Considerations for ADHD in Women

In women and folks assigned female at birth, ADHD has been, and still is, under-recognized. Women can have all three types of ADHD - hyperactive, inattentive, and combined type. Women and men are just as likely to have inattentive type, but women are less likely to have hyperactive type. Often, it's hyperactive behavior that gets the attention of teachers and leads to earlier diagnosis and treatment. Inattentive type kids are often overlooked as they tend to be far less disruptive in the classroom, praised for being compliant, if a little forgetful and quirky.

Folks with ADHD tend to have lower dopamine levels available, the brain chemical responsible for motivation, focus, and reward seeking. If you're a woman and have ADHD, you may notice your symptoms worsening at various points in your life related to hormonal transitions - namely, before the start of your period during the luteal phase of the menstrual cycle, postpartum, perimenopause, menopause. Many women are late-diagnosed (in our 30s and 40s) after hitting a point in life where their old strategies for keeping things (barely) together start to fail, resulting in dropping more important balls in life than ever before. Estrogen helps dopamine stay active in our systems longer, so when we have less estrogen available, we also seem to have less dopamine, leading to increased ADHD symptoms. Also, stimulant medication has been found to be less effective as estrogen decreases. If you're a woman entering perimenopause and your medication just does not seem to work anymore, you're probably not imagining it and it might warrant a conversation with your prescriber.

Many women experience a greater degree of shame about having a messy home or workspace than their male counterparts. Our society has an old but still present expectation that women in heterosexual partnerships be primary caregivers and organizers of the kids' lives AND the home, even if both partners are working. Perhaps there's even a cultural belief that women enjoy compulsive tidying (I know, some really do!) and just can't help but keep tidying and organizing their way through their free time.

While we can recognize and choose to reject these gender norms, many women are still carrying an outsized amount of shame when we don't fit this mold. Making messes and struggling to clean them up, losing time searching for misplaced items, feeling ashamed after the end of another day with low productivity - all while masking, smiling, and hoping others don’t notice the extent of our dysfunction - it's pretty exhausting over time. While therapy cannot eradicate or "fix" ADHD, it can help you learn more about ways to strengthen weak executive skill areas, help you to view your patterns and symptoms more neutrally, and arrive to a place of compassionate acceptance of yourself and your brain.