When was ADHD first diagnosed? And what are ADHD symptoms in women today?
by Dr. Lisandra Mendoza
Attention-deficit/hyperactivity disorder (ADHD) has long been a topic of interest and research in the field of psychology and neuroscience. It is also a fairly controversial topic, with heated discussions surrounding medication, nutrition, and modern distractions such as cell phones and social media coming to the forefront, particularly for parents who are considering treating their children with stimulant medication.
Yet it’s undeniable — accurate and early diagnosis can profoundly impact a person’s life. So why are there still so many issues with ADHD diagnosis today?
Understanding the history of ADHD and the nuances of its diagnosis can help us better support neurodivergent individuals, particularly women and girls, who have historically been underdiagnosed and underserved.
A fidgety history: How we came to understand ADHD
Today, ADHD is a well-recognized condition, but its journey to diagnosis has been a long and winding road. Buckle up because we’re diving into the fascinating history of ADHD diagnosis.
Early glimmers
ADHD-like symptoms have been documented for centuries. In 1798, a Scottish physician observed children displaying inattention and distractibility, reminiscent of the character “Fidgety Phil” from a popular children’s book around the same time. In 1902, Sir George Still, a British pediatrician, identified children with a “defect of moral control,” characterized by restlessness and inattention. These early observations formed the basis for future understanding. Interestingly, references to ADHD can be found even earlier in art and literature, such as in the Bible with the story of the Apostle Peter. This challenges the notion that ADHD is a disorder specific to modern society.
The rise of hyperkinetic and the introduction to medication
The 20th century saw a shift in terminology. In the 1930s, the term “hyperkinetic disease” emerged, focusing on physical restlessness. This era also witnessed a pivotal moment: the discovery that stimulants could improve symptoms. Dr. Charles Bradley noticed how Benzedrine, an early stimulant medication, calmed hyperactive behavior in children. This finding sparked ongoing research into ADHD treatment.
The DSM journey
The American Psychiatric Association released the first Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952, which did not include ADHD. The DSM, in its updated versions, is still used today to explain the diagnoses, causes, comorbidities, risk factors, and other aspects of recognized mental health disorders.
In 1968, the second edition (DSM-II) recognized the “hyperkinetic reaction of childhood” as a distinct disorder, focusing primarily on excessive motor activity, overactivity, restlessness, distractibility, and short attention span in children. However, the understanding of the condition continued to evolve.
In 1980, the DSM-III was published, changing the name from hyperkinetic reaction of childhood to ADD. Two subtypes of ADD were named ADD with hyperactivity and ADD without hyperactivity.
A revised version (DSM-III-R) was published in 1987, removing the hyperactivity distinction and naming the condition ADHD for the first time. However, subtypes of the disorder weren’t identified.
In 1994, the DSM-IV was published, establishing the three subtypes of ADHD that are still used today:
Predominantly inattentive type
Predominantly hyperactive type
Combined type
The DSM-V, released in 2013, did not change ADHD subtypes from its predecessor, nor did the DSM-5-TR published in 2022. ADHD remains recognized as a neurodevelopmental disorder defined by impaired levels of inattention, disorganization, and/or hyperactivity-impulsivity.
ADHD diagnosis: Gender disparities and “quiet” ADHD
ADHD is often stereotypically associated with hyperactive boys, but this misconception has led to a significant gender disparity in diagnosis. Historically, boys have been diagnosed with ADHD at much higher rates than girls. Recent statistics from the Centers for Disease Control and Prevention (CDC) show that about 11.0% of boys aged 4-17 and 5.6% of girls aged 4-17 are diagnosed with ADHD. This difference can be attributed to girls exhibiting less overtly hyperactive and more inattentive symptoms, which are frequently overlooked.
Not all ADHD is hyperactive, loud, and bouncy. Many girls and women struggle in silence with “quiet” ADHD—grappling with the inattentive subtype rather than the hyperactive subtype. Those with “quiet” ADHD may quietly daydream, struggle to pay attention, be forgetful, and lose things. Though they may not interrupt frequently or fidget, girls and women with inattentive ADHD can still suffer quite a bit if they fly under the radar and go undiagnosed. Girls and women with ADHD who go undiagnosed may not get the treatment they need to manage their symptoms, which can contribute to the development of comorbid disorders such as anxiety and depression. Lack of awareness and support can lead to problems in school, at home, and in their social lives.
Who can diagnose ADHD?
Psychologists, psychiatrists, neurologists, family doctors, and pediatricians can diagnose ADHD in children and adults. It’s important to find a healthcare provider who is aware of the gender disparities in diagnosis and is sensitive to your experience.
Do I have ADHD or depression?
This is a question many individuals ask themselves on their mental health diagnosis journey. Research widely varies, but it’s estimated between 20 and 30% of individuals with ADHD also have major depression. Unfortunately, women who have ADHD tend to be diagnosed with depression rather than ADHD. Often, symptoms of depression and also anxiety arise from untreated ADHD!
The impact of modern society on ADHD: A challenge
Modern society presents unique challenges that can exacerbate ADHD symptoms, particularly among neurodivergent individuals.
Here are three significant societal factors that impact individuals with ADHD:
Exposure to overload
Today’s fast-paced world is characterized by constant stimulation from multiple sources, such as social media notifications, pop-up ads, and e-mail alerts. This constant barrage of information can overwhelm our brains, especially for those with ADHD. The constant need to switch attention can hinder the ability to focus and complete tasks effectively.
Sensory overload
Sensory processing issues are common among individuals with ADHD. The noise, lights, and overall sensory input in urban environments, such as open-plan office environments, loud music in stores and restaurants, and bright screens, can be overwhelming. This sensorial overload can lead to increased anxiety, difficulty concentrating, and overall cognitive fatigue.
Cognitive demands
Modern life demands a high level of cognitive functioning. From managing work and household responsibilities to navigating social interactions and digital communication, the cognitive load can be immense. For those with ADHD, these demands can be particularly challenging, often resulting in feelings of inadequacy and frustration.
Thriving with ADHD: How Neurodiversity-Affirming Therapy can empower Women
Today’s fast-paced world, with constant stimulation from technology and the pressure to multitask, can be especially challenging for women with ADHD. Women with ADHD may experience symptoms of inattentiveness, hyperactivity, or impulsivity. But these ADHD symptoms in women can manifest differently than they do in men. For instance, women may be more likely to experience hyperactivity as internal restlessness or difficulty relaxing rather than physical fidgeting.
That’s why a neurodivergent-affirming approach to therapy is crucial. This approach acknowledges and respects the unique experiences and needs of women with ADHD. Rather than trying to fit you into a neurotypical mold, Avatar Cognitive and Behavioral Center offers Neurodivergent-Affirming Therapy so you can feel appreciated just as you are. We also know how to recognize ADHD symptoms in women so you don’t continue to be overlooked.
Here are some key aspects of Neurodivergent-Affirming Therapy:
Validation and understanding
Recognizing that ADHD presents differently in women and that your experiences are valid is the first step. Our expert psychologists and therapists provide a safe space for women just like you to share your struggles and achievements without judgment.
Customized strategies
Tailoring coping strategies to individual needs is essential. This might include time management techniques, sensory breaks, or mindfulness practices that cater to the unique sensory and cognitive experiences of women with ADHD.
Empowerment and advocacy
Encouraging women to advocate for themselves in various environments—whether at work, school, or home—is vital. We are here to empower you so you can navigate societal challenges more effectively with the beautiful brain you have been given!
Struggling with ADHD?
Avatar Cognitive and Behavioral Center can help
We provide comprehensive evaluations for women in Florida who suspect they have or know they have ADHD, including assessment and testing for attention and concentration, intelligence, and behavioral rating scales.
You can feel at ease discussing your symptoms and struggles with us. We know that ADHD symptoms in women aren’t always what society deems as “typical” ADHD. If you have “quiet” ADHD symptoms, your experience isn’t any less valid. Our care team will take your concerns seriously so you can get the treatment you need.
Our experienced bilingual psychologists and therapists (fluent in English and Spanish) can develop a personalized treatment plan to help you manage your symptoms and improve your quality of life.
We provide online Neuropsychological and Psychological Evaluations and Therapy tailored specifically for Women in Florida
Whether you’re in Cape Coral, Fort Myers, Gainesville, Jacksonville, Miami, Orlando, St. Petersburg, Tampa, or West Palm Beach, we are here for you!
