Women with ADHD: Falling Through the Cracks?

The complex issues around women getting a diagnosis for ADHD are having their moment in the sun - finally!

If you're here, you may have seen some high profile Australian women like Mia Freedman and Em Rusciano speaking out about their recent ADHD diagnoses.

Or maybe you've come across ABC's “Women with ADHD 'falling through the cracks' with diagnosis and treatment” exploring the barriers to women receiving the support they need for their ADHD and the need for prompter diagnosis.

I’m lucky to work with brilliant women with ADHD, and it’s heartening that most of these women have been diagnosed in the past couple of years.

A later diagnosis later in life (and I’m talking beyond childhood) provides a welcome reframing of a lifetime of struggles and knocks to self-esteem.

Many women report that when they finally get a diagnosis for ADHD and implement appropriate interventions - usually including medication - it’s like turning the lights on. And finding their glasses. The sense of relief and possibility is palpable, and exciting!

But I often see in clients that this new awareness also comes with a sadness about unmet potential, what could have been and a battered self-image after decades living with shame and negative messages.

Bottom line: it’s so heartening that there is such a ground swell of awareness happening around women and girls and how ADHD presents. Better late than never, I say!

So if you’ve got a teeny tiny inkling emerging that maybe, maybe, there’s something else going on…
Maybe you’re not just lazy, or disorganised or incapable….

These are some of the ways I see ADHD show up in women (and girls) that can provide hints that might be worth a chat with your GP.

Women and delays to ADHD diagnosis

According to Patricia Quinn MD, Director of the National Center for Gender Issues in ADHD, girls are often misdiagnosed as having an anxiety disorder or mood disorder. Even where these may have been secondary conditions, without treating the ADHD, we're not getting to the root cause.

If ADHD hasn't been picked up in childhood, the average age of diagnosis for women is 36 to 38.

What it’s like to have ADHD as a grown woman

First of all, let’s start with what it’s not like.

It’s probably not bouncing off the walls and being so hyperactive and disruptive that you can’t hold down a job or get through school or uni.

But it might feel like being “cognitively hyperactive”. In other words, constant ruminating, intrusive thoughts and sensitivity to the reactions of others (Did I upset him? Did I say something wrong? Does she like me? Are they talking about me?)

It might also feel like being outwardly successful in all the areas that society values - academic or career success, great family, all the “stuff” - while feeling constantly overwhelmed by the day-to-day chugging along of normal life.

It might feel like an underlying sense that something is wrong with you, or if you “just tried a bit harder” or “could just stop procrastinating” that you’d finally be able to follow through on the things you care about.

You may have internalised some pretty damaging childhood messages from (often well-meaning) teachers and parents about being “lazy”, “sloppy” or “off with the fairies”.

It might feel like your experience is being regularly invalidated by people around you who say “doesn’t everyone feel like that?” or “you just need to use this planner/app/general pulling-your-socks-up”.

Of course I’m not saying that having any or all of these feelings means that you have ADHD and require medication.

And not all women with ADHD experience any or all of these issues.

My suggestion is that you deserve to feel good about yourself and to dare to have dreams, and a belief that you can create them.

You deserve to have more ease in your life. If you feel constantly under water, it’s worth asking questions and seeking help from your GP.

Signs of ADHD in women you might not have thought of

ADHD and challenges with food

Many women with undiagnosed ADHD have had life-long struggles with food and their weight. These struggles can have a huge flow-on effect to self-esteem and confidence and really restrict women’s ability to participate fully in life.

There are several reasons why healthy eating can be tricky for people with ADHD, including:

  • Executive function challenges: The many steps involved in eating regular balanced meals can present a real stumbling block for people with ADHD. There’s the planning, shopping, allowing time for prepping and cooking. All these steps require the executive function skills of time management, task initiation, planning ahead and self-monitoring.
  • Low dopamine and boredom: Food provides a quick hit of dopamine and serotonin when boredom (or other uncomfortable feelings) strike. This particular habit of reaching for snacks for stimulation is usually a well worn habit developed in childhood.
  • Emotional dysregulation: People with ADHD often have greater difficulties regulating their emotions and are more likely to self-soothe with food. There is nothing inherently wrong with this as a coping strategy - we all eat for pleasure and commiseration sometimes - until the effects of using food as a constant crutch impair your life.
  • Low interoceptive awareness: This means that people with ADHD often have a poor ability to notice their body’s cues, including hunger and fullness signals.

The ADHD tax

Having ADHD can be an expensive business - and not just with the often prohibitive costs involved with intervention.

The “ADHD Tax” is the price you pay for costly mistakes due to your ADHD symptoms.

Late fees, unpaid parking tickets (guilty), unlodged tax returns. Letters from debt collectors chasing up payments for bills that just went missing. Or, if you’re old enough, being banned from every Blockbuster and Civic in a 10km radius thanks to unreturned DVDs.

Chronic money issues can also provide breadcrumbs towards some real executive function issues. It can also be a big problem in marriages.

Again, many executive skills are required to manage finances including planning for the future, organisation, self-regulation and an ability to delay gratification.

  • Attention to detail: There’s a lot of organisation and “boring” detail work required to stay on top of finances. Paying bills on time, filing receipts for tax deductions and researching options for mortgages and insurances are necessary aspects of managing finances that can all be tricky for people with ADHD.
  • Impulsive spending: I saw it, I want it, I bought it. Shopping gives people a big dopamine hit. And when there is no long-term plan or conscious allocation of the money comes in, many women with ADHD can see the money in their bank account as available to spend right now. Even when these compulsive shopping habits are causing serious financial pain that you’re trying to get out of, the ability to delay gratification and say “no” to the new shiny thing now in favour of financial security in the future requires a lot of self-regulation.
  • I’ll deal with it later: For a lot of people with ADHD, there’s now and not now. When finances get out of hand, it’s common to feel reluctant to face up to it and take action. And for people with ADHD, if you can’t see it, it doesn’t exist. This applies to bills buried in kitchen drawers, credit card statements unopened, letter boxes unchecked. Plans made at the last minute can also lead to paying more for expenses like accommodation than others might.

The straw that breaks your back

Perhaps the biggest breadcrumb that a woman may have ADHD is a feeling of being constantly overwhelmed by “normal” life. Many women report feeling like they are paddling twice as hard as everyone else, just to keep their head above water.

I hear women say all the time that other women are so much more “together” than them. That they are somehow "less than" because they can’t keep the house tidy/arrive on time/manage the kids’ schedules/cook balanced meals.

Women with ADHD often report that “everything was fine, until….”. Big life transitions, or the uplevelling of responsibilities can often be the thing that makes daily life with undiagnosed or untreated ADHD too much.

Typical life changes that can coincide with this feeling of complete overwhelm include:

  • Finishing school and starting uni, with much less structure and more independence
  • Starting full-time work
  • Moving out of the family home
  • Moving in with a partner
  • Becoming a mother
  • Caring for elderly parents

Getting help as a woman with ADHD

For official diagnosis and to explore medication options, ask your GP for a referral to a psychiatrist who specialises in adults with ADHD. Get the ball rolling on this as wait times can be loooong.

You don’t need an official diagnosis to see an ADHD coach, psychologist or therapist to help you better manage your symptoms and build the skills you need to have a better, easier and more productive life.

Life with ADHD doesn't have to be so hard.

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