The Lost Generation
ADHD in women manifests differently, often later, and can be damn near imperceptible.
There’s a character named Penelope in Brothers Bloom that collects hobbies. “I see someone doing something I like, and I get books and learn how to do it,” Penelope boasts whimsically. My saintly parents entertained this quality in me for years, my young curious brain jumping from hobby to hobby, unable to commit — drum lessons, wood carving, poetry club, dance lessons, acting classes, photography, kayaking, science camp, sign language, illustration — they dutifully indulged my every whim until the next shiny thing caught my eye and I was off again.
I know now, in my twenty-eighth year, that this is how my ADHD manifested; a total inability to focus on the thing in front of me, whether it be a musical instrument, the lesson on the board, or later, my Master’s thesis. It’s the product of an under-stimulated brain, one that is deprived of dopamine, serotonin, and/or other neurotransmitters that the brain needs for the safe passage of a thought from one neuron to another.
Optimistically, this trait can be interpreted as curiosity, which incidentally, is something I quite like about myself. That curiosity drives my desire to really understand people, has helped me to become more empathetic. It takes me down lots of interesting paths that I wouldn’t have otherwise travelled.
But lurking beneath this curiosity, is a lack of focus that has made it tough to commit to ideas and complete tasks. Writing this piece, for example, has taken several months of opening up Medium, writing a little, getting distracted, and moving onto something else. As we speak, I have 33 Medium drafts going, all in various states of maturity — from a list of point form notes, to nearly-finished pieces — that I can’t bring myself to sit and finish. The dark side of ADHD is reckless abandon in all senses, despite a fierce and sincere desire to see things through. And unlike Penelope’s hobby collection, it is not at all goddamn whimsical.
Since my diagnosis, my entire life has come into clearer focus. I’m writing again. I can consume every morsel of a conversation with someone without having them repeat things back to me. I can focus on tasks until they’re finished, and I’m less overwhelmed by all the moving pieces.
But first, how I came to be here.
I’m a designer and a strategist. I like building order from chaos, breaking down complex systems into more manageable pieces. I derive great pleasure from intersecting disciplines, discovering new ways to look at mundane problems. I’m a first principles kind of person. So when my Master’s thesis dragged on (and on and on), despite my best efforts to design my way through it, I experienced the worst anxiety of my life. (Rather ironically, my research was focused on the social neuroscience of futures thinking, and the stress of the project was making it hard for me to, uh, imagine my futures.)
My anxiety was getting out of control. I would sit for hours trying to work, but instead, jumped from one article to the next, consuming The Whole Internet rather than tackling the task in front of me. I was super isolated, and felt really insecure about my intellect. What if I’m just not intelligent enough to do this? is a thought I had every day.
At the time, I was really lacking support. I lost myself in a relationship with a partner who wanted to spend every moment together, but couldn’t talk to me in any great depth. My partner wanted all the fun parts, the parts of me that folded well into his life, but was so unable to communicate about the state of the union that it bordered on deception; he would say just enough for me to stay, but couldn’t meet me to have the conversations every adult relationship needs. It made me feel really drained, unfulfilled, and frankly, lonely. My best friends, or chosen family as I like to call them, felt both literally and figuratively far away, as we entered into the I-never-see-my-people-because-they’re-too-busy-being-amazing phase our lives. I would work contracts with companies I knew weren’t the right fit, but couldn’t seek out the work I really wanted until I finished my damned thesis. My whole life felt overwhelming, like I just couldn’t gather the pieces.
And as my mid-twenties shifted into my late-twenties, I felt like that optimistic vision I had of myself in the future — someone who was going to produce great work, meditate, read consistently, be a supportive friend, have a profound, meaningful connection with a partner, sweat every day, build an off-grid home in the forest, write for fun, pickle all the things, and be totally spiritually satisfied — was completely unattainable. I was at the bottom of a very tall hill, peering towards the peak where everyone and everything that I loved was waiting patiently for me to get my shit together.
Which is what brought me to a psychiatrist in the summer of 2015. Now, navigating this with a psychiatrist is like a choose-your-own-adventure where all roads lead to Prozac. I should emphasize that I completely respect one’s decision to go on anti-depressants. Full stop. It didn’t, however, feel right for me at the time. I just wasn’t coping. I felt scattered. Which felt somehow different; I didn’t feel hopeless about my life, I could see exactly what I needed to do to be whole again. The life I wanted was there, grazing my fingertips, but I just couldn’t quite grab it. I just needed to design my life better. Over the years, I had built hacks to get around my lack of organization, tricked myself into productivity. But my usual strategies weren’t working. And in the face of my seemingly endless Master’s thesis, unsatisfying work, fragmented social connections, and an unsupportive relationship, everything was falling apart.
I start obsessively combing the internet for something, anything that could help me move forward. At this point, I had no idea that I had ADHD. It wouldn’t have even occurred to me to consider it, because I didn’t fit the stereotype of people with attention deficit issues: little boys, bouncing off the walls, unable to sit still, talking a mile a minute and being disruptive. My only real conception of attention deficit was the episode of Clone High (RIP/never forget) wherein Tom Green is explaining what it’s like to have ADD.
ADHD has a major PR problem. Popular depictions of attention deficit are all painted in this singular, simplistic way. Even academic sources focus largely on children, usually boys, and maintain that attention issues tend to subside after childhood. It wasn’t until I stumbled across this piece in The Atlantic by Maria Yagoda, that everything clicked. Short of a few details, Maria’s story is my story. Her symptoms manifested as excessive clutter, misplaced items, and difficulty concentrating. Clutter was my default but also something that makes me really anxious, so I developed a system of controlling it that made me seem kind of compulsive. I would misplace my keys, forget my lunch at home, and be late to all my plans and meetings. Medina Standard Time (MST) is a term that emerged in my circle of friends. Sorry for being such a scattered pile, I would say. I’m not normally like this. But the truth is, I was normally like that. That was my normal. And like Yagoda, “I considered my messiness, forgetfulness, and trouble concentrating to be embarrassing personal failures.”
Which is where we find ourselves; ADHD in women manifests differently, often later, and can be damn near imperceptible. Yagoda writes, “Women with the disorder tend to be less hyperactive and impulsive, more disorganized, scattered, forgetful, and introverted.” The hyperactivity bit is often inward, thoughts flying around unfinished in our brains.
And contrary to what most of the literature says, ADHD doesn’t always present in the early years. It often goes undetected in women until they approach adulthood. Yagoda elaborates:
[Further,] while a decrease in symptoms at puberty is common for boys, the opposite is true for girls, whose symptoms intensify as estrogen increases in their system, thus complicating the general perception that ADHD is resolved by puberty. One of the criteria for ADHD long held by the Diagnostic and Statistical Manual, published by the American Psychiatric Association, is that symptoms appear by age 7. While this age is expected to change to 12 in the new DSM-V, symptoms may not emerge until college for many girls, when the organizing structure of home life — parents, rules, chores, and daily, mandatory school — is eliminated, and as estrogen levels increase.
And because teenagers are generally giant wieners, the likelihood of an attention deficit being detected in the midst of all that bratty teenage sea change is well, really really low. Adults tend to view teenagers as a hormonal black box of behavioural change that is all just part of growing up. As a result, droves of burgeoning young women struggle with their symptoms long into adulthood. Because of this, it’s estimated that ADHD goes undiagnosed in women seventy-five percent of the time. Seventy-five percent. This translates to an estimated 4 million women in the U.S. alone who struggle with attention deficits.
The only thing worse than having ADHD is not knowing you have it. Desperately seeking stimulation, an ADHD brain might self-medicate, become obsessive, seek adrenaline-inducing activities, or be impulsive. Undiagnosed ADHD is both formative and completely destructive. The brain tries to develop hacks to compensate for the hyperactivity, carving new neural networks around bad habits and warped thinking. And because women are often socialized to be self-critical, much of the impact of ADHD is internalized. As Dr Ellen Littman, author of Understanding Girls with ADHD, laments “They’ve alternately been anxious or depressed for years. It’s this sense of not being able to hold everything together.”
I sent my psychiatrist Maria Yagoda’s article, which was initially met with skepticism. My symptoms, he said, were indicative of any number of disorders in the DSM-V. He was more inclined to treat the anxiety and depression than to dig further. It took more meetings, assessments, and some revealing school report cards before the evidence was compelling enough for medication. Trying the medication, my psychiatrist told me, is the only real way to know for sure; if you have ADHD, your under-stimulated brain will respond well to the stimulant, but if you don’t have ADHD, the stimulant will most certainly cause nausea (on account of the brain being over-stimulated).
And like magic, only a few days into the medication, I started to feel amazing. I was still me, just more better. I felt more controlled. More meticulous. More clear. It felt like I could finally reach the dusty, neglected things on the top shelf of my brain that I couldn’t reach before, but that I always knew were there.
For the two decades prior to my diagnosis, I never would have suspected my symptoms were symptoms; rather, I considered these traits — my messiness, forgetfulness, trouble concentrating, important-document-losing — to be just kind of who I am. I would get frustrated and down on myself for being these things when teachers and mentors around me would continuously comment on how much potential I had. If you could only just apply yourself, they’d say. You are capable of so much, Medina, you just need to try harder.
That’s the weirdest part of ADHD: being acutely aware of the gap between your capacity, and what you can actually do.
It’s worth making the distinction between capacity versus potential here. One’s potential is a future state, it’s a multiplier of present-day efforts. It’s about possibilities. To squander one’s potential is to not put in the present-day work that will yield future possibilities. But by capacity, I mean something different. If you collected all the best parts of yourself and watched them form into a synchronized waltz, you get capacity. It’s what happens when the right conditions are present for your potential to be met.
ADHD deprives a person of their capacity in situ. You can see all the pieces, all the ideas and data you gather from your curiosities laid out in front of you. You just can’t coordinate them in any kind of sensical way. It challenges one’s ability to see through the passage of information, disrupting the smooth conversion of thought to action.
The stress of not being able to put all the pieces together is totally crippling. As someone very future-oriented, I have a very clear vision of my preferred future. Pieces of that vision form long before I can form the language to articulate it. But the bits in between my present state and my future state become anxiety-laden because my brain can’t fully act out all the steps in between. The stress that accumulates from not being able to bring the pieces together, while staring at a beacon in the distance of where you want to go, is perhaps the greatest cruelty of ADHD.
Even though it took twenty-eight years, I’m really grateful for my diagnosis. For many women, that diagnosis doesn’t come until they have a child with ADHD, and they’re peering over their child’s shoulder during the assessment, mentally ticking off their own symptoms. This was the case for Katherine Ellison, a Pulitzer-Prize winning journalist who was diagnosed at 48 when her son was being diagnosed. I find it really encouraging that lots of smart women, decorated with accomplishments, hacked their way through attention deficit problems.
The fact of the matter is, medicine is not adequately preparing healthcare professionals to consider the differences in how women experience ADHD.
Since I started opening up about my experience, I’ve had countless conversations with women who relate, some of whom have even gone onto an ADHD diagnosis. The fact of the matter is, medicine is not adequately preparing healthcare professionals to consider the differences in how women experience ADHD. Outside of specialists, even the most attentive, kind, smart physicians spout outdated research and uphold archaic stereotypes. This failure to diagnose girls from a young age means they don’t get the accommodations they need to excel, and carry that burden into their adult lives.
And if the diagnosis does come later, the chance that a woman is experiencing mental health issues as a result of her ADHD is pretty high. And without an ADHD diagnosis, we end up treating the symptoms rather than the underlying cause, figuratively speaking. “The most common diagnosis of a woman before she receives her ADD diagnosis is depression,” says clinical psychologist Kathleen Nadeau. “So many women have come in to my office and said, ‘I’ve been in therapy for years and I’ve been diagnosed with anxiety and depression, but I am still having problems.’”
Though I try not to dwell on this, the thought of what could have been stirs a deep longing that is hard to shake. It aches to think about how my life could have been different if I had my diagnosis sooner. The subjects I would have studied, the paths I could have pursued. It aches even more to think about how many more of us there are out there, struggling silently. “You can treat ADHD, you can get support and strategies, but the self-esteem challenges are going to be left over and you have to work at that for a lot longer.” Michelle Frank, a clinical psychologist and ADHD expert, remarked in Quartz.
“I think we have a lost generation of women who are diagnosed with ADHD later in life, who have had to manage the condition on their own and deal with it on their own for the majority of their lives.”
Women, especially ambitious ones trying to balance their personal lives with their career goals, are already under lots of pressure to meet often opposing demands. “I think we have a lost generation of women who are diagnosed with ADHD later in life, who have had to manage the condition on their own and deal with it on their own for the majority of their lives,” says Frank, “The diagnosis is a blessing and a curse: it’s a great relief, but they wonder what could have been different if they had only known.” It’s tragic to think about this lost generation of women, who spend their lives thinking they’re just not good enough, whose identities are defined by persistent feelings of inadequacy for something so ridiculously treatable.
I manage my ADHD in a few different ways. I row or swim every morning, because my brain needs the surge of dopamine. I’m a noticeably worse version of myself when I don’t exercise in the morning. I’m on a light dose of medication, which I’m hoping to ween off of eventually. I’ve been reading about sound therapy, that has proven to be super effective (the theory there is that folks with ADHD have a hard time tuning out background noise, and all those layers of sound make it impossible to focus). Meditation, which has shown to increase grey matter in the limbic system (the emotional centre of the brain) goes a long way in managing the frustrating parts of living with ADHD. And when I’m not too scattered to remember (a little ADHD humour for ya), I take omega 3 and vitamin c supplements which help with dopamine production and dopamine synapse function, respectively.
Huge kudos are owed to my psychiatrist did his research, consulted with his colleagues, and really heard me. That is, unfortunately, not the case with most physicians treating women with ADHD. I’ve heard countless stories (many, I should note, since I first posted this piece) about womens’ ADHD symptoms being dismissed or overlooked. A cool thing happened with him shortly after the diagnosis; as I was leaving his office, he handed me my prescription and said “I just wanted to say thank you. Before this, I didn’t know how radically different ADHD could be for women. I’ve been sharing that article you sent me with all my residents,” he paused, “you really taught me something.” I guess my curiosity was good for something, in the end.
The biggest hurdle post-diagnosis is unlearning the parts of oneself that were learned from the ADHD. The bad habits lay like highways in my mind — so paved and smooth and convenient — it will take years of discipline and mindfulness to build new ones, resisting the temptation to merge back onto the easy roads. I’m grateful for the people in my life who will help me cut through the bush and clear the stones, paving new networks in my brain that enable me be the curious, focused, and compassionate friend, partner, and daughter that I’m capable of being.
Not much has changed, except everything is different.
If this resonated, please click the 💚 below. I certainly didn’t know the subtleties of ADHD in women before all this, and it helps to get the word out to teachers, parents, health care practitioners, and fellow attention-deficient pals who may be in the same boat.