ADHD in Women: Now It All Makes Sense
Perhaps you have noticed an uptick in middle-aged women in your life receiving an ADHD diagnosis. Perhaps you are one of the women who have received an adult diagnosis. Let’s talk for a minute about adult ADHD diagnosis in women. Why does it happen? What is the experience like? And how can a diagnosis help you move forward in your life?
First, I want to address why many women with ADHD do not receive a diagnosis until adulthood. One issue many experts note is that the current criteria for ADHD diagnosis were largely framed around little boys. If you think about the prevalence of diagnosis in decades past, ADHD was conceptualized by many as a disorder that little boys sometimes experienced. At one time, there was also a prevailing belief that people “outgrew” ADHD. We know now that ADHD is a highly genetic neurodevelopmental disorder. It affects several areas of executive functioning - skills that help you plan, adapt, manage, organize, regulate, etc. It also affects motivation and focus. And it can affect any gender.
Another reason for late diagnosis in women that is cited by experts is that of cultural conditioning. The behavioral expectations for little boys and little girls are often not the same. A little girl with hyperactivity may restrain herself from some of the behaviors the little boy would embrace because she is very aware that her social safety depends on it. In addition, the cultural demands placed upon women to be strong in their role as the caretaker of others often leave them struggling silently with the disorder, feeling like they just cannot quite measure up to what they are “supposed to” be able to accomplish. What I often find in women with ADHD, especially if they went through much of life undiagnosed, is that their hyperactivity is largely internal, presenting as racing thoughts, anxiety, self-criticism, etc. And they often feel like they “aren’t good at being a woman”.
Women with ADHD often have curated perfectionist tendencies in order to mask their struggles and/or compensate for their perceived dysfunction. This is another reason why the diagnosis is sometimes overlooked. From the outside, she looks successful and capable. The truth is often that even if she appears successful on the outside, on the inside, she feels chaotic, works significantly harder at life than others, and feels fatigue and burnout. In fact, it is not unusual for a woman with undiagnosed ADHD to be diagnosed with anxiety or depression or both. Sometimes these are co-morbid disorders, but other times the woman is misdiagnosed, as the anxiety and/or depression symptoms are actually the result of longterm untreated ADHD.
So, why does she get diagnosed as an adult? Well, there are many answers to this question, but I want to point out a few. Many women discover that they have ADHD when they are trying to help their child with their struggles. With the highly heritable nature of ADHD, women who have it are fairly likely to have at least one child who does as well. When that child goes through evaluation, the mother often realizes that she herself has the signs and symptoms. So, it is not unusual to find a woman getting diagnosed after her child. It is unfortunate that our society hinges so tightly on the silent suffering of women that she is often only able to finally address her suffering with ADHD because she was showing up as a loving mother and pouring her energy into helping her child.
Another reason that ADHD diagnoses come during midlife for women is the heavy load that women often carry in this phase of life. Women with undiagnosed ADHD often have developed many coping strategies for dealing with the disorder without even realizing what they were doing. Especially if she is very bright and intellectual, she finds “workarounds” that make her life feel a little more manageable. However, the amount and intensity of executive functioning that midlife requires, potentially with career, marriage, raising children, caring for aging parents, etc., may create a scenario where her previous coping is no longer adequate. She feels like she is drowning. And she again perceives this as failure.
And finally, and this one is huge, hormonal shifts that occur in women in midlife exacerbate ADHD symptoms. The ADHD brain struggles with dopamine production and regulation. This is why ADHD medicines that increase dopamine levels are so effective. Well, guess what? Estrogen levels are also highly impactful on dopamine production and regulation. So, the symptoms of ADHD may increase as estrogen levels fluctuate and/or fall. Another layer to this hormonal issue is that hormonal fluctuations affect the performance of many medications, so even if she receives ADHD medication, there may be some inconsistencies in its effectiveness throughout the month and year.
So, what is it like for the woman who receives a diagnosis in adulthood? There are a variety of experiences, as with all things in life, but here are a few of my own observations in my life and work about this process.
She often feels relieved. She has spent her entire life feeling “different” and not knowing why. She has internalized her struggles with executive functioning as personal failure and developed an intense “inner critic”. Finding out that many of her experiences were impacted by the way her brain is wired helps her to find validation and self-compassion. She realizes that it wasn’t about effort or failure. It was about biology. This move toward self-compassion is key to healing and thriving.
Sometimes people in her life don’t believe her. Especially if she is perfectionistic and/or high performing, her loved ones and acquaintances may balk at the diagnosis because she seems so smart and “put-together”. But the reality is that ADHD does not impact intelligence, and she is only “put-together” because she is exhausted and trying so hard. What the others cannot see is the internal struggle she faces regularly. It can be difficult if she faces this kind of doubt or cynicism while she is trying to integrate her new self-understanding into her life.
Sometimes she feels grief. At times, it is the grief that no one noticed and led her to the help that she needed when she was young. This may be especially true if she discovers her diagnosis while she is helping her own child. She may wish she could have had that advocate even if she knows she did a good job of masking her symptoms. But other times the grief is more around the phrase “If I only would have known, then………”. She realizes how many decisions she has made in life and how many struggles she has endured. She knows that if she had possessed the knowledge that she had ADHD and all that it entails, she would have done things differently. She may also decide to treat her ADHD with medication and discover how much it changes things for her. This could lead to wondering how different life might have been if she had this tool before now. This grief is important and needs space to be processed.
I saved this one for last because it is my favorite. As she learns about ADHD and how her brain works, she is often able to learn about the strengths that are a part of her brain wiring. She may discover that she is creative and able to think outside the box in ways that others cannot. She may realize that she can light up a room with her energy, and her excitement can be contagious. She may realize that her intense emotionality gives her an incredibly strong intuition that helps her love people well. Because, you see, ADHD is technically a disorder. In effect, that is largely because the world in which we live is designed for the neurotypical brain. However, the ADHD brain comes with many strengths and gifts, and for those who learn how to harness them, they are priceless.
An adult diagnosis of ADHD is something that can be difficult to process. But it can also be a turning point into a life where you create systems and structures that work best for your unique brain. It can be the beginning of radical self-compassion and increased self-awareness. It can be a turning point where you find tools and treatments that work well for you. It can be the point where you finally decide to truly embrace your authenticity. And it can be a beautiful process of discovering your specific strengths and leaning into them for the rest of your life.
