This is Part 1 of a 2 part article I was asked to write for the European Mentoring and Coaching Council (EMCC) looking at late diagnosis and coaching.
Better late than never: the importance of an accurate ADHD diagnosis at age, and how coaching can help. Part 1 Dispelling the myths
In the first of two posts based on her research on coaching women with a late diagnosis of ADHD, Helen Sander-Williams dispels some of the myths surrounding ADHD.
Some comments I hear frequently are:
● Surely ADHD is just hyperactive boys? Can women even have it?
● Isn’t ADHD just for children?
● What’s the point of getting a diagnosis when you’re an adult?
● I don’t think people should be labelled
Surely ADHD is just hyperactive boys? Can women even have it?
Well, ADHD does not discriminate by gender – whilst more boys are diagnosed as children than girls, this evens out as children grow into adultdood. ADHD is believed to have both genetic and environmental components (Barkley and Murphy, 2006; Wallis, Russell, Muenke, 2008) and is highly hereditable at 80% – the same as height (Barkley and Murphy, 2006). ADHD in females was not understood until relatively recently; the first conference of gender differences in ADHD took place in 1994 in the US (Arnold, 1996). The conference highlighted that girls had been almost entirely excluded from the broad field of ADHD research, despite ADHD being one of the most extensively researched diagnoses in child and adolescent psychiatry. This exclusion represents generations of missed women – women who may have been misdiagnosed with anxiety, depression, bi-polar or borderline personality disorder.Whilst these can co-occur with ADHD, it’s not firmly established in the case of concurrent anxiety or depression if these are discrete conditions or whether they develop due to living with untreated ADHD.
Isn’t ADHD just for children?
Children with ADHD generally grow up to be adults with ADHD. In 2008, the NHS in England and Wales, via the National Institute for Health and Care Excellence, recognised that ADHD is not confined to childhood and adolescence but continues into adulthood in the majority of cases (NICE, 2008). In fact, ADHD itself was not recognised by the NHS in the UK until 2000 when recommended to do so by NICE guidelines (NICE 13, retired page). In Scotland this was not until 2008, however the Scottish Intercollegiate Guidelines Network (SIGN) withdrew treatment guidance for children in 2019, deciding it was out of date; however this has not been replaced. SIGN has never issued guidance on Adult ADHD. In 2018, updated guidance on ADHD by NICE, highlighted its under-recognition in women and girls.
What’s the point of getting a diagnosis when you’re an adult?
After all, if you’ve got as far as adulthood with ADHD, you’re obviously managing it fine, right? Well, not necessarily. ADHD symptoms manifest differently in adults than in children, leading to challenges in areas such as finances, work, and relationships (Henry and Hill Jones, 2011), with “significant consequences for all aspects of… functioning” (Painter et al., 2008, p.178). Individuals with ADHD face a higher risk of disordered eating (Nazar et al. (2016), including obesity (Cortese et al., 2016); this risk is more pronounced in women (Brewerton and Duncan, 2016). Hinshaw et al. (2012) found that girls with combined-type ADHD (ADHD-C) are 3-4 times more likely to attempt suicide than girls without ADHD, with non-suicidal self-harming behaviors being twice as common.
Hormonal fluctuations and changes affect the severity of ADHD symptoms (Young et al., 2020), with a higher likelihood of postpartum disorder and/or postpartum anxiety (Andersson et al., 2023). The Adult Psychiatric Morbidity Household Survey (2007) revealed that 27% of women who had experienced sexual and physical abuse exhibited ADHD traits (McManus et al., 2009) possibly unsurprising as low self-esteem associated with ADHD may make women particularly vulnerable to sexual harassment, abusive, coercive, or inappropriate relationships (Young et al., 2020).
If not properly managed, ADHD can lead to highly detrimental outcomes for those affected, whether due to societal pressures or the symptoms themselves. These consequences include lower job status, relationship difficulties, a higher likelihood of addiction, and more frequent motoring violations (Murphy and Barkley, 1996; Biederman et al., 1997; Farone et al., 2003). The negative effects also extend to the families of those with ADHD, contributing to elevated levels of stress, anxiety, and increased depression (Kelley et al., 2007; Mash and Johnston, 1993; Murphy and Barkley, 1996).
I don’t think people should be labelled
A diagnosis is not a label – it is knowledge. It is the first step towards self-acceptance and improving outcomes. Labels are words like: lazy, stupid, thoughtless, over-emotional, odd, crazy. All of which most undiagnosed people will have been called at some point (remember, it has been said A.D.H.D. used to be spelt B.A.D.). This highlights the importance of a diagnosis at any age – whether as a child or as an adult of any age.
It’s estimated that 12-19 % of young offenders have ADHD compared to 3-5%of the general adolescent population (Hughes et al., 2012); imagine the difference for those young people, and for society, if they had been correctly diagnosed and treated.
So, how does it feel to have ADHD?
Perhaps a story might help? Let’s imagine you are 9 years old. You are in a maths class. The teacher says something and everyone else starts writing. You missed what the teacher said but can see that all the other children are writing maths sums down in their books: it appears that they all know the answers.
“Wow,” you think, “everyone else is so good at maths! How do they know how to do this? They’re all so good at maths and I must be bad at it, because I don’t know how they’re doing it!”
A few months later, you mention something about this to your parents, who take you to an optician. The optician tells you that you are extremely myopic and fits you with a pair of (very ugly) spectacles. In the maths class, you can now see that the teacher has written everything on the board, and everyone else is just copying it into their books. That residual feeling of shame about not being good at maths remains with you, even though you now know that it was just a physiological problem with your eyes. Lucky that you went to the optician and found out so quickly.
However, what if at 9 years old you don’t get taken to an optician? You don’t know that you are short-sighted, as your eyesight is your norm and you have nothing else to compare it to. You’re still unable to see the board; you still can’t do the maths. Other people notice that you’re not doing the maths and tell you off, but whilst you really, really want to do the maths, you just can’t. You feel ashamed of yourself and worse still, other people blame you, saying you are making a choice; it’s your behaviour and attitude that are at fault. You might also be told that you’re stupid, lazy, bad or disruptive. You give up trying, as it doesn’t seem to make any difference, or you try extra hard, but the results don’t reflect the effort you are putting in – because the problem is still there: you still can’t see the board.
You grow up to be an adult who internalises these negative messages and you always wonder why you are different from the other, maths capable people. The shame stays with you and affects all areas of your life, from relationships, finances and working life. Your “eyesight” is different from other people, but you never know that it is a physiological difference that is at the root of your problem.
Imagine if the problem wasn’t your eyesight. Imagine if it was your hearing, or undiagnosed ADHD, or Autism Spectrum Disorder, or dyslexia, or dyspraxia or another neurodivergent condition. The situation is likely to be similar – a lasting impact that is potentially devastating, a lack of understanding in relationships, a lack of simple adaptations or practical support that could have made all the difference between a life well lived and a life of struggle; all for want of a proper diagnosis.