ADHD in adult females

Through the years, I worked with a lot of children and youth diagnosed with ADHD. They are quite easy to spot when they present in ways you conventionally think of them - easily distracted, “constantly on the go”, or with difficulties sitting still. They may be impulsive - blurting things out of turn, cutting others off in line, behaving ways that's "out of line".

In more recent years, I've been challenged to learn more about ADHD, and how it presents very differently in females. As a matter of fact, they often get missed completely in children. As I started working more with adults now in my private practice, I've been spotting more adult females who only recently got diagnosed in their adult years.

Here's some common statements I have heard:

- I have always been told I am a "chatter bug", that I like to talk too much.
- I day dream all the time in school, my mind drifts off all the time in conversations.
- I am so forgetful, I lose things all the time
- I procrastinate for all my assignments - it is often the night before I pull an all nighter, but I usually do well
- I always need to fidget with something, like picking my nail, twirling my hair. Doodling helps to concentrate better
- I skim things and often make careless mistakes because of that

Often, these kids get missed for having ADHD because they do not cause any obvious disruption at school. As a parent or teacher, it is very hard to observe a kid may be inattentive because often these kids are bright enough to get bits of pieces of what they heard, and then glancing to see what others are doing to figure out what they missed out on.

They are not fidgeting in an obvious way (e.g. cannot sit still and get out of their seat), but they may fidget in more subtle ways like occupying their hands with something (e.g. doodling, picking their skin) . So again it does not become obvious to parents or teachers this may be the child's struggle.

Over the years, kids with undiagnosed ADHD often get by with getting the good grades - but often do everything at the very last minute. I hear parents and teachers say "but they're doing well academically" and dismiss this as a possibility.

Many go on to continue having careers, and success without ever realizing this neurodivergence they have.

As adults, they may have developed some ways around their challenges - they may have learned to use our electronics to set reminders, lists and other ways to externally remind themselves of things they may have troubles keeping track of.

Others have learned to concentrate better in conversations - they may have to keep reminding themselves to bring their mind back, but they find ways to keep up with conversations.

How they present themselves in counselling instead:

1) Anxious

Interesting, often I spot them in my practice presenting as anxious. They may be really concerned about what others think of them, or that they will say something wrong. This is often related to the many years in their upbringing where they are old they're "too much". As a child they might have been impulsive in the way they talk or related with others and told they were "inappropriate". Over time, they became more self conscious about the way they interact, resulting in a social anxiety where they over think about every thing they say.

2) Emotionally overwhelmed

They may find themselves emotionally easier to be overwhelmed. This is connected with the reduced capacity for impulse control, which then makes emotions more expansive than typical. Often individuals with ADHD have a larger range of emotions - they have higher highs and lower lows. Some who became parents report their anger come out easier than they would like, then they feel extremely ashamed about it. The emotional dysregulation they experience is a common reason for seeking counselling.

3) Overstimulated & exhausted

The other interesting thing is that rather than seeing ADHD as purely inattention - they actually overly attend to everything! What I mean is, their ability to inhibit irrelevant stimuli is limited - so they get pulled by every sight, sound, sensation easily, rather than filtering them out as "background noise". Imagine every sound you hear, every visual that is around is pulling for your attention all day! It takes a lot of effort to try to detach from the stimuli, and refocus back on what is at hand.

As a result, I often hear adults with ADHD say they get "overstimulated". For example, if they work in a hospital with lots of ongoing sound and noise all around, they get extremely fatigued by the end of the day because of all the sensations / stimuli constantly pulling for their attention throughout the day.

For these clients, I often recommend a sensory breaks in small intervals throughout the day, making sure there's space to tune out all the sounds, dim those lights so their brain can take a proper break.

4) Burnout

Clients with ADHD can be very driven if they are passionate about something! But they often have troubles pacing themselves because the flood of ideas coming to them goes a mile a minute. When they are hyperfocused on what they are doing they want to see it through, which can often lead to them extending themselves and burning out without realizing they're doing that. Often they are very capable of handling multiple tasks all at once. They jump from task to task, handling complex issues at the same time. While this is a gift of ADHD, the lack of pacing themselves and taking proper breaks is what can lead to burnout over time.

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Disclaimer - So I hope this list of observations can support you or those around you to be aware if someone may have ADHD that's undiagnosed! This is purely a list I have observed over time in my clinical practice. This is in no way a diagnostic tool for ADHD.

If this is something you relate you, do talk to your general practitioner for further inquiry, or seek a private psychologist for a thorough assessment.