Roughly 15 million adults in the United States are diagnosed with attention-deficit/hyperactivity disorder, which often begins in childhood. But for many women, that diagnosis is missed or happens later in life, according to an expert.
Despite how common ADHD is, it's commonly misunderstood and fraught with stereotypes or stigma. There's also a major gender gap, according to Dr. Sasha Hamdani, a board-certified psychiatrist who specializes in ADHD.
Hamdani, the author of “Too Sensitive,” joined TODAY on Mar. 9 to discuss the overlooked impacts of ADHD on women.
Research shows girls are less likely to be diagnosed with ADHD than boys, and many women don't get a diagnosis until much later in adulthood. As a result, many go undiagnosed and suffer in silence, without answers or treatment.
Fortunately, things are changing. The number of women diagnosed with ADHD has nearly doubled in recent years.
“We’ve been here the whole time. We’re just getting better at talking about it more and diagnosing more frequently,” Hamdani tells TODAY. Hamdani, who has the disorder herself. She didn't realize until medical school that ADHD was the cause of her longstanding struggles with anxiety and emotional issues.
ADHD impairs the part of the brain that deals with executive functioning, or the ability to control thoughts, behaviors and emotions and plan effectively. It's linked to levels of the neurotransmitter dopamine.
“I think it’s a regulation disorder. If you’re looking at it as a whole, you’re looking at not just attention. You’re looking at emotions, you’re looking at sleep, you’re looking at appetite. Everything is dysregulated because of those changes in fluctuations in dopamine,” says Hamdani.
ADHD is a lifelong condition. You don’t “outgrow” it, but ADHD can be managed, and symptoms may become less severe so they no longer meet diagnostic criteria, TODAY.com reported previously.
However, symptoms are more likely to persist later in life for women — about 60% of women have ADHD that continues into adulthood, compared to 30% of men, per the Cleveland Clinic.
And there's one feature of ADHD in adult women that often gets overlooked or misdiagnosed, says Hamdani.
Emotional Dysregulation
Emotional dysregulation is a core symptom of ADHD, especially in adult women. While ADHD is often thought of as a disorder affecting attention, largely thanks to the name, the emotional component is "huge," says Hamdani.
Emotional dysregulation refers to trouble or the inability to control feelings and reactions. Signs include mood swings, acting impulsively, getting easily frustrated, losing your temper, verbal outbursts or shutting down, per the Cleveland Clinic.
However, these symptoms may not be attributed to ADHD, or at least not initially.
"There are women who have been diagnosed their whole lives with anxiety or depression, and really, it was this underlying ADHD that's been causing it this whole time," says Hamdani.
What's more, the emotional dysregulation caused by ADHD can be intensified by fluctuations in hormones, for example, during the menstrual cycle and perimenopause, she explains.
"Oh, it's so connected. And no one ever talks about this. But when you get fluctuations in estrogen, especially drops in estrogen, you also get a drop in dopamine and less signaling," says Hamdani.
Drops in estrogen can occur before a menstrual period, during postpartum and before menopause — "during those times, you're also getting an exacerbation of ADHD symptoms," says Hamdani. Women often suffer even more as a result.
Emotional dysregulation can cause problems in relationships or meeting goals, and feelings of self-shame.
Other Symptoms of ADHD in Adults
In addition to emotional regulation, ADHD can cause other symptoms in adults, says Hamdani:
- Feeling chronically overwhelmed
- Difficulty starting and finishing tasks
- Disorganization
- Trouble paying attention
- Poor time management
- Impulsivity
- Restlessness
These symptoms are often chronic and disruptive, per the Mayo Clinic. ADHD can affect all different areas of life, including work, hobbies, relationships, parenting and more.
When To Talk to a Doctor
Today, many people are quick to self-diagnose based on what they've read or seen online.
If you suspect you may have ADHD, pause. "You don't need to figure that out on your own," says Hamdani.
Start taking note of any symptoms. "If these have been relatively persistent, it’s worth a conversation with your doctor,” she says.
Your provider can refer you to a specialist for further evaluation and testing, which is required to get a formal diagnosis.
"Getting a good diagnosis can be so helpful, because a medical provider is not only looking if this is ADHD, but also ruling out everything else," Hamdani notes.
This includes mood disorders, underlying medical conditions or sleep problems.
For the many women who discover they have ADHD later in life, it can feel like a lightbulb moment.
“Just knowing that you have it and understanding your brain is so validating and gives you so much clarity,” says Hamdani.
However, treatment isn’t always simple — it's highly individualized and may take some trial and error.
Treatment can involve medication, therapy or a combination of both. "There's so many things besides stimulants you can treat ADHD with... there's different medications that can treat focus or mood, and you can do behavioral therapy," says Hamdani.
"You can also work on optimizing your lifestyle and building organization and structure to help you," she adds.
