Older women with ADHD: How the lost generation got found

About the author: Kathleen Nadeau, PhD, is one of the pioneering researchers on women and girls with ADHD. When she began working in the field, ADHD was thought of as something that only affected young boys. But soon, she and her colleagues began to suspect that ADHD isn’t just a “boy’s disorder” — and that it’s a lifelong condition. They were right on both counts. 

Many women who are part of the “lost generation” of ADHD are only now beginning to get diagnosed. Nadeau’s recent book, Still Distracted After All These Years, takes a look at ADHD in older adults. 

Here, Nadeau shares what she’s learned over the years and what she thinks older women who suspect they may have undiagnosed ADHD need to know.

Attention-deficit hyperactivity disorder, or ADHD, is a common condition that affects between 3 and 5 percent of all people. But these estimates might be low because so many girls and women with ADHD have been overlooked.¹

People with ADHD are not all alike. Some are active and impulsive. Others are quiet and lost in their thoughts. Some drop out of school at age 16. Others have law degrees and medical degrees. What they all have in common are struggles with distractibility, forgetfulness, disorganization, and losing track of time. 

We used to think that only kids had ADHD. Now we know that ADHD affects people at every stage of life.² We used to believe that it mostly affected boys. Now we know that girls and women have ADHD, too. ADHD runs in families — it’s genetic. 

People are born with ADHD and live with it all their lives. But ADHD can be better or worse at different points. This is especially true for women. 

We noticed hyperactive boys first. They were easier to notice because they bothered their parents and teachers! They bounced off the walls at home and disrupted the class at school. 

Girls with ADHD were less disruptive. Inattentive girls daydreamed and looked out the window in class. Hyperactive girls talked a lot and were seen as social and silly. We joked about “Chatty Cathy,” “Tomboy Tara,” and “Shy Samantha.” Adults didn’t understand that these behaviors were signs of ADHD. 

Another barrier to diagnosis is that girls with ADHD worked hard to hide their struggles. They didn’t want to get in trouble. They wanted to fit in and be accepted by other girls. Girls were supposed to be “sugar and spice and everything nice.” It’s awfully hard to do that when you’re messy, forgetful, and disorganized. Or when it’s easy for your feelings to get hurt. 

Boys’ ADHD behaviors fit neatly into male stereotypes — being loud, taking risks, and acting aggressively. Some parents rejected an ADHD diagnosis for their sons, thinking these were just traits that boys have. 

Our earlier ideas of ADHD were based on the behavior of young boys. But over the years, as we learned more about ADHD, we realized that:

• There’s an inattentive type of ADHD. It involves being distracted and forgetful, with no hyperactivity or impulsivity.

• Girls and women have ADHD. Most women with ADHD have the inattentive type. They’re not hyperactive or impulsive. In women and girls who do have hyperactive symptoms, these symptoms are often subtler and harder to spot than in boys.

• ADHD doesn’t go away. When hyperactivity calms down, ADHD is still there. It just looks different in adults.

• The core problems of ADHD are poor life management skills. These are the skills we need to “get our act together.” It’s what we use to do well in school, at work, and in relationships.

When we realized that adults have ADHD too, this opened the door for many women to seek an ADHD diagnosis. Their ADHD was overlooked when they were girls. But as adults, they didn’t need to rely on a parent or teacher to refer them for testing. 

Listen to Climbing the Walls, an investigative podcast that explores why women were historically underdiagnosed with ADHD — and how the recent surge in diagnoses is reshaping our understanding of ADHD.

More recently, older women with ADHD are beginning to seek a diagnosis. Like younger women, many have been diagnosed with anxiety or depression instead of ADHD.³ An added risk for misdiagnosis in older women is that their ADHD struggles will be viewed as dementia.⁴ Both gender and age stereotypes can interfere with receiving an appropriate ADHD diagnosis in later years.

It matters a lot.

This is where ageism comes into play. I recall one older woman who contacted me. She was one of the “lucky ones” whose ADHD was actually identified — though not until later in life. She’d been diagnosed and treated for ADHD in her 40s and started taking stimulant medication at age 45. 

Now, she was 65 and her prescriber had retired. She couldn’t find another physician who would treat her ADHD. Some told her, “Now that you’re retired, why does it matter that you have ADHD?” Others worried that it wasn’t “safe” to prescribe stimulants to older adults. Though this woman had an ADHD diagnosis, she faced age-based discrimination that made it harder to access treatment.

Of course, these physicians had it wrong. Life doesn’t stop at retirement! In fact, it often becomes more complicated due to financial and health issues. Managing retirement savings, insurance claims, and doctor’s appointments all require a sharp mind and attention to detail.

It’s always important to speak to your health care provider before taking any new medication. But with approval, stimulant medications can be very helpful for older adults with ADHD. Almost all older adults that I interviewed for my book, Still Distracted After All These Years, reported taking stimulant medication and experiencing great benefits from it.

As I mentioned, the woman who’d been diagnosed in her 40s was one of the “lucky ones.” Many women who are now in their 50s, 60s, 70s, and beyond are just beginning to suspect they have ADHD. And all those decades spent undiagnosed can take a toll.

Though the disorder looks different from person to person, ADHD affects those who have it in every area of life. ADHD symptoms don’t just create difficulties at school and at work. They can also cause challenges in social and romantic relationships.⁵

Low self-esteem is common among women with ADHD. This is because women are more likely to blame themselves for their challenges. Many women with ADHD report feeling “stupid” or “crazy.” Or they see themselves as less capable or less smart than their peers. Others may have been successful but felt like they’ve had to work much, much harder than their peers to achieve the same results. 

Some of the consequences of untreated ADHD can also be quite dangerous. Overall, people with ADHD have shorter life expectancies.⁶ They have higher rates of mental illness, substance use,⁷ joblessness, car accidents, and interactions with law enforcement.⁸ Women and girls with ADHD have higher rates of suicidal ideation, self-harm, and unplanned pregnancies, and they’re more likely to experience intimate partner violence.⁹

Without a diagnosis, many women have had to navigate these challenges without the understanding, support, or help they need.

Older women with ADHD, diagnosed or not, face specific challenges. Health issues can become more common and more serious as we age. These include:

• Hormones and menopause: The lower estrogen levels that women experience during perimenopause (age 39–49 on average) and menopause (age 50–51 on average) can greatly increase ADHD challenges. Treatments like hormone replacement therapy (HRT) that boost or stabilize hormones can help. Many women taking HRT report a significant improvement in ADHD symptoms. 

• Memory issues: Some memory problems are a normal part of aging. But for people with ADHD, who often struggle with executive functions like working memory, they can be a bigger issue. The best way to improve your memory is through brain-healthy habits. Your lifestyle has a big impact on your brain. Recent research shows that an unhealthy lifestyle is a major factor in developing dementia.¹⁰ Regular sleep, exercise, a healthy diet, and managing stress levels can all reduce memory challenges and other cognitive issues.

• Managing medications. Remembering which medications you’re taking, how often to take them, and how different medications interact with one another can be a big challenge for people with ADHD. This is especially true if you have multiple prescribing doctors. Anytime medication comes up, make sure your doctors are aware of every medication you’re taking. Using alarms or pill organizers can help you remember which medications to take when.

• Mental health disorders. Anxiety and depression are very common for women with ADHD. These issues can become worse for older women, especially if they’re socially isolated. If you’re lonely, consider joining a volunteer group or visiting a senior center where you can find activities and social connections.

Living with undiagnosed ADHD can also create other challenges for older women. Some of these may have been present throughout life. But they worsen or become more noticeable as life changes like retirement upend existing routines. 

• Chaos and clutter: Many women with undiagnosed or untreated ADHD fall into a state of clutter and chaos. This makes it more and more difficult to function in their daily life.

• Unhealthy eating patterns: Many women simply stop cooking and live on snacks, crackers, and unhealthy frozen dinners.

• Feeling defeated and unable to accomplish goals: Many women have dreams of retirement — pursuing hobbies, taking up painting, reading more. But they say that they end up just sitting around, watching television, going on social media, and feeling empty and dissatisfied with their daily life.

• Social isolation: This often sets in without the structure of work colleagues. When retirement includes moving near an adult child, longtime friendships are also lost. And when health and mobility problems develop, social activities become increasingly rare.

• Depression: This is a risk for many older adults, but a greater risk for women with ADHD. Many of them have struggled with some level of depression during their adult life.

For many women, an ADHD diagnosis comes with great relief. “Finally, I have an explanation for the struggles I’ve had all my life. It’s not my fault! I have a real, treatable disorder.” 

There are many levels of support for women with ADHD. Don’t try to go it alone. 

It can be tough to know how to talk about it with friends or family members, especially if you’re not sure how they’ll respond. Having a plan can help: 

• Share a book or article on women with ADHD with your partner or family. That way, it’s an expert explaining ADHD and may be more convincing.

• Ask your partner to listen to stories from other women. The Understood podcast ADHD Aha! is a great place to start. 

• Invite your partner to go with you to a therapy appointment. This gives them a chance to ask questions to a professional.

Remember, you won’t be able to control how people react. Don’t let the doubts of your partner or family about ADHD make you doubt yourself. 

There are other ways to find support outside of your family and friends. This can include: 

• Finding community: Before, during, and after diagnosis, it can be helpful to find a community where you can talk about your ADHD (in person or online). ADDA is another nonprofit that offers free online weekly support groups for women with ADHD.

• Getting professional help: A qualified health care provider will diagnose your ADHD and work with you to find the right treatment plan. But diagnosis and medication may only be part of the puzzle. Many women with ADHD benefit from additional support from a therapist. 

• Working with an ADHD coach: ADHD coaches are specially trained to help people with ADHD develop executive functioning skills, build better habits and routines, and learn how to manage tasks.

• Bringing in a professional organizer: If living in a cluttered or chaotic home environment is keeping you down, hiring a professional organizer can be a huge help. If a professional organizer is too expensive, try asking for help from people in your community — even from other women with ADHD. It’s always easier to organize someone else’s home than your own!

If you suspect that you have ADHD, don’t hesitate to reach out and learn more — no matter what your age. 

ADHD is real. And, even better, ADHD is a highly treatable disorder. The more you learn, the more you have the support of other women with ADHD, and the more you receive the treatment that you need, the better you’ll feel and function.

Many women with ADHD go undiagnosed. As girls, their symptoms were overlooked because parents and teachers often expect ADHD to look the same in boys and girls. But girls with ADHD usually have symptoms that are harder to pick up on. And because ADHD is a lifelong condition, they also have symptoms as adults. 

Having ADHD as an adult can create challenges at work and in women’s social lives. Distractibility, forgetfulness, disorganization, and losing track of time are common struggles.

Sometimes people wonder if getting diagnosed as an older adult is worth it. It is! Even if you’re retired, you still have a complicated life to manage — finances, medical appointments, and just day-to-day upkeep of your home and your body. You deserve to get the support you need.