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Amber Lewis has always known she has a problem keeping it together. Her wardrobe is usually empty, with her clothes strewn in piles on the floor and chairs in her apartment. She forgets to pay her bills on time. She gets so flustered following driving directions that she often misses the turns she needs to make. When the pandemic hit, Lewis, a 37-year-old high school ESL teacher in Richfield, Minnesota, suddenly had more time to think about how things had gotten out of control. After a clinical assessment in February 2021, she finally got her answer: She has ADHD.
Life under lockdown has made many people more stressed and overwhelmed, but it’s especially a struggle for some groups—including adults with ADHD, who already have a higher risk of mental health disorders. Additionally, for years society has generally overlooked, undertreated, and misunderstood adults with ADHD. But living through the pandemic also offered a breakthrough for some—a moment of pause to understand why they’re not coping better and how to get the help they need.
“For most of my life, I downplayed all of my struggles, because being a woman, you don’t take up that space,” Lewis tells SELF. The fact that Lewis always excelled academically and professionally made it even harder to notice there was a problem. “I just started realizing that most other people had a much easier time with simple tasks.”
Millions of kids and adults in the U.S. live with ADHD, which stands for attention-deficit/hyperactivity disorder. According to the 2016 National Survey of Children’s Health (NSCH), an estimated 6.1 million kids and teens between the ages of 2 and 17 in the U.S. had received an ADHD diagnosis at some point. Some of those kids and teens have diagnoses that persist into adulthood. Others aren’t even diagnosed until later in life—if at all.
Because so many people remain undiagnosed, we don’t have concrete numbers on the number of adults living with ADHD, but the lifetime prevalence in the U.S. is estimated to be 8.1% of people aged 18 to 44, according to the National Institute of Mental Health.
At all age groups, boys are more likely than girls to be diagnosed with ADHD, but that gap isn’t necessarily because it’s less prevalent in girls. Over the last few decades, experts have started to understand gender bias in referrals and how ADHD manifests differently depending on gender. As researchers and clinicians begin to understand that ADHD can last well into adulthood, a late diagnosis is not uncommon, especially for women. That’s because their symptoms don’t usually fit the stereotypical symptoms and images we have of “disruptive” boys. Girls tend to show less hyperactive and externalized symptoms and more internalized “inattentive” qualities. Instead of appearing fidgety or impulsive, girls with ADHD might seem messy, lost in thought, anxious, or sad.
Over time, the consequences of their symptoms can lead to self-harm, suicide attempts, and untimely death, especially due to accidents.
While the causes of ADHD are unknown, research shows it tends to run in families.
According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is how health care providers formally diagnose ADHD, you can have one of three types: hyperactive/impulsive, inattentive, or combined. Although the criteria have been updated over the years, ADHD experts agree that the evaluation still skews toward typical male symptoms because for decades the research focused on boys. This can make it harder to diagnose the condition in girls and women, which is complicated even further by the fact that ADHD often occurs alongside other mental and behavioral disorders. The issue of underdiagnosis becomes even more complex when factoring in race; Black girls and women are often underdiagnosed and undertreated when it comes to ADHD. The potential reasons why are multifaceted, including barriers to health care access and assumptions that Black children with ADHD are simply “defiant,” not potentially in need of help.
With researchers just beginning to understand how gender relates to ADHD, there is less data on prevalence among trans and gender-nonconforming people, but early studies suggest the rate could be even higher in this group.
Many of the women who miss early treatment have experienced years of self-loathing, internalizing the shame of being perceived as spaced-out, lazy, and not living up to their potential. Ellen Littman, Ph.D., a clinical psychologist, researcher, and co-author of Understanding Girls With ADHD, has studied adults and teens with the disorder for more than 30 years. She says women with undiagnosed ADHD may experience anxiety and depression at a higher rate because of the constant overcompensating they’re doing to keep up with gender norms.
The pressure on women to juggle all the things seamlessly—family, work, social life—can cause a tremendous amount of stress for anyone, but particularly those who struggle on a day-to-day basis with things like attention, memory, decision-making, organization, and emotion regulation. So it’s no wonder that adults with ADHD are also more likely to experience anxiety, depression, and substance-use disorders, among other related problems.
“Anxious about being judged an impostor, they are consumed with shame,” says Dr. Littman. “They’re demoralized by their inability to conform, they compare themselves harshly to their peers, and they often isolate themselves.”
Factor in the worst pandemic most of us have experienced in our lifetimes and that anxiety can be unbearable. Dr. Littman says that since the pandemic began, she’s been “absolutely inundated” with people wanting to be evaluated, which psychologists can now do via telehealth.
“The pandemic has amplified all ADHD challenges to unprecedented levels,” says Dr. Littman. “When women are robbed of routines that provide a structure for them, which is really essential to their functioning, they're reporting much more anxiety, depression, and self-doubt.”
Everyone benefits from the predictability and organization that structure provides, but when you have ADHD and struggle with self-regulation and controlling impulsivity, those external structures are even more critical, explains Dr. Littman. Routines typically help people with ADHD to be consistent and remind them of expectations and consequences.
So now, Dr. Littman says, her patients report being more overwhelmed and frantic than ever. Their family members, who are suddenly around all the time, are newly privy to the problems most of these women are trying to hide, which is how their brains work differently. One way of looking at how the ADHD brain functions is an “interest-based nervous system,” which often makes it extremely difficult for people with ADHD to do things that don’t interest them. “Women have told me that their [male] partners have shamed them by asking, ‘What do you do all day?’ and wonder why they can’t find the time to prepare dinner,” says Dr. Littman.
Meetings are another problem, which Zoom isn’t helping. When people with neurotypical brains are understimulated, they can often still motivate themselves to power through their meetings and remain engaged, says Dr. Littman. But this typically isn’t the case for people with ADHD, who, according to Dr. Littman, “will disengage and start scanning the environment for a higher-stimulation distraction.”
For some, the pandemic may serve as a tipping point that makes ADHD symptoms no longer avoidable or manageable without help. Sari Solden, L.M.F.T., psychotherapist and co-author of A Radical Guide for Women With ADHD, explains that suddenly juggling everything at home can cause an overload of executive functioning difficulties—particularly when it comes to things like compartmentalizing and prioritizing, some of the main challenges for people with ADHD.
Solden describes the role of executive function as similar to an orchestra conductor’s. “Executive functioning is orchestrating and coordinating and making decisions seamlessly,” she says.
Krista Broda, a 35-year-old mom of two young boys in the Canadian city of Regina, says she realized she had ADHD in March 2020, shortly after her province went into lockdown. Being stuck at home in those early weeks amplified some of things Broda already struggled with: disorganization, irritability, and an inability to sit still. “The traits I consider to be my biggest flaws were spiraling to a point that I felt they were no longer manageable,” she wrote in an essay for the Canadian Broadcasting Corporation.
Without the routine of her job as an educational assistant in a primary school and managing the busy social lives of an 8- and 5-year-old, Broda tells SELF, “I was completely lost. I had three or four commitments in March, drive-by birthday parties, and I missed all of them.” Then, a friend who had been recently diagnosed posted an article about adult ADHD on Facebook. “I read it and every word popped out at me, and I thought maybe this was something I should look into.”
When Broda saw a psychologist for a diagnosis, the first question he asked her was how many speeding tickets she gets, which was regularly. “He said that’s a big indication of inattentiveness. You know the cameras are there. You know they're going to be taking pictures, but you just blow right past them.”
If you suspect you have ADHD, a first step that could be helpful is seeing your family doctor, who may be able to recommend treatment right away. But they can also refer you to a psychologist or psychiatrist for a diagnosis. Treatment for adults with ADHD, similar to with children, may include medication, either with stimulants such as Adderall and Concerta, or non-stimulant options.
A therapist can also help you process the diagnosis. This is especially important because even though many women feel immense relief after learning they have ADHD and how they can finally get help, grief is also common. “They look at it as all those lost years thrown away to feeling incompetent, feeling lazy, feeling stupid,” Terry Matlen, L.M.S.W., a psychotherapist, certified ADHD coach, and author of The Queen of Distraction, tells SELF. Therapists can also refer patients to certified ADHD coaches, similar to life coaches, but trained specifically to help people with ADHD address personal needs and goals, whether it’s starting a business, going back to school, or just organizing their life better.
Experts also urge women to advocate for a referral to a health professional who understands gender differences in ADHD and is aware of emerging research on the role of hormones in the disorder. Researchers are investigating how fluctuations of estrogen levels—whether it's around a menstrual cycle or a life stage such as puberty, childbirth, or menopause—may impact ADHD symptoms. If this seems true for you, it's worth bringing up this research with your doctor.
Since being diagnosed, Lewis has felt more positive about the future. “It feels great, honestly. It just validates my struggles,” she says. She’s also started to check out brain-training tools such as Luminosity. Experts sometimes recommend these tools for people with ADHD to help with memory, focus, and executive functioning—all things Lewis scored fairly low on in her diagnostic test.
While the pandemic has been indescribably difficult, for some it has also helpfully highlighted the cracks in our lives that need more care and attention.
“Learning to set boundaries and say no to things and set limits are lessons to take back with you into the world,” says Solden. “It’s working to put yourself in the center of things instead of just scrambling around to meet everybody else's needs.”
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