Prof. Davida Hartman explains why women often receive ADHD diagnoses decades late due to male-centric diagnostic models, masking from societal expectations, and perimenopause challenges. Covers trait differences, mental health impacts, diagnosis hurdles, medication variability, and neurodiversity strengths, with tips for support and self-management.
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Multitasking challenges in ADHD for women (Credit: www.kaboompics.com via Pexels)
Women with ADHD often face delayed diagnoses, misdiagnoses such as anxiety, or go unidentified entirely. A Medical News Today In Conversation podcast explores why, featuring hosts Maria Cohut and Yasemin Nicola Sakay in discussion with Prof. Davida Hartman, Chartered Educational and Child Psychologist with the Psychological Society of Ireland, Adjunct Professor at University College Dublin School of Psychology, Clinical Director at The Adult Autism and ADHD Practice, and Co-director and Principal Psychologist at The Children’s Clinic.
Personal Experiences with Late Diagnosis
Maria Cohut shares her adult ADHD identification was not surprising, as she had always functioned differently, multitasking like walking, typing on her laptop, and talking simultaneously, which stunned colleagues. As a quiet, high-achieving schoolgirl and daydreamer who struggled with attention but "performed focus," she didn't fit the hyperactive stereotype prevalent during her childhood.
Prof. Hartman, late-identified with ADHD herself four or five years ago, was drawn to neurodivergent children early in her career supporting autistic students. She notes many professionals in the field, including herself, later discovered their own neurodivergence. Neurodivergent people often gravitate toward each other, with significant overlaps between ADHD and autism, not officially recognized as co-occurring until 2013.
"ADHD is housed within a very medicalized... model... developed by white middle-aged cis men... based on white cisgendered children, young boys."
Why Women Receive ADHD Diagnoses Later
Challenges in ADHD diagnosis for women (Credit: MART PRODUCTION via Pexels)
The diagnostic systems (DSM and ICD-11) emphasize hyperactive boys unable to stay seated, overlooking internal experiences common in women and those assigned female at birth. Societal misogyny dismisses women's reports as "women's issues" or anxiety. Social media now helps women recognize themselves in others' stories and seek assessment.
How ADHD Presents in Girls and Women
From a neurodiversity-affirmative perspective, Prof. Hartman avoids "symptoms," using "traits" instead. ADHD does not inherently present differently by gender; variations stem from culture, personality, and societal expectations, like women being "good," managing emotions, and suppressing impulses. This leads to masking: consciously or unconsciously adapting (e.g., talking less) to fit norms, causing stress, shame, and mental health issues like anxiety and depression.
Masking becomes untenable later, especially during perimenopause, when emotional regulation and executive function strain under increased demands.
Perimenopause and ADHD
Perimenopause exacerbating ADHD symptoms (Credit: Tara Winstead via Pexels)
Emerging research suggests ADHD individuals may experience perimenopause earlier with more severe symptoms, overlapping with traits like brain fog and executive dysfunction. However, ADHD requires evidence of traits before age 12, confirmed via rigorous assessment reviewing life history and functioning impact, not hasty social media diagnoses.
Without childhood witnesses or dismissive family (often neurodivergent themselves), self-reports are valid. Psychiatrists may trial medication if traits align strongly.
Perimenopause Overlaps
ADHD Traits
Brain fog
Executive dysfunction
Mood swings
Emotional dysregulation
Fatigue, forgetfulness
Interest-based attention variability
Diagnosis Challenges and Medication
Obstacles include long waitlists, costs, professional biases assuming ADHD means external hyperactivity or failure (overlooking high achievers), and comorbidities overshadowing it. Routine neurodivergence screening in mental health services is needed.
Medication is individual, not essential or a cure-all. Stimulants help some; others thrive without. Identification fosters self-understanding and authenticity, aiding mental health management.
Reframing ADHD as Neurodiversity
ADHD as neurodiversity strength (Credit: Tara Winstead via Pexels)
View ADHD as variable, interest-driven attention, not deficit. ADHD brains excel in hyperfocus, creativity, and crises (e.g., athletes, inventors). Society needs diverse neurologies for progress, beyond selective attention prized in schools and offices.
"We need lots of different brains... to progress as a society."
Supporting Women with ADHD
Friends and family: Accept lateness, forgotten birthdays/texts as executive function issues, not disinterest. Avoid shaming; normalize differences. For women: Offload tasks, prioritize self-care (exercise, rest) over perfectionism and societal expectations like school volunteering.
Identification brings permission to be authentic, reducing shame from masking.
Diagnostic systems like DSM and ICD-11 emphasize hyperactive boys, overlooking internal experiences in women. Societal biases dismiss reports as anxiety or 'women's issues,' and women mask traits to fit norms.
Masking is consciously or unconsciously adapting behaviors, like talking less or suppressing impulses, to meet societal expectations of being 'good' and managing emotions, leading to stress, shame, anxiety, and depression.
ADHD individuals may experience perimenopause earlier with severe symptoms like brain fog, mood swings, and executive dysfunction, overlapping with ADHD traits, making masking untenable.
Medication is individual; stimulants help some, but others thrive without it. Identification itself fosters self-understanding and authenticity.
Accept lateness or forgotten tasks as executive function issues, not disinterest; avoid shaming, normalize differences, and encourage offloading tasks and self-care over perfectionism.
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Editorial Team • Question of the Day
"Have you or a loved one experienced a late ADHD diagnosis?"
