A Case Study in Attentiveness

It is around May 2020 when I receive my diagnosis for ADHD, though I’d never be able to tell you the exact day—like many people with ADHD, I’m terrible with dates. I’m 14, sitting in the living room of my house with my laptop balanced on several Amazon deliveries stacked on my father’s weightlifting bench. It’s about two weeks after I received the form of ADHD symptoms that I was expected to fill out, except I could barely sit myself down to complete the nine-page document in one sitting, so it took me a week longer than I expected. I placed it in the kitchen to remember to mail it out and somehow lost it for a few days before I tore the main floor apart just to find it tucked behind the empty envelopes and magazines by the fruit rack. The psychiatrist kindly informs me over a Zoom call, while I distractedly fiddle with my necklace, that I have ADHD and have been struggling with it for a long, long time. This counsel is an overdue, highly expected diagnosis, but it is nonetheless a new revelation that the many “negative character traits” I exhibit are not inherent, but symptoms of neurodivergence.

The fish lens that I saw the world through was far from typical: being unable to remember deadlines or focus on details was something I struggled with throughout childhood, and it wasn’t uncommon for me to be dubbed “spacey” or “forgetful.” My room was constantly a mess despite frequent cleaning, and I often lost important things. But these symptoms were never labeled as signs of neurodivergence, and I never received the same help from teachers that I witnessed my male counterparts receiving. I’d later discover that the arbitrary signs of ADHD—fidgetiness, disruptiveness, and mood swings, for example—were tailored to boys and that the myth of males being more susceptible to neurodivergence was due to girls being regularly underdiagnosed rather than a difference in vulnerability.

An estimated 6.1 million children have ever been diagnosed with ADHD. Frequently, it becomes apparent in childhood, and early referral due to instructional or outside intervention is common. Yet I wasn’t aware of my own neurodivergence until I was a freshman in high school. Though the lateness of my diagnosis could be partially due to factors such as my environment, it is also due to the typical lack of visible symptoms in girls, which causes a diagnosis gap. Women typically present inattentive symptoms—difficulty focusing, listening, or remembering things—rather than hyperactive ones. Though women and men with ADHD are equally likely to experience feelings of exhaustion or overwhelmedness, external presentation of these feelings is less likely to be visible in women as a result of both societal pressure to remain competent and low clinical suspicion. As a result, women are often underdiagnosed and are less likely to receive proper help.

There is an outdated belief that boys are more likely to have ADHD. This idea is inaccurate, as it is derived from a lack of proper diagnosis due to girls exhibiting less disruptive behavior. One adult study found that there was actually a higher prevalence of ADHD in women than men within a psychiatric outpatient system. In particular, women with ADHD often also have anxiety or depression, and their ADHD is missed or misdiagnosed. Girls additionally tend to exhibit internalizing symptoms over externalizing ones. ADHD in girls is often characterized by personality traits rather than symptoms of a condition; as a result, women are often coaxed into simply learning to cope with their neurodivergence rather than receiving beneficial help. This learned coping often masks or mitigates their ADHD and further delays diagnosis. They’re often expected to learn not to make seemingly careless mistakes, or to develop methods to better focus, when in reality, these are neurological issues that cannot easily be resolved by masking.

The severity of my ADHD was enough for a recommendation of stimulant medication like Adderall or Ritalin, with a consistent dosage that would allow for me to gain a better hold on my inattention. But despite this recommendation, my doctor refused to handle it—stating that “everyone has a bit of ADHD” and because I had good grades and evident adequacy without it, “I didn’t need to be medicated.” My doctor was a man who had graduated from Stuyvesant and didn’t quite understand that neurodivergence was not just a checklist of symptoms I happened to meet and that it affected my life as a whole. From his perspective, since I didn’t seem to be having any difficulties with my education and didn’t visibly exhibit the recklessness and hyperactivity that would disrupt my environment in a way that required medication, my request was unnecessary.

ADHD has an unfair stigma that dramatizes those who have it as inadequate or slow learners. Since it causes students to struggle with organization, paying attention, and retention, there is a stereotype that people with ADHD tend to be poor students. This stigmatization needs to be eradicated because it not only causes students with ADHD to develop feelings of inadequacy or low self-esteem, but also stunts the motivation and ability of people who may suffer from ADHD but present symptoms in other ways to be diagnosed. In many cases, such as mine, it prevents one from receiving the medication one needs in order to function in a relatively “normal” way.

There is a need for a prominent change in how people, especially the medical community, regard ADHD and other neurodiversity. There are too many inaccurate ideas about neurodivergence that often lead to misdiagnosis or failure to help people. Even if I can learn to live without proper medication, there is no doubt that receiving it and an earlier diagnosis would have saved me from many years of struggle.