‘Where do I end and ADHD begins?’

At primary school, boys are far more likely to be diagnosed with ADHD than girls: the ratio is four to one. Things even out at the university level, however. Why is it that women are diagnosed so much later? And are their symptoms different from those experienced by men? Jente Smit, a third-year student of Media & Culture, was diagnosed while in college. That's why she wanted to cover this topic on DUB's Student Podcast. “Because of my diagnosis, I need ten alarm clocks to get somewhere on time. I also talk a lot. I've been noticing that this affects my studies and I would like to know what I can do about it and how the university can support me.”

Merel can relate to Jente's story. She too was diagnosed late in her studies. “Some pieces fell into place because of this. Things really started getting mixed up for me in college. You have to study but you also have a social life to attend to. You want to do everything but you can’t do anything. Last year, I was the coach of a rowing group at a club. It was a lot of fun but it was actually too much for me. I have a hard time setting limits for myself and then I get tired very quickly. This really affects my studies. I don’t keep my appointments, disappointing both others and myself. The tests gave me a bit of insight into the situation and I have learned to deal with it better as a result. Now I have more of a rhythm and try not to schedule more appointments than I can handle.”

Maxime de Jong works at the knowledge centre PsyQ and conducts research on ADHD. She acknowledges that the diagnosis tends to come much later in life for women. “As a general rule, things still go well at primary school because your parents make sure that you go to bed on time and girls often have a form of ADHD that is less of a nuisance in the classroom. So, it is less noticeable at school. It all starts to change in high school, once puberty hits. Even so, you see that these girls often still manage to mask and overcompensate for their flaws. But, when they enter higher education, that suddenly becomes a lot harder to do. They move out of their parents, get a busy social life and face a lot of pressure, study-wise. Suddenly it gets pretty busy inside their heads and they don’t manage to structure things anymore.”

Sometimes, guys receive a late ADHD diagnosis too. Sheetal's boyfriend is one of them. In the podcast, she talked about how chaotic he is and how he struggles to find the right balance. “He gets incredibly lost with things. The other day, I had to go to the town hall to pick up the passport he forgot there. It had been there for quite a while, actually, but he hadn’t even realised that he'd lost it.” At the same time, she thinks there is a positive side to ADHD. “People with ADD or ADHD can think out of the box more easily than most and they are very creative.”

The other students at the table agree. Jente: “I am a good team player. If there is a problem, I often come up with a solution”. Merel adds that she can get really excited about stuff. “I've noticed that my friends call me when they need a boost. They ask me for 'some Merel energy’. What they actually want is support. I’m more used to getting over disappointments.”

Three symptoms
Maxime de Jong then explains that ADHD presents three main symptoms: hyperactivity, impulsivity and inattention. A person with an ADHD diagnosis rarely has just one of those symptoms. Instead, they often get a combination of them, with one of the symptoms predominating over the others. For example, some have pronounced hyperactivity with a little impulsivity, while for others it will be the other way around and some just have all three. “The cause of ADHD is a lack of dopamine. The brain communicates through transmitters. Its cells absorb dopamine, which provides balance. It acts in your body as a kind of traffic regulator, determining which stimuli are important and which are not. If you’re low on dopamine, this traffic regulator doesn’t work properly. So, the automatic filtering function works at a lower level. In order to still function as a human being, you just have to start doing it yourself. People with ADHD actively regulate their stimuli, even if subconsciously, and that takes a whole lot of energy. That's why patients get tired so quickly. It is really exhausting.”

De Jong then points out that the start of the menstrual cycle can be an additional handicap for students. “The week before your period, oestrogen levels are low. As a result, dopamine levels are also low. In women with ADHD, this affects their functioning. As a patient once put it, minus times minus sucks. Many women get everything back on track in three weeks but then the cycle breaks it down again.”

Merel and Jente can totally relate. “I thought I was PMSing!” says Merel. Maxime confirms that premenstrual syndrome is more common in women with ADHD. 

Medication is one of the ways people deal with ADHD. It can be particularly helpful when things get extra busy or when one has a lot of exams in a row, as medication helps to boost dopamine levels. Merel: “The other day, I managed to get things just a little bit in order thanks to medication. I managed to do groceries without having to wander endlessly in the supermarket. That's something to celebrate. Following conversations gets easier with medication as well. But it makes me wonder: when do I end and ADHD begins?"

Unfortunately, medication does not solve all problems. Students with ADHD will always struggle with their limitations to a certain extent. De Jong: “We know the cause is in the brain but the way it is expressed depends on the environment and the dominating symptoms. It’s hard to measure dopamine levels and adjust medication accordingly.”

In women, an ADHD diagnosis is often linked to anxiety or depression. De Jong explains: “Women often assume that problems stem from their character. They call themselves lazy or stupid and blame themselves for a lack of motivation. They don’t understand themselves and that often creates a negative self-image which distances them from themselves. A sort of mismatch.”

Consideration
Jente would like the university to have more consideration for students with ADHD. She's recently watched an episode of the Dutch talk show Nadia about ADHD in which the guests stressed the importance of education that takes different kinds of brains into account. “The university could be more mindful of those who are intelligent but just need to work in a different way. There are too few contact hours and the three hours of lectures do not do students with ADHD any favours. But working together in groups does. Everyone has to perform in the same way now.”

Merel: “You can learn to think academically in more ways than just writing an essay or cramming and taking an exam. Sometimes it’s all about the tools you use. I hope that ChatGPT can help make reports easier. I am visually inclined, for example. So, I have an iPad that I use to make colourful mind maps and that really works for me. That way, the information stays manageable and it doesn’t become a big mess.”

Sheetal: “I see that people with ADHD are much better at thinking out of the box and they often think very specifically about solutions. It would be good to make use of these qualities in teaching and afterwards.”

Maxime de Jong agrees that the university could take students’ specificities into account better than it currently does. “You can adapt the programme with interventions, which is valuable. But it is not that easy.”

Students with ADHD tend to take longer to graduate as they have to adapt to the university's structure, which takes a lot of energy, not to mention they sometimes find it difficult to meet the requirements. Jente emphasises that it is good to inform your study advisor of your diagnosis in good time. Your study programme may also already have ways to take a disability into account. “I recently discovered that the student financing agency, DUO, has a certain scheme for students with chronic illnesses, including ADHD. If you need more time to finish your studies because of your ADHD, you can get a remission on part of your student debt. I had never heard of that before but I’m going to check out if I qualify for it because I know for sure that I will need more time.”

This is the third episode of DUB's Student Podcast, a series presented by four UU students. You can get to know them here. The episodes are in Dutch but you can always read a summary in English on our website. The first episode was about ChatGPT and all the possibilities it offers, while the second one was about being addicted to mobile phones. The fourth and last episode of this season will discuss the normalisation of drug use among students. This project is supported by funds from the National Education Programme.