ADHD and Gender: Why Are We Diagnosed Late?

Written by Elif Erdogan

Translated by Luca Baici

For this publication this week, VUJ is taking the spotlight to talk about the intersectionality between gender and Attention Deficit Hyperactivity Disorder (ADHD).  We interview Dr. Nakashima and people who have ADHD to learn how our gendered world affected their lives with ADHD. 

My own experience with ADHD led me to seek a diagnosis in these last months. I always knew something was not right but it was my last year of college when I realized my problems were getting more serious. It is a period of my life that I should start applying to universities or find jobs and write my thesis. I missed all the deadlines of university applications although I knew them 6 months prior. I put reminders every day for me to write my thesis, but I started 4 months later than I supposed to. Getting out of my chair to take a shower, even that was impossible. In elementary school, I was diagnosed with borderline dyslexia. After reflecting on my childhood, it made sense why it was impossible for me to read books, follow conversations, always forget something, process information, and manage my time. 

Research shows that girls are less likely to be diagnosed because they don’t show stereotypical ADHD symptoms of hyperactive or impulsive symptoms. These girls experience problems that they realize something is not quite right. I was shocked how I fell into both statistics as my brother did get diagnoses in Middle School but I did not. Patriarchy and gender roles are already making my life difficult, but I just never thought it would affect even my neurodevelopmental disorder 

“On top of (higher rates of suicide, depression)ADHD people are two times more likely to use drugs. Also, they are more likely to engage in unwanted sexual relationships and unsafe sex,” says Dr. Nakashima, a clinical psychologist who researches on adult ADHD and cognitive behavioral therapy. “Attention Deficit Hyperactivity Disorder (ADHD) is a part of developmental disability. Until the age of 12, children are diagnosed with ADHD if they show hyperactivity, impulsive and inattentiveness either in school, at home, or in social life… since it is a developmental disorder these characteristics continue till adult life.”

Mizusu Nakashima is currently researching and conducting clinical therapy on adult ADHD and cognitive behavioral therapy at Kyushu University’s Human Environment Department

Females are less likely to get diagnosed 

Why do females tend to be not diagnosed? “There are many patterns in which parents bring their sons to the hospital because problems in the classroom such as hitting their peers often happen,” explains Dr. Nakashima on why young boys usually get a diagnosis. “For girls, the hyperactivity continues in their head as they are doodling and daydreaming so these behaviors are not considered as problems in the classroom. So the risk of ignoring their ADHD gets higher until they reach high school,” says Dr. Nakashima. But why ADHD shows itself differently in different genders? “There are physically hyperactive girls too but I think this is caused because of the societal expectations. Boys are often told ‘behave’ but girls are told ‘don’t you feel embarrassed?’ so the hyperactivity shows itself differently in girls such as girls who chat a lot or write a lot,” Dr. Nakashima shows.

“I thought I can’t do it” 

“I thought I can’t do it,” says Yamamoto who has just graduated from graduate school when she was finishing her bachelor’s degree. That is when Yamamoto decided to get a diagnosis. “The first time I wanted to get a diagnosis is when I was in high school. I was going to a cram school for students who wanted to study arts in college. I was always sleepy since I didn’t had enough stamina. I felt like I couldn’t do anything.,” explains Yamamoto. “I tried to be strict over deadlines and tried to do some strategies. But these strategies did not help at all. That’s when I thought I can’t do it,” expresses Yamamoto. 

Adult ADHD 

As we grow up there are more responsibilities that everyone struggles with. But these struggles can be more difficult to deal with for people who have ADHD. “As people who have ADHD leave their parents after university or when they get a job, problems that were covered by their parents or their teachers are exposed such as not being on time, not being able to meet with the deadlines, forgetting stuff, careless mistakes increases,” explains Dr. Nakashima. “In university, I tried my best to cook, but there is this image that women can do everything properly since women are taught to behave like that,” expresses Yamamoto. These gendered expectations result in women giving their best effort to hide their struggles. “Everyone says that it is common sense for girls to clean or cook and this results in women hiding the fact that they may not be able to do those things,” adds Dr. Nakashima as well. 

Toxic Masculinity 

But how do gendered expectations affect men? “Not being able to speak about my ADHD and not being able to go to a psychiatrist was based on the fact that it was hard to accept my weaknesses. Which I think is a result of the masculine society,” says Naoshi who is an underground punk scene photographer. “When I was working at a cafe in high school I always made careless mistakes with the orders. Also, I wasn’t able to finish tasks on time” explains Naoshi. Gendered expectations surely made it difficult for females to get a diagnosis, but toxic masculinity affects men even in their neurodevelopmental disorders to talk about their struggles or admit that they do struggle. “I want to be able to speak about our weaknesses so I hope we could get rid of this patriarchal society,” expresses Naoshi.   

Our Intersections with ADHD and ASD 

“They were not necessarily put me in touch with the same resources as my brother had. Because he was that stereotypical male hyperactive ADHD person,” expresses Joe, who has a brother who was diagnosed with ADHD at the time but not them. “It would have provided me a little bit of peace of mind. If I knew these were something that was not in my control and it is just a part of who I am,” says Joe. “ADHD impacted my ability to participate in the school. Even in social circles. I experienced burnouts.” explains Joe. People who have ADHD and Autism Spectrum Disorder (ASD) can experience burnout in many situations ranging from social situations to sensory overload. 

ADHD and Japan

In Japan, along with toxic masculinity and certain gendered expectations make it difficult for people who have ADHD to go on to their daily lives. But in addition to that, ADHD people have sensory overloads in which too much sound, smell, image, textures, and so on. “In supermarkets, there is such a flow of information or going to any website in Japan there will be information popping everywhere that can get really overwhelming,” expresses Joe on how small daily tasks can cause sensory overloads. 

According to Dr. Nakashima the understanding of ADHD is getting better in Japan. “Recent years the usage of the word ADHD has increased dramatically in Japan,” says Dr. Nakashima. “Before the American book Girls Who Can’t Get Cleaned Up was translated into Japanese, people did not think ADHD was a disorder in adults or they thought its a disorder for only boys,” explains Dr. Nakashima. Let’s hope that this increased understanding of ADHD will open new paths for people to receive the support that they need.