Unseen, Unnamed and Still Expected to Excel: ADHD in Women and Medical Students

By Helan Paulose, OMS III, Touro College of Osteopathic Medicine Montana

As an immigrant, I’ve often found myself navigating challenges that seemed effortless for those around me. COVID was a revealing period of life. A lot of systems and structures unraveled in interesting ways. People unraveled too. “May” was a girl I’ve known since we were kids, for whom school and learning had always come naturally. But when 2020 hit, everything shifted. Classes moved online, routines vanished overnight and the structure she relied on evaporated. Without that external scaffolding, she suddenly couldn’t keep up—not because she wasn’t capable, but because the world she depended on had fallen away.

She would sit at her desk for hours, staring at lectures she could not finish. She missed deadlines. She forgot assignments entirely. The stillness of lockdown made her mind louder, more chaotic. Without the rhythm of walking to class or the pressure of being physically present, she felt disoriented and ashamed. She would get stuck for hours watching shows and movies, sort of frozen in time. She thought it was burnout. She thought it was stress, maybe depression. She never imagined ADHD.

Her story is not unusual. Research shows that women with ADHD often pass through childhood and adolescence unnoticed because they excel when strong external structures are in place. They appear organized because they must be. They perform well because the environment provides built-in accountability. When those structures collapse, the true degree of difficulty becomes painfully clear. Lockdowns were a turning point for many women. The sudden reliance on self-directed learning revealed struggles that had been hiding under routine.

In medical students, the pattern is even more intense. Across multiple studies, ADHD symptoms in medical learners range from about two percent to almost 40 percent depending on screening tools. Yet only a small percentage ever receive a diagnosis. In one large survey, students with high probability of ADHD had significantly worse emotional regulation scores, more academic struggles and higher rates of suicidal behavior, but only about five percent had ever been formally recognized. The rest were in the same position my cousin was in during COVID, fighting battles no one saw.

And because medical students are expected to be highly achieved and composed, their struggles are often misinterpreted. Faculty may view them as disorganized. Peers may assume they are not trying hard enough. Women, especially, mask so effectively that their symptoms blend into stereotypes. They seem anxious or perfectionistic rather than neurodivergent.

A phenomenological study in 2023 illustrates this perfectly. Medical students with ADHD described being misunderstood or judged for behavior rooted in untreated symptoms. Some overcompensate with elaborate organization systems. Others rehearse entire conversations to appear prepared. Many hide their distress out of fear of looking unprofessional. These were not minor coping skills. They were survival strategies in a system that demanded constant stability.

Residency highlights this even more. In one program’s remediation cohort, one in five residents had ADHD, but only a minority were receiving treatment. Their difficulties showed up as inefficiency, disorganization or repeated errors, but underneath it was untreated neurodivergence pushed past its limits.

For women, the emotional cost of this delayed recognition is significant. Studies describe themes of grief, shame and a sense of living life in a fog they can never quite clear. Many say they spent years trying to meet expectations shaped for neurotypical minds. They were taught to be calm, organized and consistent. So, they hid parts of themselves that did not match. Over time, this leads to exhaustion and burnout, the kind my cousin felt so deeply when the world shut down.

Medical training amplifies these struggles. The culture often rewards silence and punishes vulnerability. It demands composure even in the face of internal chaos. So, women continue pushing until their structure collapses.

But we do not have to keep overlooking this. ADHD in women and medical learners is not rare and not new. It is simply unseen. Research consistently shows that recognition and support transform outcomes. They replace self-blame with self-understanding.

When I think about May during that pandemic year, I wish she had known sooner. I wish someone had told her that her struggle was real and shared by many women who look put together on the outside but are fighting invisible battles inside.

The truth is simple. Women with ADHD are already doing the impossible. They are succeeding in systems that were not designed for them. And once their struggles are finally recognized, they do not just survive. They rise.

References

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