Ask Dr. Saline: Woman Diagnosed with ADHD at 40 Years Old

Dear Dr. Saline: I figured out I had ADHD about 10 years ago when my daughter was diagnosed. I have never been diagnosed because it was obvious to me after I learned so much. Now that my children are grown I have been concentrating more on myself. Is there a benefit, besides medication, to being diagnosed? I’m 50 years old. Thanks! Denise Sign-up for my newsletter + Free Handout | Ask Dr. Saline

From Dr. Saline 

Dear Denise: This is an important question and I’m glad you are asking it. ADHD in women can look very different than it does in men which is why it is so often misunderstood and misdiagnosed. Before I answer your question directly, let’s look at ADHD in girls and women in context. Most of the research about ADHD has long been centered on males and the externalizing symptoms of ADHD: hyperactivity, impulsiveness, aggression, fidgeting, excessive movement, visible restlessness, disorganization, loudness, trouble waiting, interrupting, and overtalking. In fact, boys are more likely to be diagnosed with ADHD than girls (12.9% compared to 5.6%). (Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD, Blumberg SJ. Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. Journal of Clinical Child and Adolescent Psychology. 2018, 47:2, 199-212.)

ADHD in Girls vs. Women

But ADHD manifests differently in girls and women which is why it tends to be diagnosed later. Girls are far more likely to experience the internalizing symptoms of ADHD: excessive talking, tardiness, disorganization, inner restlessness, distractedness, overwhelm, perfectionism, self-harm, social awkwardness, dreaminess, or early sexual activity. These traits are less disruptive in a classroom so girls are less likely to be referred by educators for an evaluation. In addition, many girls develop strategies to overcompensate for their struggles with inattention and mask their academic and/or social difficulties. As they mature and the demands on their executive functioning skills intensify, their coping methods are less effective. They become overwhelmed, anxious, or depressed. Frequently, girls and women are referred for these mood conditions or self-harming behaviors and their attention issues are overlooked.

Hormonal Shifts & ADHD

In addition, hormonal shifts in the menstrual cycle affect the symptoms of ADHD, increasing distractibility, mood changes, and forgetfulness. The onset of perimenopause and menopause can lead to extreme mood and cognitive shifts related to the declining levels of estrogen and progesterone. Women who may have experienced mild symptoms of ADHD (known or unknown) may suddenly experience issues that seem ‘new’ and distressing to them including decreased working memory and time management abilities and increased impulsivity, reactivity, disorganization, and overwhelm.   

“ADHD manifests differently in girls and women which is why it tends to be diagnosed later. ”

 

Research

With the popularity of TikTok and other social media outlets, many women have been diagnosing themselves. In a recent study by Anthony Yeung, Enoch Ng et. al., the authors reviewed 100 videos and found that 52% were misleading and 71% misattributed symptoms to ADHD. I believe very strongly in the value of obtaining an accurate diagnosis from a mental health professional rather than a video. It’s important to discuss the symptoms and patterns of ADHD in your life with someone who is trained in this area, whether or not you decide to pursue medication. If you choose to obtain a psychoeducation evaluation, you will additionally learn a lot about how your brain works and understand strengths and challenges more fully. If you don’t, you can still assess your executive functioning skills with rating scales that a professional will explain to you.  Your ADHD likely was present when you were younger, just like your daughter. But, people knew so much less about ADHD in women and girls at that time. One study found that 74% of girls who were diagnosed with ADHD in childhood persisted into adulthood. (Yeung, A., Ng, E., & Abi-Jaoude, E. (2022). TikTok and attention-deficit/hyperactivity disorder: A cross-sectional study of social media content quality. The Canadian Journal of Psychiatry, 67(12), 899–906.  Being able to look back on some of your previous challenges in school, at home, or with peers now with the new information you have about ADHD in girls and women can put so many things into perspective. For many women, a formal diagnosis brings relief and context to behaviors that have long been puzzling. For others, there is grief about the years they lost feeling misunderstood. 

In Conclusion

I strongly encourage you to find someone to work with you who really knows about ADHD in women. This is essential to receiving the help you need to accept the wonderful, unique brain you have. Instead of listening to the inner critic and its messages of doubt and judgment, embark on a journey of learning the executive functioning skills you need to live your best life as a woman with ADHD. Join a group, listen to podcasts, seek a knowledgeable therapist or coach, and practice radical acceptance. Connect with others who have shared a similar journey so reach out to the sisterhood of neurodivergent women. You are not alone.   

 

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