I Was Diagnosed With ADHD at Age 19: How Young Women Go Unnoticed and Undiagnosed

It was my girlfriend of over a year that first told me, “I don’t want you to freak out, or get upset, but I think you might have ADHD.”

My first response was to laugh. I had been labeled “gifted” by age six, an honors student throughout middle and high school as well. With the exception of one failed math class, my grades had always been solid. I had a high school GPA of 3.75, then a 3.9 for my first semester of college. A learning disability had never crossed my mind, but for someone so close to me to bring it up, I decided to listen. I had been struggling in my classes lately, but I thought I was still just adjusting to college.

She told me of a friend who had recently received her own surprise ADHD status and when we learned about the behavior that had gotten her diagnosed, we realized they were things that I did too. So we did some research.

My fast talking, high energy persona, and ability to completely throw myself into subjects I loved (and inability to pay much mind to the subjects I didn’t) might not have been personality quirks. Juggling all those extracurriculars in high school may not have indicated work ethic, but more reflected my hyperactivity, ability to multitask, and difficulty sustaining attention on doing just one thing—like the homework I always did in other classes rather than actually at home.

It wasn’t until the second semester of college that I had even noticed an issue academically. I’d never truly read through a textbook in high school and my grades rarely suffered because of it. Then I had to start analyzing articles over thirty pages long for college classes and found myself with a headache by page two. I couldn’t fully focus on a lecture for more than twenty minutes and when I had to take a test I couldn’t rely on institutional knowledge for, I didn’t do so well.

When I ended up with a significant amount of down time for the first time, I found myself frustrated and bored, no matter what I tried to do for leisure. An annoying noise in the pipes of my residence hall was a nuisance to my roommates, but one they could easily sleep through while I spent entire nights awake, unable to break focus from the noise in the ceilings. So maybe my girlfriend was on to something.

I went to the University Counseling Center to talk about what I was feeling and that I was starting to think I might have ADHD—as much a shock to me as it was my parents. After a referral for a lengthy evaluation, I received a diagnosis: Attention Deficit Hyperactivity Disorder of moderate severity.

For young women with ADHD, we aren’t often diagnosed early in life unless we display the textbook hyperactivity trait heavily enough—which girls often don’t. Basically, if you weren’t bouncing out of your seat in fifth grade, you weren’t ADHD. In fact, you might even be gifted.

Working fast, learning quickly, and becoming easily bored were characteristics chalked up to me being a “gifted” or exceptionally smart child. Working rapidly, however, was actually a frequent result of skipping directions or missing details. In subjects I loved, I excelled. In subjects I didn’t, I was described as lazy and lacking attention. Yet the disparity between the two was never enough to bring up the question of a potential learning impairment. After all, what second grader wanted to focus in math class?

There are three major reasons young women aren’t typically considered for an ADHD diagnosis. There are common misconceptions and fundamental misunderstandings of what ADHD actually entails—how it impacts all aspects of life, not just the classroom. There’s a common comorbidity of anxiety and depression along with ADHD that occurs more frequently in women than men. There are also behavioral differences in how girls present and compensate for ADHD symptoms as opposed to how boys do (or don’t).

Many people may picture hyper, even obnoxious, kids when they think of what ADHD looks like – students who can’t sit still, who daydream staring out of windows, and whine when they’re forced to do an assignment. 

For me, ADHD looked like rushing through work and ignoring things I didn’t care about learning, but learning everything about my favorite subjects. It looked like only half paying attention in class while I worked on assignments for three other courses in the back row. It looked like talking fast, cutting others off in conversation without meaning to, hyperfocusing on areas of interest, and being unable to sleep at night due to restlessness. I was hyperactive, but I wasn’t vibrating in my seat, so who could tell?

ADHD symptomatology goes beyond the classroom. Symptoms like poor planning skills, impulsivity, struggling to focus on things like conversation, affect our day-to-day lives.

I’m infamous for forgetting things like my purse, wallet, or laptop, sometimes even somewhere like a restaurant where they could be easily stolen. This means whoever is with me – friends, family, girlfriend – has to deal with going back to search for them. Whenever I’m late to an obligation, it’s usually because I lost something. This irresponsibility can put a strain on relationships and causes anxiety for myself whenever I leave a location. Do I have my bag? Phone? Wallet? Am I leaving anything behind? Am I forgetting to do anything before I leave?

Overworking is also a common symptom for us. In high school, I’d catch a train to school at 7:30 a.m., go to class until I was dismissed at 3:40 p.m., then go to an extracurricular most nights. In the spring of senior year, I would report directly to a part-time job at 5 p.m. after school and work until past midnight at least three days a week, every week. This was on top of still having activities like weekend debate tournaments, band practices, music lessons, etc. People with ADHD are frequently described as acting like they’re “driven by a motor.” Even in periods of extreme exhaustion, I would still be multitasking and in the morning, I would do it all again.

When I found myself unemployed without a dozen extracurriculars to juggle in my second semester of college, the motor didn’t stop. I was unable to relax or sleep at night, constantly frustrated and bored despite taking 18 credit hours of classes and, overall, not actually having that much free time. But I felt like I was drowning in the mornings without classes or the 90-minute breaks that came between.

Having ADHD doesn’t mean I can’t sit still, but it does mean I have trouble ever slowing down. Tasks like putting away laundry seem Herculean, but I can sit and write for hours. I can talk forever if no one stops me, creating constant worries of whether or not I’m being obnoxious when I’m speaking, or if I’m just excited about something. These kinds of worries are what often leads to women with ADHD being treated for their anxiety, but not their attention deficit or hyperactivity.

It’s less common for boys, but extremely common for girls to have ADHD in addition to an anxiety or depressive disorder, or both. Some of the symptoms of ADHD are even the same as symptoms of anxiety. Not being able to sit still, difficulty focusing or completing tasks, and a hard time sleeping are all symptoms frequently used to describe a patient as anxious. ADHD even comes with its own specific anxieties like rejection sensitive dysphoria–a symptom that causes an extreme emotional reaction over perceived disappointment of others, a fear your friends and family may be upset with you, when they are not.

I spent years in therapy for anxiety. It wasn’t all for nothing–I did and still do struggle immensely with anxiety, but the question of me having ADHD never once came up as a possibility. My symptomatology was all considered to stem from my nervousness, or a result of past bullying and high school drama. After all, my grades were good and I was too fearful of being yelled at or failing to let my fidgeting or blowing off homework get out of hand.

Women present ADHD in distinct ways compared to men with women often suffering more from internalized symptoms while men struggle more with the externalized. A 2014 study by the National Center For Biotechnology Information examined the presentation of ADHD in women in order to research why we go undiagnosed so often and for so long.

The study found that the attitude towards ADHD and what it looks like revolves around how men present their symptoms, which is mostly hyperactivity. Women present the disorder most prominently through inattentiveness, as opposed to hyperactivity, so they are often considered “subthreshold” for a diagnosis. Again, this comes back to the notion that if you can sit still in class, you must not have ADHD.

Women also develop more successful coping strategies for their symptoms. They are often able to keep their grades up or manage their responsibilities more than men with ADHD would be able to–even if women still struggle immensely to accomplish those things. They were also likely to not be considered for ADHD if they were diagnosed with anxiety and/or depression because their symptoms would be attributed to those disorders. The study found that women were frequently overlooked due to their ability to cope with their symptoms better than the typical male ADHD patient.

The study argues for gender-specific analyses of symptomatology because of the different ways the disorder presents itself in men and women. It also argues that poor academic performance should not be necessary for diagnosis because for people like me, good grades never meant I wasn’t struggling. I would have had to fail to get help sooner.

ADHD can impair function anywhere from social to academic interactions and it’s time we rethink what the disorder looks like. Myths and misconceptions about how it presents itself leaves women, especially ones who appear to be succeeding, behind when it comes to treatment. Maybe if I was diagnosed sooner, I wouldn’t have had those B’s in math and science. Maybe I could have studied harder for the SAT. Maybe my anxiety would have been more manageable if I had known this was part of it years ago. But I didn’t know what ADHD looked like.

Most people don’t.