Women with ADHD

I had a video appointment with a new patient this morning.  Video is how I “see” all my patients these days, except those who want to “see” me over the telephone so they don’t have to make themselves presentable, or what they imagine to be presentable.  Video consultation has changed my entire practice, and is changing the whole field of mental health by offering a safe and convenient alternative to in-person meetings.  When the pandemic is over, I intend to continue to offer all my patients the option of video or telephone. For those who want to come see me in person, of course, that possibility will return, but the growth of telepsychiatry it one of the silver linings to the ordeal of the pandemic.

But back to my new patient, whom I will call Jill, and whom I will describe with enough disguise to protect her confidentiality. In her mid-thirties, she described a lifetime of struggling to get organized, do school, manage the details of everyday life, and preserve some semblance of self-esteem despite frequent ridicule, “kidding,” and reprimands from parents, siblings, classmates, teachers, and pretty much the entire world she had to live in every day. Despite all this, she remained upbeat, or at least put up a good front of seeming upbeat.

Recently she’d moved from the deep south to New York to take a new job, while finishing up online classes at the fourth college she’d attended. Despite frequent failing grades, necessitating her leaving one college after another, so strong was her determination and pluck she never gave up on her education. When we met this week she was only two credits away from her degree.  But she was having a ton of difficulty juggling her classwork with the demands of her new job. She’d heard about me from a friend so she booked an appointment.

I described ADHD to her. “I have it myself,” I began, “as well as dyslexia. I wouldn’t trade either for the world. Both of these conditions are vastly misunderstood. In ADHD there is no deficit of attention. Just the opposite. We have an abundance of attention.  Our challenge is to control it. Our minds are always in motion. We have trouble slowing our thinking down. For women with ADHD, the “H” – hyperactivity – may not be there, or it may present differently. The woman with ADHD maybe quiet, appearing like a butterfly with her brain moving between many thoughts, always seeming here and there. And like a butterfly that can float through a field without being seen, her wandering mind and difficulty in focusing may not be noticed, instead she blames herself for not trying hard enough when in fact she is trying so hard.”

Of course, just as with men, women with ADHD have the strengths of the trait too. Like the curiosity which leads to so many wandering thoughts. But that curiosity, once you learn to control it, is a huge asset. You can’t teach or buy curiosity, and we have curiosity in spades. Same with creativity.  We’re naturally inventive, original, outside-the-box thinkers. That’s another asset you can’t buy or teach, creativity, and we are born with it. Once again, the challenge is to control it. And we don’t give up. I see tenacity and a persistence to keep on trying often in my female patients. Things are tough for them, but they keep on going. ”

By now my new patient was smiling ear to ear with tears in her eyes.  “At last I feel understood and seen!” she exclaimed.  We talked on and on, Jill asking me question after question, as her curiosity naturally led her to do.  She was—and is—on her way to a new and much better life.

She was one of millions of adult women who have ADHD but did not know it.  Struggling, never giving up, working all hours, they are doing their best, but they are driving on square wheels.  They manage to get places, but at an enormous expense of effort.  They are underachieving, and they know deep down that they could be doing so much better, if only…

The “if only” is if only their ADHD were diagnosed. But because many doctors do not know much about this condition, and especially how it can present differently in women, if a doctor meets a patient like Jill the doctor tends to diagnose depression or anxiety, which are there to be sure, but both are being created by the undiagnosed and untreated ADHD. The patient gets put on SSRI’s or anxiolytics which help a little bit but do not get to the underlying issue of ADHD.

The largest undiagnosed group in the ADHD population are adult women.  If only practitioners could learn about this, and if only the women themselves could learn about this, huge benefits would follow. They could find out how to tap into their strengths and manage their weaker points. Lost lives would be found, relationships brought back from the brink of failure, and untapped potential finally put to use.

If you know such a woman, or you are one yourself, consider reading my book, Delivered from Distraction, or any of Sari Solden’s books or check out my Distraction Podcast. If you see yourself there, consult with a doctor who does understand ADHD in women or please reach out to one of the Hallowell Centers.

This is such a good news diagnosis, but only if you find it.  Once you catch on to it, your life can only get better, often dramatically so.