Stories about overdiagnosis and over-pathologizing are popular these days, in part because the new DSM is coming out next month. But very little ink is spilled on the people who don’t get a diagnosis when they should, or only receive one later in life, after years of living with their symptoms. Maria Yagoda, who was diagnosed with ADHD in college, is one such person, and she writes in the Atlantic Wire that her story is a familiar one—especially if you’re a girl.
ADHD is something of a guy’s club. When we think of ADHD we tend to think of boys who are hyperactive and impulsive, but the disorder actually comes in several forms. Some kids are more hyperactive, others are more inattentive, and many have a combination of the two. In general girls are more likely to have the inattentive type of ADHD, which means that they are regularly overlooked because their symptoms don’t match our idea of what ADHD “should” look like. Dr. Ellen Littman, who wrote Understanding Girls with ADHD and spoke to Yagoda for her piece, estimates that a shocking half to three-quarters of all women with ADHD are not diagnosed. Dr. Littman suggests that part of the reason girls are underrepresented now is because boys were so overrepresented in the early clinical studies of ADHD, which were based on the symptoms of “really hyperactive young white boys who were being taken to clinics.” Girls’ symptoms also tend to tend to peak in puberty, which means that symptoms that might not have been impairing functioning in grade school (when most boys are getting their diagnoses) suddenly become a problem.
Because the signs of ADHD are more self-contained in girls, their symptoms are often considered traits or personal failings, as Yagoda considered her own extreme disorganization, forgetfulness, and poor concentration. She managed to get by until college, when she went off the rails:
“I was wrongfully allowed a room of my own, leaving me with no mother to check up on ‘that space between your bed and the wall,’ where moldy teacups, money, and important documents would lie dormant. I maintained a room so cluttered that fire inspectors not only threatened to fine me 200 dollars if I didn’t clean, they insisted it was the messiest room they had ever seen (boys’ included!) in their twenty years of service. Throughout college, I would lose my ID and keys about five times a semester. I’d consistently show up for work three hours early or three hours late. I once misplaced my cellphone only to find it, weeks later, in a shoe.”
As Yagoda later learned, this is common theme. Sari Solden, author of Women and Attention Deficit Disorder, says:
“Often, if girls are smart or in supportive homes, symptoms are masked. Because they’re not hyperactive or causing trouble for other people, they’re usually not diagnosed until they hit a wall, often at college, marriage, or pregnancy. A lot of the things that are simple and routine to other people—like buying groceries, making dinner, keeping track of possessions, and responding to emails—do not become automatic to these women, which can be embarrassing and exhausting.”
Happily, Yagoda says that medication is now giving her a “more normal, settled life,” which is another thing that makes her firsthand account so interesting. Not only is she a girl writing about her own experience with ADHD, she’s also just plain writing about what it’s like to have ADHD. We’re used to hearing that ADHD isn’t real, or that ADHD medications are academic steroids used for getting kids into the Ivy League and then law school. It’s almost a novelty for the public to have a window into the disorder as it actually is, and see medication as it is actually prescribed and used. As a girl diagnosed with ADHD as an adult, Yagoda had to deal with a lot of preconceptions:
“Of course you don’t have ADHD. You’re smart,” a friend told me, definitively, before switching to the far more compelling topic: medication. “So are you going to take Adderall and become super skinny?” “Are you going to sell it?” “Are you going to snort it?”
Yagoda, who was prescribed Concerta, was able to say no to all of the above. It’s a refreshing counterpoint to the story you thought you knew.