Dr. Jessica McCarthy, founder of Elements Psychological Services, with offices in Montvale and Chatham, wants women to feel comfortable talking to health care providers and to feel heard.
Over the years, McCarthy has noticed how often women bring their children to be evaluated for attention-deficit/hyperactivity disorder, or ADHD, only to realize the diagnosis might also apply to them. Here, she discusses why women are often diagnosed with ADHD later in life and shares expert advice on steps women with ADHD can take to improve their quality of life.
Why are women often diagnosed with ADHD in their 30s and 40s?
What ADHD and autism looked like when we were younger is much different than what we know today. Think back to when you were in school. The disruptive boys would present for treatment before the girls, who were quieter, more rule-governed and did not want to upset anyone. Sure, their lockers and backpacks were a mess, they were more likely to day-dream during class, were more anxious and chatty, were more sensitive, and were more perfectionistic (which is not as helpful or functional as one would think), but they got good grades and didn’t act out. However, nobody knew it took them two or three times longer to get assignments done. They flew under teachers’ radars until their grades began to drop or they started having emotional outbursts when their hormones fluctuated during puberty.
Now consider this. Perimenopause, which also causes hormonal fluctuations, is like a second puberty. According to a 2025 study published in the journal "European Psychiatry", perimenopause begins up to a decade earlier in women with ADHD, who report more severe perimenopausal symptoms than women without ADHD. Women are often able to hold it together until their late 30s or early 40s. Then they hit perimenopause and everything falls apart.
How does ADHD present in women?
In women, ADHD looks like a duck floating peacefully on the surface of a pond while paddling frantically underneath. You see fewer overt behavioral symptoms like hyperactivity and fidgeting and more difficulties with executive function, emotion regulation, time management, and starting and sustaining tasks. Many wait until the last minute to complete a task because time pressure increases stimulation and urgency, and tasks that have a delayed payoff (because they are too far ahead in the future) don’t signal the dopamine-based reward-response system that the brain needs to start a task. Stress hormones (like norepinepherine) also kick in and help with seeing a task through from start to completion. These women tend to be high achievers with high IQs, but what does their quality of life look like when they are getting these tasks done?
How can health care providers better help women navigating undiagnosed ADHD?
Primary care providers, mental health providers, and OB-GYNs are not always trained to detect ADHD. They often assume their patient is a stressed, anxious “supermom” and do not ask the right questions. These women are drowning, and no one has thrown them the right life vest.
Women should seek out physicians and mental health providers who are ADHD-informed and who understand that perimenopause can exacerbate underlying ADHD symptomatology. The professionals on our team, doctoral-level psychologists and master's-level specialists, ask the right questions and help women understand that the challenges they have experienced since childhood are related. They are not simply disorganized, messy or stressed out.
ADHD, anxiety and depression are often diagnosed together. ADHD in women can present very differently than what we typically think of in terms of hyperactivity and behavioral problems (although women can certainly have these as well), and the more visible manifestation of symptoms, such as depression and anxiety, are what often lead women to seek help. We ask questions to help determine whether ADHD may be part of the picture and clarify the diagnosis so patients can receive the right treatment.
The most important fact about ADHD that both health care providers as well as patients need to understand is that ADHD is a neurodevelopmental condition - meaning that the symptoms needed to be present from childhood. The idea of “adult ADHD” is misleading - it’s more that it was simply misdiagnosed or ignored in women, due to both the atypical presentation as well as the masking or camouflaging of symptoms that often occurs with women - and this, unfortunately can even start in childhood as well.
What is the best course of treatment for ADHD?
Medication can work well, but medication is meant to bring you to a baseline so you can function and actually begin to engage in the behavioral treatments and skill building that works best with ADHD in children through adults. Our team teaches children and adults how to better understand their executive function and emotion regulation needs and provide strategies to improve those areas. We also teach techniques for emotional regulation. Time and task management skills are an important part of the process, but we also focus on helping people manage feelings of overwhelm and dysregulation so they can complete tasks more efficiently.
How can family members best support loved ones with ADHD?
Validate their experience and support them. It is hard enough for someone with ADHD to function when loved ones dismiss their struggles with comments like, “You’re fine. Just get the assignment done,” or “I don’t understand why you’re getting so upset. Just calm down.” If someone is having an outburst, do not yell at them. That is like pouring gasoline on a fire.
Learn more at elementspsych.com.
It is hard enough for someone with ADHD to function when loved ones dismiss their struggles with comments like, “You’re fine. Just get the assignment done.” - Dr. Jessica McCarthy