As a psychologist, I hear a lot about attention deficit hyperactivity disorder. Not only from patients, but increasingly from my female friends and acquaintances. The marked increase of ADHD diagnoses among middle-aged and older women is celebrated as empowering and an advancement of our understanding of women’s mental health. But there are risks in so readily reducing women and their life experiences to a singular diagnostic solution.
In what has become a popular quote – misattributed to either psychoanalyst Sigmund Freud or author William Gibson – anyone considering a diagnosis of depression or low self-esteem is reminded to first check the quality of their company (more precisely, to ensure you’re not “surrounded by arseholes”). Whoever coined this saying, it’s advice that is warranted before considering an ADHD diagnosis, particularly for women.
The surge in ADHD diagnoses of women is likely an overcorrection of a time when the disorder was primarily identified in males and school-aged boys. Better understanding of masking of neurodivergent traits and increased public recognition of ADHD have prompted more girls and women to seek assessment in recent years. Open discussion of women’s mental health and improved knowledge of neurodiversity in women is long overdue. But in recognising neurodiversity in this cohort, we must be careful to not pathologise the experiences of mid-life womanhood, including the stress and overwhelm typical of this life stage. Doing so sends a dangerous and outdated message: women – not the society in which they are stretched, stressed and overworked – are the problem.
Many women seek ADHD assessment to gain a better understanding of themselves and the challenges they experience. It’s no wonder this group is overwhelmed. The “sandwich generation” provides care to children and grandchildren, in addition to shouldering increased responsibilities for ageing and unwell parents. These women are usually in paid employment while also carrying the mental load of a household. This confluence of factors, in addition to likely perimenopausal or menopausal symptoms, can lead to a psychological response that may seem similar to ADHD – forgetfulness, emotional dysregulation, and feeling distracted and restless.
Fervour around ADHD has arguably led to a skewed and diluted understanding of the condition. The acronym has entered common parlance, with comments such as “that’s my ADHD” erroneously used to explain a normal range of behaviours. At times, we all run late, feel disorganised, or become distracted. Conversely, ADHD is a chronic psychiatric disorder that is evident in childhood and associated with significant impairment in contexts such as employment and education. In reality, we are all somewhere on the bell curve of attention and hyperactivity; most people are in the normal range, with a small number (2 to 6 per cent) in the pathological range.
Unfortunately, this concept creep around the definition and understanding of ADHD may result in misapplication and misdiagnosis. Self-diagnosis from social media information or comparison of symptoms with diagnosed friends or family members is common. Some people assume they have ADHD after feeling benefit from stimulant medication, having tried a prescription intended for another adult or, in some cases, their child. But “feeling good” on stimulant medication is not confirmation of ADHD. Individuals with ADHD have lower levels, or inefficient processing, of a brain chemical called dopamine. This is associated with inattention, inactivity, and difficulties with executive functioning and decision-making. Stimulant medication provides a therapeutic correction by increasing and regulating dopamine. But people without ADHD also report positive benefits of stimulant medication, such as feeling happier, alert, and more productive. These are stimulant side effects (i.e., euphoria, increased energy) rather than a therapeutic dopamine correction.
Nature does not carve at the joints. One diagnosis can never explain a person’s whole experience. Yet ADHD assessments often try to do just that. Testing only for ADHD without considering other physical or psychological conditions (such as depression, anxiety, or trauma) is common in the rapidly growing industry of ADHD assessment. A recent Australian study showed only one in three psychologists conducting ADHD assessment screened for other conditions, while a quarter did not follow national guidelines in reaching their diagnostic conclusions. The real cause of a person’s distress or difficulties may then go unnoticed and untreated.
Most surprising to me, as both as a psychologist and woman entering middle-age, is the widespread acceptance of ADHD as a catch-all explanation for women’s distress. Is it easier to attribute challenges to ADHD than face difficult questions about our relationships, experiences of parenting and caregiving, and the distribution of workload and domestic labour? This seems reminiscent of the 1960s “Mother’s Little Helper” era, when concerns of anxious and stressed housewives were dismissed as “all in the head” and treated with liberal doses of diazepam and sedative medication. Sixty years on, we remain quick to label women as disordered, rather than query unrealistic societal demands. Meaningful discussion and opportunities for systemic change are missed with this approach.
If you are a woman pondering ADHD assessment, you should first check your workload, lifestyle, and expectations placed on you by yourself and others. You might just find you’re not the problem, after all.
Dr Bianca Denny is a practising clinical psychologist based in Melbourne.
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Dr Bianca Denny is a practicing clinical psychologist based in Melbourne.
