No longer just a kid thing: more women diagnosed with ADHD later in life

SPEAKER: Hey. October is National ADHD Awareness Month. And we wanted to replay a conversation about the impact of undiagnosed Attention Deficit Hyperactivity Disorder on adults, especially women. According to the National Institutes of Mental Health, the average age for ADHD diagnosis is six years old. But over the past few years, more adult women are being diagnosed with ADHD. Let's look back at a conversation our producer Lindsay Guentzel had about it.

LINDSAY GUENTZEL: I was diagnosed with ADHD just two months shy of my 35th birthday. Like many, my life had been completely turned upside down by COVID. I was stuck at home unemployed. And while that extra time could have been spent doing something productive, I was in a manic state of doing everything and somehow nothing all at the same time. And then I saw this tweet from a woman named Ashley Fairbanks. It said, not to open up the can of worms that is former, gifted, and talented kid Twitter.

But I really wonder how many of us have struggled with undiagnosed ADHD, because we got good grades or passed tests. So people didn't notice or care about how all the symptoms impacted us. That sounded a lot like me, I had my first appointment later that same day. On the line with me is Dr. Lidia Zylowska, a psychiatrist at the University of Minnesota Medical School, as well as M Health Fairview, where she specializes in adult ADHD. Dr. Zylowska, thanks so much for giving us some of your time today on Minnesota Now.

LIDIA ZYLOWSKA: Pleasure to be here.

LINDSAY GUENTZEL: I look back in my phone and there are screenshots of ADHD memes going back a few years, little tidbits that resonated with me. So that tweet wasn't my first inkling of a connection. What are some of the most glaring symptoms or characteristics that stand out when identifying ADHD in adults?

LIDIA ZYLOWSKA: ADHD shows up differently for each person. And that depends on what type of ADHD they have because ADHD comes in three different colors. You could say inattentive type. Hyperactive impulsive, when you have a lot of restlessness and impulsivity. And then the combined type, when you have both the trouble of attention, as well as the restlessness hyperactivity.

I think for women, in particular, oftentimes it's the inattention. It's the lack of focus, lack of organization that brings attention to the fact that someone's struggling. And in general, for adults, there's another aspect that we talked about in ADHD, is the executive functions, which has to do with planning, organizing, time management, getting tasks done, to even organizing your day, not just at work but also at home.

So those executive functions are often a challenge for adults with ADHD. And those things would often increase stress. It can set up someone to develop burnout, anxiety, depression, maybe start looking into drinking to relieve the stress. So there can be a cascade from ADHD symptoms to these other things that finally made someone realize, I'm just struggling, something's going on.

LINDSAY GUENTZEL: There's a very stereotypical image tied to ADHD. A young boy who acts out in class, who can't sit still. I'm curious how ADHD symptoms present themselves differently in children versus adults. And then even how gender plays a role in, not only what symptoms are present but how they come to the surface.

LIDIA ZYLOWSKA: Yeah. So in general, when we compare children to adults, children tend to have more of that hyperactivity restlessness, maybe acting out at school. That tends to get better with age. Even if the some restlessness continues, it tends to be more mild, more kind of fidgety.

What becomes more difficult, as an adult, is that aspect of organization and time management, getting yourself to prioritize what's important, what's not important. That's what adults have to do. So there's that shift in difficulties, more prominent difficulties, as you moved from being a child to being an adult.

For girls and women, what happens is that, as you mentioned, we have the stereotype of a hyperactive boy who is acting out in class and that's what gets attention of teachers. That's what gets attention of parents. And boys typically get referred for help, for diagnosis and for treatment a lot more than girls.

So when we look at prevalence of ADHD, it's about three times as much in boys than it's in girls. But we do think this is because of the referral bias or how we recognize boys and how we don't recognize girls who are struggling. And if girls have ADHD, it's often the inattentive type. And often has more of these, what we call, internalizing symptoms, or having more low-self esteem, or doubting yourself, more emotional reactivity.

And oftentimes, that is interpreted as, you need treatment for anxiety, you need treatment for depression. No one's thinking ADHD for them. And that's too bad, because if you really recognize the ADHD, it's often driving these other issues. If a woman or a girl has ADHD and you recognize it, you can really help them understand themselves and help them make sense of themselves.

LINDSAY GUENTZEL: You basically just described my entire story of being treated for depression and anxiety, but never having anyone even flirt with the idea of ADHD. One of the most eye-opening moments for me when looking at how I lived my life prior to my diagnosis came on the first day I took my medication. My brain was so clear.

And I realized after doing some research that I had been living with ADHD brain fog, probably going all the way back to high school, maybe even middle school. How do you explain those symptoms medically? Because I've really struggled putting into words that realization for other people.

LIDIA ZYLOWSKA: We often talk about ADHD versus ADHD medication as the difference between having glasses on or not having glasses on. So if you are nearsighted, like I am, if I were to take my glasses off, everything would be a little blurry. I could function in the world, but it will be with more effort and things wouldn't be as easy. And then when I have my glasses on, it's a lot easier. I can see things. There's detail. I feel more empowered.

And oftentimes, when you have ADHD and you take the ADHD medication, there is that sense of, I'm awake. I'm alert. I don't have this fog. I can actually get started on things that seem so overwhelming. So it does shift the ease and the your brain state. It has to do with dopamine transmission and a norepinephrine transmission. Those are the two chemicals most implicated with ADHD. They're also implicated with attention, alertness, motivation. And so we're propping that with the medication.

LINDSAY GUENTZEL: And like anything in life, medicine is just one of the tools that can be used to help treat ADHD. What are some of the other things people should look at for managing their symptoms?

LIDIA ZYLOWSKA: That's really important point, that medication is just one tool. And the other things that are really important is self-understanding, whether it's reading about ADHD, connecting to some information on the web. The self-understanding and the self-acceptance is a huge piece, because we often do see self-judgments and a lot of shame, and that creates another layer of suffering with ADHD. And that can be accomplished by doing therapy.

There's also therapy, specifically for some of the difficulties with ADHD. It's called cognitive behavioral therapy that's helpful in creating systems to be more productive, to prioritize-- mindfulness is another approach that is emerging as important ADHD, particularly in helping manage emotions and stress. By itself, mindfulness being an approach from the right for meditation. It's an attention training tool. You learn to observe your attention and have more self-directing of attention. So it is almost like exercising your attentional muscle.

LINDSAY GUENTZEL: The last thing I want to touch on is addressing the sadness and the grief that's come with my later in life diagnosis. I'm so happy I can move forward with all of this knowledge and these tools, but there is a part of me that's also grieving all of that lost time and lost opportunities. The, what could have been had I known conundrum, how do you approach that through your work?

LIDIA ZYLOWSKA: Yeah, I think you're touching on something very important. Oftentimes, when people first get diagnosed, there is a sense of excitement and relief and tremendous hope. But what often can happen too is this sense of grief, maybe anger even that, how come I didn't have this knowledge or nobody told me. And it is important to make space for that grief and yet move forward now with more kindness to myself, with more ability now to manage the difficulties, with more ability to explain it to others too, which is really important piece being your own advocate, whether it's at work or in your family or relationships.

LINDSAY GUENTZEL: Dr. Zylowska, there's so much more I would love to ask you, but we will save that for another day. Again, thank you so much for sharing your insight with us on Minnesota Now.

LIDIA ZYLOWSKA: Well, thank you so much. I really appreciate your interest. And I think it's just so helpful and so needed for women.

SPEAKER: That's producer Lindsay Guentzel and Dr. Lidia Zylowska, a psychiatrist at the university of Minnesota Medical School and M Health Fairview. Now if you're interested in hearing more, Lindsay has her own podcast called Refocus with Lindsey Guentzel. It's about ADHD. For the month of October, she features a different person's story every day to highlight the complexity of ADHD and the different ways it shows up in people's lives.