How Do I Know If I Have ADHD? Signs and Diagnosis as a Woman

Many women with ADHD are not diagnosed until adulthood because their symptoms look like disorganization, emotional sensitivity, chronic overwhelm, unfinished projects or anxiety. Dr. Conway evaluates adult ADHD in women by looking at the full picture: childhood, school, work, and marital functioning, sleep, executive function, perimenopause, and medical history.

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

Medically reviewed by William Conway, MD, FACP, FASAM

 

Lilly’s Undiagnosed ADHD in Adulthood

Lilly has known something was wrong her entire life; she just couldn’t put her finger on what it was. She is, after all, quite smart. She’s always known that, even when it felt like she wasn’t living up to her potential. Or perhaps especially when she felt she wasn’t living up to her potential. She managed to make decent grades all through school and college, but she feels like her grades don’t accurately reflect her intelligence.

She has left behind her a trail of half-finished projects, each begun with great enthusiasm. She has also always been incredibly sensitive. A phrase, or even a look, that might possibly be construed as critical, she would pick apart in her mind for days, for weeks. She recently left a job that she really liked after she received an email that felt like a personal attack. In hindsight, it was probably just a piece of gentle constructive criticism.

These clues are the breadcrumbs that have been there all along. These are all very common signs of ADHD for someone who knows what to look for. Unfortunately for Lilly— and for so many other girls and women like her— this type of ADHD is often underdiagnosed.

Why ADHD Goes Undiagnosed in Women for So Long

Dr. Conway commonly sees women who have spent years with undiagnosed ADHD. These women are labeled as anxious, depressed, overwhelmed, and simply stressed.  The goal of the ADHD is to understand the woman in her life and recognize the impairments of her unrecognized ADHD.

The ADHD Diagnostic Gap in Girls and Women

The reasons so many women arrive at adulthood (or middle age, or beyond) without an ADHD diagnosis are many. The most common is the simple fact that ADHD in females tends to look different from the “classic” hyperactive presentation. Studies on ADHD, up until very recently, were done primarily on boys, who are far more likely to have that “can’t sit still” variety of ADHD.

Girls, on the other hand, more commonly present with the inattentive type of ADHD; they’re easily distracted, forgetful, disorganized, more “daydream-y,” and more emotionally sensitive. These are real symptoms, but they can more easily and conveniently be dismissed as personality traits or emotionality. These girls aren’t disrupting classrooms, so they’re not getting the help they need.

In response to the lack of treatment, they learn to compensate.

ADHD Masking in Women

Masking refers to the strategies someone uses to hide or make up for their ADHD symptoms. This is something so many women are doing right now. They develop (sometimes elaborate) systems of workarounds. This might look like a complicated color-coded system for filing household papers, or a series of alarms set up on their phones to remind them of daily tasks or work meetings. This can come across as more organized than average, when the truth is that these women are often overwhelmed by the sheer effort of keeping their heads above water as the world hurls wave after wave at them.

The workarounds and reminders can help for years, or even decades. But then, life will step in and throw a curveball.

It might be a job change where there’s less structure. It might be a new baby, a move, or even perimenopause. The mask slips. Hormone changes, for example, strongly affect the brain’s ability to use dopamine, which in turn directly affects executive dysfunction. This might be the point where a woman finally goes to her doctor about the symptoms. At this point, she might think it’s a new problem. But it’s not. It’s an old one; it’s just finally visible.

Signs of ADHD in Women: What It Actually Looks Like

Inattentive ADHD Symptoms in Women

Inattentive ADHD is tricky. There’s a strange paradox with ADHD where starting a task can feel insurmountable, but certain activities can create a state of hyperfocus. This can make the person with ADHD seem like they’re just avoiding things they don’t want to do. As in, if they can spend hours reorganizing a bookshelf, why can’t they just make that phone call to the dentist?

This can be mistaken for selective laziness. This is part of the reason Lilly has low self-esteem. She knows people think these things about her, and–– so much worse–– she thinks them about herself because she doesn’t understand that her brain functions differently from neurotypical brains. It isn’t laziness; it’s neurobiology. Her dopamine pathways need to be activated in specific ways. She’ll learn more about that soon. (That’s the beauty of diagnosis!)

Common inattentive symptoms in women include chronic disorganization (despite real efforts), losing things, forgetting daily tasks, and an inability to complete projects once the novelty wears off.

The Emotional Symptoms of ADHD in Women

One of the least-discussed (but often most upsetting) aspects of inattentive ADHD is emotional dysregulation. This refers to intense emotions that can shift rapidly and can be difficult to control. This can include rejection sensitivity (RDS), which we discussed in a prior article about Lilly. It can also refer to the low frustration tolerance and easy irritability that many women with ADHD experience.

This difficulty with emotional regulation is the reason so many women are misdiagnosed with depression and anxiety and are treated for those conditions without anyone recognizing the underlying ADHD  pattern. This serves up a double whammy: they’re taking medication that doesn’t particularly help (and might hurt), and they’re still not getting the diagnosis and treatment that would actually help.

The Executive Function Symptoms in Adult ADHD

Executive function, simply put, is what helps people turn intention into action. It includes planning, prioritizing, organizing, getting started, maintaining effort, and managing time. There’s also an element of emotional regulation involved.

ADHD is basically a disorder of executive function. The part of the brain that controls executive function is the prefrontal cortex, which also contains most of your personality. The prefrontal cortex helps you manage your emotions and make decisions. It’s what gets you started on a task (especially something kind of dull, like necessary housework). In a neurotypical brain, the promise of completing a task is usually enough of a motivator for someone to get the task started. In an ADHD brain, the dopamine pathways are altered in such a way that starting a task when there’s no immediate reward can feel almost impossible. That all-important preemptive dopamine hit just doesn’t come.

How ADHD is Diagnosed in Adult Women

What an Adult ADHD Evaluation Should Include

Adult ADHD diagnosis isn’t a simple checklist. If your medical provider is doing it right, they’ll ask for a detailed history, including any symptoms you might have experienced in childhood or adolescence. There should also be an effort made to rule out other conditions that can have similar symptoms, such as thyroid or sleep disorders or–– for women in midlife–– perimenopause or menopause, which might respond well to treatment including hormone therapy.

Dr Conway looks at the whole patient. Every patient is both unique and complicated.

Who Can Diagnose ADHD

ADHD can be diagnosed by psychiatrists, psychologists, certain nurse practitioners, and physician assistants. If you’re a woman in midlife, be sure to talk to your provider about the possibility of a hormonal factor exacerbating your symptoms.

What Happens After the  Adult ADHD Diagnosis

The power of an ADHD diagnosis for a woman who has spent her life thinking her symptoms were somehow a personal failing cannot be overstated. This reframing of her experience from character flaws to neurobiology can be wildly empowering.

Lilly, now 34, still loses things sometimes. She still feels too much, too fast. She still has days when she can’t seem to climb over that wall between intention and action. But now she has medication to help. And she has understanding. She has a framework that helps her to be gentle with herself. She isn’t broken; she’s just wired differently, and she can afford herself some grace.

A diagnosis isn’t a destination; however, it’s a door. Figure out how best to walk through that door. Know your treatment options. There are a variety of medications and therapies, and self-help strategies that can help. Walk through the door and start living your best life!

ADHD in Women Can Be Diagnosed and Treated

It is never too late to get evaluated and treated for ADHD. If you think this disorder has been holding you back, now is the time to find a healthcare provider with experience diagnosing and treating ADHD. If this article resonates with you, consider talking to your doctor about potential treatments. Find a doctor who helps you figure out how to move forward into your best life!

Dr. Conway can evaluate your ADHD. Call 615-708-0390

Frequently Asked Questions

What are the signs of ADHD in adult women?

ADHD in adult women generally looks like the inattentive type. Common signs are chronic disorganization, difficulty initiating tasks, forgetfulness, lateness, and often a slew of half-finished projects left in their wake. Emotional symptoms are also common, including heightened sensitivity to criticism and rapid mood shifts.

Can you have ADHD and not know it as an adult?

Absolutely! In fact, it’s much more common than people realize, especially in women. Girls— who more often have the quieter, inattentive type of ADHD— are underdiagnosed early in life, and ADHD never goes away. Girls are taught to manage their own symptoms, which can be effective for decades while also wreaking havoc on their self-esteem. Often, it’s only when a woman is taking her child in to get tested for ADHD that she realizes she might also have the disorder.

Is it worth getting an ADHD diagnosis as an adult?

In short, yes. Finally being able to name the issues that might have plagued you for decades is invaluable. And having an understanding of the neurology behind it can make it feel real in a way that many women find validating. It also opens up the conversation about treatment options. Many women were misdiagnosed at some point in their lives with depression or anxiety rather than ADHD, and finally getting the appropriate treatment can be a game-changer.

Author Bio

I’m Leigh Anne Hulva, BSN, RN- a registered nurse, women’s health educator, mother of teenaged 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. William Conway, MD, and I work directly under his licensure as a nurse educator.