ADHD in Women Looks Different

Late next month, I’ll be evaluated by a licensed professional for ADHD. I have no idea what I’ll do if I end up with a diagnosis, but I’m expecting one. As I consume more and more science journalism on the differences in ADHD presentation between men and women, especially women in or approaching perimenopause, I’m convinced much of it describes my own experience. And like Kate Jarvis, who spoke to NPR about the road to ADHD diagnosis in her late 30s, I’m hoping the diagnosis will lead me towards the help I need to be my best self.

Growing up, Jarvis was a superstar student — organized, creative and described by her mother as “bright-eyed and bushy tailed.” Then, puberty hit. Maintaining focus grew harder, so her grades slipped. As her performance waned, so did her self-esteem, and diagnoses of anxiety and depression soon followed. Already feeling out of place, the responses from the adults around her didn’t make things better. “Kate has so much potential,” they’d say, “if only she’d apply herself.” She felt fundamentally flawed until an ADHD diagnosis years later changed her perception.

Jarvis’s story is common, researchers say. Long seen as a childhood condition affecting mostly boys, girls were excluded from ADHD research. Now that science understands that girls get it too, studies show symptoms differ between genders. “(Girls are) more likely to appear distracted, disorganized, kind of have their head in the clouds rather than show that overt, hyperactive or impulsive behavior that can disrupt a classroom,” explains Julia Schechter, clinical psychologist and co-director of the Duke Center for Girls and Women with ADHD. Those quieter symptoms get missed, so girls are often diagnosed years later than boys, sometimes after being treated for anxiety or depression that were really downstream effects of unmanaged ADHD.

The costs of oversight are steep. Women with ADHD face higher rates of interpersonal struggles in relationships, intimate partner abuse, teen pregnancy, self-harm, eating disorders, obesity, type 2 diabetes and cardiovascular disease. Just last year, a study involving 30,000 adults with ADHD from the UK found that women with the condition die nearly nine years earlier than women without it. “It’s not just an excuse for ‘why I’m always late for work,'” says pediatrician Dr. Patricia Quinn. “It’s a significant problem in their lives.”

For many women, the breaking point arrives in midlife, when years of masking symptoms creates a collapse under new pressures — careers, kids, aging parents. Amy Reyer hit that wall at 48, amid perimenopause. Early research suggests that diminishing estrogen levels can worsen ADHD symptoms — and women with the disorder tend to enter perimenopause earlier and more severely. After diagnosis, medication helped her get back on track. “I remember just saying to myself, ‘Oh my God, this must be what normal feels like,'” Reyer said.

But medication isn’t the only option. Hormone therapy and lifestyle changes like regular exercise, eating nutritious foods and meditation all help, experts say, as does cognitive behavior therapy to reframe years of self-blame. Psychologist Ellen Littman works to shift women’s self-image from “‘I’m a broken loser and I’m useless’ to helping them see themselves through the lens of this neurological information,” she says. “It changes their self-esteem and their ability to be effective in their lives and more confident as a parent and a partner.”

For Jarvis, a combination of medication and therapy following diagnosis was life changing. After finally accepting herself, she says, “there is so much joy waiting on the other side.”