21 Years Later: Confronting the Gender Gap in Mental Healthcare

Earlier this month, as a 21 year old in her last semester of college, I was diagnosed with combined-type Attention-Deficit Hyperactivity Disorder, which means I have both the hyperactive and inattentive symptoms of the condition. 

I always thought it was normal to regularly zone out during conversations, despite feeling very engaged in them, or to frequently have to reread paragraphs because my brain won’t comprehend the words my eyes keep scanning. Now, I understand that’s a part of my ADHD. 

When I told my friends and family members I suspected I might have ADHD, I was told I’m just really smart, creative and goofy — but I knew I could be all of those things and still have ADHD. 

My best friend and brother were supportive of my suspicion though — they said they noticed ADHD-like symptoms in me after working with me at our summer camp. Due to insurance, it took a while to take an assessment through a licensed professional, but once I did, I scored in the 97th percentile for women my age. 

My lengthy experience receiving an ADHD diagnosis is far from uncommon for most women. 

As National Women’s History Month, March is all about honoring the women who advocated for gender equality in the U.S. and acknowledging women’s societal contributions. Although our country has made significant social progress, inequities still exist — especially in the mental health field. 

Until 1990, women were all but excluded from healthcare research. Mental healthcare research funded by the National Institute of Health only started requiring women be included in clinical studies in 1993, according to mental health organization Charlie Health. 

Gender bias in research has fostered a lack of understanding in how women experience mental health conditions — like ADHD. These biases have also created a gender myth for ADHD, causing many to believe only men can have the condition. 

However, because of the current understanding of symptoms, this myth isn’t too far off — ADHD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders is heavily male-biased. 

In early DSM field trials, males were overrepresented, which still causes diagnostic criteria to be biased toward men despite later DSM revisions, according to the National Library of Medicine. The diagnostic rate of ADHD in men is 69% higher than women, leaving women consistently under-identified and underdiagnosed, according to ADDitude Magazine. 

Men more frequently present hyperactivity and impulsivity, whereas women present more inattentive symptoms, according to the National Library of Medicine. Because hyperactivity and impulsivity are more noticeable in general, parents and teachers are more likely to observe kids displaying these symptoms, forming ADHD’s gender-based social stereotypes.  

Because these are the ADHD symptoms most people are exposed to, and therefore familiar with, kids displaying these signs are the ones most often referred to clinicians, so young girls who have internalized and miniscule hyperactivity symptoms — like me — fly under the radar. 

For me, hyperactivity isn’t loudly drawing attention to myself in class or acting disruptive in public — it’s unconsciously fidgeting with my hair throughout class, even though I’m focusing on what my professor is saying. 

It’s aimlessly singing and humming to myself on the CTA when conversation with a friend has come to a halt. And it’s needing to have Dr. Dre and Snoop Dogg’s “Nuthin’ But A ‘G’ Thang” on repeat for hours so I can do my homework. 

Because these symptoms are non-distruptive to others, most go unnoticed.

Learning about and resonating with these often unseen aspects of ADHD made me wish I received more support as a kid. 

The Individual Disabilities and Education Act provides students with specially designed instruction in a free public education, along with related services, such as audiology, speech pathology and social work services. Section 504 prohibits discrimination against individuals with disabilities in programs that receive federal funding.  

Under Section 504, public schools and universities are required to provide accommodations to students with disabilities to ensure equal access to education is upheld. 

The protection of equal education exists because of federal oversight from the U.S. Department of Education. If the Department of Education were to be eliminated — which is a current aim of the Trump administration — enforcement of student rights and academic support would be returned to the states. Access and accommodations would depend solely on where a child lives. 

Young girls with ADHD — who are already underdiagnosed — would have even fewer opportunities to receive support in schools. I can’t help but wonder how my school experience would’ve been different if I had received the support I needed earlier. 

Without clear federal regulations and guidelines, schools may reinforce the same gender bias that’s left women’s health insufficiently researched and underdiagnosed, further perpetuating the cycle.   

Progress means very little if we don’t protect it — and it starts with health and education, especially for our youth.