When I was young, I didn't understand why I constantly felt stressed out, or why I attempted suicide at age 16 after feeling extremely worried about failing school and disappointing my parents. At age 29, when I entered rehab for alcohol use disorder, I was also diagnosed with generalized anxiety disorder.
This came as a massive shock to me at the time. Didn't everyone always worry about everything and have ruminating thoughts about the worst things that can happen? Apparently not. I sought treatment for my anxiety and continue to see a therapist to this day. But it still felt like maybe that wasn't the whole story. I still struggled in different, non-anxiety-related ways—which can happen even if you don't have a mental illness. And yet… I wasn't so sure.
It all came to a head this summer when I experienced the worst anxiety I had ever felt—and this comes from someone who had already experienced terrible perinatal anxiety during pregnancy and then gave birth at the start of the pandemic.
Due to some significant life changes, like moving from Florida to Colorado, my husband and I had taken on some additional financial burdens. The financial anxiety left me overwhelmed, burned out, and completely unable to focus on my job for weeks. I thought that maybe I just needed an increase of my anxiety medication, which I had begun to take after giving birth, but found myself instead walking away with a diagnosis for Attention-Deficit/Hyperactivity Disorder after meeting with my doctor.
Later-in-life ADHD diagnosis
I was 29 years old when I received my anxiety diagnosis and 35 years old when I received my ADHD diagnosis. After talking with a few friends who also have this diagnosis, I realized that I was unfortunately not the only one to be diagnosed well into adulthood.
"For most people, ADHD symptoms arise during childhood," David Mou, MD, MBA, a part-time lecturer at Harvard Medical School and the chief medical officer at online mental health company Cerebral, tells Health. "Though increasingly, research is beginning to suggest that some won't get symptoms until later in life. Additionally, not all children with ADHD are correctly diagnosed and treated, so it is possible that you've had symptoms of ADHD your entire life, and only later after a crisis did the symptoms worsen."
When I think back to my childhood, it's challenging to figure out if I had ADHD symptoms or not. The official DSM-5 diagnostic criteria for ADHD states that symptoms must be "present prior to age 12 years" to make it an official diagnosis. But my poor memory of my childhood doesn't necessarily indicate that I have a wrong diagnosis. Instead, it may suggest that I developed coping mechanisms throughout my life without knowing what I was doing.
"There are many intelligent, capable people with ADHD who have managed their symptoms alone with strategies developed over time," Christy Duan, MD, a private practice psychiatrist in New York City, tells Health. "A crisis or breaking point can overcome the strategies someone with ADHD has relied on for most of their life. When someone with ADHD reaches this point, they might seek out professional help and be diagnosed after a careful evaluation."
Although I didn't go to my doctor because I suspected ADHD and wanted an evaluation, some of the struggles I've had as an adult sound pretty typical of those of a person with this neurodivergent condition.
"In adulthood, clients seek therapy with stories of having difficulty maintaining employment or having persistent interpersonal difficulties," Michelle Hintz, PsyD, MT-BC, a licensed psychologist, board certified music therapist, and owner and executive director of the Cadenza Center for Psychotherapy & the Arts, tells Health. "Some struggle with time management, such as being on time, meeting deadlines, and generally being as productive as expected. Others struggle with completing tasks with sufficient attention to detail, have difficulty being direct during conversations, and frequently misplace or lose things. And, let's not forget about the high level of distractibility and wasted time doing meaningless tasks."
She lists inhibition—the inability to stop ourselves from distractions—as another struggle for adults with ADHD. She points to things like pulling out your phone when stopped at a red light (which even those without ADHD struggle with) as a common sign.
As someone who has always struggled with inhibition and impulse control (another ADHD symptom), getting a diagnosis felt like making sense of so many issues I've had in the past. But why wasn't I diagnosed sooner?
Why do women go undiagnosed?
It turns out that the answer is, unfortunately, sexism. "Parents, educators, and clinicians also have a harder time recognizing ADHD symptoms in girls," says Dr. Duan. "Girls and women have more symptoms of inattention, which are harder to spot than symptoms of impulsivity and hyperactivity. So, for example, kids who keep getting out of their seat and running around the classroom are easier to spot than kids who have more inattentive symptoms."
Leah Kaplan, a licensed professional counselor and certified life coach who runs a private practice in Boulder, Colorado, tells Health that a few factors may lead to more women getting a diagnosis later in life—such as ADHD typically presenting differently based on sex at birth, women exhibiting less traditional hyperactive behaviors (like trouble sitting still and disruptive behaviors), and the fact that women are more likely to be misdiagnosed with depression or anxiety.
"Some well-meaning but uninformed doctors and even psychologists will write off general life struggles as anxiety and/or someone just needing to try harder (make a list! read this book so you can get organized!)," Kristen Carder, a certified life coach and host of the I Have ADHD podcast, tells Health. With her later-diagnosed clients, an ADHD diagnosis often comes after a significant decline or life stressors such as infidelity, financial crisis, deep depression, an inability to keep a job, or "shit hitting the fan in higher academics, like a bachelor's or master's degree," Carder explains.
For me, that proverbial shit hit the fan after becoming a mom during the pandemic and experiencing extreme financial stress, which Carder says "makes so much sense."
"There is so much executive functioning and multitasking needed to be a mom," says Carder. "You go from having to manage yourself (hard enough) to now having to manage other people, as well. Time management, sustaining focus, emotional regulation, organization, prioritization, planning, and working memory are all key skills in running a 'successful,' smooth, happy household."
Hintz agrees. "As adults, women who have ADHD report to me that they often feel 'scattered' and anxious by competing demands and constant interruptions," she says. "My adult female clients tell me that one of the most difficult things about ADHD is the belief that they should be experts at multitasking, yet most of us struggle with this."
Additionally, Hintz says that the societal expectations on women—to simultaneously build an amazing career while being an accomplished homemaker and wife and an engaged mother—can be a huge challenge for women with ADHD.
For me, becoming a mom has been all-consuming and easily overwhelming. Before my diagnosis, I thought I was just bad at mothering. But now I realize that many things I struggle with in my parenting are mainly due to my formerly undiagnosed ADHD. "Think about all of the planning, organization, memory, focus, and time management it takes just to make a meal or get your kids to school on time," says Carder. "Unfortunately, ADHDers are deficient in every single one of those skills needed to keep our house and our kids happy."
Hintz points to this cycle of adult women with ADHD who are mothers feeling "two steps behind" as yet another reason we feel chronically distracted by worries that we are not good enough—something I experience quite often myself. "As expected, the prevalence of anxiety, depression, and low self-esteem is much higher for women with ADHD than those without," Hintz adds.
What comes after diagnosis?
There's no way for me to know if my ADHD or anxiety came first. However, I do know that I do not want ever to feel the fear I felt just before giving birth or the burnout I experienced just before getting my ADHD diagnosis. This is why I am currently on medication for both my ADHD and my generalized anxiety disorder. But medication is a very personal decision.
For some with an ADHD diagnosis, supplements, lifestyle changes, and working with an ADHD coach can be the right call. Elizabeth Brink, a neurodivergent coach at Thriving Sister Coaching, suggests working with a therapist trained in somatic (body-based) modalities, talk therapy, or individual or group coaching.
"Specifically, ADHD coaches are trained to help people understand their neurobiology and guide in exploring ways to support themselves based on their unique needs," she tells Health. "In my experience, individuals who have done some work in therapy usually get more out of the coaching partnership in furthering their self-discovery and acceptance."
But ultimately, no matter what course of treatment a person seeks, just getting a diagnosis can be a huge win. "I was finally diagnosed with ADHD in my mid-20s, after struggling for many years to adapt to the expectations that came with adulthood," Sam Dylan Finch, an ADHD coach and writer who believed they were "bad" at adulting before getting their diagnosis, tells Health. "Chaos was the name of the game as an adult with undiagnosed ADHD. It was so frustrating and isolating to feel like I was just lazy, or incompetent, or both. It was a huge relief to finally have my diagnosis and realize that others were struggling with the same things."
Like Dylan Finch, I very much felt the same after my diagnosis—a huge relief to finally have an answer as to why certain things are just so damn difficult for me. But I'm working with my doctor and my therapist to understand my ADHD better and trying to accept who I am now that a piece of the puzzle has been answered.
As Dylan Finch says: "I have to adapt to the brain that I have, rather than the one that I'd like to have, which means radically embracing the quirky, annoying, and even frustrating parts of having ADHD."
And most of all, I'm being gentle with myself as someone who's still figuring things out.
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