These are just a few of the ways that ADHD (attention deficit hyperactivity disorder) can manifest. This disorder, which is often associated with overly energetic and disruptive kiddos, is estimated to affect 2.5% of adults1. And it’s getting a lot of attention lately in regard to the unexpected ways it can affect women, who are more likely to go undiagnosed as children because their symptoms often don’t include the obvious hyperactivity and they may not have struggled academically. Of course, not everyone who’s highly distractible has ADHD—and not everyone with ADHD responds to the same treatment. For example, around 50% of adults2 with ADHD also have an anxiety disorder, so getting relief may involve some different strategies. That’s why it’s so important to educate yourself and seek out a qualified practitioner before you self-diagnose. Whether you know you have ADHD or you’re just exploring the possibility, mbg has gathered valuable insights on how it can manifest in adults and women, what lifestyle factors exacerbate symptoms, and how both natural approaches and medication can play a role in treatment. But there are no hard-and-fast rules for what ADHD looks like in every case. These core elements of ADHD (inattention, hyperactivity, impulsivity) encompass a range of different behaviors, experiences, and symptoms depending on the individual. Excessive fidgeting, chronically interrupting friends and colleagues, daydreaming, forgetting to pay bills, misplacing items, abusing drugs or alcohol, feeling inadequate, constantly having to pull all-nighters to finish work, losing your cool at the drop of a hat, not being able to focus on some things while hyperfocusing on others—these are all ways ADHD can manifest in adults. What’s incredibly important to understand, however, is that ADHD doesn’t mean you lack the intelligence, skills, or desire to succeed or change. Many people with ADHD start their day determined to be productive and organized, only to end up feeling defeated. “A phrase that comes up a lot for people with ADHD is ‘consistent inconsistency,’” says Russell Ramsay, Ph.D., co-director of the University of Pennsylvania’s Adult ADHD Treatment and Research Program. “You know you can do something, but you don’t know if you can get yourself to do it when you need to do it.” “ADHD typically presents in women or girls5 as lower severity but more pervasive inattention and hyperactivity than in males, and tends to become more obvious with age,” says Uma Naidoo, M.D., a Harvard-trained nutritional psychiatrist and author of This Is Your Brain on Food. “This can often be recognized through disorganization, quickness to feeling overwhelmed, and a lack of effort or motivation.” Additionally, women with ADHD tend to have the inattentive type, which is harder to diagnose at an early age in girls because it doesn’t present as the disruptive, hyperactive stereotype common among boys, says Lidia Zylowska, M.D., a psychiatrist at the University of Minnesota Medical School and author of The Mindfulness Prescription for Adult ADHD. This can delay a diagnosis, sometimes until a stressful life event or change in a woman’s life (e.g., changing jobs, having a baby, getting a divorce, living through a pandemic) exacerbates ADHD symptoms to a point that they are no longer manageable with existing coping mechanisms. Inattentive-type symptoms are also more likely to be misdiagnosed or incompletely diagnosed as anxiety, stress, or depression. Women’s ADHD symptoms tend to be more internalized than men’s, too, including symptoms of low self-esteem, anxiety, and depression. Even hyperactivity can be internalized. “Internal hyperactivity in females often leads to feelings of overwhelm, while external hyperactivity in males leads to excess energy or activity,” says Naidoo. This internalization may be partly the result of biology, but some experts believe longstanding societal pressures for women to be nice, quiet, and polite play a role, too. Another major characteristic of women with ADHD is their tendency to struggle with emotional regulation—and yet, this aspect of ADHD is not fully acknowledged in the DSM-5 criteria and can sometimes lead to a misdiagnosis of borderline personality disorder or depression. “Things like intense impulsive emotional outbursts of anger can be common, along with rejection sensitivity, in which you spiral into feeling bad about yourself in situations where you sense rejection from another person,” says Zylowska. “We do believe there’s a biological difference in people with ADHD,” says Zylowska. “If you study those with ADHD and those without, you do see brain differences in how information is being processed.” For example, connections between the prefrontal cortex (the “thinking” brain) and the striatum (which deals with reward behaviors) may be disrupted in people with ADHD. Neurotransmitters play a role, too—and in many people with ADHD, the dopamine and norepinephrine systems don’t activate as robustly in certain settings compared to people without ADHD. This can affect focus and motivation and make it more difficult to power through a task when something is boring or overwhelming to you. In fact, one reason people with ADHD tend to procrastinate until the last minute may be because they experience a surge of activation in these neurotransmitter systems when faced with an imminent deadline—“this can make the person more alert, focused, and productive, which is helpful in the moment but exhausting and unsustainable in the long run,” says Zylowska. “Of course, procrastination can backfire, too. If the stress of the deadline is too overwhelming, you can have more of a freeze response.” We also know ADHD runs in families, so there’s a genetic component. However, there’s not one single ADHD gene that you either have or don’t—rather, a variety of genes likely influence whether someone has ADHD, and a person’s particular “genetic loading” will place their symptoms anywhere from mild to severe on the ADHD spectrum, according to Zylowska. The good news: There’s a constant interplay between genes and environment—and as with any genetic predisposition (like a family risk of high blood pressure), certain healthy lifestyle practices can influence how much you express a trait, and thus, how severe your ADHD symptoms are. For many people with ADHD, experts believe these factors can make symptoms worse: But these medicines aren’t a magic bullet, and it’s important to understand what they can and can’t do. Medication is generally effective for improving focus, impulsivity, hyperactivity, and motivation, but these drugs don’t specifically help with executive function challenges such as time management, organization, and prioritization, says Zylowska. So you’ll need to deliberately work on things like implementing routines, creating detailed to-do lists, and practicing mindfulness if you want to reap the biggest mental rewards. Medication can be life-changing for some—particularly those with severe ADHD symptoms that can’t be managed solely with lifestyle. They can also be beneficial for people in the short term, says Zylowska, to help them get over that initial hump where they may feel completely overwhelmed and unable to implement certain lifestyle strategies on their own. For others, these medications aren’t always tolerated, effective, or necessary. And while these drugs are relatively safe and well researched, you can form a dependence on them. You and your doctor will work together to decide if medication is right for you. It’s also important to seek out a practitioner who can help you manage your treatment in a way that aligns with your goals and values. If you’re interested in working with someone who can help you identify and address the main lifestyle, environmental, and dietary contributors to your specific ADHD symptoms and, if needed, go the extra step of testing you for micronutrient deficiencies and various toxin exposures, consider searching for an integrative or functional medicine psychiatrist or physician with a focus on ADHD. This type of whole-body approach to tackling ADHD can be a total game-changer for productivity, confidence, and long-term well-being.
