ADHD in Women: What a Daughter’s Diagnosis Reveals About the Mother

Many women first recognize their own ADHD symptoms when their child is evaluated for ADHD. In Nashville, Dr. William Conway and Nashville Concierge Medicines help adult women understand how ADHD, family history, perimenopause, mood, sleep, and attention problems can overlap—and how treatment can improve daily life.

By Leigh Anne Hulva, BSN, RN- Women’s Health Educator

This article is published under the supervision of Dr. William Conway, MD, Nashville Concierge Medicines

ADHD Symptoms in Girls and Women are Often Missed

Meet Jennifer

Jennifer found herself sitting in yet another doctor’s waiting room with her daughter Maya, in Nashville. She had spent months trying to get help for her 11-year-old child. Maya was a treasure, bright and funny, but prone to tears when faced with any school assignment that involved multiple steps or significant time. She felt she just couldn’t focus on anything unless she was truly interested in it. Jennifer couldn’t count the number of times she had reached out to a teacher to let them know that Maya’s work would be late.

It was the history teacher who suggested the ADHD evaluation. The month-long school project on the Civil War had been a disaster. Maya had said she was keeping up with what needed to be done, and then two days before the huge project was due, she had come to Jennifer in tears, wailing that she still had 95% of the project left to complete. Jennifer had asked the teacher for an extension, explaining what had happened, and the teacher had responded with empathy. He had also suggested an ADHD evaluation.

That evaluation had led here, to a physician who specialized in ADHD treatment.

When a Child’s ADHD Diagnosis Reveals ADHD in the Mother

The physician began running through the list of symptoms that Maya had displayed or reported. It sounded, she said, like a textbook example of the inattentive variety of ADHD, the type where hyperactivity isn’t a problem. This type is more often found in girls. It’s also the type that’s hardest to see from the outside. The child in the classroom who is merely unfocused is less likely to receive help than the child who is acting out and distracting their classmates.

The physician mentioned heightened emotional sensitivity, poor working memory, and difficulty starting tasks. High intelligence coupled with academic inconsistency. The ability to hyperfocus when the activity was interesting. She went on and on, and a light flickered on in Jennifer’s head. The physician wasn’t just describing Maya; she was describing her.

Dr. Conway often sees the same pattern in adult women: ADHD is not obvious hyperactivity. In many women, it looks like chronic overwhelm, emotional sensitivity, difficulty starting tasks, disorganization, inconsistent performance, or exhausting feeling of working twice as hard to keep up.

Why ADHD Often Runs in Families

ADHD is one of the most heritable of all neurological conditions. It has a heritability of about 75%, indicating that genetics accounts for most of the risk. This also means that when a child is diagnosed, the chances that one or both parents also have ADHD are meaningfully increased. Often, the parent doesn’t know until they have an experience like Jennifer’s. The signs are sometimes easier to see in hindsight, especially for people with the inattentive type of ADHD.

And so it is that mothers of daughters recently diagnosed with ADHD are heading to the doctor to investigate their own suspected ADHD. For Jennifer, the part of the report that described Maya’s “difficulty with transitions” and the “gap between her potential and her performance” rang intimately true. She had lived this all her life; she just hadn’t had a name for it.

Jennifer struggled with feelings of guilt, thinking she had saddled Maya with a lifetime of struggle. But the truth is, she gave Maya the gift of early diagnosis, and she continues to be an excellent advocate for her. She knows first-hand the difficulties Maya faces and can express her pride when Maya learns new skills or overcomes a challenge. She is able to remind Maya of the positive side of ADHD: empathy, creativity, the ability to hyperfocus, and the passion Maya can feel when she’s interested in something.

How Perimenopause Can Worsen ADHD Symptoms in Women

At 43, Jennifer had begun noticing a few changes in her body and her moods. Her periods were still pretty regular, but she had been dealing with irritability and an especially short fuse in the past few months. She had also been disorganized and flustered more than usual and had shown up late to work more than once in the past week alone. She had attributed this to the increase in stress surrounding Maya’s struggles at school.

What was happening was that Jennifer’s perimenopausal transition had begun. The interaction between estrogen and dopamine (an important neurotransmitter) is an important clinical connection.

Dopamine is involved in focus, impulse control, motivation, and working memory. It’s vital in any situation requiring attention. Estrogen- in addition to doing so many other things- directly controls dopamine production. When estrogen levels are stable, so too is the production and use of dopamine. When estrogen declines- as it does during perimenopause and menopause- dopamine activity becomes inefficient.  This appears to influence dopamine signaling, which may affect attention, motivation, emotional regulation, and working memory. When estrogen fluctuates or declines during perimenopause and menopause, some women notice that attention, mood, sleep, and executive function become harder to manage.

This means that women who have been successfully managing their ADHD symptoms (either diagnosed or undiagnosed) suddenly find that their established coping mechanisms are no longer working. The workarounds they’ve put in place over decades are now being undermined by declining estrogen levels, sleep disruption, mood symptoms, and increased cognitive demands of midlife.

For a woman who has compensated ADHD for decades, perimenopause can feel like her world is no longer working. She may be more disorganized, more emotional, or have more difficulties keeping up with work, family, and daily responsibilities.

Conditions That Can Look Like ADHD in Women

As with any diagnosis, a thorough evaluation is important. Other possible issues should be considered, such as thyroid function, depression, or the altered mood that perimenopause itself can deliver. These, too, have treatment options.

What an ADHD Evaluation Should Include for Adult Women

Dr. William Conway does not rush an evaluation for adult ADHD in women. What has occurred over time with education, work, and relationships? The goal is not a label. The goal is to understand what is driving the symptoms, so a practical treatment plan can be designed.

Treatment Options for ADHD During Perimenopause

Discussing treatment options for ADHD warrants a nuanced conversation. Dealing with ADHD during perimenopause involves two separate but interacting conditions.

Hormone Therapy and ADHD Symptoms

For women whose ADHD symptoms worsened during perimenopause or menopause, replacing estrogen can help significantly. Hormone treatment is effective for hot flashes, night sweats, and mood changes. This may be especially true when estrogen levels have declined in a way that has made prior coping mechanisms ineffectual. Some women find that this alone is enough to regulate their dopamine levels, which in turn helps their ability to focus and maintain emotional regulation.

Hormone therapy is not an ADHD treatment, but in the right woman, it may be an important part of the broader treatment. All treatments are always individualized.

ADHD Medication for Adult Women

Stimulant medications have always been the gold standard in treating ADHD. Treating it in perimenopause or menopause is no exception. These medications include methylphenidate (such as Ritalin and Concerta) and amphetamine-based medications (such as Adderall).

There are also non-stimulant options available for women who don’t tolerant stimulants well or who have contraindications (such as severe cardiovascular disease or moderate-to-severe hypertension).

Treatment decisions should always be individualized, especially in women with hypertension, insomnia, bipolar disorder, substance use, and metabolic and cardiovascular risk. At Nashville Concierge Medicines, Dr. William Conway’s approach is the match the treatment to the patient’s real daily life.

CBT Lifestyle Strategies For Women with ADHD

Cognitive Behavioral Therapy, or CBT, specifically for ADHD symptoms, has been shown to be effective in many individuals. This treatment can be taught by a therapist, or studied online, or studied independently using textbooks and workbooks. Find the style that works for you.

Practical ADHD strategies include

• external reminders,
• written task lists,
• simplified routines,
• Sleep protection
• Exercise
• Reduced Clutter
• School or workplace accommodations

For Jennifer and Maya, a combination of these worked. Jennifer started on hormone therapy and Maya thrived on a combination of medication and school accommodations. Together, they completed a workbook on CBT for ADHD and compared notes. Maya and Jennifer both feel more seen than they ever have before. And Jennifer always smiles to herself when she thinks about Maya getting a thirty-year head start on learning to manage her ADHD journey.

 

 ADHD in Women Can be Diagnosed and Treated at Any Age

You can be diagnosed with ADHD and seek treatment for it at any point; it’s never too late. ADHD doesn’t expire. And its effect on your quality of life should be taken seriously. Ideally, you will choose a healthcare provider with experience treating ADHD. Find a doctor who helps you figure out how to move forward into your best life!

ADHD symptoms during perimenopause are real, common, and often overlooked in women. Fortunately, treatment that is effective is available.

Dr. William Conway in Nashville treats Adult ADHD and Mature Women.  Call 615-708-0390 for an appointment.

 

 

 About the Authors

I’m Leigh Anne Hulva, BSN, RN- a registered nurse, women’s health educator, mother of teenage daughters, and passionate advocate for women navigating perimenopause and menopause. I recently completed the Harvard Medical School course on Women’s Health and in these pages I relish sharing what I learned there alongside what I know from lived experience. I bring to this work not only my training, but also the personal experience of navigating the very transition I write about. It is my privilege to share both, because this work is personal to me. I hope it feels that way to you, too.

I have been on the other side of this conversation, and I understand how much it matters to feel truly heard. At Nashville Concierge Medicines, my work is supervised by Dr. Dr. William Conway, MD, and I work directly under his licensure as a nurse educator.

Dr. William Conway, MD, practices concierge medicine in Nashville with a special focus on Adult ADHD and the Mature Woman