This week, the writer talks to a psychologist and a psychotherapist who shed light on ADHD, a disorder that is overlooked in women and leads to underdiagnoses. Read on…
Doom scrolling on my Instagram feed, as I try to skip through a string of chucklesome reels showing men struggle, zone out, lose focus or show disruptive behaviours, I wonder if these are gender specific traits. The answer is obviously no.
These habits and traits can be symptoms of a behavioural disorder, a group of mental health conditions involving challenging or disruptive behaviour patterns in both male and female genders, the most common one being ADHD (Attention-Deficit Hyperactivity Disorder) which is a condition that is overlooked in women and leads to underdiagnoses.
“Behavioural disorders are conditions where a person struggles with self-regulation, leading to persistent patterns of disruptive, impulsive, or socially inappropriate behaviour. These behaviours aren’t just occasional; they’re long-term, repetitive, and interfere with daily life, whether at home, school, or work,” explains Maheen Waqar, a clinical psychologist.
One might think that your neurological activity decides your routine habits and how you behave but Maheen points out that mental disorders like depression and anxiety are more about internal struggles. “A person with severe anxiety may withdraw, avoid social interactions, or have suicidal thoughts,” she elucidates.
However, Maheen, who is also a school psychologist at Learning Alliance and a lifetime member of Pakistan Psychological Association (PPA), notes that behavioural and mental disorders often overlap because a child with severe anxiety might refuse to go to school. Similarly, a teen with conduct disorder may also be dealing with underlying trauma, leading to depression or substance abuse. “That’s why proper diagnosis matters - treatment isn’t just about stopping bad behaviour; it’s about understanding the root cause,” she emphasises.
ADHD and its underdiagnoses in women
Women are meant to be perfect beings or at least that is what society pushes to mould us into. So in their eyes if you are not attentive to the smallest of the detail, remain calm through everything and stay focused during a task, that instantly equals to you being an academic failure and means and you are just not good enough - the possibility of having a condition like ADHD would never strike them because, “Aren’t you meant to be flawless?”
Ishmal Rizwan, a psychotherapist of Level 4 Diploma in Therapeutic Counselling qualification awarded by the Counselling and Psychotherapy Central Awarding Body (CPCAB) in the United Kingdom, explains ADHD as a condition in which it feels like your brain is always changing channels, making it hard to focus, sit still, or think before doing something. “It’s not just being ‘distracted’ or ‘hyper,’” she says
Sharing her expertise, the psychologist says that ADHD is often diagnosed around ages 6 to 12; when kids start school and their behaviours become more noticeable. While boys are frequently diagnosed because their hyperactivity and disruptive behaviours are easier to spot, girls might be better at disguising their symptoms, leading to underdiagnoses.
“Especially in Pakistani culture, there’s a strong emphasis on academic achievement and discipline where parents and teachers might view these symptoms as a lack of effort or willful disobedience. This can lead to boys’ behaviours being more frequently diagnosed, while girls’ symptoms might be overlooked or attributed to anxiety or depression,” informs Maheen.
Drawing a more elaborate comparison, the psychologist tells us to picture a boy in school who can’t sit still and is interrupting the teacher. “His hyperactivity and impulsivity are noticeable, so his guardians recognise that something is up. Boys with ADHD tend to be more hyperactive, impulsive, and disruptive,” she points out.
Now, picture a girl in the same class who isn’t roaming around but is staring out the window, lost in her own thoughts. She is forgetful and loses track of her school supplies. People think of her as lost or unorganised, so her ADHD isn’t spotted right away. “Girls with ADHD can be more inattentive, struggle with organisation, forgetful but they often don’t exhibit the hyperactivity seen in boys,” observes Maheen.
“Having ADHD does not make you different from others. You are still the same, you are not the odd one out. Some people will try to shame you for it but just remember there is nothing to be embarrassed about,” this is what *Sumaiya, a 13-year-old student diagnosed with ADHD, wants you to know. “Some problems I faced with my diagnosis is that I would try to get a task done but then lose focus and start thinking about something like, ‘Hm, I wonder what I’d eat for dinner? I wonder what I will be getting for my birthday?’ and then I’d simply remain behind at my work,” the teen shares.
She says that one of the main traits her parents picked up on was her being a slow learner, “I wasn’t quick like the other kids,” she adds. Sumaiya’s mother recalls getting her daughter first diagnosed for autism, then ADHD. “Her problems were mainly not sitting still, homework was always a problem and she had a lot of outbursts, overall, a lot of behaviour issues,” Sumaiya’s mother tells this scribe.
When asked about how it feels to be a woman living with it, Hina Imtiaz, a 39-year-old freelance creative, also shares her moments of energy outburst. “I try to do a lot of physical activities and then I crash out, unable to get out of home for weeks.” Hina likens it with a truck pulling her from both directions. “My friend who has severe ADHD pointed out that I might have it as well because decision paralysis was a really big problem. I got my diagnosis two years ago, however, I’d say I have known it for eight years. I have been in therapy before but my screening made sure that it was ADHD and not PTSD from my past traumas,” expresses Hina.
She also shared that waking up in the morning has always been a problem for her which is why she went to a second-shift school and even today works a job overnight. “Hours and days and months pass by really quickly and my perception of time is bad. Normal people just get up and perform tasks on auto-pilot but I have to bargain with my brain and make it aware of its needs. It feels like there is a separate entity within you. You will get it if you watched the movie Venom,” explains Hina.
Not everyone can be as lucky as Sumaiya to have a parent who takes note of crucial behavioural patterns. Our society views women to be calm and collected in order to embrace the textbook definition of the ‘perfect girl’.
Sharing her insights, Maheen says that gender norms play a leading role in the underdiagnoses of ADHD in women because society expects girls to be well-behaved so when they struggle, people assume it’s just ‘shyness’ or ‘being emotional’ rather than a neuro-developmental condition.
“This leads to a huge gap in diagnosis and treatment. Many women don’t realise they have ADHD until adulthood. It’s not that women don’t have ADHD as much as men - it’s that their symptoms are often overlooked, misunderstood, or mislabelled due to outdated diagnostic criteria that were largely based on how these conditions show in boys,” she observes.
Agreeing with the psychologist, Ishmal adds the stigma can be more pronounced for females who might be discouraged from seeking help due to fear of being judged or seen as ‘weak’.
“Instead of acting out, girls become quiet. This subtlety can lead to their symptoms being overlooked and attributed to shyness or introversion. Moreover, the diagnostic criterion for disorders has a history of being based on studies involving boys because of more obvious symptoms. So, the signs professionals look for are more aligned with typical male presentations of psychological disorders. Unfortunately, past researches have been for the men, by the men.
This bias means girls are less likely to be diagnosed correctly or may be diagnosed later in life after years of misunderstanding their experiences,” elaborates Ishmal.
Maheen also observes social conditioning as another factor, considering that girls are encouraged to be more socially aware, polite and accommodating from a very young age. “This leads to many women with ADHD to develop masking behaviours - forcing themselves to make eye contact, memorising social scripts, or mimicking peers to fit in,” comments Maheen.
Besides underdiagnoses, misdiagnosis is also a point at issue because many women are first diagnosed with anxiety, depression, or even borderline personality disorder and since they internalise their issues, they may report feeling overwhelmed, exhausted, or emotionally unstable - symptoms that overlap with mood disorders.
“However, these emotional difficulties are often secondary to an undiagnosed neuro-developmental condition. Many women don’t realise they have ADHD until adulthood, sometimes only after their own child receives a diagnosis and they start recognising the same patterns in themselves,” notes Ishmal.
Men have been free to behave however they like, thanks to the infamous chants of “boys will be boys” but suddenly when it is a girl behaving in the same manner, we are quick to call her “lazy” or “messy” or “disorganised.” The barriers discussed at length come off as nothing but alarming that gender norms, social conditioning and cultural beliefs are engraved deeply enough to stop women from getting the medical attention they need. To clue in enough people, Maheen says that it’s about time we start talking about it through seminars, include such topics in our education courses, and most importantly, include more women generally in its research.
*Name has been changed to retain privacy.
Mahnoor Tariq is a journalist dedicated to highlighting topics around women and underrepresented voices.
She can be reached at smahnoort11@gmail.com
