ADHD: why do women like me get diagnosed late?

What this episode is about

The discussion centers on the late diagnosis of ADHD in women, particularly highlighting Emily Bates' personal experience of receiving her diagnosis at age 34. It emphasizes that women often face a delay of about five years compared to men, which can lead to heightened emotional and functional challenges due to societal stereotypes that overlook female presentations of ADHD, commonly associated with inattention and procrastination rather than the more visible hyperactivity.

Key takeaways

• Delayed ADHD diagnoses for women often lead to years of misattributed laziness and anxiety – a double whammy.
• While boys' ADHD can be disruptive, girls' symptoms fly under the radar, masked as 'chatty' or 'daydreamy.'
• Women with ADHD face unique setbacks, including higher rates of anxiety and depression before receiving proper diagnosis.
• Hormonal fluctuations may exacerbate ADHD symptoms in women, yet research lags behind due to historical oversight.
• The 'model student' stereotype can keep ADHD hidden in women, creating a facade that masks real struggles.

Who speaks in this episode?

• Emily Bates (Host) · 6 min speaking
• Dr. Jessica Agnew-Blais (Guest) · 4 min speaking
• Helena Kobayashi-Wood (Guest) · 2 min speaking
• Eve Holden (Guest) · 2 min speaking

What is discussed, and when

1. 0:00 – 3:00: Brian Bates, Dr. Jessica Agnew-Blais
2. 3:00 – 6:00: Eve Holden, Helena Kobayashi-Wood
3. 6:00 – 9:00: Eve Holden, Helena Kobayashi-Wood
4. 9:00 – 12:00: 2023 TikTok Study

Notable quotes from "ADHD: why do women like me get diagnosed late?"

• First, in my exploration of my own brain, I went to visit Dr Jessica Agnew-Blais a researcher who specialises in ADHD and in particular how it affects women.

  about Brian Bates · at 1:22

• HELENA KOBAYASHI-WOOD: I had just recently started thinking about ADHD as potentially being part of my kind of puzzle.

  about Helena Kobayashi-Wood · at 6:02

• EVE HOLDEN: I think something that can potentially be validating for some people in that context is a lot of people think of ADHD as attention deficit hyperactivity disorder.

  about Eve Holden · at 6:54

• Clearly, this is content that people want to consume, but they were also riddled with misinformation.

  about 2023 TikTok Study · at 10:39

Who and what is mentioned in this episode?

People

• Brian Bates — Person · Main speaker / filmmaker-narrator · 3 mentions · first at 0:00
  Narrates her late ADHD diagnosis and frames the episode’s investigation into why women are diagnosed later, interviewing researchers and reflecting on her own experience while finishing a film.
• Dr. Jessica Agnew-Blais — Person · Referenced expert / interviewee (ADHD researcher) · 1 mention · first at 1:23
  Provides clinical-research context on ADHD symptom domains, gendered presentation differences, comorbidities/misdiagnosis (SSRIs), and the lack of research on hormonal factors in adult women.
  JESSICA AGNEW-BLAIS: So ADHD is a condition that's kind of generally characterised by two domains of symptoms.
• Eve Holden — Person · Referenced expert / study co-author (qualitative researcher) · 3 mentions · first at 5:30
  Co-authored a study collecting late-diagnosed women’s lived experiences; discusses validation, shame/regret themes, and risks of being undiagnosed (self-medication, suicidality).
• Helena Kobayashi-Wood — Person · Referenced expert / study co-author (qualitative researcher) · 2 mentions · first at 5:30
  Co-authored the study on late diagnosis; shares her own late-diagnosis journey and the process of making sense of experiences through ADHD research and others’ stories.

Places & events

• 2023 TikTok Study — Event · Case study · 1 mention · first at 10:42
  Mentioned to illustrate the spread of ADHD information and misinformation on social media, and its potential impact on self-diagnosis.

Full transcript with timestamps

0:00 EMILY BATES: It is five days before I have to submit a cut of this film, and I cannot bring myself to do anything. Although if you're watching this, I guess that means I have done it. I have ADHD. I got my diagnosis a few months ago at the age of 34, and I'm one of many women who are being diagnosed later in life. Research shows women with ADHD get their diagnosis on average five years later than men, even though symptoms tend to appear around the same time in everyone. And this delayed recognition is linked with greater emotional and functional difficulties for women when they are diagnosed.

0:36 Now I'm fresh off the back of my diagnosis. I'm not on any medication yet. My brain still feels like it's actively fighting against me. There are piles of boxes that need to be taken down to the bin in my hallway. There are clothes pretty much everywhere in my flat. I'm not even going to let you look at my bedroom, and I still procrastinate doing work until the very last minute. Maybe reading a book, maybe playing a video game, maybe doing absolutely nothing, or even cleaning my flat. I am the stereotypical social media example of ADHD in women.

1:09 So why did it take over three decades before I could put a name to the noises in my brain? First, in my exploration of my own brain, I went to visit Dr Jessica Agnew-Blais a researcher who specialises in ADHD and in particular how it affects women. JESSICA AGNEW-BLAIS: So ADHD is a condition that's kind of generally characterised by two domains of symptoms. So the first domain is hyperactivity impulsivity. So these are things like being quite restless, not being able to sit still being fidgety, making split decisions, not really thinking things through.

1:48 The second domain of symptoms is inattention. So this is more like distractibility, procrastination, not being able to focus. The stereotypical sort of ADHD presentation I think everyone talks about is the little boy in class not paying attention, running around, fidgeting. How is that different when it comes to girls and women? So girls tend to present with more of these inattentive symptoms that I describe. So this is more like being distractible or being kind of daydreamy. And in general, these are things that can be not as obvious, I think.

2:17 And this is one of the reasons we think that girls might get missed, in the sense that if you have this boy who's running around the classroom not sitting still, it's kind of disruptive, right? So the teacher will really notice if you have a little girl that's kind of, you know, just staring out the window. It's not going to be bothering the other kids as much. So they might kind of fly under the radar more. Additionally, something that might be a bit different for girls is that kind of restlessness that for a boy might come out with running around.

2:42 There's some evidence that for girls, this might be more to do with being talkative, for example. So if you have a girl who's in class and she's always chatting with her friends, that might be the way that she's expressing that restlessness in a slightly different way than a boy might. I have personal experience with that. Yes. If you were to look at me at school, you would have seen a model student. I was well behaved. I got good grades. The only telling thing was in some of my reports, it would say something along the lines of “If only she applied herself a little more”. At university, I would go out partying and then come back and rush coursework on the day it was due.

3:19 I honestly just thought I was lazy and that I thrived under pressure, and that eventually I would grow out of it. But I didn't. And throughout my adult working life, I became an expert at hiding it and eventually I put myself under such stress that I was diagnosed with an anxiety disorder. One thing that we see a lot of is that women come in to getting their ADHD diagnosis with higher rates of other mental health conditions prior to that. So they're more likely, for example, to have had a diagnosis of depression or anxiety leading up to their ADHD diagnosis.

3:56 Interestingly, they're also more likely to have been prescribed SSRI, so treatment for depression before they get their ADHD diagnosis. And there's some really interesting work from my colleague in Wales that finds that so women come into the diagnosis with a higher rate of SSRI use. And then after they get a diagnosis, they're also more likely to discontinue their SSRI as compared to male. So it does suggest that perhaps there's some kind of misdiagnosis diagnostic overshadowing going on, especially for women prior to receiving their ADHD diagnosis.

4:29 Is there any evidence that hormonal fluctuations in women have an effect on ADHD presentation? It's a question that a lot of women with ADHD ask. And there's very little research on this, largely because for a long time we didn't think that adult women had ADHD. So things that affect adult women, like the menstrual cycle or, pregnancy or menopause and perimenopause just don't have any research on them. We have some evidence now that women with ADHD might have kind of more hormonal sensitivities, where they see that women with ADHD are more likely to have a diagnosis of postpartum depression, or postpartum anxiety than women without.

5:04 So in general, there's this suggestion that times of hormonal change or hormonal fluctuation might carry more challenges for women with ADHD. So I think this has implications for other times of hormonal change, for example, menopause or the menstrual cycle. And these are things that we need to keep in mind. And that in general, sort of in the women's health context, we may need to keep in mind for women with ADHD. I wanted to find out more about the lived experiences of other women with ADHD, and I came across a study by doctor Eve Holden and Helena Kobayashi Wood, in which they collected the stories of other women who had been diagnosed later in life and found out how that delay impacted them.

5:41 They gathered qualitative data through surveys and discovered recurring themes of people being dismissed by others, struggling with a sense of self-perception and thinking about what could have been. When we spoke, I discovered that both of them were also diagnosed later in life with ADHD. And we chatted for hours. We spoke about their research and about their own personal journeys. HELENA KOBAYASHI-WOOD: I had just recently started thinking about ADHD as potentially being part of my kind of puzzle. And so when I looked into the research around ADHD in women, I realised that, okay, there's a lot of reasons as to why it's been this long before I've kind of figured out that I've got ADHD. Having recently got my diagnosis and my algorithm is telling me all these things are ADHD.

6:28 And I'm like, really? Is that another thing that like, comes down to like, ADHD and isn't just, you know, an individual experience that I've had. And like, part of me is really concerned that I'm attributing ADHD onto things like putting ADHD onto things that aren't due to the ADHD. But it does really feel like a lot of things are sort of fitting into place and making sense when I hear other people's stories, which is what your paper obviously was able to sort of scientifically do. EVE HOLDEN: I think something that can potentially be validating for some people in that context is a lot of people think of ADHD as attention deficit hyperactivity disorder.

7:06 So attention and hyperactivity and that it's so much more than those two adjectives. There's a lot of people with ADHD who struggle at school, and then they're labelled as disruptive, or you have people who are good at school, and then they get labelled as they're fine and they're okay, even if they're struggling in other ways. One of the themes that came up for us in our research was that that reflecting on what could have been and some of that being about if I, if I'd had a diagnosis, I would have been kinder to myself and that had a diagnosis than other people would have understood me better.

7:43 Or if I had the diagnosis, I would have done better at school when if I had a diagnosis, I would have maybe been able to like, keep down that job and people are describing like, actually, I've ended up in a job now, like we had one participant who is, self-employed and they say, self-employed artist I think, and they were saying how for them the self-employment is great because it gives them that flexibility. They don't have to turn up at 9 am and leave at 5, which can be a really difficult structure for some people with ADHD to stick to.

8:16 One of the things that I found most emotional about participants responses was how often, people express feelings of shame about themselves, or about their behaviors, or about how they, like, have regrets in their lives. And it was people who are struggling to cope. So people with ADHD are more likely to, if they're undiagnosed, they’re more likely to self-medicate with more dangerous, substances than ADHD medication. They're more likely to smoke, they're more likely to be alcoholics, they're more likely to commit suicide.

8:49 They're more likely to get into hard drugs. There's so many things that people are at risk of if they are not diagnosed with ADHD. And like, we're all getting emotional. Yeah. Yeah, I think it's and actually that it's a really serious thing that like if you go unsupported, there's really serious consequences. We have participants talking about suicide in our, responses, and their diagnosis was enough to save their lives. And like this is where like when people are not taking it seriously enough it's really harmful for those people.

9:35 Diagnosis can actually be a preventative of mental health issues. One of my favorite things about the paper is how positively and how validated people feel about the diagnosis that they received, or that they were able to receive, because that helped them have a better perspective on their life. They're talking about like their improved, sense of self, their improved well-being. And even if the diagnosis has been late, they're glad that they got it even even with all of the things that happened before that, it's still made a difference.

10:09 When I read that study and the different answers to the questions, a lot of the time it was like reading something that I could have written. It can be really comforting to know that there are a group of people out there who are having similar experiences and struggles to you, and I think that's why a lot of people are turning to social media. But there could be a darker side to that. A study in 2023 looked at the top 100 videos on TikTok using the hashtag ADHD. Together, they had amassed nearly half a billion views.

10:39 Clearly, this is content that people want to consume, but they were also riddled with misinformation. In fact, more than half the claims in these videos didn't align with clinical guidelines, which could lead to people incorrectly self diagnosing. And I think it's a bit of a double edged sword. So I think, you know, there is some misinformation online. So sometimes you'll see TikTok videos of people say, oh, you know, if you, walk into a room and you've forgotten why you're there, that means you have ADHD. And it's like, well, that can be a lot of things.

11:10 Just one thing isn't going to mean you have ADHD. But at the same time, I think sometimes people with ADHD or people who think they might have ADHD, they get a lot of helpful information from social media and from other people sharing their experiences or sharing things that, help them or help them cope. So I think there can be a lot of benefit. But I do think that maybe people should have, some kind of healthy skepticism sometimes about what's on social media as well. Do you think it accounts for some of the supposed rise in diagnosis, or at least people reaching out for a diagnosis?

11:46 I think that it would, and I think that people are just kind of thinking more that some of the challenges they might have might be ADHD. In some cases it may be, but I think it can be very helpful to have that clinical conversation because, you know, the symptoms of ADHD can be quite nonspecific. And you can have some of these symptoms for other reasons. So, you know, it could be that someone is feeling really distracted. But if that distraction could come from anxiety or from, you know, a traumatic experience. So it is often helpful to have that conversation with a specialist to try to disentangle those things.

12:24 I mean, is there a rise in women getting diagnosed at the moment? Yes. So we do see that there is about there is some work from the UK showing between 2000 and 2018, about a 20 fold increase in rate of first prescriptions amongst women, adult women. We do see an increase in males as well. So there was about an eight times increase of first prescription of ADHD medication in men. So we see it rising in both genders, but we see it rising more quickly in adult women than in adult men. Why do you think that's come about?

12:55 I think some of that is this catch up, basically. In adulthood, for the girls who are missed. So research finds it rates of diagnosis in childhood, are higher in boys than girls, so about 2 to 3 times higher. But if you look in adulthood, it's about 1 to 1. So basically you see this evening of the gender ratio as we move into adulthood. And I think this tends to be, women coming into the adult ADHD population. It's the age old story of people who have a menstrual cycle being dismissed and not included in research.

13:25 Hormones are complicated and they make trials difficult, but they also have very real effects on people. We need to know more about how ADHD presents in people who have a menstrual cycle, how hormones interact with medication, and how this can change throughout our lives. Personally, for me, making this film has been illuminating and also pretty difficult. My ADHD is part of who I am, and this has helped me see my own story as part of a wider shift, one where understanding is catching up with evidence and recognition is beginning to arrive earlier than it once did.

Questions about this episode

Who speaks in "ADHD: why do women like me get diagnosed late?"?

Emily Bates (Host), Dr. Jessica Agnew-Blais (Guest), Helena Kobayashi-Wood (Guest), Eve Holden (Guest).

What is "ADHD: why do women like me get diagnosed late?" about?

The discussion centers on the late diagnosis of ADHD in women, particularly highlighting Emily Bates' personal experience of receiving her diagnosis at age 34. It emphasizes that women often face a delay of about five years compared to men, which can lead to heightened emotional and functional challenges due to societal stereotypes that overlook female presentations of ADHD, commonly associated…

What is mentioned in this nature video episode?

5 people, works and ideas are mentioned, including Brian Bates, Dr. Jessica Agnew-Blais, Eve Holden, Helena Kobayashi-Wood, 2023 TikTok Study. Each one on this page links to its own page with every episode that mentions it.

How long is "ADHD: why do women like me get diagnosed late?"?

The episode runs 14 min; the transcript is about 2,528 words in 24 timestamped sections.

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