ADHD: Tauranga woman calls for more education on symptoms in females after being diagnosed at age 36

Xena Jones first noticed her “almost paralysing” symptoms at work.

The Pāpāmoa mindset coach struggled to focus and would sometimes “freeze” when talking to clients, forgetting what their conversation was about.

“I started to think
there was something wrong with me.”

At first, the 37-year-old thought she might have dementia.

Instead, last year, she was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).

Jones is sharing her story to raise awareness about what ADHD looks like in females compared to males.

“Everybody has that picture in their brain of that little boy who’s at school disrupting everyone… And it’s so different in the girls.”

Her comments come as a psychiatrist says girls and women are more likely to have undiagnosed ADHD and be diagnosed later in life.

Rotorua woman Ayla-Anne Gwilliam, 31, has previously spoken out about her costly battle to get a diagnosis while Tauranga’s Ashleigh Yates, 28, described the “ridiculous” process for accessing ADHD medication.

Speaking to the Bay of Plenty Times, Jones said she was diagnosed with ADHD a year ago, aged 36.

She said she experienced “typical” ADHD symptoms and felt “all over the place”.

“I was going from one thing to the next to the next and never finishing anything. That in itself was incredibly frustrating,” Jones said.

“It just got to the point where it was almost paralysing at times — I just couldn’t get things done that I used to be able to do.

“Just finishing projects and getting things done and then being on a call with a client… I would just freeze and have no idea what we were just talking about or what I was about to say.”

After researching ADHD, Jones asked a GP for a referral to see a psychiatrist to discuss it.

Jones was referred to a private psychiatrist in Tauranga and was diagnosed with ADHD. She is taking a medication called dexamphetamine which has been going “really well” and helping her to focus at work.

“Once you know that you are neurodivergent… it’s very freeing and very validating. And once you know that, you can actually change the way you do things to achieve things like everyone else does.”

Jones believed there needed to be more awareness and education on what ADHD looks like in females because their symptoms presented differently than boys.

Because of this, Jones believed women were getting diagnosed later in life than men, which she found “heartbreaking”.

“The lack of education and awareness, I think, is the problem.”

The Royal Australian and New Zealand College of Psychiatrists New Zealand national committee chairman Dr Hiran Thabrew said evidence showed girls and women were more likely to have undiagnosed ADHD, be diagnosed later, and “may be more likely” to receive an incorrect diagnosis of another mental health or neurodevelopmental disorder.

“While more research is needed in this area, one reason may be how symptoms present. Boys are more likely to show signs of hyperactivity and impulsivity, whereas we’re often seeing girls present with inattention as the most dominant symptom,” the child and adolescent psychiatrist and pediatrician said.

“We also often see more masking and internalisation of symptoms in girls, which can make it harder to identify.”

Thabrew said ADHD symptoms may also vary during the menstrual cycle, pregnancy or menopause.

“These are important considerations for diagnosis and treatment that we simply do not know enough about yet. More research is needed.”

Thabrew said early identification and treatment “significantly” improved the lives of people with ADHD.

Untreated ADHD was associated with an increased risk of depression, anxiety, accidents and injury, substance abuse, eating disorders and suicide, he said.

Thabrew said ADHD was “complex” and “often misunderstood”, even among many health professionals.

“Having a comprehensive framework for the identification, diagnosis, treatment and ongoing management is important for lifting the standard of care for people with ADHD right across the board.”

ADHD New Zealand chief executive Suzanne Cookson said there was “this outdated idea” that ADHD was “boys bouncing off the walls”.

Cookson said the “inattentive” subtype of ADHD was most frequently associated with females.

“They are daydreaming and have a very active, internal dialogue going on, which means they’re sort of tuned out of what’s happening in the classroom. But that is much less noticeable than a boy who can’t sit still and is blurting out and interrupting.”

A Te Whatu Ora Health New Zealand spokeswoman said it was “working hard” to improve Aotearoa’s approach to mental wellbeing, including people with neurodiverse conditions having “fair access” to help.

The intention of the current approach was for people to receive support earlier and, where possible, prevent them from reaching a point where they needed specialist treatment.

This work was being carried out with the Ministries of Health and Disabled People and the Māori Health Authority, the spokeswoman said.

The spokeswoman said ADHD was diagnosed and treated in a range of environments, including adult mental health services, primary care, pediatric/child health services, and infant child and adolescent mental health services.

People with ADHD were likely to see a range of professionals, including (but not limited to) psychologists, occupational therapists, and/or speech-language therapists. Primary care providers, such as GPs, could give advice on diagnostic testing/investigations, treatment options and where to go to get expert advice, the spokeswoman said.

“Similar to other healthcare pathways, treatment of ADHD varies based on individual needs – for instance, not everybody with an ADHD diagnosis requires medication, even though it has high efficacy.

“There is a proportion of individuals who instead receive help for managing their skills and making lifestyle changes.”

The spokeswoman said the Government was investing “significantly” in mental health. In Budget 2019, $455 million was allocated to increasing access to mental health and addiction services. In Budget 2022, $100m was invested in these services.

What is ADHD?

ADHD is a neurodevelopmental condition caused by the slower development of the frontal lobe, specifically the prefrontal cortex. This “neurodevelopmental delay” to the prefrontal cortex makes automatically controlling and filtering attention, behaviours and emotions harder. Other behaviours, such as restlessness, impulsivity or inattention, can also result from this delay.

ADHD in adults

– Living in the moment, becoming easily bored, leaving activities to the last minute.

– Racing mind skirts over numerous subjects. This and impatience can be a challenge when making realistic goals. Often over-commit, multi-task and get off-track, inhibiting the completion of projects.

– Easily distracted by noise, people walking past or email alerts.

– ADHD brains have to work much harder to control and filter attention, behaviours, and emotions commonly resulting in significant fatigue.

– Constantly tired, yet often have difficulty getting to, or staying, asleep. Headaches and allergies but succumb to food/sugar cravings, and habitual nail-biting.

ADHD in children

– Lack of routine.

– Finding food they will eat, let alone that is nutritious, is the next challenge. And that is only if they sit for long enough to eat it.

– Makes friends easily but can struggle to keep them.

– Melt-downs are a common after-school occurrence. Screen-time is calming.

Source: ADHD New Zealand

Megan Wilson is a health and general news reporter for the Bay of Plenty Times and Rotorua Daily Post. She has been a journalist since 2021.