Undiagnosed ADHD in women poses extra barriers to remote learning

As the Winter 2021 semester comes to a close, many McGill students have reported a range of challenges in finishing the academic year. One challenge in particular affects some students more than others, and often does so without their awareness: An undiagnosed mental disorder. Attention Deficit Hyperactivity Disorder (ADHD) often goes under-diagnosed among women, largely due to differences in the way symptoms present themselves across genders and the gender-bias present in the medical field. With McGill’s mental health services coming under strain over the pandemic, some students allege that diagnostic services have become harder to access.

ADHD is listed among the Diagnostic Statistics Manual of Mental Disorders (DSM-5), and is characterized by pervasive issues with executive functioning—which include activities like attention, organization, time management, and self-control.

While individuals with ADHD often struggle academically, Tina Montreuil, assistant professor in the Department of Educational and Counselling Psychology and associate member of the Department of Psychiatry at McGill, emphasized that the difficulty is not due to a lack of cognitive ability.

“ADHD, a lot of [the] time, affects the individual not at the cognitive level,” Montreuil said. “So when we assess individuals [with ADHD] cognitively, there are people that do really well. But, when you look at their functioning at the executive level, in terms of attention, concentration, focus, there seems to be some difficulties or deficits.”

There are two common types of ADHD: Inattentive and hyperactive-impulsive. The inattentive type is characterized by concentration issues, such as an inability to focus during a lecture, and the hyperactive-impulsive type—which is typically more present in boys—is characterized by poor impulse control and restlessness. 

Steven R. Shaw, associate professor in the Department of Educational and Counselling Psychology at McGill, explained that ADHD symptoms present differently in each individual.

“ADHD is one of those topics that everyone thinks they know a little bit about,” Shaw said. “But in fact, it is very difficult to make a diagnosis, and everybody who has it is very different […] It is not something where there is a typical case.”

While many students report struggling with mental health issues, an important step to treating a mental disorder is getting a diagnosis. According to Teri Phillips, the director of the Office for Students with Disabilities (OSD) many students have struggled to access diagnostic services this year.

“Anecdotally, and particularly during the COVID-19 pandemic, it seems that accessing assessment services have been measurably more difficult due to the need for certain in-person activities as part of a thorough assessment process,” Phillips wrote. 

Statistics show that for every two males, one female is diagnosed with ADHD. Montreuil believes that gender biases present in the medical field are part of the reason behind the diagnosis gap.

“Sometimes, because of gender biases, these [symptoms] will be excused in males with the assumption that males are just less calm than females,” Montreuil said. “That is just a construct and a stereotype we are assuming. That can also impact referrals, diagnosis, and just helping in general.”

Juliette Vermes-Monty, U2 Arts and Science, spoke with The McGill Tribune about her personal experience in receiving an ADHD diagnosis and the impact that it had on her. 

“I did not get diagnosed for many years, so there was this constant battle of being too loud but not hyperactive enough to have ADHD,” Vermes-Monty said. “When I got diagnosed […] my life completely changed because […] although I did not fit the stereotype of ADHD, it made sense all of the struggles I had gone through in the past.” 

Certain symptoms of ADHD, such as hyperfixations, can be exacerbated by rigid teaching styles. Hyperfixations are a non-specific symptom of ADHD which manifest as a total engrossment in  a particular activity or interest. Phillips explained that there is a fine line between productivity and exhaustion when dealing with one’s hyperfixations.

“Counting hyperfixation as a superpower rather than an obstacle is definitely doable, […] however balance is the key,” Phillips wrote. “While focussing on an assignment for five hours straight might seem like a good idea, this neglects all the other things your mind and body need to be balanced.”

Vermes-Monty spoke about the complicated power of immersing herself into a hyperfixation, noting the importance of taking breaks.

“I sing and I play the ukulele, and also I sew,” Vermes-Monty said. “Those are things that once I start, I do not stop for hours [….] Last semester, […] I really did not have the time, and I would feel like I was wasting my time focussing on these hobbies. When you allow yourself to take breaks, it is fun to be so immersed in something.”

According to Shaw, professors who follow status quo teaching styles—often characterized by rigid grading structures, similar lecture styles every week, and rigorous academic workloads—may contribute to learning procedures that do not benefit students with ADHD.

“The undergraduate instruction can be quite uneven in terms of acceptability,” Shaw said. “You will have some professors who are wonderful in […] providing a scaffold for which things can be developed, [and] really helping students to develop skills. But you will also have other professors who may really have a difficult time avoiding the cookie cutter approach, [and] they tend to be more comfortable with that [approach].”

Vermes-Monty encouraged students with ADHD to embrace their own learning styles when navigating the learning structures in place.

“I wish that I had not been pathologized by the school system,” Vermes-Monty said. “The [educational system] is so narrow that you are bound to not fit into it, and it is totally okay. It is hard to believe that and tell yourself that […] because so much of our lives are based on how well we do in school [and] how well we fit in with the system [….] At the end of the day, if you do embrace the way that you learn and listen to your mind and your body and your intuition, it is going to help you.” 

Vermes-Monty added that students with ADHD exemplify the importance of prioritizing mental wellbeing and seeking help when struggling—two key ways to being resilient in the face of stress.

“I feel like in the past my ADHD has not been that big of an issue,” Vermes-Monty said. “Because I have had my accommodations [and] with my medication, I have been able to focus for the most part. But [last semester] was the first time that that was no longer enough for me, and I just did not really know what to do about it. This semester I just learned to prioritize myself.” 

Despite the dealing with the hurdle of dealing with undiagnosed ADHD, Montreuil urged students to continue to push forward in their journeys through university.

“We want [teenagers and young adults with ADHD] to feel as though ‘this is who you are,’” Montreuil said. “With the right environment, the right strategies, and the right accommodations, some people go on to being very successful. But it first starts with [individuals] acknowledging this and then advocating for what [they] feel [they] need to really optimize [their] potential.”

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