Are we failing our girls?
Women over 40 fastest-growing segment of population diagnosed with ADHD
Kyla Crowell was never sure what was wrong with her. She always thought she suffered from anxiety, but the diagnosis didn’t quite fit — worry wasn’t her primary concern.
“I’m disorganized, I can’t focus, I can’t follow through on tasks — even ones I need or want to — I’m too talkative at inappropriate times,” rhymes off the Annapolis Valley, N.S., woman.
When she was in her thirties, she read an online infographic that listed the symptoms of adult ADHD ….and a lightbulb went on.
“I had never read anything I related to more in my life,” says Crowell. “I didn’t even know how ADHD presents differently in women than men. I couldn’t believe how much it described the way I am and the stuff I struggle with.”
After getting the courage to talk to her family doctor, it only took Crowell two months to receive her official ADHD diagnosis.
Elizabeth Mason-squires of Middleton, N.S., also felt constant anxiety.
“I would ruminate on upcoming tasks and have to plan every step, constant checklists to ensure I didn’t forget something. I always felt different, as if I wasn’t capable of the same level of understanding as my peers. For years, I thought that it must be that I am stupid,” she admits.
At the age of 46, Masonsquires, too, was diagnosed with inattentive ADHD.
“The discovery that there is a reason for my struggles and that there are real, tangible solutions is potentially lifechanging,” she says.
LATER DIAGNOSIS INCREASING QUICKLY
One of the fastest-growing segments of the population being diagnosed with ADHD are women over 40, says Sandy Slade, executive director at ADHD P.E.I., a network of support and advocacy for those with ADHD and their loved ones.
“It’s important to realize that these women did not just now ‘get’ ADHD, this is something they’ve lived with their whole lives and just not known,” says Slade.
Some of these later diagnoses may be the result of the women receiving an ADHD diagnosis for their child. Through this process, they are researching and learning more about it, and seeing the connections within themselves, says Pam Boutilier, chairperson for ADHD P.E.I.
That’s exactly what happened with Mason-squires; through her work at Rowan’s Room Development Society with families and children with exceptionalities such as ADHD, was exposed to the possibility.
It’s often said ADHD the most under and over-diagnosed condition in the 21st century, says Lisa and Laurie Pinhorn, holistic family interventionists in St. John’s, and co-owners of Empowered Parents, an organization dedicated to cultivating calm, connected and compassionate environments for children and families.
“Sometimes, we are very quick to diagnose ADHD in both boys and girls without being brave enough to dive deep into a person’s development, history of trauma, or biological makeup,” Pinhorn says.
“We now have mountains of neuroscience that help us untangle what is happening in a brain and nervous system that has difficultly focusing, looks impulsive, hyper-focusing and inability to be still.”
Pinhorn points out an ADHD diagnosis is often done very quickly, without looking at the whole life of a person, such as their health, sleep, possible allergies, nutrition, attachment styles, trauma history, or generational trauma.
“There is a lot of overlap with anxiety, depression and stress,” she says.
This is also why it may be hard to receive a proper ADHD diagnosis.
Take Melanie Strong, who lives on Nova Scotia’s South Shore and struggled with mental illness all her life.
In her late thirties, she finally sought treatment and started taking medication for anxiety and depression, but realized there were a lot of other issues that couldn’t easily be explained by either of her diagnoses.
When she suggested ADHD to her clinician, she was told it couldn’t be that because she successfully owned a business.
“For years, I was either working days straight without much sleep or food, or I was in bed for hours on end, too overwhelmed to start my day. Because of these extreme ups and downs, the only other thing that made sense to me was to seek a diagnosis for bipolar disorder,” she says, noting she soon started medication for this, but it was still not helping.
“I was in bed for months, partially suicidal and entirely hopeless.”
MORE OFTEN RECOGNIZED IN BOYS
Research shows ADHD is more commonly diagnosed in boys (10 per cent) than girls (five per cent), says Slade.
Most people think of the hyper and disruptive aspects of ADHD, but this can present differently in girls, Slade says, and instead manifest as anxiety or internal restlessness, or appearing outwardly as chattiness and animation.
And those with inattentive-type ADHD often fly under the radar in school because they aren’t causing disruption, she says.
Girls can appear distracted, like daydreamers, and don’t easily follow instructions, says Mason-squires. They can also mask their differences to blend better in social situations. This makes diagnosing extremely difficult if you don’t know what you are looking for, she says.
“A lot of us look like a shy girl or a spacey teenager,” says Strong.
Hyperactive or impulsive traits may look like being fidgety, not being able to keep up with the workload and risk-taking, says Slade.
“This is a neurodevelopmental disease that has a profound impact on a person’s life. It needs to be caught and treated holistically,” says Strong.
“It is entirely unfair that we are made to struggle for no reason other than ignorance.”
IMPACTS OF DELAYED DIAGNOSIS
Many women who have been diagnosed at older ages reflect on how their life could have been different with earlier recognition.
“I made it to mid-life with many failed relationships, no real assets, and a career that overtaxed my weaker executive function skills caused by impulsive behaviour and poor decision-making skills,” says Katie Rankin, secretary and treasurer for ADHD P.E.I.
“I could have had a very different young adulthood with early intervention to implement the proper treatment and strategies.”
Mason-squires’ struggle to fit in also took her on a path of self-destruction: increased anxiety, depression, selfharm, misdiagnosis of bipolar disorder, severe eating disorders and a host of mental health issues stemming from feeling unaccepted and misunderstood.
“I turned to smoking and alcohol at different parts of my journey in order to self-medicate, which led me down paths that were dark and unsavoury,” she says.
“Had I been diagnosed as a child and received therapy or been given self-management strategies or medication, I would like to think that my life growing up and in my younger adult years might have been healthier.”
With a diagnosis, Masonsquires is more accepting of who she is and all her idiosyncrasies. She is on several medications and is still trying to find the right combination, but within a week of being on one of the medications, she completely stopped drinking.
“Finally, my brain didn’t need me to compensate or self-medicate. Now, I can focus better on tasks and follow through. My brain fog is gone,” she says.
“I feel more clear-headed and alive than I have ever felt. I am more present with my daughter, and I feel our already strong bond has grown even more. I am a better boss, a better wife, a better friend. A better me.”
For Crowell, her diagnosis felt like a weight was lifted off her shoulders.
“I am the way I am because my brain is the way it is. I now have a reason to give myself a little compassion and understanding, and I have a shot at accessing treatments that will hopefully improve my quality of life,” she says.
Now that Strong is being treated for her ADHD, she no longer feels depressed or anxious when her other symptoms are under control. She was very angry after her diagnosis, however, about the amount of time it took to get there.
“Medication is essential, as long as you can tolerate it,”
“The discovery that there is a reason for my struggles and that there are real, tangible solutions is potentially life-changing.” Elizabeth Mason-squires
says Strong, but it doesn’t fix everything.
“It’s just the foundation you have to build to keep your ADHD brain propped up enough to exist in this neurotypical world,” she says.
“You also have to do the hard work of looking at yourself, seeing what parts are you, and what parts are ADHD. You have to see where all of your issues are and then you have to learn ways to reduce the negative effects these issues have on your life. It takes a lot of time and a lot of work.”
MORE AWARENESS NEEDED
Going forward, Slade says there needs to be more awareness about the range of ways ADHD can present, and how to better recognize ADHD in girls.
Educators, employers, the general public, and even medical professionals all contribute to the difficulties these girls face when they don’t understand what ADHD actually is, she says.
“Too many professionals and people, in general, see ADHD as a childhood challenge that is grown out of or is the result of ineffective parenting,” says Masonsquires. “This is such a disservice to all of those impacted by ADHD in any form but especially for females.”
Destigmatization of mental health issues in general, and ADHD more specifically, is also needed, adds Slade.
“Misinformation makes many people avoid getting diagnosed or have insecurity around getting treatment or accommodations,” she adds.
And most of all, Strong wants to see more people talking about the subject.
“I want to destigmatize mental illnesses and neurodi-vergence, and I want to destigmatize taking medications. I want my words, however small, to positively affect someone who is also struggling.”