While headlines are full of claims of overdiagnosis, many people who receive an ADHD diagnosis describe it as life-changing, life-affirming or, in some cases, life-saving. Many say they finally feel seen, understood, or are just glad to know they are not alone.
Women and girls with ADHD in particular have been overlooked for decades, according to Dr Sally Cubbin, a consultant psychiatrist with over 30 years of expertise working with patients with ADHD, and Gillian Johnson Shakespeare, ADHD coach, writer and illustrator. Both are authors of Women and ADHD: From Puberty to Menopause and Beyond.
Johnson experienced her own “aha” moment after being diagnosed with ADHD at 59. The rise in referrals among adult women for ADHD in recent years is “less about a sudden epidemic [of] ADHD in perimenopausal (or menopausal) women, than a reflection of the change in what now gets noticed, as well as some overdue catching up”, Cubbin and Johnson say. “A diagnosis can be a profound turning point. For many adults, especially women later in life, it finally explains why things never quite came together, even when the ability was there.”
ADHD affects the brain’s ability to regulate attention and motivation, especially during tasks that are repetitive or boring, or which offer no instant reward (a dopamine hit). “Difficulties with planning, organising, switching tasks, managing time (time blindness) and following through make it hard to start, stick with and finish tasks reliably. It often shows up as a gap between intention and follow-through, even when the person knows what needs to be done”.
Other core symptoms include hyperactivity – a restless body or mind – and impulsivity, which can make someone more likely to engage in risky or dangerous behaviours, such as substance misuse, shopping impulsivity or dangerous driving. “People usually have a mix of symptoms,” Cubbin says. “ADHD in one person can look very different to ADHD in another, which is one reason why some can be sceptical”.
Alongside these more familiar presentations, Cubbin and Johnson share some more subtle symptoms of ADHD that can have a profound impact on everyday life.
Checking the same email six times
Women with ADHD can end up working twice as hard to keep pace and avoid mistakes or criticism, say the experts. “Checking an email six times, arriving early to avoid being late – it’s driven by a fear of getting things wrong, driven by ADHD-related difficulties,” says Johnson.
Masking, overcompensating, people-pleasing, and perfectionism are common coping strategies used by many women to hide the traits of ADHD, “which come at a high emotional and physical cost,” Cubbin says. “Masking is pretending that everything is fine and covering up your difficulties to look ‘normal,’ but underneath, everything is a really huge struggle.” This then leads to people-pleasing and overcompensating.
“We all have to mask at times, and learn how to be polite,” adds Johnson. “But it’s the degree to which you have to completely become someone else in order to survive your job or a relationship. These behaviours are cumulative and can become ingrained in both what we expect from ourselves and what others expect from you.”
Falling into unhealthy eating
A lack of ability to plan ahead as part of ADHD can have a negative influence on a person’s overall diet, Cubbin says. This has been associated with poorer health outcomes for some – research suggests a link between ADHD and obesity. “To eat well requires organisation – you need to plan, shop, remember the food is in the fridge and get it out before it rots, then see it through and actually cook a meal with it.
“Or people will forget to eat all day because they are either distracted or don’t perceive hunger in the same way, then suddenly they are starving and have to grab the nearest thing, which can lead to less healthy choices,” says Cubbin.
Poor oral care
“Some people with ADHD are very high energy and hyperactive, but lots are low energy and have quite low motivation, and particularly struggle with mundane routines,” Cubbin says. “One lesser-known association with ADHD is struggling to be consistent with [things like] tooth brushing, largely because it is so boring, and doesn’t offer any immediate reward.”
“Many people with ADHD need novelty, excitement or competition to thrive,” Johnson adds. “Without those stimulating factors, they really struggle to get the task done and that often shows up in boring chores such as washing up or unloading the dishwasher.”
Decision paralysis for simple things
Overthinking everything, and struggling to prioritise or make simple, seemingly mundane decisions, is something Cubbin sees often in people with ADHD. Some of this is down to having a busy mind that makes it hard to think clearly.
“To make a decision, you need to be able to problem-solve, look at the information that’s available and think through the consequences,” she says. “This comes naturally to many people, but if you can’t hold on to information, with one thought constantly leading to another and another, it can be hard to weigh things up in a measured way.”
Sensitivity to criticism and a strong sense of justice
While not formally recognised in the diagnostic criteria, problems with emotional regulation are very common in both women and men with ADHD,” according to Cubbin.
“This can feel like intense reactions or rapid, up-and-down mood swings on a daily basis,” says Johnson. “People with ADHD can be particularly sensitive to criticism or perceived criticism, and rejection, or perceived rejection, and tend to really feel people’s comments with their entire visceral being. This can be combined with a strong sense of justice, where people notice injustice or unfairness more easily and feel it deeply. The consequences of that emotional reactivity can harm relationships and be very costly.”
Regretting saying too much
“I see lots of patients who have been told they have social anxiety, that is often missed ADHD,” Cubbin says. “They may feel socially anxious because they know they are prone to interrupting – when someone with ADHD has an idea, they might not always wait for the right moment in the conversation to bring it in, for fear of forgetting what they were going to say – they might dominate conversation or zone out and lose track.”
“You end up withdrawing because you can’t find the insertion points in a conversation”, Johnson adds. “Or you overshare, say way too much and regret it. Some people use alcohol to try and calm that social anxiety but that inevitably generates other problems.”
Difficulty keeping in touch with friends
“This is something I see often,” Cubbin says. “People with ADHD can find it difficult to maintain friendships or keep in touch with friends, either because of their emotional side, they may fall out with people more easily, or by losing touch with friends because they are not great at replying to messages. Friends think they’re not interested, or they’re always late (time blindness) or they double-book themselves.”
Hard can feel easy, but the easy feels impossible
There is a “baffling central paradox to ADHD,” Cubbin and Johnson argue, “where hard feels easy and easy feels impossible, where you can shine in a crisis but shut down before a call from your accountant,” and it can be difficult for people to understand why.
Like with many conditions, symptoms fluctuate in response to context – stress, mental load and even hormones. Some days you feel capable, other days you do not, which can be a source of frustration, confusion and shame for people living with ADHD, Johnson says.
“When life has enough structure, you might cope well but when demands change, for example, divorce, the arrival of kids, kids leave home, your parents get sick or perimenopause sets in, your ability to cope changes with it.”