Mind

Could you have ADHD?

Why so many adult women are ‘coming out’
Images: Getty

Here’s the thing: We all misplace our keys or phone. We don’t always finish what we start. We might fidget or zone out in meetings, miss appointments, make impulse purchases, fall down the rabbit hole of social media when procrastinating and sometimes feel overwhelmed by the juggle that is modern life. But that doesn’t mean we have attention deficit hyperactivity disorder (ADHD). We’re humans, not bots – and even they don’t function glitch-free!

For most of us, these symptoms are a momentary nuisance, but for an estimated 280,000 New Zealanders, they become a major stumbling block for managing the “big” stuff – getting a degree, managing a mortgage, parenting effectively or holding down a job.

“Women are more likely to experience both ‘missed’ diagnosis of ADHD or ‘misdiagnosis’ of ADHD,” says Dani Bultitude, a therapeutic coach for neurodivergent adults. “Women are commonly diagnosed with stress – which is assumed as normal for mothers of young children – anxiety, depression, postnatal depression, premenstrual dysphoric disorder or bipolar disorder. At times, some of these conditions may exist in addition to an undiagnosed ADHD, but for many it’s simply a misinterpretation of ADHD symptoms.”

Part of the diagnostic difficulty is that women are often very good at masking. We’re socialised into “keeping it together” from an early age.

“Young girls more commonly experience either inattentive ADHD traits or they internalise their experience of their ADHD, which causes distress for them but is not noticed by observers,” says Dani. “Boys are more likely to externalise, which not only causes distress for the child, but also for those around them.”

As a result, it’s often not until later in life, when difficulties with organisation and task completion become more evident, that it’s identified as a problem, according to the Ministry of Health.

As psychiatrist and author Dr Lisa Myers explains, ADHD is a neurodevelopmental disorder. It changes the brain’s biological development. She says women with ADHD often have reduced dopamine (required for motivation) and noradrenaline (responsible for attention).

“ADHD has multifactorial causes and is likely an interplay of genetics and environmental factors,” says Lisa. “Women tend to have more symptoms of inattention and executive dysfunction. They may be unable to organise and manage their lives, tend to be more chaotic and scattered, are easily overwhelmed and emotionally reactive. All of this can lead to increased rates of anxiety, depression and low self-esteem.”

Although researchers have thoroughly explored it, ADHD remains widely misunderstood and stigmatized.

“Current evidence suggests that a large proportion of late diagnosed women have a higher-than-average IQ and manage ADHD through compensatory masking behaviours,” says Dani. “It busts the myth that ‘smart people can’t have ADHD’. They can indeed, but usually the result is that they live with very high levels of stress.”

According to Lisa, women with ADHD can be quick thinkers, very personable, creative, energetic and hyper-focused when working on an interesting task.

“ADHD is less obvious when people are very intelligent or have made accommodations,” says Lisa. But masking the symptoms doesn’t reduce the risk of anxiety, depression or burnout, especially when hormonal changes are a complicating factor.

“ADHD affects the regulation of many things, including mood instability, irritability and frustration tolerance,” says Dani.

“The additional impact of hormones results in many women experiencing greater frequency of mood fluctuations, being quick to anger and overwhelmed, tearful or annoyed.”

While it’s not uncommon to experience emotional highs and lows during midlife hormonal changes, it makes ADHD even harder to manage.

“Women who have an existing diagnosis of ADHD and are taking medication might find their treatment is no longer as effective for managing their symptoms in menopause,” says Lisa. “It can be particularly distressing for these women who might lose self-confidence, and become (more) depressed and anxious.”

While some people with ADHD will require medication, non-pharmacological treatments are a key part of managing ADHD.

“These include education, engaging with specific strategies to help organise self and manage time, and learning coping skills to manage reactive emotions, depression, anxiety and impulsivity,” explains Lisa.

You’ll need an official diagnosis first, though. Your GP can arrange for you to see a specialist with experience assessing and treating ADHD. A diagnosis can be life-changing. It’s a chance to reframe a negative self-image or a lifetime of low self-esteem.

“You no longer view yourself through a lens of being not enough, too much, too intense, misunderstood, dismissed and ignored,” says Dani. “The challenges faced by adults with ADHD aren’t a result of laziness, not putting in the effort or not being disciplined. Let go of these ideas and instead use your creative brain to innovate solutions that work for you.”

Diagnosing ADHD. Is this you?

Difficulties with:

  • Concentrating
  • Staying focused
  • Organising tasks and activities
  • Sitting for long periods
  • Waiting for your turn
  • Engaging in quiet activities
  • Forgetfulness
  • Tendency to lose things
  • Fidgeting and restlessness
  • Acting or speaking before thinking things through.

Is it really ADHD?

ADHD shares many similarities with anxiety, depression and a dysregulated nervous system, according to psychiatrist Dr Ashwini Padhi. “ADHD is a neurodevelopmental disorder. However, when we talk about a dysregulated nervous system, it’s more like the rhythm of normal regulation patterns gets disrupted, so people cannot respond to life in a flexible and resilient way,” he says.

As it impacts thoughts, feelings and behaviour, it can lead to a disproportionate response to stress (as either an under or overreaction). “For example, if you find yourself absentmindedly staring into the refrigerator, wondering how you got there, or perhaps you can’t sit still for long periods and need to busy yourself, you may well be experiencing a reaction to a stressful interaction or thought process.”

Although nervous system dysregulation can look a lot like ADHD on the surface (restless, mood fluctuations and anxiety, for example), Ashwini says there are key differences. Nervous system dysregulation is often linked to unprocessed stress or trauma (often from childhood). It can be remedied by changing influencing circumstances and habits in consultation with a health professional.

“We all have varying levels of ability to cope with what life throws our way,” says Ashwini. “Generally speaking, those who are dysregulated are unable to regulate themselves because they never had the chance to learn how to, but there are many ways people can learn to master their nervous system responses and harvest energy from them instead of anxiety or despair.”

Are you a nervous wreck?

Pyschotherapist Andrea Szasz suggests the following strategies.

  1. Slow down and pay attention. What do you notice in your body/mind?
  2. Disrupt the pattern of emotional dysregulation. Breathe in via the nose and breathe out via the mouth, making sure the out-breath is slower and longer than the in-breath.
  3. Orient to joy. Look for pleasant experiences and take time to mindfully savour them.
  4. Look for positive social connections. Try purposefully spending time in nature.
  5. Seek professional help. A therapist can help you work through stress.
  6. Take a holistic approach. Try to maintain a balanced lifestyle with adequate sleep, nutrition, and connection to nature and people. This is not easy, but worth it to live your best life.

Life hacks

Dani shares her top tips for managing ADHD in day-to-day life.

  1. Task management system. Don’t kid yourself that you will remember to do “the thing”. You most likely won’t. Write down everything you need to do. This can be an electronic task management system that syncs from your laptop to your phone. Or a visual system, such as a whiteboard or a notepad that is carried with you. Please note that the notepad will often go missing and then you may end up with three notepads, many loose scraps of paper and no idea what you need to remember!
  2. Calendars. Record where and when you need to be somewhere. Sync your phone calendar to your partner’s or children’s calendars, and your email. Check it every day.
  3. Stop procrastinating. Nobody ever built a house without breaking the build down into pieces of work that need to be done. Start with a small bite-sized piece. Then another. Then another.
  4. Simplify. Don’t host your kid’s birthday party at home. Go to a bowling centre and limit the numbers.
  5. Delegate. Do the things you are good at and remember, ALL of the jobs are not yours.
  6. Outsource. Get a cleaner if you can, stock the freezer with some ready-to-eat meals and hire a virtual assistant to sort out your invoicing if necesscary.
  7. Exercise. It creates dopamine and will make doing everything else that much easier.
  8. Don’t try harder, do differently. For example, buy socks in the same colour so they don’t need pairing.
  9. ‘Hook’ tasks. For example, turn the light on in the laundry when you put on a load. When you walk past on your way to bed and go to turn out the light, that’s your prompt to put the load in the dryer so it doesn’t go mouldy.
  10. Stop worrying… about what other people are doing.

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