A significant increase in ADHD diagnoses among middle-aged and older women is prompting professional scrutiny. While some view the rise as an improvement in mental health recognition, clinical psychologists and researchers highlight a complex interplay of hormonal influences, societal pressures, and diagnostic practices that may be contributing to both accurate identification and potential misdiagnosis.
The Hormonal Connection
Recent research from Monash University indicates a strong correlation between hormonal fluctuations and ADHD symptom severity in women. A study of 600 women diagnosed with ADHD found that:
- Menopause: 97.5% of participants reported a worsening of ADHD symptoms during menopause.
- Postpartum: 70.4% reported symptom worsening after giving birth.
- Menstrual Cycle: Among premenopausal participants not using hormonal therapy, 88.6% noted changes across their cycle, with 74% reporting more severe symptoms during the luteal phase.
"Menopause causes a drop in oestrogen levels. Oestrogen is understood to protect the brain against inflammation and cell death, making this transitional phase a period of vulnerability that may reveal or exacerbate pre-existing ADHD."
— Associate Professor Caroline Gurvich, clinical neuropsychologist and study co-author
The next phase of this research will involve brain imaging and hormone analysis to build cognitive profiles of women with ADHD.
Diagnostic Challenges and Societal Context
The rise in diagnoses is occurring within a broader context of increased public awareness. Historically, ADHD was primarily identified in males and school-aged boys. Improved understanding of how neurodivergent traits can be masked, combined with greater public recognition, has led more girls and women to seek assessment.
However, some clinical psychologists express concern about potential misattribution. Multiple sources note that many women seeking assessment belong to the "sandwich generation," managing care for children, grandchildren, and aging parents alongside paid employment and household responsibilities. These factors, combined with potential perimenopausal or menopausal symptoms, can produce psychological responses—forgetfulness, emotional dysregulation, restlessness—that resemble ADHD symptoms.
The widespread public discussion of ADHD may have contributed to a diluted understanding of the condition. While attention and hyperactivity exist on a spectrum, ADHD is defined as a chronic psychiatric disorder originating in childhood, associated with significant impairment in areas like employment and education, affecting an estimated 2-6% of the population.
Misdiagnosis Concerns
Professionals identify several pathways to potential misdiagnosis:
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Self-diagnosis: Some individuals may self-diagnose based on social media information or comparison with others.
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Medication response: A positive reaction to stimulant medication does not confirm an ADHD diagnosis. While these medications correct dopamine imbalances in individuals with ADHD, they can produce stimulant side effects like euphoria and increased energy in people without the disorder.
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Assessment practices: A study found that only one in three psychologists conducting ADHD assessments screened for co-occurring physical or psychological conditions, such as depression, anxiety, or trauma, and a quarter did not adhere to national diagnostic guidelines. This can result in underlying causes of distress going untreated.
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Co-occurring conditions: An estimated 20-30% of individuals with ADHD also have anxiety, with some studies suggesting up to 50%. Depression and bipolar disorder can also co-occur. Experts advise that if anxiety or depression co-occurs with ADHD, treating the underlying condition first is recommended, as inattention may improve without ADHD-specific treatment.
Broader Health Implications
Research indicates that ADHD is associated with increased risk for other health conditions, including anxiety, disordered eating, autoimmune disease, migraines, long COVID, and chronic pain. A study published in Scientific Reports (spring 2024) examining 958 adults with treatment-resistant chronic pain found that ADHD symptoms were approximately twice as common in the study group as in the general population.
Neuroinflammation, implicated in ADHD, may also increase risk of central sensitization—a condition where the nervous system becomes overstimulated, worsening pain, fatigue, and memory problems.
Individuals with ADHD may face additional challenges in managing chronic illness, as such management requires high executive function (planning, time management, task follow-through), which is impaired in ADHD.
Professional Recommendations
Experts suggest that women considering an ADHD assessment should first evaluate their workload, lifestyle, and the expectations placed upon them. A comprehensive psychiatric assessment, ideally face-to-face, is necessary to differentiate conditions. Telephone-only practice is not supported by the Royal Australian and New Zealand College of Psychiatrists due to the risk of missing clinical signs.
General practitioners (GPs) are considered well-positioned to manage female patients with ADHD, given their experience with taking menstrual histories and using patient diaries to track symptom changes. Stimulant medications and antidepressants may improve both ADHD symptoms and chronic pain, but stimulant medication for ADHD can worsen anxiety and depressive disorders, and in bipolar disorder, may trigger mania. Cognitive behaviour therapy and acceptance and commitment therapy can help with both ADHD and anxiety.