Flying under the radar: growing up with undiagnosed ADHD

According to a paper written by Darby E. Attoe and Emma A. Climie, young girls with ADHD are often underdiagnosed due to their symptoms presenting differently compared to boys. While boys are often more hyperactive (which is mainly what parents and teachers know to look for), girls typically fall within the attention-deficit side of the spectrum, often going unnoticed (Attoe and Climie 2023).

The first time anyone told me I may have ADHD, I was 18 years old. I was explaining how I don’t know what facial expression I make during conversations, and I worry that I look bored or that I’m making a weird face. Instead, I put effort into looking attentive and engaged with the conversation by keeping my eyebrows raised, making eye contact, nodding, and smiling just enough to look interested but not weird. The conversation fades into white noise behind the internal dialogue I have over which eye to look at and how often I should nod my head. By that point, I am officially (and unintentionally) not listening.

My friend’s roommate, whom I had only met once before this, said it sounded like I have ADHD. I was resistant at first, explaining that I did well in school, and none of my teachers ever said or noticed anything. The roommate described how if a student has something that they are good at in school—whether it be math, history, or another subject—teachers will assume that there’s nothing to be concerned about, especially since it is a common assumption that children with ADHD do not perform well in school. Mind you that this is more anecdotal than scientifically backed, but I have had several people agree with this assessment and deal with the same things I did.

In my case, my thing was writing. I was an avid reader for all of my life, especially because I felt consistently isolated from, or outside of, social interactions. To replace that social stimulation I craved, I read. Books became my companion during class, after bedtime, during lunches and recesses, and every time in between. Because I was so avidly involved in literature and its techniques, I naturally moved on to writing, and my skills were quickly noticed by teachers.

My parents were also school-focused my entire life; it was academics first and everything else second. Homework was the first thing I did when I got home, and they would sit with me, explaining concepts to me as my brain wrapped around them. When I was doing it alone, I would stare at the kitchen table and trace the wood grains with my eyes, wondering what I wanted for breakfast the next day or other inconsequential things. It took me a long time to do homework sometimes, but I always got it in on time, and that was what mattered to both my parents and teachers.

Admittedly, this routine did help give me the study ethic needed to cope with the focus issues I was having, but it also made me seem much more proactive with school and homework than I was. Teachers didn’t know to look for my problems in class because in every other way, I showed almost no sign of the stereotypical child with ADHD. I was a smart kid who did well in school, and the first thing teachers often looked for was hyperactivity. Without having that as blatantly as boys would, I was an easily missed case. I slipped through the cracks of a diagnosis by learning to mask my symptoms without knowing it.

Patricia O. Quinn and Manisha Madhoo write that anxiety and depression are common comorbidities of ADHD with female patients specifically, making misdiagnosis even more common due to symptom overlap (Quinn and Madhoo 2014). Anxiety symptoms worked against me in the sense of the facial expression topic mentioned earlier; I would stop focusing in class because I was trying to look like I was paying attention, if only so my teachers wouldn't be disappointed in me. I had internalised the academic validation and made it personal, and any sense of disappointment from educators would absolutely gut me. I also had to work harder to get where I was, but it was a fight that was entirely mental and never communicated.

Attoe and Climie also highlight the “higher burden of emotional problems required for girls to be referred for treatment.” (Attoe and Climie 2023). Teachers and parents often don’t notice girls until they have emotional problems that cannot be ignored, suggested by the fact that girls have more psychiatric visits before being referred for diagnosis than boys do, often have more non-ADHD medications prescribed, and are also referred for diagnosis for emotional problems, while boys are referred for behavioural symptomology.

As well, girls were referred when their symptoms presented extremely abnormally compared to regular behaviour, which implies that the threshold of symptom severity differs for boys and girls, respectively (Ibid.). With my carefully controlled façade of focus, and the dedication to school my parents provided me, I was never going to be seen as a child with these issues until high school.

I had trouble making friends for a long time, even though I did have people to talk to. I was not necessarily a loner, which I think would have made teachers more concerned, but I lacked the genuine connection with people that I saw so many other kids form. With my neurodivergence combined with my anxiety, I was never sure of where I stood with most people, and every conversation felt forced and ambiguous. I would fail to understand jokes, sarcasm, and unspoken social rules even when I had friends. I never knew when to stop talking and had a hard time knowing when an inside joke was dead and when it was still socially acceptable to reference it.

At the time, I wasn’t aware ADHD even existed—all I knew was that I felt different in a way that couldn’t be fixed. I felt as if everyone else was in on a joke that I didn’t understand, and I was simply waiting for someone to loop me in. In middle school especially, when my biggest social issues became apparent, I became more ashamed of who I was and more adamant that I needed to embrace it simultaneously, pushing back against the self-hatred in such a way that it only made me feel worse.

I thought the things that othered me from my classmates were my interests, which included Doctor Who, reading, writing, and social issues that made me seem like an angry teenager. I believed that my “nerdiness” was to blame for a childhood full of confusion and isolation, and I isolated myself further by insisting that my interests were incompatible with other kids my age; it didn’t help that I was enrolled in a small private school, where the class sizes were around 10-15 kids. Every kid craved validation and acceptance by their peers to some extent, and the friends I did have fell victim to that urge by being embarrassed by me.

After I grew out of that phase, I still didn’t feel like I was meshing with any of my classmates. I started high school in a new country, which was a whole new set of social norms and expectations that I was not privy to. It was also more difficult academically, and with more independence in my study time came more intense struggles against my wandering brain. I started therapy for anxiety in 11th grade, and while I was given many helpful tips to manage, I was still never given exact answers to my problems, nor was I given a diagnosis at the time.

My brain was filled with constant noise, telling me that everything I said was going to be criticized and made fun of behind my back. The social struggles weighed heavily, and the inattentiveness only added to that frustration. Why did I struggle so much to listen to these classes when they were essential for me to do well? Why did I feel like I was never doing enough, always lazy and messy, and like I was never going to amount to anything?

I managed to figure out that I was an introvert, and that had to have been why my social battery was so drained when hanging out with my friends, right? Until I adjusted my hang-out times and left when my social battery ran out, and still I felt that exhaustion. In hindsight, I was masking to the point where I was tiring myself out, withholding my thoughts, behaviour, and speech patterns and fine-tuning them to fit into a certain mould.

I cannot describe how truly exhausting it is to have to change who I was every single day, reading into cues I didn’t understand and having to act as if I were as normal and well-functioning as everyone else. Meanwhile, I was painfully aware that all of my efforts didn’t work and people still thought I was weird anyway. I could never figure out what made me so unlikeable, so easy to make fun of, out of all people, and masking didn’t give me those answers either. I wasn’t masking on purpose, but I felt like an imposter in my own skin by betraying the wondrous way my brain works and being somebody I wasn’t.

Luckily for me, high school was the time for kids to grow past the initial desperation for acceptance, and I didn’t struggle on the social front as much. While I was still masking as a defence mechanism, I was still more myself than I had been in a very long time. When I told my high school friends about my diagnosis years later, many said it made a lot of sense given how I have always been.

I was still in high school when the COVID-19 pandemic hit, and my inattentiveness came into full view. Getting up in the morning became a chore, and focusing in online class was even worse; I was grasping for that familiar routine that I had, the one that helped me cope with my ADHD symptoms as best as I could with no treatment or diagnosis, and found only empty air. There were no more lunch breaks to spend with friends that gave me that refreshing space to breathe; there was no more one-on-one teacher time after class if I had questions. Everything had changed so significantly that it unravelled all of the progress I had made and all the coping strategies that had helped me scrape by in school before.

Anxiety and depression spiked, and executive dysfunction infected every minute of my day. My brain would be giving my body every signal to move, and I felt completely incapable of anything at all. It is difficult to describe how badly executive dysfunction can mess with your head if you have never experienced it before. Similar to masking, it wears you down over time without fully knowing why; you feel as if you have sandbags all over you, and that signal that your brain gives to your body to move is faulty. Something feels broken in your head, and you can’t figure out how to voice that issue at all, never mind work to fix it.

With that desperation to do something, anything, comes severely low self-esteem. Because I didn’t know what was happening, I would berate myself to the point of tears. "Why are you so useless? You need to study. You need to eat. You need to do something, but you’re just lying here taking up and wasting space. Get up. Why aren’t you getting up? What’s wrong with you?"

My parents questioned why I was having such a hard time and I had no answer for them. How do you describe that feeling of complete helplessness, especially to people who are able to get up and do something when they think of it?

Where I lived at the time, restrictions were lifted after only six weeks, and going back to school was just as confusing as going online. Rebuilding my focus strategies up again was proving to be very difficult when I was back in person, and my frustration grew as the days went on. I was no longer the good student I used to be, and the negative self-talk started to sound a lot more true.

The subjects I took were difficult to begin with, but I put enormous amounts of pressure on myself to do better, to work harder. Ironically, that only made it harder for me to function.

We went back online in January of my senior year, and I was much more ready this time. In the previous lockdown, while I had missed my friends, I discovered how much I truly loved being alone. I missed the ability to make coffee whenever I wanted, cook my own lunch, and sleep in a bit longer. During the second lockdown, I honestly flourished. I was handing in homework on time. I would go out and stretch in the backyard when classes ended every day; I made myself iced coffees and ate well.

Studying for finals was when I really shone, though. Looking back, I was definitely still struggling with focusing, but the discipline I had was astonishing for me. I was up at 4:30 A.M. every day to make breakfast and study before class, and I studied for several hours after classes ended too. The practice exams and study materials I did took me stupidly long amounts of time, but I was doing it in a way that worked for me. Similar to how my parents used to help me with homework, it didn’t matter how long it took, it just mattered that it was done.

I graduated with decent grades, and I was happy with everything I had accomplished at that point. I had survived the hellhole of high school, unknowingly living with something that made my brain unreliable and fickle.

And then university began.

Working through this as a newly fledged adult felt different. It went past the childish tendencies towards distraction, past the hormonal craziness of teenagers. It leaned more towards a fundamental problem in my own brain, wires crossed and cut. I no longer had excuses for why I was struggling so much, since I was getting older and had independence while living with my mom. I couldn’t blame anyone but myself for why I felt like I was failing every step of the way.

I completed one year of university while living with my mom before transferring to another university in a whole other province, in a bigger city. I was well and truly on my own for the first time.

For a while, I held to my routine and did my best to reform the discipline I had not even a year earlier. That mental structure crumbled eventually under the pressure; I started skipping lectures, barely focused in class, and procrastinated assignments until the day of the due dates. I was still getting good grades, but it was hard work without the familial support system I was used to.

I started the process of an ADHD assessment on the tail end of my third year of university, after two full academic years in the new university. It took around three sessions for my psychiatrist to officially diagnose me with ADHD, anxiety, and depression.

When I got my diagnosis, my psychiatrist said that I was the epitome of an adult woman with undiagnosed ADHD. Everything I had told her pointed to me showing symptoms since childhood and also matched with what adults living with untreated ADHD are like. Everything I had suspected about myself for years, the answer I was looking for but never felt comfortable to ask for until then, was realized. It was a weight lifted off my shoulders, no longer my own failings as a student and person, nor a matter of laziness and lack of commitment, but a genuine difference in my brain compared to other people.

My first month on medication, I remember feeling elated by the way my brain worked and the full force of focus. But I was also angry.

Is this what I had been missing my whole life? Is this how other people operated on a day-to-day basis? If this is what “normal” felt like, how much was I robbed of in my childhood? Who could I have been, and what could I have done, if this had been caught when I first started showing symptoms?

One of the hardest parts of getting diagnosed as an adult is thinking of what could’ve been if I just had a brain that worked or even one teacher who saw something in me that others didn’t. It became both frustration in myself (even though it was out of my control) and in the adults who had failed me in some ways. To be fair to them, I had a difficult mix of symptoms to diagnose, and it was not just me that got missed. During childhood, the ratio of boys to girls with ADHD is 3:1, while in adulthood it is 1:1, which does lend to the theory that girls are underdiagnosed in their childhood (Ibid.). I blame the system that allows this to happen more than the people around me.

The truth is that going undiagnosed for so long gave me lower self-esteem issues and more difficulties in socialising and emotional regulation. Without knowing why I felt so different compared to my classmates, why I felt like I was always doing the wrong thing in every social interaction, and why I was struggling so much in school and my personal life, I built up the narrative that it was something wrong with me that I was allowing; I was convinced that I was the reason I was struggling, that it was within my control to change and I just wasn’t smart enough to. Nothing I did was ever good enough.

My childhood and young adult life are ingrained with this inescapable shame: shame of who I was, how I interacted with others, how weird and embarrassing I was, and how stupid I felt every time I could not wrap my head around something.

While low self-esteem is characteristic of women with ADHD, could it have been helped if I had known why I struggled so much in the first place? Would it have saved me years of social humiliation and isolation if I knew I was never going to be on the same level as some of my classmates? Maybe at least then I wouldn’t have tried so hard to be liked by them.

Ultimately, even with my diagnosis (which I am so grateful for), there are two decades of built-up frustration and guilt, two decades spent hating every way my brain worked that I will never get back. I can only hope that the further research on ADHD will help reshape the systems in place that allowed me to go without help for so long, if only to save another little girl who flew below the radar for far too long.