to alleviate the difficulties women face in integrating family and work responsibilities.”