The plight of Pakistani women to get assessed for ADHD
Illustrations by Mahnoor Khan
Author chose to write anonymously.
I had just gotten off the phone with Saba. She's been struggling to get a diagnosis for ADHD for the past two years.
“Typically women who exhibit ADHD symptoms are prescribed medicine for anxiety and depression,” Saba says. “Mine was mislabeled as OCD, though I knew it was ADHD because A, it's genetic and runs in our family, and B, I’m a doctor myself and understand better. Let down by one therapist, I went to see two more but had the same misfortune every time.” Saba went on expressing her sheer disappointment. “Though I had glaring symptoms of a stereotypical ADHD-er, I was shut down, even told I’m acting up to score medicine for myself.”
This isn’t the experience of just one woman, either. While talking to ladies navigating their lives with ADHD, the questionable behavior of their mental health professionals had me thinking how stigmatized and gendered mental health is in Pakistani culture, where being born in a female body seems to mean you can have and be treated for cancer, but not ADHD.
Another Pakistani woman I talked to, my friend Sonia, shared with me the hardships she faced looking for validation of her feelings.
“I signed up for therapy to understand why I swung between dull moments to intense concentration only to hear: You can’t have ADHD. That happens to kids only.” Her psychiatrist dismissed the possibility when she emphasized getting assessed for ADHD. He assumed she had BPD.
Both of these women withdrew from therapy after a short while.
Mahnoor Khan
Throughout my journey with ADHD, I leaned into learning coping mechanisms and made do without medication until I hit a point where medical intervention became necessary for me.
My 20s went by being distracted, inattentive, and impulsive. On the surface, what looked like a lack of discipline or bad memory was just a manifestation of one of the symptoms. With my head always up in the clouds, halfway through the movie, I’d forget the plot or the protagonist's name. It was troublesome, but my inner monologue screamed, “You’re the issue.”
Wanting to get things done the neurotypical way, my neurodivergent self would make a to-do list, hoping to check off the list item by item. The activity would get me pumped up, but my impulsive nature usually derailed me. And if completing a to-do list was tough, building a lasting habit was a nightmare. I often turned to productivity apps, but couldn’t stick with them.
While I was beating myself up for zoning out, I failed to initially notice that it’s not inattention but dysregulated attention that caused me issues. Studies show the signs of ADHD are less physically apparent in girls than boys, with girls experiencing “associated internalizing problems” related to inattention (studies are often conducted on children with ADHD). Now I get it: there is no deficit of attention in ADHD, which makes the name of the condition unhelpful, to say the least. We pay attention plenty — to what commands our attention.
Mahnoor Khan
In Asian cultures, women have this silent expectation to be super. Anything less is unacceptable. When we hear the word ADHD, many people still think of it as a men’s issue because women in our society are often expected to be compliant and competent. The research skewed heavily toward boys adds to the problem. What this stigma perpetuates is a culture of denying diagnosis to women.
Misconceptions about ADHD can be damaging to those with it — especially women. ADHD is not a condition for only one gender. Girls are as prone to having it as boys are. But because it can manifest differently in women, they are often subjected to a runaround or point-blank denial of the condition by healthcare providers.
On our side of the hemisphere, where the masses grapple with the struggle for fair pay and equal rights, this health disparity is yet another man-made calamity inflicted upon women. The discrimination is pervasive and harmful, but nothing new. Nonetheless, women with ADHD are everywhere and need support. You have almost certainly encountered at least one or more women with (diagnosed or undiagnosed) ADHD.
It's time we establish communities that help build solidarity and strength — and push for awareness and comprehensive diagnosis to break the cycle.
Women are largely underdiagnosed/misdiagnosed because of their ability to mask the symptoms, which is what we call it when people make an effort (consciously or not) to make certain traits less visible to others. This is often chalked up to socialized leanings toward people-pleasing and high communication levels. But masking is akin to putting makeup on a wound — it might conceal the issue, but won’t heal it. What it certainly will do is prolong suffering in the end. So here’s to removing the mask and fighting against stigma each and every day. Neurodivergence is beautiful and women with ADHD deserve more and better chances at self-acceptance, in Pakistan and beyond.