Why Are So Many Midlife Women Being Diagnosed With ADHD?

When we think of ADHD, we often imagine a little boy running wildly around a classroom. Until recently, the face of this disorder was certainly not a 40-something woman. But as ADHD diagnoses in adult women surge, a fuller picture of this disorder is emerging.

What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition marked by hyperactivity, inattention and impulsivity. “We now know there is a biological basis for this,” says Dr. Gurdeep Parhar, medical director of the Adult ADHD Centre in Burnaby, B.C. Researchers have pinpointed a relationship between low levels of dopamine and norepinephrine—chemicals associated with the function of the prefrontal cortex, the part of the brain that controls attention, organization and motivation.

It’s estimated that up to 13 percent of children have ADHD, and most do not grow out of the disorder. That means if you’re at a party with 10 women, it’s likely that at least one of you has been—or should be—diagnosed with ADHD.

Why is ADHD diagnosis so tricky?

Most of Parhar’s patients are women, in part because women are more likely to have been undiagnosed or misdiagnosed when they were children, which is a reflection of old-fashioned thinking about the condition. Doctors tend to stereotype when screening patients, but experts say there is a distinct gender difference in how symptoms present: Young girls tend to “daydream,” while boys can’t seem to sit still.

Related: I Was A Stressed, Disorganized Mom. Then, at 43, I Was Diagnosed With ADHD

General practitioners often don’t have the time to do a thorough assessment, says Dr. David Wong, clinical lead of the Provincial ADHD Program at the University of Prince Edward Island. Some moms start to wonder if they have ADHD only after they go through screening questionnaires with their kids, he says. Unfortunately, the results of screenings alone aren’t always sufficient to identify ADHD in adults, whose symptoms are more nuanced and may include anxiety, forgetfulness and difficulty meeting deadlines.

The decrease in estrogen women experience during menopause can lead some to struggle with focus and concentration, says Parhar. And because many women with ADHD have already been diagnosed with anxiety, mood or substance-abuse disorders, a practitioner must figure out if these other issues developed as a result of living with untreated ADHD.

What does ADHD treatment look like?

A successful treatment plan is multi-pronged and built around patient goals, which might include being more productive at work, better navigating relationships or reducing substance use. It often involves education about the disorder, counselling and medication.

Drugs like methylphenidate, also known as Ritalin, increase the activity of neurotransmitters in the prefrontal cortex so they function as they should, but the dosage has to be just right. That’s why Wong has his patients check in with him often to monitor how well their meds are working. (Some of Parhar’s patients who are particularly sensitive to hormonal changes even adjust their medication based on their menstrual cycle.) Other medications, including antidepressants, also require adjusting as treatment unfolds.

“If you’ve already struggled through your childhood and adulthood with [ADHD],” says Parhar, “you shouldn’t struggle another day.”