“I have always felt weird inside my head,” says Eshani Mathur (27), who thinks she has perceived the world very differently from those around her. Throughout her life, she experienced challenges like forgetfulness, chronic procrastination, time management issues, and delayed emotional responses, but struggled to comprehend why.
Looking for some form of intervention, Mathur approached a psychiatrist in 2018 who diagnosed her with dysthymia or chronic depression. “She asked me to get a proper psych evaluation done, but somehow I felt that she would not be able to resolve my issues,” Mathur recalls. In the following year, Mathur, who was an IT professional at the time, felt like she ‘hit rock bottom’ and left her job to move back home to Ajmer. What followed was a long process of trying to find a therapist whom she could connect with.
During the last year, Mathur had several sessions with a therapist who suspected that she was on the neurodivergent spectrum who then referred her to a psychiatrist. Finally getting her answer, she says, “The psychiatrist asked me a lot of probing questions, made me do a lot of worksheets, and then ultimately diagnosed me with adult attention-deficit hyperactivity disorder (ADHD), predominantly inattentive type in clinical jargon.”
In many ways, Mathur’s story illustrates the significant impact of adult ADHD on women. Even research of ADHD in women continues to fall short compared to that of adult males. "Historically, research on ADHD has focused almost exclusively on hyperactive little boys, and only in the past six or seven years has any research focused on adult ADHD," psychologist Kathleen Nadeau told the American Psychological Association.
Now an MBA student, Mathur maintains that had she received the diagnosis and appropriate treatment earlier, her personal and professional life could’ve looked extremely different. “It took me four years to apply for my master’s degree because I couldn’t bring myself to write the statement of purpose, four years to talk about what I’ve achieved in my life,” she says.
Challenges of late diagnosis
Mathur is not alone, she is just among the thousands of women who have struggled to navigate the symptoms of ADHD and being diagnosed late in life compared to boys. Research has revealed that their symptoms can sometimes deviate from what is conventionally observed in young boys and can thereby, be overlooked. In girls and women, ADHD often presents as inattentiveness rather than hyperactivity, which can impact how the condition is recognised.
Nadeau observed that many women in their 30s and 40s get diagnosed only after one of their children gets diagnosed and they start recognising the symptoms in themselves. She is one of the few psychologists and mental health practitioners who are fighting to highlight the importance of addressing ADHD in women.
Currently, many clinicians are finding crucial concerns and co-existing conditions in women with ADHD, which will go unaddressed unless detection rates improve among women. Issues like compulsive overeating, substance abuse, and chronic sleep deprivation may be present in women who live with ADHD.
Compared to men with ADHD, research has shown that women appear to experience more psychological distress and have lower self-image, but both experience symptoms like dysphoria (unpleasant mood), depression and anxiety disorders at a similar rate.
Research has revealed that the combination of these challenges often leads these women to engage in more emotion-oriented solutions to reduce stress and takes the focus away from being task-oriented.
A diagnosis clears the way for both the person and their doctor to decide on treatment methods. While there is no cure, there are many ways in which symptoms can be managed, ranging from behavioral intervention to prescription medication like Adderall, Ritalin and its other variants.
By underdiagnosing women with ADHD, the medical system is essentially keeping them from being able to navigate issues that affect them every day. Therapists can also provide useful techniques to help them manage time blindness, impulsivity and trouble concentrating.
How a diagnosis can change a life
Getting a diagnosis is not the destination but serves as a key step in identifying behaviors that could be impeding daily functioning and helping the person seek out solutions. Mathur shares that while getting her diagnosis hasn’t resolved all her issues, she is more aware of her actions and the repercussions they have rather than letting the condition take its course.
“I participate more in class. I had to present a slide and I formatted the script in such a way that I don’t lose track and know what word to read next,” she says. “I know that my diagnosis will help me see things more clearly and make better day-to-day decisions,” she says stressing how it has impacted her life.
However, getting medical intervention like a psychiatric evaluation or ADHD medication is not very easy or accessible in India, especially in non-urban settings. As of 2020, India has 0.75 psychiatrists per 100,000 people and one session with a private practitioner can go up to Rs 1,500, which is unaffordable for large swathes of the population and even more so for women who have often have limited financial resources in comparison. From systemic negligence to unaffordability, many challenges stand in the way of getting an ADHD diagnosis for young women, for whom it could mean the difference between surviving and thriving.
(Edited by Amrita Ghosh)