Are You Anxious, Disorganized, and Forgetful? It Could Be ADHD
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When Torrian Timms, a K-12 public school administrator in Dallas, was diagnosed with attention-deficit/hyperactivity disorder (ADHD) three years ago at age 31, her first reaction was disbelief. “I told my therapist some of my issues, that I’m always disorganized, that my house is cluttered, that I forget stuff. I couldn’t seem to follow through with things, and I would lose interest in relationships,” Timms recalls. “She came back to me one day and said, ‘Have you ever heard of ADHD?’ And I was like, ‘Yes, but isn’t that something young boys who jump off their desks and can’t sit down have?’ That was the only way I was familiar with it.”
Ask most people about ADHD, and they’ll likely imagine something similar: that fidgety boy who could never sit still in class. But society is finally recognizing that ADHD happens in females, too, and that it can present very differently than in males—which is exactly why it’s been overlooked for so long by clinicians, teachers, and parents. Girls and women often live with symptoms that are less glaring (disorganization, distraction, forgetfulness) but just as debilitating as the hyperactivity and impulsivity seen in boys.
Indeed, many undiagnosed women spend their lives feeling like something is fundamentally wrong with them, and the resulting shame can, in turn, lead to depression and anxiety—both common co-occurring conditions with ADHD that can further confuse diagnosis. Getting a diagnosis, however, can be a cloud-parting, angels-are-singing moment, because it’s instant validation that nothing is really wrong with you; you simply have a neurodivergence that can now be treated and managed.
But let’s rewind for a moment to explain in more depth why girls were left behind, and how, in adulthood, they’ve caught up.
If you studied ADHD back in the 1970s or ’80s, the field was extremely narrow. “The belief was that not only was ADHD just in little boys, but that it would basically resolve by puberty because boys typically get less hyperactive as they get older,” says clinical psychologist Ellen Littman, PhD, coauthor of the book Understanding Girls with AD/HD. “Girls would only get diagnosed if they, quite frankly, acted like super-hyperactive 7-year-old boys.”
That thinking started to shift about 30 years ago, when researchers finally turned their attention to girls. “We learned that ADHD isn’t just about out-of-control motor behavior,” says Stephen Hinshaw, PhD, distinguished professor of psychology at the University of California, Berkeley, and a pioneer in the research of ADHD in girls and women. “The other dimension of ADHD behaviors is inattention and disorganization—things like not being able to follow multipart directions, having a really tough time fending off distractions, being forgetful or messy, or having difficulty planning out tasks. These symptoms are more subtle to recognize and diagnose.“
Along the way, Hinshaw and other researchers also realized they were wrong about ADHD resolving by puberty. “We assumed it did because kids stop being as physically all over the place as they get older. But they may be still interrupting and over-talking as adults,” Hinshaw says. “We saw that their inattention and disorganization often intensify once things get harder in high school or college or in the workforce.”
Thanks to this research, experts now identify two forms of ADHD: inattention and hyperactivity/impulsivity. From there, they’ll determine if an individual falls into one of three main presentations: combined, which means you have aspects of both inattention and hyperactivity/impulsivity; predominantly hyperactive/impulsive; or predominantly inattentive. While all genders can fall into any of these categories, women and girls most commonly fall into the third group.
But here’s the thing—even with these advances, boys are still diagnosed at around 2.5 times the rate that girls are, while by the time they reach adulthood, women are being identified with the disorder at nearly the same rate as men. The upshot: Women are still being overlooked when they are young. So what gives?
Why ADHD gets missed in females
As we now know, the signs of inattentive ADHD are less overt, especially in elementary and middle school. After that, they’re easily covered up. “If you’ve got a family that’s helping you, if you’re pretty smart, and especially if you’re a girl, you learn to compensate,” says Hinshaw. Plus, if you happen to be a person of color, studies have found that racial biases make it even more likely that you’ll fall under the radar.
Timms, who is Black, says that’s what happened to her. “I had the messy backpack. I had the messy desk. I even remember my teacher ripping out my binders filled with cluttered papers. But I was smart, so no one said, ‘Oh, hey, maybe this is hindering her learning.’ I think that’s where I got overlooked,” she says. Another detractor: Constantly trying to please your teachers and family, make good grades, and keep up with peers can take an emotional and developmental toll and lead to anxiety, says Hinshaw, so parents or teachers might peg a student as an “anxious child” when it’s actually ADHD. This is when those coexisting mood disorders like anxiety and depression might begin—and when an individual may be wrongly diagnosed as suffering only from those conditions.
Inattentive symptoms also typically become more pronounced in late adolescence or early adulthood, when structure and support fall away and life becomes more stressful. “Often when a young person hits college or work situations, and that scaffolding isn’t there, they really begin to struggle,” says Frances Levin, MD, professor of psychiatry at Columbia University and a leading expert on adult ADHD. Self-esteem takes a hit, and women might develop depression or eating disorders, or enter abusive relationships. (Studies have found that women with ADHD experience higher rates of all three, as well as other significant side effects, including difficulty in family and romantic relationships, suicidal thoughts, and anger issues.)
Another roadblock to diagnosis is the fact that researchers now see the disorder as a spectrum condition whose hallmark is variability, says Hinshaw, meaning that symptoms can range from mild to severe and wax and wane as tasks and situations change. “Very few people are shackled by it at extreme levels all the time,” Hinshaw says. “You change jobs and have more independence, and maybe you do better. Or you’re in a more supportive relationship, and it feels less present.” Of course, the opposite is possible, too. Say your boss asks you to do three jobs in one, and suddenly your struggles with organization and focus are front and center, potentially damaging your career.
Many women learn to live with the constant variability, even though the ups and downs can be exhausting or even debilitating. “If you can compensate, or you have people around you who help you compensate, ADHD may not become a significant issue until you hit a wall,” says Levin. “But just because you can work around stuff most of the time doesn't mean that you wouldn't function better if you were identified and treated.”
If you think you have ADHD...
You can explore online checklists and screening tools, but Hinshaw cautions against putting too much weight in them. “They can be a starting point to see if you might be in the running for getting an official opinion and diagnosis, but they are not an endpoint,” he says.
Your best bet is to seek out a trained therapist—but be wary of anyone who diagnoses you without gathering enough info. “ADHD is not a diagnosis you can make in 10 or 15 minutes,” says Levin. She says a therapist needs to get a good life-span history, possibly talking to other family members to identify how long these symptoms have been going on, and consider other conditions that might explain the symptoms, such as hormone changes like perimenopause or depression. (The criteria for determining an ADHD diagnosis is much the same for adults as it is for children—which has prompted a group of experts to begin drafting the first U.S. guidelines for the diagnosis and treatment of ADHD in adults. Levin is cochair leading that committee and says publication is forthcoming.)
The most important factor you and your clinician will need to consider is whether your symptoms truly impede your day-to-day life. Because as much as ADHD may be underdiagnosed in women, some clinicians overdiagnose it, says Levin, and that’s led to drug misuse and a shortage in FDA-approved medications. “What constitutes getting to the threshold of a psychiatric disorder is that you have to have evidence of impairment—socially, work-wise, and with self-esteem,” she says.
Hinshaw concurs: “Look, you can put almost anybody in a very challenging situation and it will strain all of their cognitive capacities. All of us can experience a little ADHD at times in our life. But do you experience it in most situations? Is it interfering with your schoolwork or your job or your relationships? Is it related to your depression? It’s a matter of degree, how chronic it is, and how much it impairs your daily function.”
Okay, I’ve been diagnosed. Now what?
At the moment, treatment for adult ADHD entails managing and minimizing symptoms. That can include: medication (stimulants, such as methylphenidate or amphetamines, are commonly prescribed first; if someone doesn’t respond well to them, they might be prescribed non-stimulants, like certain antidepressants such as bupropion); proven psychotherapies such as cognitive behavior therapy; skills training to help individuals develop more structure and routine (ADHD coaches and therapists can help with this); support groups, and stress-reducing practices, like mindfulness meditation.
“I tend to be a ‘medication last’ person, in that I think there are lots of ways to intervene before prescribing,” Littman says. “I’ll do a lot of talking with patients to help them create more structure and routine in their lives. But either way, one should expect trial and error when trying to manage ADHD.” Some people who don’t want to take daily medication might take stimulants on an on-needed basis, like on weekdays so they stay on top of things at work, but not on weekends when pressures give way. “Stimulants are quick-acting and clear from the body quickly, but they should be used like this only if there’s a valid diagnosis of ADHD and a doctor is monitoring,” says Hinshaw.
Therapy and medication helped Torrian Timms, but what she really wanted was a support network of people who looked like her. “When ADHD showed up in my life, I started looking online to see if there were other Black women speaking about it, and I think I found two,” she recalls. “So I decided to create a safe space for Black women to share their experiences—the good, the bad, and the ugly.”
Timms’s advocacy and support community, Sistas with ADHD, is for “anyone, no matter color or creed. But I chose the colloquialism sistas to be intentional about who we’re centering in this space,” she says. Receiving her diagnosis and understanding her neurodivergent brain has changed her life for the better, she says. “I went my whole life thinking something was wrong with me, that my ADHD symptoms were character flaws. After getting diagnosed, I started being kinder to myself. I got a chance to see myself as the woman I am, with a different type of brain, to know that was okay, and to love myself more. And that’s why I started my group: I thought, I must help other people experience this, too. I want women to feel free. Just call me the Harriet Tubman of ADHD.”
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