As a family physician who specializes in ADHD, I see patients who are not just frustrated by their interactions with providers but devastated by the way they have been treated. They have significant impairments that provider after provider has minimized, and they have a very hard time getting help.

I have been treating ADHD for more than 15 years and what my new patients tell me about the struggles they’ve endured while seeking care is disheartening and depressing. Many of us providers haven’t been taught about ADHD in adults and are afraid to diagnose or treat it. To help you, the provider, be part of the solution, instead of part of the problem, I offer the following points to help you understand ADHD and really see the patient in front of you.

The Person in Front of You

• The person in your office is scared to death that you are going to judge them or invalidate their experiences. They have probably spent weeks or months debating whether they should say anything about their impairments.
• This person likely has been let down by the medical system that minimizes their impairments and even scoffs at their pain. As they’ve learned to expect such treatment, they may feel they have to go overboard to convince you that they really are impaired.
• At the same time, the person in front of you likely feels ashamed that they can’t “adult” — that they can’t handle the mundane details of human existence that we all have to deal with, so they may minimize their impairments. Patients, in sum, will either overstate or minimize their impairments. Both sides are normal.

[Read: Is Adult ADHD Real? Yes — and Still Heavily Stigmatized]

You, the Provider

• Please check your filters at the door and listen to your patient with curiosity and an open mind. It may help to think, “What if everything they’re saying is true?” Remember that your patient showed up because they are sure that something is wrong with them. They feel awful, tired, and overwhelmed no matter what they do. Attend to your patient’s concerns thoroughly.
• Pause if you catch yourself thinking, “That’s normal. I do that.” We all know what it is to experience forgetfulness, moments of impulsivity, and other behaviors that look like ADHD. What signals ADHD is the degree to which a patient’s symptoms cause impairment and suffering.
• Treating ADHD is incredibly rewarding. Most of us went into medicine to help people and make a positive difference in someone’s life. Helping a patient manage their condition results in truly life-changing outcomes.

On Diagnosing ADHD

• There is no one perfect way to diagnose ADHD. Most people are diagnosed with the use of rating scales like the ASRS, Barkley, or Conners, which are often sufficient to screen for ADHD alone.
• Even if you aren’t a specialist, you can diagnose ADHD.
• Neuropsychological tests are not a good way to diagnose ADHD. The psychologists who do those tests feel even less comfortable diagnosing ADHD than you do.
• ADHD is more underdiagnosed than it is overdiagnosed.

[Get This Free Download: The Clinicians’ Guide to Differential Diagnosis of ADHD]

On Treating ADHD

• Stimulants really are the best first-line treatment for ADHD.
• The Schedule II controlled substance classification for stimulants makes them sound more addictive than they actually are. After all, consider the fact that many patients who take prescribed stimulant medication for ADHD frequently miss doses and, in my experience, days of medication. How often do you think your patients who take opiates or benzodiazepines forget to take their medication? Not very often because they get physical withdrawal symptoms if they miss a dose.
• There is no way to know ahead of time what stimulant and dosage will work best for a patient. Trust what the patient says about how their medication is working. My experience shows that, if left to make the decision on their own, most patients will choose too low of a dose.
• Stimulants need to work for as long as possible during the day, not just for a few hours. A patient shouldn’t have to pick and choose the hours during which their medication should work in order for them to function and meet life’s demands. Would you want that for yourself? Would you present your most focused, productive self only to your morning patients? What about your afternoon patients and your family? Is it fair that they see your most irritable, unfocused self? These are the kinds of decisions patients have to make if their stimulant doesn’t last all day long.
• Most patients are not drug seeking. They are desperately trying to find a way to function like adults and gain control over their lives. What they seek most is your understanding and support.

Listening to Patients with ADHD: Next Steps

• Get This Free Download: The Clinicians’ Guide to Treating Complex ADHD
• Read: A Clinicians’ Guide to Better Patient Communication
• Read: Racial Disparities in ADHD Care — How Clinicians Can Better Serve Patients

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Register to reserve your spot for this free webinar and webinar replay ►

Not available January 28? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.

Sleep problems are among the most frequent co-occurring disorders in people with ADHD. Research has shown that many people with ADHD even suffer from more than one sleep disorder, often of different etiology. Science has not yet solved the questions arising from these findings, but we do know that sleep loss impairs concentration, memory, mood stability, and the immune system’s functioning, increasing risk for infections and allergies. Not surprisingly, ADHD is associated with many allergies and infections. The importance of good sleep and its association with overall health cannot be overstated.

The good news is that most sleep disorders can be treated effectively, and doing so can reduce ADHD symptoms and lead to improved health and wellness.

In this webinar, you will learn:

• Why people with ADHD commonly suffer with sleep problems and disorders
• About the different kinds of sleep disorders, including the circadian sleep-wake disorder, delayed sleep phase type, insomnia, restless legs, periodic limb movement disorder and sleep apnea
• How researchers are working to better understand the close relationship between ADHD and sleep disorders
• About treatment study findings that show low-dose melatonin, bright light therapy and other interventions may help reduce ADHD symptoms and lead to better overall health.

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

Meet the Expert Speaker

J.J. Sandra Kooij is a psychiatrist at PsyQ, psycho-medical programs, and Head of the Expertise Center Adult ADHD, in the Netherlands. She is a professor of adult ADHD studies at the Department of Psychiatry, VU University Medical Center, Amsterdam. She has published more than 100 peer-reviewed international papers and more than 20 books or book chapters on ADHD in adults.

Since 2002, Dr. Kooij has been the head of the Dutch Expertise Center Adult ADHD, leading research, treating patients, educating professionals, informing the public, and publishing books, scientific papers, websites, webinars and podcasts. She recently launched a new ADHD app, Super Brains. Read more about Dr. Kooij here.

Join an ADHD and Women’s Health Survey!  PsyQ Expertise Center Adult ADHD, in collaboration with ADHD Europe, developed an international survey on the experiences and health of women with ADHD. Are you a woman and do you have ADHD symptoms? You are invited to participate in this survey!

ADHD and Sleep: More Resources

• Download: Sleep Disorders Linked to ADHD
• Self-Test: Could You Have Delayed Sleep Phase Disorder?
• Read: What Comes First: ADHD or Sleep Problems?
• Read: How to Fall Asleep with a Rowdy, Racing ADHD Brain
• Free eBook: How to Sleep Better with ADHD

Webinar Sponsor

The sponsor of this ADDitude webinar is…

ADHD and disordered sleep can disrupt daily life, but you can take back control. Play Attention, inspired by NASA technology and backed by Tufts University research, helps you strengthen executive function and gain cognitive control. By combining mindfulness training with cognitive exercises, our program empowers you to manage focus, emotions, and routines—building the foundation for better sleep and overall well-being.

Start our online ADHD assessment now or schedule your 1:1 consultation. www.playattention.com 828-243-9291

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

Certificate of Attendance: For information on how to purchase the certificate of attendance option (cost $10), register for the webinar, then look for instructions in the email you’ll receive one hour after it ends. The certificate of attendance link will also be available here, on the webinar replay page, several hours after the live webinar. ADDitude does not offer CEU credits.

Closed captions available.

The diagnostic criteria for ADHD are largely based on studies of young white boys — and do not reflect the lived experiences of many adults with the condition. This gap between clinical guidance and real-life symptoms has contributed to a decades-long problem with misdiagnosis, missed diagnoses, and inadequate treatment for individuals who slipped under the ADHD radar in childhood.

ADHD persists into adulthood for up to 90% of children with the condition, however, only 33% of pediatricians, 30% of family practitioners, 25% of nurse practitioners, and 22% of internists said that they received adequate training on ADHD in medical school, according to data presented by the American Professional Society of ADHD and Related Disorders (APSARD) at its 2024 conference. APSARD is now working to remedy this obstacle to care with the first-ever guidelines for the diagnosis and treatment of ADHD in adults. In 2023, it established a 27-member task force that is devising clinical practice guidelines for the diagnosis and treatment of ADHD in adults. According to David Goodman, M.D., who is leading the medical subcommittee for the task force, the adult ADHD guidelines have the greatest chance at widespread adoption if they are research-based, clinically informed, and patient-focused. APSARD hopes to publish the guidelines in 2025.

Continue reading “The State of Adult ADHD Today” to learn more.

2. ADHD Medication Use Lowers the Risk of Death, Hospitalization

Treating ADHD with medication can lower the overall risk of mortality by 19% and overdose by 50%. It also reduces hospitalizations, both psychiatric and non-psychiatric, according to two large-scale Swedish studies.^{1, 2} These findings highlight the importance of ADHD medication use for long-term health and longevity, underscoring the urgent need to end the stimulant shortage that has prevented U.S. patients with ADHD from consistently accessing medication since the Fall of 2022.

Continue reading “ADHD Medication Use Lowers the Risk of Death, Hospitalization” to learn more.

3. Massive Study Ties Leaded Gasoline Exposure to 150 Million Mental Health Diagnoses in U.S.

Leaded gasoline and exposure to its exhaust may help explain an estimated 151 million U.S. cases of psychiatric disorders, including ADHD, depression, and anxiety, according to a new cross-sectional study spanning the last 75 years.

Exposure to leaded gasoline from car exhaust was tied to population-wide cases of mental health disorders from 1940 to 2015 in the study, published in December in the Journal of Child Psychology and Psychiatry.³ It estimated that more than half of the current U.S. population was exposed to harmful levels of lead in childhood, resulting in profound effects on their mental health, personality traits, and overall well-being. People born between 1966 and 1986 (referred to as Generation X) experienced the highest rate of lead exposure and are at the greatest risk for anxiety, depression, ADHD, and personality changes.

Continue reading “Massive Study Ties Leaded Gasoline Exposure to 150 Million Mental Health, ADHD Diagnoses in U.S.” to learn more.

4. High and Low Estrogen Exacerbate ADHD Symptoms in Females

The impact of rising and falling hormone levels on ADHD symptoms is compounded for females beginning in puberty, according to the multiple hormone sensitivity theory explained in a review article published in January in Hormones and Behavior.⁴ The theory offers valuable insight into how hormones — namely, high and low estrogen levels — may influence ADHD symptoms in females across the lifespan, including during the menstrual cycle, puberty, pregnancy, and menopause.

Per the theory, females may be more likely to engage in risk-taking and reward-seeking behaviors in the days leading up to ovulation. These behaviors coincide with a steady rise in estrogen levels that drops off during ovulation. In contrast, withdrawal and/or depletion of estrogen at a cycle’s end may be characterized by increased negative affect, avoidant behaviors, and reduced executive functioning.

Continue reading “High and Low Estrogen Exacerbate ADHD Symptoms in Females: New Theory.” to learn more.

5. ADHD Medication Costs Soar

ADHD medication costs have nearly doubled or tripled for doses of Ritalin, Concerta, and Focalin since the Adderall shortage began in October 2022, according to a report published in USA Today in late 2023. The newspaper analyzed the prices that retail community pharmacies pay for common ADHD prescriptions. For specific dosages of methylphenidate (i.e., Ritalin and Concerta), the average price paid by small to mid-sized independent and chain pharmacies nearly doubled from late 2022 to December 2023. The average cost of certain versions of dexmethylphenidate (Focalin) more than doubled during that period.

Continue reading “ADHD Medication Costs Soar: Price Report” to learn more.

6. ADHD Traits May Have Provided an Evolutionary Advantage

ADHD traits such as distractibility and impulsivity may have benefited our ancestors as they foraged for food, and they continue to play a crucial role in how people with ADHD adapt and survive, suggests research published in February in the journal Proceedings of the Royal Society B Biological Sciences.⁵

“We speculate that ADHD serves as an adaptive specialization for foraging, thus explaining its widespread prevalence and continued persistence in the human population,” the researchers said. “This tendency to explore while foraging might extend to other behaviors such as cycling more frequently between information sources in the classroom or sources of stimulation in the home environment.”

Continue reading “ADHD Traits May Have Provided an Evolutionary Advantage” to learn more.

7.

In June, the Justice Department charged two top officers at the telehealth company Done Global with allegedly distributing Adderall and other stimulants for ADHD to patients who officials said did not merit a proper diagnosis. While health officials warned that the “disruption” to Done could affect as many as 50,000 adult patients⁶, many of whom were already impacted by the ongoing ADHD medication shortage, this criminal action highlights another important issue: the limited access to clinical care for people with ADHD in the United States.

Continue reading “Done ADHD Investigation Sparks Worry of Inadequate Care” to learn more.

8. Boredom Triggers High Stress Response in Impulsive People

Boredom causes a heightened stress response in impulsive people, as evidenced by the elevated cortisol levels documented in research published in Physiology & Behavior in October.⁷ The research deepens the scientific community’s understanding of the interplay between impulsivity and boredom, suggesting that this relationship may be mediated by the hypothalamic-pituitary-adrenal (HPA) axis.

“This research suggests that the lived experience of boredom feels more intense and aversive for people who are highly impulsive, transforming into an overwhelming need to escape that boredom,” explained Matt Parker, Ph.D., the study’s senior author and a neuroscientist at the University of Surrey.

Continue reading “Boredom Triggers High Stress Response in Impulsive People: New Study” to learn more.

9. DEA OKs Expanded Production of the ADHD Medication Vyvanse

Vyvanse and its generic equivalents (lisdexamfetamine dimesylate) became more readily available at pharmacies following a decision in September by the Drug Enforcement Administration (DEA) to allow expanded production of the stimulant medication used to treat ADHD and moderate-to-severe binge-eating disorder (BED) in adults. The DEA approved a 24% production increase in response to the ongoing stimulant shortage.

“These adjustments are necessary to ensure that the United States has an adequate and uninterrupted supply of lisdexamfetamine to meet legitimate patient needs both domestically and globally,” the DEA said in a letter on September 5.

Continue reading “Vyvanse Shortage Update: DEA OKs Expanded Production of the ADHD Medication” to learn more.

10. ADHD Medication Prescriptions Spiked Ahead of Adderall Shortage

Prescriptions for ADHD medications increased significantly during the COVID-19 pandemic, especially for women and for adults aged 20-39, according to a study published in January in JAMA Psychiatry. The most significant increases were found among prescriptions for adults aged 20-39, up 81% for non-stimulants and 30% for stimulants; and for women, up 59% for non-stimulants and 25% for stimulants.⁸ By contrast, researchers found a decrease or no change in rates of prescriptions during the pandemic for medications used to treat other behavioral health disorders, including anxiety, depression, and opioid use disorders.

Continue reading “ADHD Medication Prescriptions Spiked Ahead of Adderall Shortage: New Report” to learn more.

Sources

¹Li, L., Zhu, N., Zhang, L., et al. (2024). ADHD Pharmacotherapy and Mortality in Individuals With ADHD. JAMA. https://doi.org/10.1001/jama.2024.0851

²Tipale, H., Bergström, J., Gèmes, K., et al. (2024). Attention-Deficit/Hyperactivity Disorder Medications and Work Disability and Mental Health Outcomes. JAMA Netw Open. 7(3):e242859. https://doi.org/10.1001/jamanetworkopen.2024.2859

³McFarland, M.J., Reuben, A. and Hauer, M. (2024). Contribution of Childhood Lead Exposure to Psychopathology in the US Population Over the Past 75 Years. J Child Psychol Psychiatr.https://doi.org/10.1111/jcpp.14072

⁴Eng, A.G., Nirjar, U., Elkins, A.R., Sizemore, Y.J., Monticello, K.N., Petersen, M.K., Miller, S.A., Barone, J., Eisenlohr-Moul, T.A., & Martel, M.M. (2024). Attention-Deficit/Hyperactivity Disorder and the Menstrual Cycle: Theory and Evidence. Hormones and Behavior. 158(105466).https://doi.org/10.1016/j.yhbeh.2023.105466

⁵Barack, D.L., Ludwig, V.U., Parodi, F., Ahmed, N., Brannon, E.M., Ramakrishnan, A.M., and Platt, M.L. (2024). Attention Deficits Linked with Proclivity to Explore While Foraging. Proceedings of the Royal Society B Biological Sciences. https://doi.org/10.1098/rspb.2022.2584

⁶CDC. Disrupted Access to Prescription Stimulant Medications Could Increase Risk of Injury and Overdose. June 13, 2024. https://emergency.cdc.gov/han/2024/han00510.asp

⁷ Clay, J.M., Badariotti, J.I., Kozhushko, N., Parker, M.O. (2024). HPA Activity Mediates the Link Between Trait Impulsivity and Boredom. Physiology & Behavior. 284, 114637. https://doi.org/10.1016/j.physbeh.2024.114637

⁸Chai, G., Xu, J., Goyal S, et al. (2024). Trends in Incident Prescriptions for Behavioral Health Medications in the US, 2018-2022. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2023.5045

ADHD is not a static condition with fixed symptoms, but rather a dynamic disorder with symptoms that wax and wane over the lifespan, sometimes disappearing for years at a time. This was the finding of a new study published in the Journal of Clinical Psychiatry ¹ that made another unexpected discovery: periods of higher environmental demands were associated with times of remission or reduced ADHD symptoms.

Led by Margaret Sibley, Ph.D., professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, the research used data from the longitudinal Multimodal Treatment of ADHD (MTA) study, which followed 483 participants, diagnosed with ADHD at 7-10 years of age, for 16 years.² Follow-up assessments, which were administered every two years, asked participants and parents about the severity and frequency of ADHD symptoms and impairments, as well as about environmental demands, including responsibilities in education, work, and finances.

The researchers found that longitudinal patterns revealed four groups:

• Fluctuating ADHD: 64%

Alternating periods of remission and recurrence

• Stable Partial Remission: 16%

A significant reduction in symptoms was experienced, typically beginning in late adolescence or early adulthood, that remained stable afterward

• Stable Persistence: 11%

High symptoms that met diagnostic thresholds with minimal or no improvement over time

• Recovery: 9%

Sustained full remission of symptoms

Among the group that experienced fluctuating ADHD, the following trends were uncovered:

• There were typically three to four transitions between remission and recurrence over the 16-year period.
• The first remission period often began in early adolescence, around age 12, with symptoms returning within a few years.
• Compared to other groups, symptom severity was moderate.

ADHD symptoms improved to a point of remission at some point over the 16 years for most study participants, Sibley explains in an article titled “ADHD’s Vanishing Act” that appears in ADDitude’s forthcoming spring 2025 issue. In most cases, faded symptoms returned three to four years later, Sibley says.

“In other words, most individuals with ADHD can expect to go through years when their symptoms do not cause meaningful problems,” Sibley writes. “The neurocognitive risks are always present, but the clinical problems may only emerge sometimes. This is comparable to a person who may struggle with weight gain biologically, but who may fluctuate in and out of the obesity range over the course of their lifetime.”

A Busy Schedule Linked to Reduced ADHD Symptoms

The MTA study gathered information about environmental demands, such as an increase in significant responsibilities at work, school, or home, in order to explore whether these demands impacted ADHD symptoms. It turns out they did — but not in the way researchers hypothesized.

“We speculated that increased stresses would be associated with higher levels of ADHD in participants,” Sibley explains. “We were surprised to find quite the opposite, [that] higher levels of demands were associated with remission of ADHD. In other words, people with ADHD were rising to the challenge when demands were high.”

Sibley notes that the nature of the relationship between higher demands and reduced symptoms remains unclear; the study revealed a link, but not how the link works.  “One explanation is that ADHD symptoms fade when consequences in the environment create an urgent need to stay on track,” she speculates. “It is also possible that, when people have lower ADHD symptom levels, they are able to take on greater responsibilities.” Likely, it’s a combination of the two, Sibley says.

Childhood Factors Predict Long-Term Outcomes

The study found that certain childhood factors served as predictors for long-term outcomes. Individuals in the stable persistent group tended to be at higher risk for mood disorders, substance use problems in adolescence, low medication utilization, and poorer response to treatment in childhood. Those in the partial remission group tended to have higher rates of comorbid anxiety. By contrast, individuals in the recovery group were less likely to have mood disorders and parents with psychopathology.

The study helps the scientific community more fully understand the complex landscape of ADHD, and Sibley sees great potential benefit if clinicians pass along this nuanced understanding to patients.

“For some people with ADHD, this may mean staying busy and keeping an active schedule,” Sibley ventures. “It may also mean working with practitioners to leverage a nuanced understanding of ADHD fluctuations when designing a treatment plan that boosts wellbeing.”

Sources

¹Sibley MH, Kennedy TM, Swanson JM, Arnold LE, Jensen PS, Hechtman LT, Molina BSG, Howard A, Greenhill L, Chronis-Tuscano A, Mitchell JT, Newcorn JH, Rohde LA, Hinshaw SP. Characteristics and Predictors of Fluctuating Attention-Deficit/Hyperactivity Disorder in the Multimodal Treatment of ADHD (MTA) Study. J Clin Psychiatry. 2024 Oct 16;85(4):24m15395. doi: 10.4088/JCP.24m15395. PMID: 39431909.

²The MTA Cooperative Group: A 14-Month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder (ADHD) . Arch Gen Psychiatry 1999;56:1073-1086.

If you’re a mom who has it all figured out, with a clean and tidy house, and clean and tidy children who do their homework on time with no prodding, and you prepare elegant meals that Martha Stewart would envy, after a full day of work, congratulations. This webinar is not for you.

If you’re a mom with ADHD, and you feel overwhelmed by the daily chaos of getting kids off to school, managing piles of clutter, planning meals, and juggling household chores with after-school activities, doctor appointments, and more — regardless of whether you work outside the home — then you won’t want to miss this event. ADHD expert, psychotherapist, and author Terry Matlen, LMSW, will provide working and stay-at-home moms with practical tools and strategies to improve their day-to-day life.

• About the societal expectations that push women to demonstrate good executive functioning and the emotional impact on mothers with ADHD
• How to battle disorganization, procrastination, sensory overload, and more
• How to change and reframe internal and external expectations
• How to problem-solve as a family
• How to better manage your time and help your children improve their own time management
• About the importance of self-care

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Motherhood & ADHD: More Resources

• Download: Parenting Guide for Caregivers with ADHD
• Read: 13 Survival Strategies for Moms with ADHD
• Read: “Today, We Will Give Ourselves Grace.”
• eBook: Women with ADHD — How Hormones, Symptoms & Late Diagnoses Impact Females

Obtain a Certificate of Attendance

If you attended the live webinar on December 17, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Terry Matlen, LMSW, is a psychotherapist, consultant and author of the award-winning book, The Queen of Distraction and Survival Tips for Women with AD/HD. (#CommissionsEarned) She runs www.ADDconsults.com, an online resource serving women with ADHD, and www.PowerfulWomenWithADHD.com, an online community for women with ADHD looking for connection and skill building.

With over 25 years of experience helping women with ADHD, Terry has written hundreds of articles for various publications. She served for many years on the board of directors of ADDA and is immediate past coordinator of the E. Oakland County Chapter in Michigan. Terry can be reached at terry@ADDconsults.com.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Webinar Sponsor

The sponsor of this ADDitude webinar is…

Feeling the weight of ADHD while managing work and family life? The mental load can be exhausting, but there’s a way to lighten it.

Play Attention, inspired by NASA technology and backed by Tufts University research, is designed to strengthen executive function and improve focus, memory, and emotion regulation. With the help of a personal focus coach, you’ll gain the tools to handle life’s challenges with confidence. Learn how you can improve executive function in just 10 minutes a day. Schedule a consultation or take our ADHD test. Call 828-676-2240. www.playattention.com

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
Apple Podcasts | Spotify | Google Play | Amazon Music | RadioPublic | Pocket Casts | iHeartRADIO | Audacy

More than half of individuals with ADHD — and significantly more women than men — were diagnosed in adulthood, according to new data published in the U.S. Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR).¹ These findings constitute the CDC’s first update on the prevalence and age of diagnosis for ADHD in nearly 20 years.

The CDC report, which found that 6 percent of U.S. adults have a current ADHD diagnosis, identified several gender-based discrepancies regarding the age of diagnosis. Sixty-one percent of women received their ADHD diagnosis during adulthood, compared to 40 percent of men. One-quarter of women received an ADHD diagnosis before age 11, compared to 45 percent of men.

“Taken together, these data highlight the significant public health burden of ADHD and challenges experienced by adults with this diagnosis,” said Greg Mattingly, M.D., president of the American Professional Society of ADHD and Related Disorders (APSARD), and Ann Childress, M.D., past president of APSARD, in an article published in Psychiatric Times.²

The MMWR analyzed data collected from the National Center for Health Statistics Rapid Survey System (RSS) from October through November 2023 on the prevalence, treatment barriers, and telehealth usage of adults with ADHD.

Consequences of Undiagnosed Adult ADHD

Once considered a childhood condition, ADHD is now recognized as one of the most common mental health conditions in adults, affecting men and women almost equally. ³,⁴ A new national survey of 1,000 American adults by The Ohio State University Wexner Medical Center and College of Medicine revealed that as many as one in four adults suspect they may have undiagnosed ADHD, however, only 13 percent have consulted a doctor about their suspicions. The researchers say the findings raise concerns that self-diagnosis may lead to incorrect treatment.

“In recent years, the number of adults diagnosed with ADHD has risen significantly – thanks, in part, to decades of research that has advanced awareness of ADHD as a lifelong disorder,”⁵ wrote APSARD secretary Maggie Sibley, Ph.D., in the ADDitude article, “Why We Need U.S. Guidelines for Adults with ADHD.” “Though ADHD is commonly detected in childhood, later-in-life diagnoses are providing clarity and relief for many adults with once unexplained, misunderstood, or overlooked lifelong struggles.”

Untreated adult ADHD symptoms may impair individuals personally and professionally, and they may exacerbate comorbidities like depression, anxiety, bipolar disorder, insomnia, substance use disorders, and trauma-related conditions. ⁶, ⁷

“ADHD does not happen in a vacuum, and its effects are far more impairing when the condition goes undiagnosed, untreated, or improperly treated,” said Nelson M. Handal, M.D., DFAPA, in the ADDitude webinar, “New Insights Into and Treatments for Comorbid Depression” “It’s not difficult to see how untreated symptoms of ADHD — from impulsivity and emotional instability to poor planning and execution skills — compromise one’s ability to find success in school, work, relationships, and other parts of life.”

Even with an ADHD diagnosis, adults face barriers to care amid the ongoing stimulant shortage. Approximately 7 in 10 adults treating ADHD with stimulant medications reported difficulty obtaining their prescriptions, the CDC found.

The CDC’s findings suggest that telemedicine may improve access to healthcare and decrease systemic discrepancies in care. Nearly half of adults with a current ADHD diagnosis said they received some of their ADHD healthcare via telemedicine.

“These benefits must, however, be balanced with the need for thorough diagnostic evaluation and follow-up for both the in-person and virtual models of care,” said Mattingly and Childress.

“Some telehealth companies are under federal investigation for their prescribing practices, highlighting a need for clarity on appropriate practices for the prescription of stimulants – a first-line treatment for ADHD,” Sibley wrote. “APSARD’s forthcoming adult ADHD guidelines will address this urgent need for providers and patients alike — making evaluations more thorough, diagnosis more reliable, and treatment safer.”

Importance of Adult ADHD Guidelines

The Ohio State study and CDC data underscore the need for adult ADHD diagnosis and treatment guidelines, which APSARD is working to finalize by late this year or early 2025.

“These will be the first U.S. guidelines for the diagnosis and treatment of adults with ADHD, and they will provide a valuable framework of treatment for clinicians and families,” said Mattingly and Childress. “While many unanswered questions remain, these findings bring us one step closer to a deeper understanding of the needs of adults with ADHD.”

The impact of the APSARD guidelines may be felt most profoundly by adult women.

“Many women do not recognize that they have ADHD or seek evaluations until their children are diagnosed,” wrote Childress in an ADDitude article earlier this year. They are often treated for anxiety or depression that developed secondarily to ADHD. Helping clinicians recognize the difference in presentation of ADHD symptoms in women is important.”

Sources

¹taley, S.B., Robinson, L.R., Claussen, A.H., et al. Attention Deficit/Hyperactivity Disorder Diagnosis, Treatment and Telehealth Use in Adults – National Center for Health Statistics Rapid Surveys System, United States, October – November 2023. MMWR Morb Mortal Wkly Rep. 2024;73(40)

² Mattingly, G., Childress, A. (2024). Clinical Implications of Attention-Deficit/Hyperactivity Disorder in Adults: What New Data on Diagnostic Trends, Treatment Barriers, and Telehealth Utilization Tell Us. J Clin Psychiatry; 85(4): 24com15592. https://doi.org/10.4088/JCP.24com15592

³Ayano, G., Tsegay, L., Gizachew, Y, et al. (2023). Prevalence of Attention Deficit Hyperactivity Disorder in Adults: Umbrella Review of Evidence Generated Across the Globe. Psychiatry Res; 328:115449. https://doi.org/10.1016/j.psychres.2023.115449

⁴Faraone, S.V., Bellgrove, M.A., Brikell, I., et al. (2024). Attention Deficit/Hyperactivity Disorder. Nat Rev Dis Primers; 10(1):11. https://doi.org/10.1038/s41572-024-00495-0

⁵Sibley, M.H., Arnold, L.E., Swanson, J.M., Hechtman, L.T., Kennedy, T.M., Owens, E., Molina, B.S., Jensen, P.S., Hinshaw, S.P., Roy, A., Chronis-Tuscano, A. (2022). Variable Patterns of Remission from ADHD in the Multimodal Treatment Study of ADHD. American Journal of Psychiatry;179(2):142-51. https://doi.org/10.1176/appi.ajp.2021.21010032

⁶Kessler, R.C., Berglund, P., Chiu, W.T., et al. (2004). The US National Comorbidity Survey Replication (NCS-R): Design and Field Procedures. Int J Methods Psychiatr Res; 13(2):69–92. https://doi.org/10.1002/mpr.167

⁷Katzman, M.A., Bilkey, T.S., Chokka, P.R., et al. (2017). Adult ADHD and Comorbid Disorders: Clinical Implications of a Dimensional Approach. BMC Psychiatry. 17(1):https://doi.org/10.1186/s12888-017-1463-3

Art is Hayley Wall’s love language. Since Wall was a young child, she has found her footing as a communicator through drawing. Wall struggled academically as a child due to dyslexia and undiagnosed ADHD and autism, but she says, “What I did have was this gift where I could create images and I could tell stories.”

When Wall graduated from university and considered where to take her art, she was drawn to the topic of disability. “I was exploring the things I felt were important, the things that needed to be spoken about,” Wall explains. “My mom is disabled, so that’s been around me for a long, long time and it’s felt like people with disabilities are always the last to be thought of.”

Wall was asked to illustrate an article on chronic illness for the cover of Sick magazine, and then another on the same topic for It’s Nice That. These illustrations caught the attention of The New York Times, which commissioned Wall to illustrate a package celebrating the anniversary of The Americans with Disabilities Act. Her work became known for her signature bodies — large, gender-fluid forms, typically without faces, that exude strength, joy, and confidence.

As Wall’s art career gained momentum, so too did her personal journey to understand her own neurodivergence. Though Wall struggled with mental health challenges all her life, it wasn’t until she was 34 that she received a diagnosis of ADHD and autism.

Below, Wall shares her creative process, the challenges and joys of being a neurodivergent artist, and her commitment to a future that celebrates different minds and bodies.

[Read: “Happily Neurodivergent — at Last”]

Q: How did your diagnoses come about?

I’ve always wondered, ‘What’s wrong with me?’ and always struggled with my mental health. It was a feeling of being too much — too emotional, too sensitive, I always carried this feeling of, I just don’t fit in.

When I was 30, I sat down with my partner at the time, and was like, ‘I found this article about adults that have been diagnosed with ADHD and I’ve just done multiple quizzes. Can you do the quiz as well, please?’ They did, and they scored really low. I was like, ‘So you don’t do that? And that?’ It made me think, ‘OK, I think something’s going on.’ I approached my general practitioner, and from there, it took four years to get a diagnosis.

When I was 36, a year ago, I got diagnosed with autism and a mental health condition. I’m coming to terms with all these diagnoses and trying to understand how to navigate them. To me, what’s more important is not the label but just working out what I need.

Credit: Hayley Wall, illustrator

[Self-Test: Autism Test for Adults – Signs of ASD]

Q: When did your love of art begin?

I was a kid who bounced off the walls, I had so much energy. I wouldn’t shut up, and I would cry and scream. To calm me down, my parents would give me pens and paper and I would draw. It was the one time I was calm and focused.

Q: How does your ADHD inform your work?

After graduating, it took me 8 to 10 years to establish myself. I’ve done so many random jobs. I’ve worked as a nanny, in factories, in cafes. But running parallel to that was my hyperfocus, which kept me on track to pursue art. My hyperfocus is the reason I’ve been able to turn art into a career.

My work is all about bodies, usually gender ambiguous bodies. They are these big bodies that take up space — maybe because I’ve always felt really small and inferior. The bodies in my work are powerful. I can live through them.

The whole ‘taking up space’ idea is a big f&*k you to society for being like, ‘You have to be like this, or like that.’ It’s, ‘No, we can be whomever we want to be.’

Q: Can you tell us about your creative process?

A commission will come through and it’s like jumping on a roller coaster. There’s a voice that goes, ‘Here we go.’

I center myself and breathe to remove any negative voices and let the process take me.

As I read the commission, the visuals start coming, and my brain is joining dot-to-dots. I have a background in dance, and the dancing lives in my work now. Sometimes I’ll get myself or my friends into different positions and I’ll draw from that. I create loose, playful hand-rendered drawings and textures, and then I bring it onto my computer to work with.

Once I’ve got my concept down, I enter the most playful part of the process. I can enjoy coming to the end of the roller coaster nice and slowly.

Q: What’s the hardest part of your job?

The first bit of the process, mind-mapping concepts, is hard because I’ve got so many ideas, and I need to hone in. It’s the organization of thoughts that’s hard.

What crushes mind-mapping is impostor syndrome, a feeling I’ve carried of being inferior. I wish I was able to remove that saboteur voice that creeps in to say, ‘You’re not good enough,’ so I could just let my brain run free.

Q: What ADHD supports have you found helpful?

Freelance work is definitely hard because you don’t have HR, you don’t have colleagues to turn to. You are your absolute everything, and it’s really tough.
I was doing it for a long time all by myself, and I reached burnout. My mental health crashed.

In the UK, we are very lucky in terms of the benefits we get from the government. The ‘Access to Work’ program offers a sort of grant or reimbursement scheme to cover the cost of a support worker. It has been very helpful to me, and I’ve used that to have somebody support me through the admin tasks.
I never want to go back to a point where I’m trying to manage it all alone.

Q: Any advice for other artists with ADHD?

If you can tune into your voice and communicate your story, that’s when you’re going to create something nobody’s ever seen before.

Q: Where are you now on your journey of understanding your neurodivergence?

With the community I’ve found, I have a feeling of being able to unmask, to be my true self, to be able to be too much, weird, overly emotional, and sensitive.

Recently, I did a commission for a London museum and library called The Wellcome Collection. They asked me to respond to an article written by a person who was diagnosed with autism as an adult, and because this piece was so personal to my experience, I really wanted to place myself in the work. It was a three-part series: before, during and after diagnosis.

For the final image, I Photoshopped my face in quite a warped way onto the figure. I’ve hid behind my work for years, so to put my own face on this figure felt quite important. It was like, ‘I’m unmasking now. I’m showing myself. I’m allowing myself to actually come through. This is me.’

ADHD, Art, and Mental Health: Next Steps

• Read: Stifled Creativity and Its Damaging Impact on the ADHD Brain
• Read: Why ADHD Masking Is a Form of Self-Sabotage
• Read: “I’m Not Hiding My ADHD Anymore”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Rachel Feinstein finds herself in some ridiculous situations courtesy of her ADHD. Because she’s been gifted with a razor-sharp sense of humor, she takes these unlikely, sometimes absurd moments and turns them into comedy gold in her stand-up routine.

Rachel is a nationally touring comedian and actress whose newest hour-long comedy special, Big Guy, is now streaming on Netflix, where it premiered in the Top 10. In it, she talks about everything from her aggressively liberal mother and Facebook-blundering dad to the odd-couple relationship she has with her fire chief husband, who affectionately calls her “Big Guy.” In vivid detail, Feinstein illustrates how perplexing and frustrating her annoyingly neat husband finds her chronic messes.

“One morning, I walk into the kitchen and my husband is just pacing,” she recounts. “He goes, ‘One question. I got one question for you: Why are there three open seltzers? I’d love to hear the story behind that.” And I’m like, ‘It’s not gonna be a good tale. It’s not like I’m gonna tell you ‘Well, there was blow and hookers and then three open La Croixs!’”

Feinstein’s been praised for her “amazing impersonations” (Vulture), “acute observations,” and ability to be “subtly, exquisitely attuned to her audience” (AV Club). She’s had three Comedy Central specials, co-hosted The View, and been a guest on The Tonight Show with Jimmy Fallon and Last Week Tonight with John Oliver, among other late night shows, not to mention her slew of TV and film appearances. And she’s the mother of a three-year-old, who provides plenty of comedy material. “My daddy’s a hero,” her daughter likes to say. “And my mommy’s sarcastic.”

Below, Feinstein opens up about the good, the bad, and the funny of her ADHD journey.

[Read: In Praise of the ADHD Funny Bone]

Q: What does your ADHD look like?

I am insanely disorganized. I am always running late. I shed debit cards. I’m always leaving a shoe in somebody’s car. I lose a passport almost every year.

My husband, who is OCD, always says to me: ‘Why don’t you just put things back in the same place?’ And I’m like, ‘You’re assuming I know where I put them. My hands take trips throughout the day. It’s like my hands are not connected to my body.’

I’m a workaholic — but only if someone’s sitting with me. I always have to have a babysitter for myself. I pay people to sit with me.

[Read: Get More Done With a Body Double]

So, for example, an editor expressed interest in working with me on my Netflix special, but I knew I was never going to go through it and email him time codes. So I said to the editor: ‘I’m going to come to your house and sit with you and edit every line with you.’ I don’t think he thought I was going to really do that. Then I was over at his place — just me and him and his wife in his little apartment. I’d leave and bathe and give him time to implement notes, but we were together for two weeks and we got it done. I think we were common law wed by the end of that process.

Q: What was school like for you?

When I even smell a school now, it brings me back to all these weird bad feelings about myself. Ever since I can remember, I was always doing so terribly in school. I was failing, getting Ds and Fs in my public school. They couldn’t stuff information into my brain. I had no idea what was going on in any of the classes. I remember getting 23% on a quiz and thinking, ‘Wow! I can’t believe I know 23% of this!’

I felt like a quaking, throbbing mess in school. It created my core self-esteem issues. When I was 11, I was diagnosed with ADHD, inattentive type.

Then, junior year in high school my parents took me out of the local public school and got me into a tiny Quaker school. There were 60 kids in the whole school, 8 kids in each class. I was able to learn there. I wasn’t distracted and confused. I had a 3.8 GPA for a beat.

Q: When did your love of comedy begin?

From very early on, I loved accents and imitating people and affectations. My parents got me into acting classes and I’d put on living room plays and impersonate everyone in my family.

I always thought I had to entertain people. I remember trying to make everybody laugh in school — and being good at that. That was one thing I could do.

Q: How does ADHD inform your comedy?

I think about things in a funny way. I wasn’t able to think about things in a straight way, so that was the only option left available to me. I need things to hook on to that are funny; that’s what helps me pay attention. So, if someone uses a weird word choice, I’m going to notice what’s funny about it, otherwise I won’t retain anything.

My mom said I was always friends with people who had very distinct personalities and accents — it woke me up, jolted me. That’s true to this day; I’m married to a Brooklyn firefighter pronounced “fiya fida.”

Q: What’s your favorite part of your job?

When I’m on stage, I get a very immediate reaction: it either works or it doesn’t. I am addicted to it, the way my husband’s addicted to the adrenaline rush of being a firefighter. This also helps me as an editing process: I know what works and what doesn’t, and I shed, shed, shed as I go.

The other great thing about stand-up for somebody with ADHD is once you’re booked, you have to do it — you have to be on stage. It’s not something you have to turn in; if it was, I’d never turn it in.

Q: Your least favorite part of your job?

The constant rejection, which mimics all those bad feelings I had about myself in school. There’s always a new insult, even when you think you’ve gotten past that and you’re accepted.

I have to retrain my mind every day to not focus on the person that isn’t into me, that doesn’t like what I’m doing. When the rejection starts to take its toll, I go to the Comedy Cellar and have an immediate connection with the audience.

Q: Where have you found inspiration or encouragement along the way?

I had a therapist who told me that I could juggle a lot of things and that I could grow up and do something where I could be thinking of a million things at once. I remember thinking, ‘This is a man with a desk, who went to graduate school, and he believes this?’ I thought. ‘If Dr. Castellano thinks I won’t be in a Gray Gardens situation for the rest of my life, maybe I won’t be.’

Later, when I was 17, I moved to New York with this random guy and his band, which was named ‘Dick’s Sister.’ I was very obsessed with guys at the time, thinking more about them than what I was going to do with the rest of my life. I had a vague idea of being something funny.

I really didn’t know how to keep a job and I kept getting fired from everything — waitressing, bartending. Then I started nannying for this five-year-old boy with autism. That was the one job I could keep. I really related to his struggles.

I remember I’d tell him, ‘Go put that in the trash can and come right back,’ and he’d get caught between where we were sitting and the trash can. I’d see him get almost there and then get lost. I really related to the feeling of making it halfway to what you were supposed to do. I still do that — I do most of the work and it falls apart at the end.

I worked really hard at the nannying job because I just had this feeling that he had really complicated thoughts, that he was really smart. I didn’t know if I was projecting onto him, but there really was something very special and creative and gifted about him. He ended up going to Harvard. We’re still in touch. He came to my wedding!

It was the first successful experience I had of following something through, until I did stand-up full time. He taught me a lot more than I taught him.

Q: What’s your advice to other people with ADHD?

For anyone who struggles with those old bad feelings from school, my message would be what a lovely therapist said to me: Believe in the way your mind works. Do what you need to do to support yourself.

What might be considered indulgent or lazy might be your own weird route to success. When I was getting started, I did stuff like take cabs everywhere because I was always late. That’s the way I had to do it. I knew I would never be the person who was going to take two buses and be there on time. I spent money to make money. I bet on myself.

ADHD and Comedy: Next Steps

• Read: Laughter Is the Best Medicine
• Watch: “ADHD is Awesome – The Holderness Family Guide to Thriving with ADHD”
• Read: Laugh It Up
  
• Read: Stifled Creativity and Its Negative Impact on the ADHD Brain

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Women who reported physical intimate partner violence (IPV) before menopause experienced a significantly greater decline in working memory after menopause as compared to women who had not reported violence, according to new research.

Comprising a subgroup analysis of the Study of Women’s Health Across the Nation (SWAN), this research revealed that women who reported physical intimate personal violence showed an annual decline of 0.17 points in working memory performance post-menopause, compared to women who had not reported IPV. Declines in other areas of cognition, including processing speed and verbal memory, were not observed.

SWAN is a multisite, longitudinal cohort study that began in 1996. It seeks to investigate physical, psychological, and social changes that occur during midlife. Baseline information was collected at the start of the study from participants, women aged 42 to 55, and follow-up visits continue to be conducted annually. The subgroup analysis focused on IPV was led by Jillian Baker, MPH, of the University of Michigan in Ann Arbor, and presented at the annual meeting of the Menopause Society this month.

Baker’s subgroup analysis measured the cognitive performance over time of women who reported physical IPV in the year prior to the SWAN baseline. That subgroup comprised 3.1% of all participants.

The cumulative effect of working-memory decline can dramatically impact quality of life. “Over the course of several years, a decline like this would equate to a drop of nearly two points. and a ten-year change of nearly two points is objectively a loss of nearly a quarter of the average baseline score,” Baker explains. “We think of working memory as the ability to follow directions you just heard or to remember the steps of a task you need to do. If this function is impaired, it can feel pretty debilitating.”

Connecting IPV to Working Memory Impairments

Much remains unknown about how physical IPV contributes to working memory decline. Baker explains that many survivors of IPV have experienced brain injury, often repeatedly, which is linked to changes in cognitive performance. In addition, IPV survivors often struggle with mental health conditions including anxiety, depression, or post-traumatic stress disorder. They may also experience poor sleep and chronic hypervigilance, which may have a deleterious impact on working memory.

“We need more research into these potential mechanisms,” urges Baker. “As they may indicate points of intervention to prevent declines in working memory.”

Another question that remains: Why was physical IPV associated with working memory decline but not with declines in other areas of cognition? These unknowns underline the necessity of additional research, says Baker: “This work sends a strong signal that the association between intimate partner violence and change in cognitive performance is worth studying further.”

Implications for Women with ADHD

Research has proven that women with ADHD are at a particularly high risk for physical IPV due to low self-esteem, high rejection sensitive dysphoria (RSD), and social skill deficits. A study published in the Journal of Abnormal Child Psychology found that:¹

• Girls with ADHD were five times more likely to be victims of physical intimate partner violence than non-ADHD girls (30% vs. 6%)
• Greater ADHD symptom severity in childhood was associated with increased risk for physical victimization

While the sub-analysis did not include data on ADHD, Baker notes that, “it is both an interesting and important research question to understand how ADHD may play a role in this association,” especially given that women with ADHD often struggle with pre-existing challenges in working memory.

According to the WHO, one-third of women worldwide will experience some form of intimate partner violence during their lifetime, making this research critical to a broad audience of women. “Millions of women are at risk for health effects of partner violence,” says Baker. “We hope this research contributes to the call to invest in violence prevention and support for survivors.”

Sources

¹Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.

The answer? Laundry.

Putting away clean laundry, according to Makkai, is an “insurmountable task.” So is making doctors’ appointments, keeping track of her keys, tolerating conversational lags, and opening a package neatly with scissors. These are the parts of ADHD that Makkai, who was diagnosed just three years ago, finds frustrating. But for Makkai, these annoyances are just a small part of the big neurodivergent picture.

Makkai says ADHD affords her the hyperfocus, bold instinct, and associative thinking that’s allowed her to craft novels like I Have Some Questions for You and The Great Believers, lauded as “spellbinding, “enthralling” and “emotionally riveting” by media outlets including The New York Times Book Review.

“My mind goes in 17 different directions at once, and I’m constantly reaching for new ideas. Everything in the world contains a million things behind it and they’re all fascinating,” Makkai explains. “I’m sure that there are certainly plenty of artists who are linear thinkers but, to me, that feels like a disability. You’re trying to make art and you can only think of one thing after another in a straight line?”

[Download: Your Free Guide to All the Best Parts of ADHD]

Below, Makkai talks about her recent ADHD diagnosis, the gift afforded to her by an unusual education, and how she harnesses the powers of her neurodivergence to create unforgettable stories.

Q: When were you diagnosed?

I was diagnosed two or three years ago, mostly because I have a daughter who is not neurotypical and I was doing these online quizzes for her.

The diagnosis was almost entirely a relief and a revelation. Now, when I lose my keys or mis-manage my time, I know I have reasons other than ‘I’m lazy, I’m spacey, I don’t care.’ It offered me the ability, in certain situations, to stop masking and to help my daughter, who got diagnosed after I did.

[Read: Not Ditzy. Not Lazy. And Definitely Not Dumb.]

It’s been amazing to look back and acknowledge how much of my life I’ve faked, how often it’s like I’m listening to a radio with very poor reception, catching three words and pretending I know what’s going on.

Q: What does your ADHD look like?

I live in a world in which objects move behind my back. I put down my keys and they’re gone. Streets rearrange themselves.

My physical hyperactivity is subtle. If I stand near the food at a party, I will not stop eating — not because I have food issues, but because eating is something to do with my hands. I can only slow down my rapid speech with effort, and I panic at conversational lags. It takes everything I have not to interrupt people constantly.

I have a highly associative brain and a tendency to start several sentences at once. I’ve learned to explain this to my writing students on the first day of class. I’ve learned to start a lot of sentences with “Sidebar” and hold up one finger so students understand that I’m not permanently derailing the conversation.

Q: What was school like for you?

Traditional school can be an ADHD torture chamber. I went to Montessori School until 8th grade, and it was perfect for this kind of mind. It was like, ‘OK, you’re not in the mood for math? You’ll have to do it eventually, but right now, you can go do a report on hedgehogs and knock yourself out doing that for three days. When it’s time for math, you can write your own word problems, or you can do it with a friend, or you can do it in the hall.’

There are so many plusses to this, the biggest one of which is that I learned how my brain works and how I get work done. I’ve been able to carry that with me.

I’m not someone who writes every day. Why would you write every day? If I sit down to work and I’m not in a place to write, then I research. I can do other stuff all week and then I can write for 16 hours if I’m in the mood, so I’m not going to beat myself up for not writing 1,000 words every day.

Before I published my first book, I taught Montessori for 12 years, and that was great for me. There are 30 things going on all the time and you have to pay attention to all of them. I’d be helping a kid with long division, keeping an eye on a discipline issue, answering a question for another kid. Give me that all day long.

Q: How does your ADHD inform your writing?

I’m happiest when I’m doing five things at once. If I could somehow ride a bike and do a Sudoku puzzle and watch a movie and drink a smoothie at the same time, I’d be in heaven. The great news is that the mental juggling you have to do in order to hold a 300-page novel in your mind — ADHDers were built for that.

I teach a lot of really talented writers and I’ve noticed that one of the things that really holds a lot of people back is a dearth of ideas. They start something and they have a couple of elements going on, but they don’t have the urge to add more things that might enrich this. They are marching along this straight and predictable path, which can make for boring writing.

I think a lot of people don’t have good boredom detectors. People who have an above-average sense of patience are going to overestimate the patience of most readers. I am so easily bored that, if I can manage not to bore myself, I probably won’t bore anyone else.

I don’t have infinite patience with a text that’s beautiful but there’s no real craftsmanship to the plot. It’s an art to be able to keep hooking people.

Q: Do you have any ADHD hacks for getting work done?

Deadlines are fantastic for me; they kick me into high gear. Often, I really can’t bring myself to do it until the day before and then I suddenly put my cape on and fly at it and it’s great.

For example, I have a writing group and I know that, if I’ve told them I’m going to get them pages by our meeting on October 1, I have to get those pages to them by then. That helps a lot.

I’ve learned to lean into the sprint in little ways, too. I’ll fail to plug in my computer, realize it’s running low on power, and then try to see how much I can write before it dies. One of the reasons I write well on an airplane is I know I only have so long before they say you have to put away your laptop.

Then, too, so much of the business of writing is not writing. It’s blurbing and interviewing and answering emails. An assistant helps a lot with those things.

Q: What’s your advice to other people with ADHD?

I am so fortunate that I was able to figure out how my mind works at an early age. I’m trying to do that with my daughter now. I tell her, ‘You don’t have to do the same thing everyone else is doing, but you do have to get this done. Let’s analyze: What is your plan? Where do you need to be to get work done? What’s a distraction? What’s a useful distraction? What’s a good break?’

Yes, we need to acknowledge the challenges. And, yes, I frustrate myself, but I love the way my brain works. I’m love my career and how my career is going — and it’s largely due to the brain I have.

The Upsides of ADHD: Next Steps

• Read: Stifled Creativity and Its Damaging Impact on the ADHD Brain
• Buy: I Have Some Questions for You and The Great Believers by Rebecca Makkai
• Read: 10 Things I Wish the World Knew About ADHD
• Watch: “ADHD is Awesome – The Holderness Family Guide to Thriving with ADHD”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

But I was confused. I associated ADHD with fidgety grade-school boys. Little did I know that I, an adult woman, could also be diagnosed with ADHD. My daughter’s descriptions of time and organizational overcompensation, decision paralysis, procrastination, overwhelm, and hyperfocus resonated deeply with me. When I suggested that I might have ADHD myself, she agreed.

While waiting for an evaluation and the results, I had daily epiphanies as I connected my lifetime of experiences with information about the ADHD brain. Like so many of us, I’d spent years feeling inadequate, hypersensitive, and too ashamed to say any of it out loud. How many paralyzing hours did I lie on the couch, wondering what was wrong with me? My diagnosis came in August 2022.

[eBook: Women with ADHD: How Hormones, Symptoms & Late Diagnoses Impact Females]

Six years earlier, at almost 49, I’d unknowingly set in motion a seismic journey of personal reinvention with the decision to stop drinking (10 years in the making) and enter therapy for the first time. I was finally able to follow through on both steps, even in the face of intense anxiety and self-hatred. My sobriety and therapy unleashed a flood of unresolved issues and traumas. Recovery was just the beginning of my self-discovery.

I ended my 26-year marriage and became an empty nester. My work as a commercial interior designer suddenly felt toxic. I had come to realize that there was a fundamental misalignment between my strengths, interests, and responsibilities. Near crippling self-doubt and fear of rejection had kept me tethered to my career for 28 years. Finally, my ADHD diagnosis shattered the narrative of not good enough, paving the way for self-compassion and newfound confidence and hope.

Standing at the intersection of creative expansion and personal revolution, I found a community of midlife women on similar paths and planted the seed for starting my company, Triple Moon Coaching. I enrolled in a holistic coach certification program so I could build a side practice and phase into full-time professional life coaching.

Empowered by clarity and optimism, I focused on creating my new vision. ADHD impulsivity has been a consistent thread for as long as I can remember. My resignation was bold and necessary, and a bit premature. But I was learning. No regrets.

I am on a solid path to successful entrepreneurship. It’s a joy and a privilege to coach women who are taking charge of their lives and growing into their own unique potential.

ADHD in Women: Next Steps

• Self-Test: Symptoms of ADHD in Women & Girls
  
• Sign Up: Essential Support for Women with ADHD
• Read: The Transformative Power of an ADHD Diagnosis for Older Women
  
• Read: 10 Books Every Woman Should Read After Her ADHD Diagnosis
  

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Episode Description

Brain fog, emotional meltdowns, and fear of dementia. Perimenopausal women with ADHD face these and myriad other challenges to brain and body due to hormonal changes during their final reproductive years. Many women, with and without ADHD, are not fully aware of the hormonal processes that start up to 10 years before menopause. During this busy time of life, many women carry great responsibility for children, aging parents, career, and family logistics. Already burdened by stress, most women assume the physical and psychiatric symptoms of perimenopause are unavoidable. At the same time, they struggle to understand and effectively treat their changing ADHD symptoms during this time of hormonal transition, which has been largely ignored by medical research to date.

All of this is true, however many researchers and clinicians continue to dismiss patients’ concerns saying that “there are no studies exploring adult or older women” or “there is no evidence to support advice on adjustment of medication or other treatment efforts for (peri)menopausal women.” It is, of course, important to base our medical advice on the best available research. But is it ethical to allow adult women with ADHD to suffer just because researchers and clinicians haven’t paid them enough attention?

We think not! That is why I’m passionate about doing the best and the most we can and to communicate the evidence that actually exists.

In this webinar, you will learn the following information to share with your clinician:

• How the ADHD brain reacts to fluctuating hormones in vulnerable periods of the female life
• How you can differentiate between ADHD and menopausal symptoms
• How the “swinging” decrease of estrogen and progesterone during perimenopause can worsen ADHD symptoms and influence medication effect
• How psychiatric and physical symptoms interplay with ADHD in (peri)menopause
• How to treat ADHD and menopausal symptoms in adult females
• How the ADHD life beyond menopause can look

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO

ADHD in Perimenopause & Menopause: More Resources

• Download: Menopause & ADHD: Treatments & Interventions
  
• Replay: The Emotional Lives of Girls with ADHD
• Read: “How I Restarted My Life After a Post-Menopausal ADHD Diagnosis”
• Advocate: We Demand Attention! A Call for Greater Research on Women with ADHD
• eBook: How Hormones, Symptoms & Late Diagnoses Impact Females with ADHD
• Sign Up: Get a 30% discount on LetterLife — an app founded by Dr. Lotta Borg Skoglund that empowers you to better understand ADHD symptoms, hormones, and lifestyle factors. Gain exclusive access to top experts specializing in women and ADHD. Sign up today!

Obtain a Certificate of Attendance

If you attended the live webinar on October 16, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Lotta Borg Skoglund, M.D., Ph.D., is an author, keynote speaker, and entrepreneur from Sweden. Her specialty is in psychiatry/addiction and family medicine with a specific focus on ADHD and ADD. In 2015, she defended her thesis, When ADHD and Substance use Disorders Coexist – Etiology and Pharmacological Treatment, at Karolinska Institute, Stockholm.

Dr. Skoglund currently holds a position as Associate Professor at Uppsala University, Department for Women’s and Children’s Health, where she continues her research into ADHD, comorbidity, and gender influences. She is specifically interested in how hormones affect mental health across the female lifespan — a field that is not even close to being researched enough! Together with colleagues from around the world, she leads the pioneering research group GODDESS ADHD.

Listener Testimonials

“Today was so great. Such a relief to hear my symptoms discussed and validated! Thank you!”

“The list of information to take to a medical appointment was particularly helpful. Thank you!”

“Amazing speaker, so knowledgeable and up to date. Very helpful.”

Webinar Sponsor

The sponsor of this ADDitude webinar is….

“Is it ADHD, menopause, or both?” The overlap between the two can be confusing and overwhelming. At Inflow, we understand the unique challenges of managing ADHD during this transitional phase of life. Our CBT-based app program, developed by expert ADHD clinicians, provides you with effective strategies to navigate the combined effects of ADHD and menopause. From mood swings to memory lapses, we’ll help you develop coping techniques to manage your symptoms and stay on track. Don’t let the confusion of ADHD and menopause hold you back. Take the free ADHD quiz today to kick off your self-care journey.

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
Apple Podcasts | Spotify | Google Play | Amazon Music | RadioPublic | Pocket Casts | iHeartRADIO | Audacy

Some of these women feel overwhelmed with overcommitment and dread moral judgment of their efforts. They feel ill-equipped to manage life’s complexities. These are the women with hidden ADHD: undiagnosed, untreated, and underserved.

Evading ADHD detection for so long suggests these women were able to present a seamless façade; that they passed for neurotypical, which may have felt like a win. But perfectionistic masking almost always comes at a high emotional cost. The self-monitoring is relentless; the hypervigilance, fueled by anxiety, exhausting.

While hiding their true selves may have seemed necessary to escape anticipated judgment and rejection, women who receive an ADHD diagnosis later in life report a new appreciation for the courage and determination that served them for so long.

Getting an ADHD Diagnosis Can Be Revelatory

Diagnosis at midlife unleashes a kaleidoscope of sensations—shock, anger, relief, regret, shame, fear, guilt, resentment, and sadness. On the life-changing journey toward understanding and acceptance, your first step is to learn everything you can about ADHD in women. Make use of audiobooks, articles, podcasts, webinars, support groups, and therapy.

[Read: Women with ADHD – No More Suffering in Silence]

Gradually, the explanation for your years of distress and confusion will emerge with increasing clarity. Share it with the people most important to you. Honor the regret you feel about the opportunities lost, then embark on building a more rewarding future.

The Impact of Hormones

For women with ADHD, declining estrogen levels in perimenopause and menopause trigger a perfect storm: functionality suffers as the severity of ADHD symptoms and coexisting anxiety and depression spike. Fluctuating hormones also disrupt mood, memory, sleep, concentration, and motivation. Shame and self-doubt, amplified during the premenstrual phase, become more intrusive and destabilizing.

Ambushed by tsunamis of emotion and memory lapses, many women attribute their worsening struggles to character flaws and judge themselves harshly. Since women now spend about a third of their lives in menopause, it’s a game-changer to discover that your unpredictable functioning is hormonally mediated.

Reinvent Yourself

We cannot change our age, history, or brain wiring, but we can change the lens through which we view our world. Changing our perspective and redefining our identity is best achieved through an alliance with a therapist who has expertise in working with women with ADHD.

[Read: Relief, Grief, and More Raw Reactions to an Adult ADHD Diagnosis]

In the meantime, begin the process of creating a new version of yourself by doing the following:

• Embrace your strengths. Understanding the far-reaching impact of ADHD in midlife enables a more realistic assessment of your strengths and weaknesses. After years of ruminating about your limitations, you’ll learn that there is strength in knowing when you need help and asking for it.
• Trust your unique vision. Non-linear thinkers are differently abled. Your passion and creativity enhance the neurotypical status quo with novel solutions.
• Create boundaries. To many women, social acceptance is an indicator of self-worth. Social dynamics are confusing, and you may consider others’ agendas more important than your own. Boundaries can help you find a balance between feeling trapped by overcommitment and withdrawing from interactions to avoid confrontation.
• Prioritize self-care. It takes a serious investment in your wellbeing to change the way you interact with your body. Women with ADHD tend to skimp on attention to their health. Creating a bedtime routine to improve sleep requires small changes over time. Eating healthier foods, drinking more water, and maintaining an exercise routine demand healthy vigilance. Balance conflicting needs—protection vs. connection, self-care vs. accommodating others, and passivity vs. assertiveness. Each small step will improve your quality of life.
• Develop systems that work for you. When chaos and clutter threaten to consume your environment, you may feel more frantic and unable to envision solutions. Creating organization and routine will help you manage your time and space more effectively.
• Seek pleasure. Take a designated amount of time each day, even just 15 minutes, to do something you find pleasurable. This transition will allow your brain to revel in unstructured downtime, whether that means chilling out with music, meditating, or having a cappuccino while playing Wordle.

After decades of shame, apologizing, and fearing criticism, a diagnosis gives you explicit permission to forgive yourself for being your own harshest critic. Whether you’ve punished yourself in the past with isolation, substance abuse, binge eating, or other kinds of self-harm, a midlife diagnosis can help you accept that you are worthy of being nurtured—by yourself and by others.

Diagnosis at midlife is the beginning of an ongoing journey toward enlightenment and transformation. Seize this unexpected second chance to believe in yourself. As you get the hang of reinvention, you will rejoice.

Reinvent Yourself Post-Diagnosis: Next Steps

• Watch: The Science Behind Diagnosing and Treating ADHD in Older Adults
• Download: Free Guide to ADHD in Older Adults
• Read: ADHD in Older Adults – Distinct Diagnostic and Treatment Considerations

Ellen Littman, Ph.D., a clinical psychologist in New York, is co-author of The Hidden Side of Adult ADHD, Understanding Women with ADHD, and Gender Differences in ADHD.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

“In talking with Maria, it is clear that her family and instructors have historically viewed her as being intellectually quite bright and an underachiever.”

These are not a passive-aggressive bully’s words, a sibling’s backhanded compliment, or careless remarks delivered at a parent-teacher conference. These are the very deliberate words of a neurologist, neuropsychologist, and medical-education specialist following my ADHD evaluation in childhood. The intended audience: my parents, my family physician, and my teachers.

The clinic’s problematic “assessment” and cruel words still haunt me years later. I didn’t read their words until I was in my 40s, and I finally understood why I had a decades-long habit of telling people I have no special talents. The specialists stated in scientific terms that I, a child, was a talentless loser. My parents and my family physician believed them without question. What could my parents have done differently?

[Take This Self-Test: ADHD Symptoms in Women and Girls]

Set in Their Ways

Despite education and experience, we know that experts make mistakes all the time. It’s why we frequently seek second medical opinions. My parents certainly needed one when the politely insulting report described my problems as “common” with ADHD, but the tone of the recommendations was “do better.” A second opinion would have offered my parents another analysis of my behaviors. Most importantly, I could have had a chance at a better life.

But my parents – education experts – were inclined to go along with what the evaluators said, as they shared similar vocational backgrounds. Though my mother still harbored some suspicions that I had ADHD, she and my father ultimately assumed that I was failing my classes on purpose. They made sure to share their theories about my behaviors with my teachers, who were more inclined to default to their opinions rather than their own judgment about my classroom behavior they saw every day.

What I Cannot Forgive

I can forgive science not catching up in time. (After all, it’s been more than 30 years since that evaluation and we’re still working to better understand ADHD in girls.) What I cannot forgive is my parents and the clinic for the cruelty, sexism, and failure to recognize the fact that I didn’t want to do poorly. In any setting, telling someone they do not have any special talents or that they’re an underachiever is an appalling insult.

[Read: “11 Things I’d Tell My Younger Self”]

The rest of the report would eventually prove hilariously inaccurate. “During the evaluation Maria did not demonstrate many of the learning deficits often observed in adolescents with a primary attention deficit hyperactivity disorder,” reads part of the report. Thirty-one years later, I received my ADHD diagnosis at age 44.

Ironically, the experts who wrote the report that detailed my carelessness and sloppiness also committed typographical, punctuation, and grammatical errors along with listing my incorrect home address on every page and misspelling my last name. Perhaps they were gifted in other areas? Unfortunately, those doctors didn’t provide their full names in the “scientific” report they authored, so I was never able to track them down to find out. What a relief for them.

Undiagnosed ADD: Next Steps

• Free eBook! We Demand Greater Research on Women with ADHD
• Read: “I Could Have Been Myself for So Much Longer.”
• Read: Stop the Cycle of Shame for Girls with ADHD

Maria Reppas lives with her family on the East Coast. Visit her on X and at mariareppas.com.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Children with ADHD or autism are twice as likely to experience chronic disabling fatigue by the age of 18, even when controlling for comorbid depression, according to a new study published in the journal BMJ Open. Researchers point to the high levels of inflammation (often resulting from elevated stress levels) found among research subjects as a possible explanation for this association.¹

While previous research has demonstrated a high prevalence of chronic fatigue in patients with ADHD,² this is the first study to investigate potential mechanisms underlying the association.

Data from The Avon Longitudinal Study of Parents and Children (ALSPAC) was analyzed to assess whether children who scored above the threshold for ADHD or autism at ages 7 and 9 had an increased risk of chronic disabling fatigue at age 18. Mediation analyses were performed to investigate whether an inflammatory marker (IL-6) at age 9 was linked to fatigue and neurodivergence.

In fact, it did. IL-6 levels at age 9 were associated with a higher likelihood of chronic disabling fatigue at age 18. Though the causes of inflammation are myriad, it is often exacerbated by elevated stress levels, common among neurodivergent children.

“Research shows that neurodivergent children experience higher levels of loneliness, and are more likely to experience bullying,” the authors of the study explain. “Neurodivergent children are also more vulnerable to experience pain.”

In addition to chronic fatigue, adults with ADHD suffer in higher numbers with many different physical conditions. In fact, a recent study found that adults with ADHD are at elevated risk for 34 of 35 conditions studied, including nervous system, respiratory, musculoskeletal, metabolic, circulatory, gastrointestinal, genitourinary, and skin conditions. ³ These include:

• ulcer or chronic gastritis
• pulmonary disease
• Type 2 diabetes
• epilepsy
• heart failure
• kidney infections
• spinal conditions
• eczema

The mechanisms of action underlying the association between ADHD and its comorbid physical conditions are not yet known, but this study brings us one step closer to understanding a complex and critically important picture, the authors of the study explain.

“Children who are suspected to be or diagnosed as neurodivergent should routinely be screened for physical and mental health concerns,” they urge. “Earlier integration of brain-body concerns in a holistic framework can facilitate tailored support and improve quality of life of neurodivergent individuals.”

Putting a Spotlight on Chronic Fatigue

“When you think of hyperactivity, you think of talking non-stop, fidgeting, interrupting, distractible,” says Walt Karniski, M.D., a developmental pediatrician. “Lethargy is the last thing you would think about.” Yet, Karniski says he has seen an increase in pediatric patients who present with lethargy as one of the most problematic symptoms. A slightly different approach is needed to treat ADHD patients dealing with chronic fatigue, he adds.

The authors of the study assessed the presence of “chronic disabling fatigue” (defined broadly as lacking energy and getting tired during the last month) rather than the presence of myalgic encephalomyelitis/chronic fatigue syndrome because up to 91% of ME/ CFS cases go undiagnosed. “Despite its evident detrimental impact on quality of life, prolonged or chronic fatigue as a medical symptom is frequently described as an ‘unexplained’ symptom, and patients regularly report being dismissed about their experience,” the study’s authors write.

The symptoms of ME/ CFS include chronic widespread pain, unrefreshing sleep and rest, and dysfunction in the areas of memory, attention, and cognition — many of the same symptoms as ADHD.

“Neurodivergence and chronic fatigue are conditions with complex individual neurodevelopmental pathways,” the researchers explain. “It is therefore likely that inflammation is not the only mediating or moderating factor […] Additional mechanistic insights are needed to disentangle the intricacies of this relationship.”

As is the case with all ADHD comorbidities, optimized treatment is a byproduct of comprehensive diagnostic care and a holistic picture of each individual’s conditions. When diagnoses are missed, patients suffer.

“For years I have struggled with chronic fatigue syndrome, going in cycles of boom and bust. I would work successfully for years, energetic and committed to what I was doing. Eventually, I could no longer sustain the pace and would crash, taking months to recover, unable to work,” explains Cathy, an ADDitude reader in the United Kingdom. “Only recently have I realized that I also have ADHD and begun my journey to a formal diagnosis.”

Polly, an ADDitude reader with chronic fatigue syndrome, depression, anxiety, and chronic pain, shares this: “I have taken various medications over the years for these issues, which have had benefits and drawbacks but never resolved anything. It is so clear to me now where the root of it all lies. I’ve only recently realized, at the age of 60, that I am neurodivergent and probably have ADHD.”

Sources

¹ Quadt, L., Csecs, J., Bond, R., et al. (2024). Childhood Neurodivergent Traits, Inflammation and Chronic Disabling Fatigue in Adolescence: A Longitudinal Case Control Study. BMJ Open. 14:e084203. doi.org//10.1136/bmjopen-2024-084203
² Sáez-Francàs, N., Alegre, J., Calvo, N., et al. (2012). Attention-Deficit Hyperactivity Disorder in Chronic Fatigue Syndrome Patients. Psychiatry Res. 200: 748, 53 doi:10.1016/j.psychres.2012.04.041

³ Du Rietz, E., Brikell, I., Butwicka, A., Leone, M., Chang, Z., Cortese, S., D’Onofrio, B.M., Hartman, C.A., Lichtenstein, P., Faraone, S.V., Kuja-Halkola, R., Larsson, H. (2021). Mapping Phenotypic and Aetiological Associations Between ADHD and Physical Conditions in Adulthood in Sweden: A Genetically Informed Register Study. Lancet Psychiatry. 8(9):774-783. doi.org/10.1016/S2215-0366(21)00171-1