Transcription
ADHD in women looks almost nothing like the image most of us grew up with. The outdated picture, the fidgety little boy who can't sit still in class, has left an entire generation of women undiagnosed. Developing coping strategies that look fine from the outside while running on empty underneath.
A new study published just this year makes that problem harder to ignore. Researchers analyzed the lived experience of adults with ADHD and found nine distinct categories of symptoms. Not two, not three, nine. And the majority of those categories are either barely mentioned in the diagnostic criteria or not there at all. So if you spent years being told that you're too anxious or scattered or just too sensitive and the explanation never quite fit, that gap may not be in you. It may be in the criteria that we had. And this video is all about that.
The reason so many women arrive at a diagnosis in their 30s, 40s, or 50s isn't random. It's the direct result of how ADHD was originally studied. The early research was done almost entirely on young boys. I know the diagnostic criteria were built around the presentation that showed up in that specific population. Things like hyperactivity, impulsivity, obvious disruption in the classroom, the kid the teacher couldn't ignore.
Girls with ADHD were largely invisible to that framework because girls tend to present differently. Instead of externalizing, acting out, being visibly disruptive, girls tend to internalize. They become the masters of compensating. They sit still, but their minds are somewhere else entirely. They write everything down because without the external structure, they'll forget. They smile and nod and stay after class to ask the questions they missed because they were spacing out. And when the compensation eventually breaks down, which it does under the weight of adult life, the result gets misread as anxiety, depression, or a kind of personal failing.
There's also a masking piece that's particularly relevant here. Many women with undiagnosed ADHD learned very early to pretend to be normal, kind of perform normally, to hide the struggle, to people please and overfunction and manage everyone else's experience of them. The overlap between ADHD and childhood emotional neglect and like trying to earn love. These patterns are not coincidental. When a child's brain works differently and the adults around her don't have the framework to understand why, the child often concludes that she's the problem. She learns to mask, to compensate, to earn her way through every situation. The ADHD and people-pleasing become completely intertwined. And hold on to that thought because we're going to come back to that.
But let me walk you through what this actually looks like in adults. And I want to use that research I mentioned at the start because it matters here. Okay. Now, the study identified nine categories of ADHD symptoms from qualitative interviews with adults who have ADHD. And what that means is that they didn't just like tally up some numbers from a scale they gave out to people. They actually sat down and chatted with them and then pulled all their findings from those conversations. And I honestly think that this is just a much better way to do psychological research. So, I'm glad that they did. Anyways, okay.
They identified nine categories of ADHD symptoms. The first three are the ones that you probably already know. Inattention, hyperactivity, and impulsivity. Those are already in the DSM. Those are what clinicians such as myself were trained to look for when we're going to diagnose someone with ADHD. Okay, so those three, but we got those done. The other six are where the real learnings are.
And the first is disorganization. Now, this isn't just a messy desk. This is when we have a difficult time doing things in a sequence, right? Like we have to do this in order to do this next. That's really hard. You have to keep track of what needs to happen in what order. Like managing a home, following through on plans that we've made. The researchers found that this almost always is accompanied by a strong sense of overwhelm, and it gets dismissed as not trying hard enough or being a chaotic person or just "I'm just scattered." However, it's not really either of those things. It's part of ADHD. Okay. Found that so interesting.
Number two is forgetfulness. Now, the DSM mentions forgetting daily tasks like chores or errands, but the study found that it actually goes further, like difficulty keeping track of appointments, struggling to recall recent events or retain information from a conversation that they just had, losing things repeatedly because the location didn't get encoded. They talked about things getting encoded that like if we saw it and we recognized and we took a minute to be like, "I put my keys here," it could get locked in. But if we're in a rush and we just drop something off, we won't remember where we put it. So, we lose keys, phones, um, like trying to run to the airport, can't find our passport or our ID, our wallet, like we misplace things all the time. And these are not memory problems. Okay, that's that was an important piece when I was reading this article is that it doesn't have anything to do with our memory in the traditional sense. It's it our brain when we have an ADHD brain, it holds things in a different way or it can fail to hold certain information. It's almost like the way that we have to encode or remember things is a little bit different. And so if we don't take the time to figure out how that works for us or recognize that we have ADHD, then we can fail to remember things and lose things all the time.
Now, moving on to number three, that's activation. Now, this is the one that creates the most shame in people, the difficulty starting tasks, even tasks that we want to do, even tasks that we care about. The researchers called it a state of inertia where the only thing that can like break through to get us to start something is urgency. Like, "It has to happen now. This is the only time it can happen." External pressure like my boss is making sure I do this or I have to, you know, someone else is telling me or that someone else is involved. So like a group project knowing that someone else is part of it and they're counting on us all. It can hit all of those points right now. The DSM frames it as avoidance of difficult or unpleasant tasks. That's what we have now. But the experience in this research, it showed that it just goes way beyond that. Like people reported being stuck on tasks they were interested in, like "I want to start and I like this this subject or this thing that I'm working on" and just feeling this internal almost like being frozen. They said that they're like completely unable to like some people reported as like "I'm stuck." Some people said, "I don't I don't understand what's wrong with me. I want to do this and I just can't." So it doesn't matter that we're interested in it or we want to do it. We can feel like for whatever reason we just can't. And that is not avoidance. That is like a neurological difference in how the brain initiates action. And what it looks like in daily life is like a to-do list that creates more paralysis the longer it gets. Or starting something and getting derailed 30 seconds in, never coming back to it. Or knowing exactly what needs to happen and just being unable to make yourself do it. This is not laziness. That's something that a lot of people had felt over the years is that they must just be lazy. That's not what this is. ADHD brains need interest, urgency, challenge, or external structure to activate the things that don't have those qualities. So even if we like it, if it doesn't have one of those qualities, it can feel genuinely impossible to begin regardless of how capable we are.
Moving on to number four. This is emotion dysregulation. I thought this was such an interesting and important piece to talk about because this one does not appear in the diagnostic criteria at all despite being extensively documented in research for years now. Emotions in ADHD can feel immediate and very large, okay? Kind of like overwhelming. A criticism that would maybe roll off, you know, my back would land hard on someone with ADHD. Rejection itself, a lot of people reported, feels physical, like physically painful. Frustration will escalate faster than you want it to. And the researchers noted that many participants found even intense positive emotions draining. So, it's not just like the negative things or, you know, it's positive and negative because it wasn't about the type of emotion. It was the intensity itself that was the issue.
Now, for women, this can get labeled as being too emotional. I've heard that. I don't even have ADHD and I've been told like, "You're too emotional, too sensitive, too intense," and it sometimes leads to a misdiagnosis of things like borderline personality disorder or bipolar disorder. And it is frequently the thing that finally brings someone into a therapist's office. Not because they know they have ADHD, but because they're exhausted by the emotional turbulence and don't know why it keeps happening.
Now, I want to briefly mention rejection sensitive dysphoria. Because it's the extreme emotional pain triggered by the perception of rejection, criticism, or failure. Not actual rejection, perceived rejection. Someone not texting back quickly enough. A slightly neutral tone in an email or being left out of something, the response feels completely out of proportion to the event. Meaning, like my emotional response to it or the pain I feel is just way more intense than what the thing itself was. And people with ADHD often build their entire lives around avoiding these moments. We people-please to prevent rejection. We don't try things that we might fail at. We read every interaction for signs of disapproval. And it's exhausting to live like that without knowing why. And oh, I also do have a full video on rejection sensitive dysphoria if you want to learn more. But I felt like it was important to mention here because I think it's kind of like a piece of that emotional component.
Moving right along to number five, time perception. We've talked about this online all the time that we can lose track of time. And the study confirmed what research has been pointing to for years, that ADHD changes how people experience time itself. I thought that was really key, that ADHD changes how we perceive or experience time itself. Not just managing time, actually perceiving it. Like how long is an hour? How long does it feel to be somewhere for that long or to do something for that long? For those of us with ADHD, time will slip away when our attention isn't actively on it. Like tasks that feel boring get overestimated, right? "This is taking forever." "Oh, I've been doing this forever," and you're like, "It's been 20 minutes," right? Which reinforces us avoiding them because even that 20 minutes feels like hours. And tasks that are engaging to us get underestimated. Like, "I've only been working on this for 15 minutes," and it's been 3 hours. Which is part of why hyperfocus can eat entire afternoons without warning and deadlines will arrive feeling kind of sudden or shocking even when they were known well in advance. This is also why hyperfocus happens. The same brain that can't start a tax return can lose six hours on something genuinely fascinating without even noticing that any time has gone by. And this is often where the ADHD woman has found her competence and her identity. She is exceptional at the things that activate her brain and struggles with everything else. This inconsistency is part of why ADHD and high-achieving women gets dismissed. People will say things like, "But you finished your degree. But you have a successful career." Yes. And also hasn't opened her mail in 4 months and cried in a parking lot because she forgot an appointment. Again, both things are true. They are the same brain.
Moving on to our final criteria, sleep. This one is almost never part of the ADHD conversation and it should be. The research shows that people with ADHD are more likely to have delayed circadian rhythm. I found this fascinating and from the people I know in my life who have ADHD, it is 100% true. What this means is that their natural sleep cycle runs later than the rest of the world expects. The result is fatigue during the day, difficulty with morning functioning, which I mean that resonates for me, but will have increased irritability that can look like mood problems rather than a sleep problem. Okay, so this can come along with racing thoughts, lying in bed with a brain that won't slow down. Mental hyperactivity that continues after your body's ready to stop. So you can feel like, "I need to go to bed and I should be sleeping," but your brain won't shut off and you feel like, "Oh, I should be doing all these things." And at night you feel like almost more mentally energized and it's not anxiety. I think that's a big important thing to say here is that this is not anxiety though it can be mistaken for it. A lot of people that they talked to in this study said that they just thought it was anxiety. They thought that was what they were experiencing and they'd been misdiagnosed. So it's not anxiety. It is a nervous system that like hasn't found the off switch. Right? Brain works a little bit differently and so our circadian rhythm runs differently and nighttime might be the time that we feel the most ourselves or the most alive. I don't know. You tell me in the comments.
ADHD is largely genetic and neurological. But how it develops and how it's experienced is profoundly shaped by the environment a child grows up in. A child with undiagnosed ADHD in a home with emotionally attuned, patient, adaptable parents has a very different outcome than a child with ADHD in a home that was chaotic, critical, or emotionally unavailable. In the second environment, the ADHD traits that might have been understood as a different kind of brain gets interpreted as problems with the child. "She's too much." "She doesn't listen." "She's being dramatic." "She needs to try harder." "She's so lazy." She doesn't know that she has ADHD. She just knows how she works doesn't match what's expected. And she concludes that the problem is her, honestly, because she's kind of been told that it is because they just don't know that where it's coming from. And this is kind of where the overlap with the patterns that we talk about on this channel become significant because the same child who's trying to earn love by being easy and good and helpful is also trying to mask the ADHD traits that keep getting her in trouble. Now, the two survival strategies kind of like converge. And 20 or 30 years later, she's sitting in a therapist's office wondering why she's so exhausted all the time. ADHD was not caused by childhood, but childhood could have shaped how she learned to live with it. I want to say that again because I think that's really important. ADHD was not caused by childhood, but childhood could have shaped how she learned to live with it. And understanding both pieces is part of what makes it possible to stop judging ourselves so harshly.
If any of this sounds like you, let's move into what we can do. And the first, and you probably saw this coming, is to get a proper evaluation. A good ADHD evaluation should include, because we haven't talked about this before, but this is really important, should include a clinical interview, meaning you sit with a therapist, psychologist, and you talk to them, and they interview you. They ask you specific questions. Okay? So, clinical interview, a detailed history, and and this is something I again I haven't talked about this is that ideally they'd get input from someone who knew you as a child. Could be a teacher, could be a parent, could even be a sibling. And it should be done by a clinician with experience in adult presentations and if possible, women specifically. Now obviously all of this is like in a perfect world, but that's really what it should entail because questionnaires alone are not sufficient, particularly for women who have spent decades masking. It's almost like we know what they want us to say, what answers they want us to give, and we'll give them those answers. But it's really important that we're honest about the things that don't work, not just the things that you found a way to manage. Clinicians will see the compensation, but they need to hear about the cost to you. So, you have to tell them all of that. Okay.
The second thing I want you to do is to understand that a diagnosis is not a label. It is a map. And what a diagnosis gives you is language, right? I have a word to put to this thing that I'm struggling with. And with that language comes the ability to find the right tools, the right support, and a much more accurate understanding of why certain things have been so hard. Instead of asking, "Why can't I use the to-do list like everyone else? Like, why can't I just figure this out?" You start asking, "Hmm, I wonder what would work for my brain that I learned activates differently, right?" And that shift moves out of kind of this self-blame or shame space and into problem-solving, which is where we want to be. Much more empowering, right?
The third thing I want you to do is to separate the neurology from the meaning you made of it. Now this is a big one. Okay. Separate neurology from the meaning that we made of it. Because many women who receive a late ADHD diagnosis kind of go through, I've heard from a lot of you, go through this period of grief for the years you spent believing that you were the problem. And that's a real valid response, right? That's shitty. You've been through a lot of tough times and all of the beliefs that we had about ourselves and our intelligence and our abilities when we finally realize, "Oh my god, this is what it was." Like one of my girlfriends just got diagnosed. I'm 42, so she'd be 40. She just got diagnosed at 40 and she was like, "I knew something was wrong." And all this while, like I remember we went to college together and she really struggled in school and she had all these beliefs about herself like, "I'm just not that smart or I'm just not that good at that." And getting this diagnosis, it was great and it has been life-changing, like being on medication. She's like, "Oh my god." But she's also like, "Kind of angry and sad for like young her that thought she was stupid or that she couldn't do this because it wasn't really about that." So that's a completely valid response. I just want you to know that if you had that feeling of grief, that's totally reasonable and I would expect you to. However, the work is separating what was always neurological. So your ADHD was always, our brain works differently. It's a neurological thing, from what was learned. It's like we have to separate out our diagnosis from what we think about ourselves. The forgetting, the difficulty starting, the emotional intensity, those were always ADHD. The belief that those things meant you were unreliable or lazy or not even trying hard enough, that part was taught. And we have to pull those things apart, right? Because the behavior was never the character flaw. Most of us were taught to treat it like one. And untangling this should be something that you work on in therapy. And trust me, it's going to be hard, but it can be life-changing. Not only can it minimize those familiar shame thoughts, but it can also help us build healthy confidence and self-worth as we move forward, right? We can see it for what it is. It's not about me. That's my ADHD. That's how my brain works. I have to work with it.
Okay, moving on. Number four. Look at the people-pleasing with fresh eyes. For many of us, people-pleasing is not only about early relational patterns. It's also about a nervous system that feels things intensely and has learned to prevent disconnection at any cost. We over-explain. We over-apologize. We try to get everything exactly right so no one is upset with us. Now, this behavior isn't who you are. It's not a personality trait. I know. I thought it was personally for a long time. It's not. It's something that we learn to do to keep people from pulling away. And once you start to understand that, you can start to change it, you know, with more precision and less shame. So it's not about like, "People aren't going to like me," or "I have to do all this to get people to like me." It again, we're building that confidence. We're building that understanding that my brain works differently. I had learned to people-please to try to mitigate or mask or make up for this fact. However, now that I understand this, I can find ways to manage those symptoms and I don't have to do this anymore. Okay.
Now, if something in this video felt familiar, give yourself some time with it. A 2026 study just confirmed that the official picture of ADHD captures maybe a third of what people with ADHD actually experience. The other two-thirds, the activation difficulties, the emotional intensity, the time distortion, the sleep, the disorganization, the forgetting, those have been real and documented for years. They just haven't made it into the criteria used to diagnose people. So, if you went looking for answers and didn't find them, that gap is not a reflection of how clearly you were paying attention. It's a reflection of how limited the map has been.
If the rejection sensitivity piece landed particularly hard, I have a video that goes directly into why ADHD and emotional sensitivity often show up as overgiving and people-pleasing in relationships and how that connects back to what you learned about earning love. A lot of you have told me that this one hits differently once you understand that RSD piece. So, I'll link it here for you. And if this is your first time here, this is the work we do together every single week. Understand where our patterns came from, why they made sense back then, and what we can do to actually change them. Now, if any part of this video resonated, make sure you hit subscribe so you don't miss out because we'll be moving through this together. Thank you so much for watching, and I'll see you next week.