More than half of individuals with ADHD — and significantly more women than men — were diagnosed in adulthood, according to new data published in the U.S. Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR).¹ These findings constitute the CDC’s first update on the prevalence and age of diagnosis for ADHD in nearly 20 years.

The CDC report, which found that 6 percent of U.S. adults have a current ADHD diagnosis, identified several gender-based discrepancies regarding the age of diagnosis. Sixty-one percent of women received their ADHD diagnosis during adulthood, compared to 40 percent of men. One-quarter of women received an ADHD diagnosis before age 11, compared to 45 percent of men.

“Taken together, these data highlight the significant public health burden of ADHD and challenges experienced by adults with this diagnosis,” said Greg Mattingly, M.D., president of the American Professional Society of ADHD and Related Disorders (APSARD), and Ann Childress, M.D., past president of APSARD, in an article published in Psychiatric Times.²

The MMWR analyzed data collected from the National Center for Health Statistics Rapid Survey System (RSS) from October through November 2023 on the prevalence, treatment barriers, and telehealth usage of adults with ADHD.

Consequences of Undiagnosed Adult ADHD

Once considered a childhood condition, ADHD is now recognized as one of the most common mental health conditions in adults, affecting men and women almost equally. ³,⁴ A new national survey of 1,000 American adults by The Ohio State University Wexner Medical Center and College of Medicine revealed that as many as one in four adults suspect they may have undiagnosed ADHD, however, only 13 percent have consulted a doctor about their suspicions. The researchers say the findings raise concerns that self-diagnosis may lead to incorrect treatment.

“In recent years, the number of adults diagnosed with ADHD has risen significantly – thanks, in part, to decades of research that has advanced awareness of ADHD as a lifelong disorder,”⁵ wrote APSARD secretary Maggie Sibley, Ph.D., in the ADDitude article, “Why We Need U.S. Guidelines for Adults with ADHD.” “Though ADHD is commonly detected in childhood, later-in-life diagnoses are providing clarity and relief for many adults with once unexplained, misunderstood, or overlooked lifelong struggles.”

Untreated adult ADHD symptoms may impair individuals personally and professionally, and they may exacerbate comorbidities like depression, anxiety, bipolar disorder, insomnia, substance use disorders, and trauma-related conditions. ⁶, ⁷

“ADHD does not happen in a vacuum, and its effects are far more impairing when the condition goes undiagnosed, untreated, or improperly treated,” said Nelson M. Handal, M.D., DFAPA, in the ADDitude webinar, “New Insights Into and Treatments for Comorbid Depression” “It’s not difficult to see how untreated symptoms of ADHD — from impulsivity and emotional instability to poor planning and execution skills — compromise one’s ability to find success in school, work, relationships, and other parts of life.”

Even with an ADHD diagnosis, adults face barriers to care amid the ongoing stimulant shortage. Approximately 7 in 10 adults treating ADHD with stimulant medications reported difficulty obtaining their prescriptions, the CDC found.

The CDC’s findings suggest that telemedicine may improve access to healthcare and decrease systemic discrepancies in care. Nearly half of adults with a current ADHD diagnosis said they received some of their ADHD healthcare via telemedicine.

“These benefits must, however, be balanced with the need for thorough diagnostic evaluation and follow-up for both the in-person and virtual models of care,” said Mattingly and Childress.

“Some telehealth companies are under federal investigation for their prescribing practices, highlighting a need for clarity on appropriate practices for the prescription of stimulants – a first-line treatment for ADHD,” Sibley wrote. “APSARD’s forthcoming adult ADHD guidelines will address this urgent need for providers and patients alike — making evaluations more thorough, diagnosis more reliable, and treatment safer.”

Importance of Adult ADHD Guidelines

The Ohio State study and CDC data underscore the need for adult ADHD diagnosis and treatment guidelines, which APSARD is working to finalize by late this year or early 2025.

“These will be the first U.S. guidelines for the diagnosis and treatment of adults with ADHD, and they will provide a valuable framework of treatment for clinicians and families,” said Mattingly and Childress. “While many unanswered questions remain, these findings bring us one step closer to a deeper understanding of the needs of adults with ADHD.”

The impact of the APSARD guidelines may be felt most profoundly by adult women.

“Many women do not recognize that they have ADHD or seek evaluations until their children are diagnosed,” wrote Childress in an ADDitude article earlier this year. They are often treated for anxiety or depression that developed secondarily to ADHD. Helping clinicians recognize the difference in presentation of ADHD symptoms in women is important.”

Sources

¹taley, S.B., Robinson, L.R., Claussen, A.H., et al. Attention Deficit/Hyperactivity Disorder Diagnosis, Treatment and Telehealth Use in Adults – National Center for Health Statistics Rapid Surveys System, United States, October – November 2023. MMWR Morb Mortal Wkly Rep. 2024;73(40)

² Mattingly, G., Childress, A. (2024). Clinical Implications of Attention-Deficit/Hyperactivity Disorder in Adults: What New Data on Diagnostic Trends, Treatment Barriers, and Telehealth Utilization Tell Us. J Clin Psychiatry; 85(4): 24com15592. https://doi.org/10.4088/JCP.24com15592

³Ayano, G., Tsegay, L., Gizachew, Y, et al. (2023). Prevalence of Attention Deficit Hyperactivity Disorder in Adults: Umbrella Review of Evidence Generated Across the Globe. Psychiatry Res; 328:115449. https://doi.org/10.1016/j.psychres.2023.115449

⁴Faraone, S.V., Bellgrove, M.A., Brikell, I., et al. (2024). Attention Deficit/Hyperactivity Disorder. Nat Rev Dis Primers; 10(1):11. https://doi.org/10.1038/s41572-024-00495-0

⁵Sibley, M.H., Arnold, L.E., Swanson, J.M., Hechtman, L.T., Kennedy, T.M., Owens, E., Molina, B.S., Jensen, P.S., Hinshaw, S.P., Roy, A., Chronis-Tuscano, A. (2022). Variable Patterns of Remission from ADHD in the Multimodal Treatment Study of ADHD. American Journal of Psychiatry;179(2):142-51. https://doi.org/10.1176/appi.ajp.2021.21010032

⁶Kessler, R.C., Berglund, P., Chiu, W.T., et al. (2004). The US National Comorbidity Survey Replication (NCS-R): Design and Field Procedures. Int J Methods Psychiatr Res; 13(2):69–92. https://doi.org/10.1002/mpr.167

⁷Katzman, M.A., Bilkey, T.S., Chokka, P.R., et al. (2017). Adult ADHD and Comorbid Disorders: Clinical Implications of a Dimensional Approach. BMC Psychiatry. 17(1):https://doi.org/10.1186/s12888-017-1463-3

Art is Hayley Wall’s love language. Since Wall was a young child, she has found her footing as a communicator through drawing. Wall struggled academically as a child due to dyslexia and undiagnosed ADHD and autism, but she says, “What I did have was this gift where I could create images and I could tell stories.”

When Wall graduated from university and considered where to take her art, she was drawn to the topic of disability. “I was exploring the things I felt were important, the things that needed to be spoken about,” Wall explains. “My mom is disabled, so that’s been around me for a long, long time and it’s felt like people with disabilities are always the last to be thought of.”

Wall was asked to illustrate an article on chronic illness for the cover of Sick magazine, and then another on the same topic for It’s Nice That. These illustrations caught the attention of The New York Times, which commissioned Wall to illustrate a package celebrating the anniversary of The Americans with Disabilities Act. Her work became known for her signature bodies — large, gender-fluid forms, typically without faces, that exude strength, joy, and confidence.

As Wall’s art career gained momentum, so too did her personal journey to understand her own neurodivergence. Though Wall struggled with mental health challenges all her life, it wasn’t until she was 34 that she received a diagnosis of ADHD and autism.

Below, Wall shares her creative process, the challenges and joys of being a neurodivergent artist, and her commitment to a future that celebrates different minds and bodies.

[Read: “Happily Neurodivergent — at Last”]

Q: How did your diagnoses come about?

I’ve always wondered, ‘What’s wrong with me?’ and always struggled with my mental health. It was a feeling of being too much — too emotional, too sensitive, I always carried this feeling of, I just don’t fit in.

When I was 30, I sat down with my partner at the time, and was like, ‘I found this article about adults that have been diagnosed with ADHD and I’ve just done multiple quizzes. Can you do the quiz as well, please?’ They did, and they scored really low. I was like, ‘So you don’t do that? And that?’ It made me think, ‘OK, I think something’s going on.’ I approached my general practitioner, and from there, it took four years to get a diagnosis.

When I was 36, a year ago, I got diagnosed with autism and a mental health condition. I’m coming to terms with all these diagnoses and trying to understand how to navigate them. To me, what’s more important is not the label but just working out what I need.

Credit: Hayley Wall, illustrator

[Self-Test: Autism Test for Adults – Signs of ASD]

Q: When did your love of art begin?

I was a kid who bounced off the walls, I had so much energy. I wouldn’t shut up, and I would cry and scream. To calm me down, my parents would give me pens and paper and I would draw. It was the one time I was calm and focused.

Q: How does your ADHD inform your work?

After graduating, it took me 8 to 10 years to establish myself. I’ve done so many random jobs. I’ve worked as a nanny, in factories, in cafes. But running parallel to that was my hyperfocus, which kept me on track to pursue art. My hyperfocus is the reason I’ve been able to turn art into a career.

My work is all about bodies, usually gender ambiguous bodies. They are these big bodies that take up space — maybe because I’ve always felt really small and inferior. The bodies in my work are powerful. I can live through them.

The whole ‘taking up space’ idea is a big f&*k you to society for being like, ‘You have to be like this, or like that.’ It’s, ‘No, we can be whomever we want to be.’

Q: Can you tell us about your creative process?

A commission will come through and it’s like jumping on a roller coaster. There’s a voice that goes, ‘Here we go.’

I center myself and breathe to remove any negative voices and let the process take me.

As I read the commission, the visuals start coming, and my brain is joining dot-to-dots. I have a background in dance, and the dancing lives in my work now. Sometimes I’ll get myself or my friends into different positions and I’ll draw from that. I create loose, playful hand-rendered drawings and textures, and then I bring it onto my computer to work with.

Once I’ve got my concept down, I enter the most playful part of the process. I can enjoy coming to the end of the roller coaster nice and slowly.

Q: What’s the hardest part of your job?

The first bit of the process, mind-mapping concepts, is hard because I’ve got so many ideas, and I need to hone in. It’s the organization of thoughts that’s hard.

What crushes mind-mapping is impostor syndrome, a feeling I’ve carried of being inferior. I wish I was able to remove that saboteur voice that creeps in to say, ‘You’re not good enough,’ so I could just let my brain run free.

Q: What ADHD supports have you found helpful?

Freelance work is definitely hard because you don’t have HR, you don’t have colleagues to turn to. You are your absolute everything, and it’s really tough.
I was doing it for a long time all by myself, and I reached burnout. My mental health crashed.

In the UK, we are very lucky in terms of the benefits we get from the government. The ‘Access to Work’ program offers a sort of grant or reimbursement scheme to cover the cost of a support worker. It has been very helpful to me, and I’ve used that to have somebody support me through the admin tasks.
I never want to go back to a point where I’m trying to manage it all alone.

Q: Any advice for other artists with ADHD?

If you can tune into your voice and communicate your story, that’s when you’re going to create something nobody’s ever seen before.

Q: Where are you now on your journey of understanding your neurodivergence?

With the community I’ve found, I have a feeling of being able to unmask, to be my true self, to be able to be too much, weird, overly emotional, and sensitive.

Recently, I did a commission for a London museum and library called The Wellcome Collection. They asked me to respond to an article written by a person who was diagnosed with autism as an adult, and because this piece was so personal to my experience, I really wanted to place myself in the work. It was a three-part series: before, during and after diagnosis.

For the final image, I Photoshopped my face in quite a warped way onto the figure. I’ve hid behind my work for years, so to put my own face on this figure felt quite important. It was like, ‘I’m unmasking now. I’m showing myself. I’m allowing myself to actually come through. This is me.’

ADHD, Art, and Mental Health: Next Steps

• Read: Stifled Creativity and Its Damaging Impact on the ADHD Brain
• Read: Why ADHD Masking Is a Form of Self-Sabotage
• Read: “I’m Not Hiding My ADHD Anymore”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Rachel Feinstein finds herself in some ridiculous situations courtesy of her ADHD. Because she’s been gifted with a razor-sharp sense of humor, she takes these unlikely, sometimes absurd moments and turns them into comedy gold in her stand-up routine.

Rachel is a nationally touring comedian and actress whose newest hour-long comedy special, Big Guy, is now streaming on Netflix, where it premiered in the Top 10. In it, she talks about everything from her aggressively liberal mother and Facebook-blundering dad to the odd-couple relationship she has with her fire chief husband, who affectionately calls her “Big Guy.” In vivid detail, Feinstein illustrates how perplexing and frustrating her annoyingly neat husband finds her chronic messes.

“One morning, I walk into the kitchen and my husband is just pacing,” she recounts. “He goes, ‘One question. I got one question for you: Why are there three open seltzers? I’d love to hear the story behind that.” And I’m like, ‘It’s not gonna be a good tale. It’s not like I’m gonna tell you ‘Well, there was blow and hookers and then three open La Croixs!’”

Feinstein’s been praised for her “amazing impersonations” (Vulture), “acute observations,” and ability to be “subtly, exquisitely attuned to her audience” (AV Club). She’s had three Comedy Central specials, co-hosted The View, and been a guest on The Tonight Show with Jimmy Fallon and Last Week Tonight with John Oliver, among other late night shows, not to mention her slew of TV and film appearances. And she’s the mother of a three-year-old, who provides plenty of comedy material. “My daddy’s a hero,” her daughter likes to say. “And my mommy’s sarcastic.”

Below, Feinstein opens up about the good, the bad, and the funny of her ADHD journey.

[Read: In Praise of the ADHD Funny Bone]

Q: What does your ADHD look like?

I am insanely disorganized. I am always running late. I shed debit cards. I’m always leaving a shoe in somebody’s car. I lose a passport almost every year.

My husband, who is OCD, always says to me: ‘Why don’t you just put things back in the same place?’ And I’m like, ‘You’re assuming I know where I put them. My hands take trips throughout the day. It’s like my hands are not connected to my body.’

I’m a workaholic — but only if someone’s sitting with me. I always have to have a babysitter for myself. I pay people to sit with me.

[Read: Get More Done With a Body Double]

So, for example, an editor expressed interest in working with me on my Netflix special, but I knew I was never going to go through it and email him time codes. So I said to the editor: ‘I’m going to come to your house and sit with you and edit every line with you.’ I don’t think he thought I was going to really do that. Then I was over at his place — just me and him and his wife in his little apartment. I’d leave and bathe and give him time to implement notes, but we were together for two weeks and we got it done. I think we were common law wed by the end of that process.

Q: What was school like for you?

When I even smell a school now, it brings me back to all these weird bad feelings about myself. Ever since I can remember, I was always doing so terribly in school. I was failing, getting Ds and Fs in my public school. They couldn’t stuff information into my brain. I had no idea what was going on in any of the classes. I remember getting 23% on a quiz and thinking, ‘Wow! I can’t believe I know 23% of this!’

I felt like a quaking, throbbing mess in school. It created my core self-esteem issues. When I was 11, I was diagnosed with ADHD, inattentive type.

Then, junior year in high school my parents took me out of the local public school and got me into a tiny Quaker school. There were 60 kids in the whole school, 8 kids in each class. I was able to learn there. I wasn’t distracted and confused. I had a 3.8 GPA for a beat.

Q: When did your love of comedy begin?

From very early on, I loved accents and imitating people and affectations. My parents got me into acting classes and I’d put on living room plays and impersonate everyone in my family.

I always thought I had to entertain people. I remember trying to make everybody laugh in school — and being good at that. That was one thing I could do.

Q: How does ADHD inform your comedy?

I think about things in a funny way. I wasn’t able to think about things in a straight way, so that was the only option left available to me. I need things to hook on to that are funny; that’s what helps me pay attention. So, if someone uses a weird word choice, I’m going to notice what’s funny about it, otherwise I won’t retain anything.

My mom said I was always friends with people who had very distinct personalities and accents — it woke me up, jolted me. That’s true to this day; I’m married to a Brooklyn firefighter pronounced “fiya fida.”

Q: What’s your favorite part of your job?

When I’m on stage, I get a very immediate reaction: it either works or it doesn’t. I am addicted to it, the way my husband’s addicted to the adrenaline rush of being a firefighter. This also helps me as an editing process: I know what works and what doesn’t, and I shed, shed, shed as I go.

The other great thing about stand-up for somebody with ADHD is once you’re booked, you have to do it — you have to be on stage. It’s not something you have to turn in; if it was, I’d never turn it in.

Q: Your least favorite part of your job?

The constant rejection, which mimics all those bad feelings I had about myself in school. There’s always a new insult, even when you think you’ve gotten past that and you’re accepted.

I have to retrain my mind every day to not focus on the person that isn’t into me, that doesn’t like what I’m doing. When the rejection starts to take its toll, I go to the Comedy Cellar and have an immediate connection with the audience.

Q: Where have you found inspiration or encouragement along the way?

I had a therapist who told me that I could juggle a lot of things and that I could grow up and do something where I could be thinking of a million things at once. I remember thinking, ‘This is a man with a desk, who went to graduate school, and he believes this?’ I thought. ‘If Dr. Castellano thinks I won’t be in a Gray Gardens situation for the rest of my life, maybe I won’t be.’

Later, when I was 17, I moved to New York with this random guy and his band, which was named ‘Dick’s Sister.’ I was very obsessed with guys at the time, thinking more about them than what I was going to do with the rest of my life. I had a vague idea of being something funny.

I really didn’t know how to keep a job and I kept getting fired from everything — waitressing, bartending. Then I started nannying for this five-year-old boy with autism. That was the one job I could keep. I really related to his struggles.

I remember I’d tell him, ‘Go put that in the trash can and come right back,’ and he’d get caught between where we were sitting and the trash can. I’d see him get almost there and then get lost. I really related to the feeling of making it halfway to what you were supposed to do. I still do that — I do most of the work and it falls apart at the end.

I worked really hard at the nannying job because I just had this feeling that he had really complicated thoughts, that he was really smart. I didn’t know if I was projecting onto him, but there really was something very special and creative and gifted about him. He ended up going to Harvard. We’re still in touch. He came to my wedding!

It was the first successful experience I had of following something through, until I did stand-up full time. He taught me a lot more than I taught him.

Q: What’s your advice to other people with ADHD?

For anyone who struggles with those old bad feelings from school, my message would be what a lovely therapist said to me: Believe in the way your mind works. Do what you need to do to support yourself.

What might be considered indulgent or lazy might be your own weird route to success. When I was getting started, I did stuff like take cabs everywhere because I was always late. That’s the way I had to do it. I knew I would never be the person who was going to take two buses and be there on time. I spent money to make money. I bet on myself.

ADHD and Comedy: Next Steps

• Read: Laughter Is the Best Medicine
• Watch: “ADHD is Awesome – The Holderness Family Guide to Thriving with ADHD”
• Read: Laugh It Up
  
• Read: Stifled Creativity and Its Negative Impact on the ADHD Brain

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Women who reported physical intimate partner violence (IPV) before menopause experienced a significantly greater decline in working memory after menopause as compared to women who had not reported violence, according to new research.

Comprising a subgroup analysis of the Study of Women’s Health Across the Nation (SWAN), this research revealed that women who reported physical intimate personal violence showed an annual decline of 0.17 points in working memory performance post-menopause, compared to women who had not reported IPV. Declines in other areas of cognition, including processing speed and verbal memory, were not observed.

SWAN is a multisite, longitudinal cohort study that began in 1996. It seeks to investigate physical, psychological, and social changes that occur during midlife. Baseline information was collected at the start of the study from participants, women aged 42 to 55, and follow-up visits continue to be conducted annually. The subgroup analysis focused on IPV was led by Jillian Baker, MPH, of the University of Michigan in Ann Arbor, and presented at the annual meeting of the Menopause Society this month.

Baker’s subgroup analysis measured the cognitive performance over time of women who reported physical IPV in the year prior to the SWAN baseline. That subgroup comprised 3.1% of all participants.

The cumulative effect of working-memory decline can dramatically impact quality of life. “Over the course of several years, a decline like this would equate to a drop of nearly two points. and a ten-year change of nearly two points is objectively a loss of nearly a quarter of the average baseline score,” Baker explains. “We think of working memory as the ability to follow directions you just heard or to remember the steps of a task you need to do. If this function is impaired, it can feel pretty debilitating.”

Connecting IPV to Working Memory Impairments

Much remains unknown about how physical IPV contributes to working memory decline. Baker explains that many survivors of IPV have experienced brain injury, often repeatedly, which is linked to changes in cognitive performance. In addition, IPV survivors often struggle with mental health conditions including anxiety, depression, or post-traumatic stress disorder. They may also experience poor sleep and chronic hypervigilance, which may have a deleterious impact on working memory.

“We need more research into these potential mechanisms,” urges Baker. “As they may indicate points of intervention to prevent declines in working memory.”

Another question that remains: Why was physical IPV associated with working memory decline but not with declines in other areas of cognition? These unknowns underline the necessity of additional research, says Baker: “This work sends a strong signal that the association between intimate partner violence and change in cognitive performance is worth studying further.”

Implications for Women with ADHD

Research has proven that women with ADHD are at a particularly high risk for physical IPV due to low self-esteem, high rejection sensitive dysphoria (RSD), and social skill deficits. A study published in the Journal of Abnormal Child Psychology found that:¹

• Girls with ADHD were five times more likely to be victims of physical intimate partner violence than non-ADHD girls (30% vs. 6%)
• Greater ADHD symptom severity in childhood was associated with increased risk for physical victimization

While the sub-analysis did not include data on ADHD, Baker notes that, “it is both an interesting and important research question to understand how ADHD may play a role in this association,” especially given that women with ADHD often struggle with pre-existing challenges in working memory.

According to the WHO, one-third of women worldwide will experience some form of intimate partner violence during their lifetime, making this research critical to a broad audience of women. “Millions of women are at risk for health effects of partner violence,” says Baker. “We hope this research contributes to the call to invest in violence prevention and support for survivors.”

Sources

¹Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.

Rebecca Makkai is a New York Times bestselling author whose books have been translated into more than 20 languages. She is a Pulitzer Prize and a National Book Award finalist. She teaches graduate fiction writing at Northwestern University, among other places, and is artistic director of StoryStudio Chicago. A review of her accomplishments would leave you wondering: What can this woman not do?

The answer? Laundry.

Putting away clean laundry, according to Makkai, is an “insurmountable task.” So is making doctors’ appointments, keeping track of her keys, tolerating conversational lags, and opening a package neatly with scissors. These are the parts of ADHD that Makkai, who was diagnosed just three years ago, finds frustrating. But for Makkai, these annoyances are just a small part of the big neurodivergent picture.

Makkai says ADHD affords her the hyperfocus, bold instinct, and associative thinking that’s allowed her to craft novels like I Have Some Questions for You and The Great Believers, lauded as “spellbinding, “enthralling” and “emotionally riveting” by media outlets including The New York Times Book Review.

“My mind goes in 17 different directions at once, and I’m constantly reaching for new ideas. Everything in the world contains a million things behind it and they’re all fascinating,” Makkai explains. “I’m sure that there are certainly plenty of artists who are linear thinkers but, to me, that feels like a disability. You’re trying to make art and you can only think of one thing after another in a straight line?”

[Download: Your Free Guide to All the Best Parts of ADHD]

Below, Makkai talks about her recent ADHD diagnosis, the gift afforded to her by an unusual education, and how she harnesses the powers of her neurodivergence to create unforgettable stories.

Q: When were you diagnosed?

I was diagnosed two or three years ago, mostly because I have a daughter who is not neurotypical and I was doing these online quizzes for her.

The diagnosis was almost entirely a relief and a revelation. Now, when I lose my keys or mis-manage my time, I know I have reasons other than ‘I’m lazy, I’m spacey, I don’t care.’ It offered me the ability, in certain situations, to stop masking and to help my daughter, who got diagnosed after I did.

[Read: Not Ditzy. Not Lazy. And Definitely Not Dumb.]

It’s been amazing to look back and acknowledge how much of my life I’ve faked, how often it’s like I’m listening to a radio with very poor reception, catching three words and pretending I know what’s going on.

Q: What does your ADHD look like?

I live in a world in which objects move behind my back. I put down my keys and they’re gone. Streets rearrange themselves.

My physical hyperactivity is subtle. If I stand near the food at a party, I will not stop eating — not because I have food issues, but because eating is something to do with my hands. I can only slow down my rapid speech with effort, and I panic at conversational lags. It takes everything I have not to interrupt people constantly.

I have a highly associative brain and a tendency to start several sentences at once. I’ve learned to explain this to my writing students on the first day of class. I’ve learned to start a lot of sentences with “Sidebar” and hold up one finger so students understand that I’m not permanently derailing the conversation.

Q: What was school like for you?

Traditional school can be an ADHD torture chamber. I went to Montessori School until 8th grade, and it was perfect for this kind of mind. It was like, ‘OK, you’re not in the mood for math? You’ll have to do it eventually, but right now, you can go do a report on hedgehogs and knock yourself out doing that for three days. When it’s time for math, you can write your own word problems, or you can do it with a friend, or you can do it in the hall.’

There are so many plusses to this, the biggest one of which is that I learned how my brain works and how I get work done. I’ve been able to carry that with me.

I’m not someone who writes every day. Why would you write every day? If I sit down to work and I’m not in a place to write, then I research. I can do other stuff all week and then I can write for 16 hours if I’m in the mood, so I’m not going to beat myself up for not writing 1,000 words every day.

Before I published my first book, I taught Montessori for 12 years, and that was great for me. There are 30 things going on all the time and you have to pay attention to all of them. I’d be helping a kid with long division, keeping an eye on a discipline issue, answering a question for another kid. Give me that all day long.

Q: How does your ADHD inform your writing?

I’m happiest when I’m doing five things at once. If I could somehow ride a bike and do a Sudoku puzzle and watch a movie and drink a smoothie at the same time, I’d be in heaven. The great news is that the mental juggling you have to do in order to hold a 300-page novel in your mind — ADHDers were built for that.

I teach a lot of really talented writers and I’ve noticed that one of the things that really holds a lot of people back is a dearth of ideas. They start something and they have a couple of elements going on, but they don’t have the urge to add more things that might enrich this. They are marching along this straight and predictable path, which can make for boring writing.

I think a lot of people don’t have good boredom detectors. People who have an above-average sense of patience are going to overestimate the patience of most readers. I am so easily bored that, if I can manage not to bore myself, I probably won’t bore anyone else.

I don’t have infinite patience with a text that’s beautiful but there’s no real craftsmanship to the plot. It’s an art to be able to keep hooking people.

Q: Do you have any ADHD hacks for getting work done?

Deadlines are fantastic for me; they kick me into high gear. Often, I really can’t bring myself to do it until the day before and then I suddenly put my cape on and fly at it and it’s great.

For example, I have a writing group and I know that, if I’ve told them I’m going to get them pages by our meeting on October 1, I have to get those pages to them by then. That helps a lot.

I’ve learned to lean into the sprint in little ways, too. I’ll fail to plug in my computer, realize it’s running low on power, and then try to see how much I can write before it dies. One of the reasons I write well on an airplane is I know I only have so long before they say you have to put away your laptop.

Then, too, so much of the business of writing is not writing. It’s blurbing and interviewing and answering emails. An assistant helps a lot with those things.

Q: What’s your advice to other people with ADHD?

I am so fortunate that I was able to figure out how my mind works at an early age. I’m trying to do that with my daughter now. I tell her, ‘You don’t have to do the same thing everyone else is doing, but you do have to get this done. Let’s analyze: What is your plan? Where do you need to be to get work done? What’s a distraction? What’s a useful distraction? What’s a good break?’

Yes, we need to acknowledge the challenges. And, yes, I frustrate myself, but I love the way my brain works. I’m love my career and how my career is going — and it’s largely due to the brain I have.

The Upsides of ADHD: Next Steps

• Read: Stifled Creativity and Its Damaging Impact on the ADHD Brain
• Buy: I Have Some Questions for You and The Great Believers by Rebecca Makkai
• Read: 10 Things I Wish the World Knew About ADHD
• Watch: “ADHD is Awesome – The Holderness Family Guide to Thriving with ADHD”

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But I was confused. I associated ADHD with fidgety grade-school boys. Little did I know that I, an adult woman, could also be diagnosed with ADHD. My daughter’s descriptions of time and organizational overcompensation, decision paralysis, procrastination, overwhelm, and hyperfocus resonated deeply with me. When I suggested that I might have ADHD myself, she agreed.

While waiting for an evaluation and the results, I had daily epiphanies as I connected my lifetime of experiences with information about the ADHD brain. Like so many of us, I’d spent years feeling inadequate, hypersensitive, and too ashamed to say any of it out loud. How many paralyzing hours did I lie on the couch, wondering what was wrong with me? My diagnosis came in August 2022.

[eBook: Women with ADHD: How Hormones, Symptoms & Late Diagnoses Impact Females]

Six years earlier, at almost 49, I’d unknowingly set in motion a seismic journey of personal reinvention with the decision to stop drinking (10 years in the making) and enter therapy for the first time. I was finally able to follow through on both steps, even in the face of intense anxiety and self-hatred. My sobriety and therapy unleashed a flood of unresolved issues and traumas. Recovery was just the beginning of my self-discovery.

I ended my 26-year marriage and became an empty nester. My work as a commercial interior designer suddenly felt toxic. I had come to realize that there was a fundamental misalignment between my strengths, interests, and responsibilities. Near crippling self-doubt and fear of rejection had kept me tethered to my career for 28 years. Finally, my ADHD diagnosis shattered the narrative of not good enough, paving the way for self-compassion and newfound confidence and hope.

Standing at the intersection of creative expansion and personal revolution, I found a community of midlife women on similar paths and planted the seed for starting my company, Triple Moon Coaching. I enrolled in a holistic coach certification program so I could build a side practice and phase into full-time professional life coaching.

Empowered by clarity and optimism, I focused on creating my new vision. ADHD impulsivity has been a consistent thread for as long as I can remember. My resignation was bold and necessary, and a bit premature. But I was learning. No regrets.

I am on a solid path to successful entrepreneurship. It’s a joy and a privilege to coach women who are taking charge of their lives and growing into their own unique potential.

ADHD in Women: Next Steps

• Self-Test: Symptoms of ADHD in Women & Girls
  
• Sign Up: Essential Support for Women with ADHD
• Read: The Transformative Power of an ADHD Diagnosis for Older Women
  
• Read: 10 Books Every Woman Should Read After Her ADHD Diagnosis
  

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Brain fog, emotional meltdowns, and fear of dementia. Perimenopausal women with ADHD face these and myriad other challenges to brain and body due to hormonal changes during their final reproductive years. Many women, with and without ADHD, are not fully aware of the hormonal processes that start up to 10 years before menopause. During this busy time of life, many women carry great responsibility for children, aging parents, career, and family logistics. Already burdened by stress, most women assume the physical and psychiatric symptoms of perimenopause are unavoidable. At the same time, they struggle to understand and effectively treat their changing ADHD symptoms during this time of hormonal transition, which has been largely ignored by medical research to date.

All of this is true, however many researchers and clinicians continue to dismiss patients’ concerns saying that “there are no studies exploring adult or older women” or “there is no evidence to support advice on adjustment of medication or other treatment efforts for (peri)menopausal women.” It is, of course, important to base our medical advice on the best available research. But is it ethical to allow adult women with ADHD to suffer just because researchers and clinicians haven’t paid them enough attention?

We think not! That is why I’m passionate about doing the best and the most we can and to communicate the evidence that actually exists.

In this webinar, you will learn the following information to share with your clinician:

• How the ADHD brain reacts to fluctuating hormones in vulnerable periods of the female life
• How you can differentiate between ADHD and menopausal symptoms
• How the “swinging” decrease of estrogen and progesterone during perimenopause can worsen ADHD symptoms and influence medication effect
• How psychiatric and physical symptoms interplay with ADHD in (peri)menopause
• How to treat ADHD and menopausal symptoms in adult females
• How the ADHD life beyond menopause can look

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

ADHD in Perimenopause & Menopause: More Resources

• Download: Menopause & ADHD: Treatments & Interventions
  
• Replay: The Emotional Lives of Girls with ADHD
• Read: “How I Restarted My Life After a Post-Menopausal ADHD Diagnosis”
• Advocate: We Demand Attention! A Call for Greater Research on Women with ADHD
• eBook: How Hormones, Symptoms & Late Diagnoses Impact Females with ADHD
• Sign Up: Get a 30% discount on LetterLife — an app founded by Dr. Lotta Borg Skoglund that empowers you to better understand ADHD symptoms, hormones, and lifestyle factors. Gain exclusive access to top experts specializing in women and ADHD. Sign up today!

Obtain a Certificate of Attendance

If you attended the live webinar on October 16, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Lotta Borg Skoglund, M.D., Ph.D., is an author, keynote speaker, and entrepreneur from Sweden. Her specialty is in psychiatry/addiction and family medicine with a specific focus on ADHD and ADD. In 2015, she defended her thesis, When ADHD and Substance use Disorders Coexist – Etiology and Pharmacological Treatment, at Karolinska Institute, Stockholm.

Dr. Skoglund currently holds a position as Associate Professor at Uppsala University, Department for Women’s and Children’s Health, where she continues her research into ADHD, comorbidity, and gender influences. She is specifically interested in how hormones affect mental health across the female lifespan — a field that is not even close to being researched enough! Together with colleagues from around the world, she leads the pioneering research group GODDESS ADHD.

Webinar Sponsor

The sponsor of this ADDitude webinar is….

“Is it ADHD, menopause, or both?” The overlap between the two can be confusing and overwhelming. At Inflow, we understand the unique challenges of managing ADHD during this transitional phase of life. Our CBT-based app program, developed by expert ADHD clinicians, provides you with effective strategies to navigate the combined effects of ADHD and menopause. From mood swings to memory lapses, we’ll help you develop coping techniques to manage your symptoms and stay on track. Don’t let the confusion of ADHD and menopause hold you back. Take the free ADHD quiz today to kick off your self-care journey.

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

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Some of these women feel overwhelmed with overcommitment and dread moral judgment of their efforts. They feel ill-equipped to manage life’s complexities. These are the women with hidden ADHD: undiagnosed, untreated, and underserved.

Evading ADHD detection for so long suggests these women were able to present a seamless façade; that they passed for neurotypical, which may have felt like a win. But perfectionistic masking almost always comes at a high emotional cost. The self-monitoring is relentless; the hypervigilance, fueled by anxiety, exhausting.

While hiding their true selves may have seemed necessary to escape anticipated judgment and rejection, women who receive an ADHD diagnosis later in life report a new appreciation for the courage and determination that served them for so long.

Getting an ADHD Diagnosis Can Be Revelatory

Diagnosis at midlife unleashes a kaleidoscope of sensations—shock, anger, relief, regret, shame, fear, guilt, resentment, and sadness. On the life-changing journey toward understanding and acceptance, your first step is to learn everything you can about ADHD in women. Make use of audiobooks, articles, podcasts, webinars, support groups, and therapy.

[Read: Women with ADHD – No More Suffering in Silence]

Gradually, the explanation for your years of distress and confusion will emerge with increasing clarity. Share it with the people most important to you. Honor the regret you feel about the opportunities lost, then embark on building a more rewarding future.

The Impact of Hormones

For women with ADHD, declining estrogen levels in perimenopause and menopause trigger a perfect storm: functionality suffers as the severity of ADHD symptoms and coexisting anxiety and depression spike. Fluctuating hormones also disrupt mood, memory, sleep, concentration, and motivation. Shame and self-doubt, amplified during the premenstrual phase, become more intrusive and destabilizing.

Ambushed by tsunamis of emotion and memory lapses, many women attribute their worsening struggles to character flaws and judge themselves harshly. Since women now spend about a third of their lives in menopause, it’s a game-changer to discover that your unpredictable functioning is hormonally mediated.

Reinvent Yourself

We cannot change our age, history, or brain wiring, but we can change the lens through which we view our world. Changing our perspective and redefining our identity is best achieved through an alliance with a therapist who has expertise in working with women with ADHD.

[Read: Relief, Grief, and More Raw Reactions to an Adult ADHD Diagnosis]

In the meantime, begin the process of creating a new version of yourself by doing the following:

• Embrace your strengths. Understanding the far-reaching impact of ADHD in midlife enables a more realistic assessment of your strengths and weaknesses. After years of ruminating about your limitations, you’ll learn that there is strength in knowing when you need help and asking for it.
• Trust your unique vision. Non-linear thinkers are differently abled. Your passion and creativity enhance the neurotypical status quo with novel solutions.
• Create boundaries. To many women, social acceptance is an indicator of self-worth. Social dynamics are confusing, and you may consider others’ agendas more important than your own. Boundaries can help you find a balance between feeling trapped by overcommitment and withdrawing from interactions to avoid confrontation.
• Prioritize self-care. It takes a serious investment in your wellbeing to change the way you interact with your body. Women with ADHD tend to skimp on attention to their health. Creating a bedtime routine to improve sleep requires small changes over time. Eating healthier foods, drinking more water, and maintaining an exercise routine demand healthy vigilance. Balance conflicting needs—protection vs. connection, self-care vs. accommodating others, and passivity vs. assertiveness. Each small step will improve your quality of life.
• Develop systems that work for you. When chaos and clutter threaten to consume your environment, you may feel more frantic and unable to envision solutions. Creating organization and routine will help you manage your time and space more effectively.
• Seek pleasure. Take a designated amount of time each day, even just 15 minutes, to do something you find pleasurable. This transition will allow your brain to revel in unstructured downtime, whether that means chilling out with music, meditating, or having a cappuccino while playing Wordle.

After decades of shame, apologizing, and fearing criticism, a diagnosis gives you explicit permission to forgive yourself for being your own harshest critic. Whether you’ve punished yourself in the past with isolation, substance abuse, binge eating, or other kinds of self-harm, a midlife diagnosis can help you accept that you are worthy of being nurtured—by yourself and by others.

Diagnosis at midlife is the beginning of an ongoing journey toward enlightenment and transformation. Seize this unexpected second chance to believe in yourself. As you get the hang of reinvention, you will rejoice.

Reinvent Yourself Post-Diagnosis: Next Steps

• Watch: The Science Behind Diagnosing and Treating ADHD in Older Adults
• Download: Free Guide to ADHD in Older Adults
• Read: ADHD in Older Adults – Distinct Diagnostic and Treatment Considerations

Ellen Littman, Ph.D., a clinical psychologist in New York, is co-author of The Hidden Side of Adult ADHD, Understanding Women with ADHD, and Gender Differences in ADHD.

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“In talking with Maria, it is clear that her family and instructors have historically viewed her as being intellectually quite bright and an underachiever.”

These are not a passive-aggressive bully’s words, a sibling’s backhanded compliment, or careless remarks delivered at a parent-teacher conference. These are the very deliberate words of a neurologist, neuropsychologist, and medical-education specialist following my ADHD evaluation in childhood. The intended audience: my parents, my family physician, and my teachers.

The clinic’s problematic “assessment” and cruel words still haunt me years later. I didn’t read their words until I was in my 40s, and I finally understood why I had a decades-long habit of telling people I have no special talents. The specialists stated in scientific terms that I, a child, was a talentless loser. My parents and my family physician believed them without question. What could my parents have done differently?

[Take This Self-Test: ADHD Symptoms in Women and Girls]

Set in Their Ways

Despite education and experience, we know that experts make mistakes all the time. It’s why we frequently seek second medical opinions. My parents certainly needed one when the politely insulting report described my problems as “common” with ADHD, but the tone of the recommendations was “do better.” A second opinion would have offered my parents another analysis of my behaviors. Most importantly, I could have had a chance at a better life.

But my parents – education experts – were inclined to go along with what the evaluators said, as they shared similar vocational backgrounds. Though my mother still harbored some suspicions that I had ADHD, she and my father ultimately assumed that I was failing my classes on purpose. They made sure to share their theories about my behaviors with my teachers, who were more inclined to default to their opinions rather than their own judgment about my classroom behavior they saw every day.

What I Cannot Forgive

I can forgive science not catching up in time. (After all, it’s been more than 30 years since that evaluation and we’re still working to better understand ADHD in girls.) What I cannot forgive is my parents and the clinic for the cruelty, sexism, and failure to recognize the fact that I didn’t want to do poorly. In any setting, telling someone they do not have any special talents or that they’re an underachiever is an appalling insult.

[Read: “11 Things I’d Tell My Younger Self”]

The rest of the report would eventually prove hilariously inaccurate. “During the evaluation Maria did not demonstrate many of the learning deficits often observed in adolescents with a primary attention deficit hyperactivity disorder,” reads part of the report. Thirty-one years later, I received my ADHD diagnosis at age 44.

Ironically, the experts who wrote the report that detailed my carelessness and sloppiness also committed typographical, punctuation, and grammatical errors along with listing my incorrect home address on every page and misspelling my last name. Perhaps they were gifted in other areas? Unfortunately, those doctors didn’t provide their full names in the “scientific” report they authored, so I was never able to track them down to find out. What a relief for them.

Undiagnosed ADD: Next Steps

• Free eBook! We Demand Greater Research on Women with ADHD
• Read: “I Could Have Been Myself for So Much Longer.”
• Read: Stop the Cycle of Shame for Girls with ADHD

Maria Reppas lives with her family on the East Coast. Visit her on X and at mariareppas.com.

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Children with ADHD or autism are twice as likely to experience chronic disabling fatigue by the age of 18, even when controlling for comorbid depression, according to a new study published in the journal BMJ Open. Researchers point to the high levels of inflammation (often resulting from elevated stress levels) found among research subjects as a possible explanation for this association.¹

While previous research has demonstrated a high prevalence of chronic fatigue in patients with ADHD,² this is the first study to investigate potential mechanisms underlying the association.

Data from The Avon Longitudinal Study of Parents and Children (ALSPAC) was analyzed to assess whether children who scored above the threshold for ADHD or autism at ages 7 and 9 had an increased risk of chronic disabling fatigue at age 18. Mediation analyses were performed to investigate whether an inflammatory marker (IL-6) at age 9 was linked to fatigue and neurodivergence.

In fact, it did. IL-6 levels at age 9 were associated with a higher likelihood of chronic disabling fatigue at age 18. Though the causes of inflammation are myriad, it is often exacerbated by elevated stress levels, common among neurodivergent children.

“Research shows that neurodivergent children experience higher levels of loneliness, and are more likely to experience bullying,” the authors of the study explain. “Neurodivergent children are also more vulnerable to experience pain.”

In addition to chronic fatigue, adults with ADHD suffer in higher numbers with many different physical conditions. In fact, a recent study found that adults with ADHD are at elevated risk for 34 of 35 conditions studied, including nervous system, respiratory, musculoskeletal, metabolic, circulatory, gastrointestinal, genitourinary, and skin conditions. ³ These include:

• ulcer or chronic gastritis
• pulmonary disease
• Type 2 diabetes
• epilepsy
• heart failure
• kidney infections
• spinal conditions
• eczema

The mechanisms of action underlying the association between ADHD and its comorbid physical conditions are not yet known, but this study brings us one step closer to understanding a complex and critically important picture, the authors of the study explain.

“Children who are suspected to be or diagnosed as neurodivergent should routinely be screened for physical and mental health concerns,” they urge. “Earlier integration of brain-body concerns in a holistic framework can facilitate tailored support and improve quality of life of neurodivergent individuals.”

Putting a Spotlight on Chronic Fatigue

“When you think of hyperactivity, you think of talking non-stop, fidgeting, interrupting, distractible,” says Walt Karniski, M.D., a developmental pediatrician. “Lethargy is the last thing you would think about.” Yet, Karniski says he has seen an increase in pediatric patients who present with lethargy as one of the most problematic symptoms. A slightly different approach is needed to treat ADHD patients dealing with chronic fatigue, he adds.

The authors of the study assessed the presence of “chronic disabling fatigue” (defined broadly as lacking energy and getting tired during the last month) rather than the presence of myalgic encephalomyelitis/chronic fatigue syndrome because up to 91% of ME/ CFS cases go undiagnosed. “Despite its evident detrimental impact on quality of life, prolonged or chronic fatigue as a medical symptom is frequently described as an ‘unexplained’ symptom, and patients regularly report being dismissed about their experience,” the study’s authors write.

The symptoms of ME/ CFS include chronic widespread pain, unrefreshing sleep and rest, and dysfunction in the areas of memory, attention, and cognition — many of the same symptoms as ADHD.

“Neurodivergence and chronic fatigue are conditions with complex individual neurodevelopmental pathways,” the researchers explain. “It is therefore likely that inflammation is not the only mediating or moderating factor […] Additional mechanistic insights are needed to disentangle the intricacies of this relationship.”

As is the case with all ADHD comorbidities, optimized treatment is a byproduct of comprehensive diagnostic care and a holistic picture of each individual’s conditions. When diagnoses are missed, patients suffer.

“For years I have struggled with chronic fatigue syndrome, going in cycles of boom and bust. I would work successfully for years, energetic and committed to what I was doing. Eventually, I could no longer sustain the pace and would crash, taking months to recover, unable to work,” explains Cathy, an ADDitude reader in the United Kingdom. “Only recently have I realized that I also have ADHD and begun my journey to a formal diagnosis.”

Polly, an ADDitude reader with chronic fatigue syndrome, depression, anxiety, and chronic pain, shares this: “I have taken various medications over the years for these issues, which have had benefits and drawbacks but never resolved anything. It is so clear to me now where the root of it all lies. I’ve only recently realized, at the age of 60, that I am neurodivergent and probably have ADHD.”

Sources

¹ Quadt, L., Csecs, J., Bond, R., et al. (2024). Childhood Neurodivergent Traits, Inflammation and Chronic Disabling Fatigue in Adolescence: A Longitudinal Case Control Study. BMJ Open. 14:e084203. doi.org//10.1136/bmjopen-2024-084203
² Sáez-Francàs, N., Alegre, J., Calvo, N., et al. (2012). Attention-Deficit Hyperactivity Disorder in Chronic Fatigue Syndrome Patients. Psychiatry Res. 200: 748, 53 doi:10.1016/j.psychres.2012.04.041

³ Du Rietz, E., Brikell, I., Butwicka, A., Leone, M., Chang, Z., Cortese, S., D’Onofrio, B.M., Hartman, C.A., Lichtenstein, P., Faraone, S.V., Kuja-Halkola, R., Larsson, H. (2021). Mapping Phenotypic and Aetiological Associations Between ADHD and Physical Conditions in Adulthood in Sweden: A Genetically Informed Register Study. Lancet Psychiatry. 8(9):774-783. doi.org/10.1016/S2215-0366(21)00171-1

Why Women with ADHD Don’t Disclose Their Diagnosis

In part, the survey results suggest that women with ADHD are perceived differently than are men with ADHD — a finding that more than half of survey respondents (three-quarters of whom were women) agree to be true.

We know that self-stigma is a key barrier to seeking professional support.¹While the survey’s findings relate to ADHD specifically, they speak to a larger societal phenomenon: Individuals internalize public stigma, e.g., stereotypes, prejudice, and discriminatory attitudes endorsed by the public. We see examples of internalized public stigma across women’s mental and general health, including their ADHD diagnosis.

Although men and women are just as likely to have learning and thinking differences, girls with ADHD are diagnosed one-third as often as boys. ² Many women receive their ADHD diagnoses in their 30s, 40s, and beyond. When a woman is diagnosed with ADHD later in life, she’s likely spent decades struggling without understanding why. A late-in-life diagnosis may be the route of frustration, self-doubt, and anxiety.

Researchers have primarily based assessment tools on studies of boys and they do not norm for female populations. Gender bias built into testing instruments is one of the biggest reasons women and girls with ADHD may go undiagnosed, something 87% of survey respondents acknowledged, the survey revealed.

[Free Resource: What to Ask Yourself to Find the Perfect Job]

Women diagnosed with ADHD later in life often express how they made efforts and investments to get answers, but providers routinely dismissed their concerns as “hormones,” “mom brain,” or “lack of self-care.” Many received diagnoses of depression or anxiety instead of ADHD.

They finally got an accurate diagnosis after enduring years of unsuccessful treatments — along with blame for non-compliance. The experience of having their providers meet their initial concerns with disbelief, in a sense, trained women not to disclose.

Many women develop the core belief that “there’s something wrong with me.” And this doesn’t change overnight. Often, women need time, support, and community to learn how to voice their newly learned diagnosis in a way that feels right to them.

Choosing not to disclose an ADHD diagnosis is a logical response to stigma, bias, and backlash. Half of the adults surveyed believe that the negative stigma surrounding neurodiversity is stronger now than ever before. Among respondents with learning and thinking differences, 59% worry that disclosing their diagnosis would negatively impact their careers. Nearly 1 in 4 respondents who requested workplace accommodations said they lost their jobs or got demoted after asking. In that kind of workplace culture, it’s no surprise that people stay silent.

[Take the ADHD Self-Test for Women]

How to Create an Inclusive Culture

The culture that too often makes silence the best option for women must shift. The solution to silence is not as simple as telling women to “speak up” at work. We need to create a culture that places women’s voices and needs at the core. We need to raise awareness and challenge the stigma around neurodivergence (particularly ADHD and dyslexia) for women. We need better resources, awareness, and action, to start the shift toward progress.

Here are a few steps individuals, providers, and employers can take to create a more inclusive culture:

• Learn: Patients, employers, and providers need to let go of old assumptions and dial up their curiosity because the information about ADHD has historically been based on homogeneous, primarily male experiences. Even among the most knowledgeable, there’s still much to learn and unlearn.
• Embrace the gray: Disclosure isn’t “on” or “off.” You don’t need to share your diagnosis with everyone. You get to choose who, when, and how much you share.
• Listen: Often people don’t speak up because when they do, they aren’t heard or understood. For providers, this means actively listening to clients and patients. Employers need to actively listen to employees and take their concerns and requests seriously. Individuals need to listen to their inner voice without judgment.

Inclusive Culture: Next Steps

• Free Download: Dream Jobs for Women with ADHD
• Read:5 Hallmarks of a Neurodivergent-Inclusive Workplace
• Read: “ADHD Masking Is Another Undue Burden for Women at Work”
• Watch: Invisible Disabilities at Work: How to Foster Neurodivergent Advocacy and Acceptance

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Lannin, D.G., Bible, J. (2022). Self-Stigma of Seeking Help: A Meta-Analysis. The Cambridge Handbook of Stigma and Mental Health. Cambridge Handbooks in Psychology. Cambridge University Press; 111-142.

² Young, S., Adamo, N., Ásgeirsdóttir, B.B. et al. (2020). Females with ADHD: An Expert Consensus Statement Taking a Lifespan Approach Providing Guidance for the Identification and Treatment of Attention-Deficit/Hyperactivity Disorder in Girls and Women. BMC Psychiatry. 20, 404. https://doi.org/0.1186/s12888-020-02707-9

If you are trying to convince a loved one to get evaluated and/or to start treatment for ADHD, you already know the conversations can be frustrating and the decision is theirs alone. You can’t force a loved one to accept help, but you can lovingly nudge them in the right direction.

1. Start with shared experiences

Since you mention that you have ADHD, it may help to talk to your mother about your own symptoms and the experiences that led to your diagnosis. Ask if any of your experiences or challenges resonate with her. You can start to bridge the gap by sharing commonalities.

[Get This Free Download: ADHD in Older Adults]

2. Frame it as an opportunity

Even if your mother concedes to having symptoms, she may say, “What’s the point of getting diagnosed? I’ve lived this long without being treated.” To that, you can say, “If there were a way that your memory, forgetfulness, emotions, and overall functioning could improve, would you want to take the opportunity to explore it?” Another way to frame it: “If you had poor vision, would you try glasses to help you see better?”

If your mother agrees, then you’ve identified a common goal, which is crucial in negotiating. A possible small next step is to ask your mother, “If improving your memory is a goal of yours, can I get you to see this clinician who’s an expert in memory and cognition and see what they have to say?” (You may want to avoid saying “an expert in ADHD” since older people tend to only associate ADHD with children. It’s best to cite the symptoms the doctor can treat to increase buy-in.) This may have to happen over multiple conversations before you see results.

It helps to keep in mind that people generally don’t seek help for symptoms. Rather, we seek help when we experience distressing impairments that affect daily life, whether we see it or if it’s pointed out by others. If you frame discussions around how your mom may be suffering unnecessarily rather than on symptoms, she may be more open to seeking help.

3. Change your own perspective

If your mother still refuses to seek evaluation or treatment, then it’s time to focus your efforts on what you can control. If you are convinced that your mother has ADHD, then you don’t have to wait for a formal diagnosis to help her manage her symptoms and have more productive interactions with her. If you know your mother is forgetful, then rely on written information and reminders to help jog her memory. Expect your mother to show up late to events if she struggles with time management.

[Read: The Transformative Power of an ADHD Diagnosis for Older Women]

No matter the problem, don’t say, “Mom, why can’t you do this?!” Simply operate under the assumption that your mother has untreated ADHD, a condition that causes impairments and difficulty with functioning, and is doing the best she can.

My Mom Has ADHD: Resources on ADD in Older Adults

• Read: The Transformative Power of an ADHD Diagnosis for Older Women
• Read: ADHD in Older Adults — Distinct Diagnostic and Treatment Considerations
• Read: “I’m Newly Diagnosed at 90 — and So Thankful”

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “ADHD in Older Adults: Clinical Guidance and Implications” [Video Replay & Podcast #499] with David Goodman, M.D., LFAPA., which was broadcast on April 4, 2024.

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

First, ADHD is a complex condition comprising genetic, environmental, and neurobiological factors. This intricate relationship makes it challenging to pinpoint specific brain patterns or abnormalities that definitively indicate ADHD. Unlike some neurological conditions in which a distinct physical anomaly (e.g., tumor, stroke, etc.) or clear activity pattern (e.g., seizure) can be observed, ADHD presents a more nuanced picture.

Second, the symptoms of ADHD can vary widely among individuals. While difficulties with attention, motivation, and impulsivity are hallmark features, these symptoms present differently from person to person. Some may primarily struggle with attention and focus, while others exhibit more impulsive behaviors. This variability makes it difficult to identify a universal brain signature for ADHD across all affected individuals. In addition, claims of certain types of ADHD based on particular brain patterns go way beyond what the research supports. This is why using brain scans to diagnose ADHD is not supported by any of the professional organizations, including the American Medical Association.

Brain scans, such as functional MRI (fMRI) or PET scans, measure brain activity by detecting changes in blood flow or metabolic activity. These techniques provide valuable insights into brain function and can help detect certain kinds of neurological problems. Unfortunately, they don’t sufficiently capture the more subtle underlying neurochemical processes associated with ADHD. The brain’s intricate network of neurotransmitters, like dopamine, norepinephrine, and serotonin, are involved in ADHD. But their levels and interactions cannot be assessed through conventional brain imaging alone.

Clinical Assessments Are the Gold Standard for ADHD Diagnosis

ADHD is best diagnosed through comprehensive clinical assessments that consider a range of factors. These assessments typically include interviews with the individual, observation of behavior, reports from family members, and standardized rating scales. These methods provide a holistic view of a person’s symptoms, functioning, and history under real-life conditions and across time and circumstances. By contrast, brain scans capture a snapshot in time, sitting still in a scanning device. To put it bluntly, ADHD should be diagnosed based on an evaluation of real-life functioning, not test results.

[Get This Expert Resource: Unraveling the Mysteries of the ADHD Brain]

It’s essential to recognize that brain scans do contribute to our understanding of ADHD in meaningful ways. Research using neuroimaging techniques has identified differences in ADHD brain structure and connectivity, specifically in the regions involved in attention, executive function, and impulse control. While such findings are valuable for scientific knowledge, they are not yet precise or consistent enough to serve as diagnostic markers for individuals in clinical settings.

The interpretation of brain scan results requires expertise and context. It’s not possible to equate a particular brain pattern or system observed in an MRI or PET scan to ADHD. Many other factors can influence brain activity, function, and structure, including mood, medication effects, substance abuse, sleep deprivation, and co-occurring conditions such as anxiety or depression. Failing to consider all these variables and relying solely on brain scans for ADHD diagnosis can lead to misinterpretation or misdiagnosis.

ADHD Assessment Requires a Holistic View

Advances in technology and methodology may eventually lead to more refined ways of using brain imaging for ADHD diagnosis, such as incorporating machine learning algorithms to analyze complex brain patterns. In the meantime, a comprehensive and individualized approach remains the gold standard for ADHD assessment. This approach considers not only brain function, but also the psychological, behavioral, and environmental factors that contribute to an individual’s experience of ADHD. It emphasizes the importance of tailored interventions, including behavioral therapies, educational support, and medication management.

While brain scans offer valuable insights into the complexities of brain function, they currently don’t add much as diagnostic tools for ADHD. The disorder’s multifaceted nature, variability in symptoms, and the need for comprehensive assessment underscore the limitations of relying on neuroimaging. Understanding ADHD requires a holistic perspective, including clinical expertise, thorough evaluation, and ongoing research into its biological underpinnings.

Functional MRI (fMRI) for ADHD? Next Steps for Parents of ADHD Teens

• Self-Test: Do I Have ADHD? Symptom Test for Adults
• Download:What Every Thorough ADHD Diagnosis Should Include
• Read:Mapping the ADHD Brain: MRI Scans May Unlock Better Treatment and Even Symptom Prevention
• Watch: How Brain Imaging Helps Us Understand and Treat Attention Deficit

This personal essay reflects the opinions of the authors.

Stephanie Sarkis, Ph.D., is an author, mediator, and therapist.

Ari Tuckman, Psy.D., is a psychologist and the author of More Attention, Less Deficit: Success strategies for Adults with ADHD (#CommissionsEarned)

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Social anxiety disorder (SAD) is characterized by an intense fear of scrutiny and judgment by others in social situations. Individuals with social anxiety fear that they will be negatively evaluated — judged as anxious, weak, boring, weird, or unlikeable. They fear being observed and/or performing in front of others, and they worry that their nervousness and anxiety will show through.

Everyone experiences social anxiety occasionally. For individuals with social anxiety disorder, the fear of social scrutiny — often out of proportion to the actual threat posed by the social situation — is immensely distressing. It can interfere with work, school, and other daily activities, and make it difficult to meet people and maintain friends.

Social anxiety (among other anxiety disorders) commonly occurs with ADHD. “Experiences common to ADHD, like rejection sensitive dysphoria, shame, and emotional dysregulation, may exacerbate social anxiety,” writes writes Sharon Saline, Psy.D. “ADHD symptoms like hyperactivity and inattention may also undermine social skills and cause difficulties.”

Take this social anxiety test and share your results with a licensed mental health professional.

The questions in this social anxiety test are informed, in part, by criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). This social anxiety test is designed to screen for the possibility of SAD symptoms, and it is intended for personal use only. This social anxiety test is not intended as a diagnostic tool.

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Social Anxiety Test: Next Steps

• Take this Test: Generalized Anxiety Disorder in Adults
• Take this Test The RSD Self-Test for Adults
• Free Download: Social Anxiety Facts and Falsehoods
• Read: You’re Not Shy or Stuck Up. You Have Social Anxiety Disorder.
• Read: Where Does ‘Introvert’ End and Social Anxiety Begin?
• Read: “How Exposure Therapy Reduced My Social Anxiety”
• Find: Specialists or Clinics Near You

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

For decades, ADHD was thought to begin in childhood with many people outgrowing symptoms by adulthood. However, new scientific insights reveal findings that have reshaped the ADHD community’s understanding of how ADHD symptoms evolve, fluctuate, wax, and wane over the lifespan. 

We now know that ADHD may emerge later in life in some individuals, and we have insight into factors that impact earlier versus later onset presentations. We also understand that very few people experience a form of ADHD that is always severe and debilitating. Instead, most people appear to experience a fluctuating course through adulthood in which certain situations may be associated with the flare up or down of ADHD symptoms. 

In this webinar, you will learn:

• About the latest science behind our modern conceptualization of ADHD across the lifespan
• About the difference between late-onset and late-identified ADHD, and whether people can develop ADHD for the first time as adults 
• Whether people can be considered “recovered” from ADHD if symptoms have been at bay for a long time
• About the situations that can trigger flare-ups or lead to an abatement of ADHD symptoms 
• How to decide if a person with mild ADHD-like traits qualifies for a clinical diagnosis, and what happens if they do not meet ADHD criteria but still want help 
• About the implications for diagnosis and treatment, as well as how loved ones can best support individuals with ADHD through ups and downs — and what individuals with ADHD can do to live happy and healthy lives

Watch the Video Replay

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ADHD in Adults: More Resources

• Download: How Common Is ADHD in Adults?
  
• Read: Is Adult ADHD Real? Yes — and Still Heavily Stigmatized
  
• Read: Why We Need U.S. Guidelines for Adults with ADHD
  
• eBook: ADHD After 40: A Guide to Symptoms, Diagnosis & Treatment Later in Life
  

Obtain a Certificate of Attendance

If you attended the live webinar on August 20, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Dr. Margaret Sibley is a Professor of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine and a clinical psychologist at Seattle Children’s Hospital. She has authored over 120 scholarly publications on ADHD in adolescence and adulthood with research funded by the National Institute of Mental Health and the Institute of Education Sciences. She is Secretary of the American Professional Society for ADHD and Related Disorders (APSARD), a Professional Advisory Board Member for Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD), and an Associate Editor of the Journal of Attention Disorders. She is the author of Parent-Teen Therapy for Executive Function Deficits and ADHD: Building Skills and Motivation published by Guilford Press in 2017. (#CommissionsEarned) 

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“The research studies and their outcomes presented were very informative.”

“Got a lot out of today’s presentation. Thank you!”

“This was very helpful to our understanding of late diagnosed ADHD, and to raise the question of other causes of symptoms that may be involved.”

Webinar Sponsor

The sponsor of this ADDitude webinar is…

Play Attention: Boost Your Brainpower at Any Age! Got ADHD? No worries! Keeping your mind sharp and focused is key, no matter how old you are. That’s why Play Attention offers a personalized program to boost your executive function and keep your brain buzzing across all stages of life. With research backed by Tufts University School of Medicine, Play Attention helps you level up your attention, emotion regulation, and overall performance. Our NASA-inspired tech gives you the custom support you need, whether you’re a kid, a busy professional, or rocking your golden years.

And guess what? We have awesome family plans too! Take our ADHD test or schedule a consultation to kickstart your journey to sharper focus and a better quality of life with Play Attention. Call 828-676-2240 or visit www.playattention.com.

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

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