ADHD Across the Lifespan

ADHD across the lifespan is one of the most misunderstood conditions in modern mental health. For years, the perception of ADHD has been limited to young boys running around the classroom and disrupting learning. ADHD is so much more than that. It is incredibly important that we better understand what ADHD looks like in different genders and across the lifespan. The first step to helping those struggling with ADHD is to know what to look for.

ADHD is a neurodevelopmental disorder that affects executive function, emotional regulation, and attention span. With ADHD manifesting differently for boys and girls, men and women, we must better recognize the symptoms. It is no surprise that the young girl in class staring out the window and struggling with inattention is far less likely to receive a diagnosis as compared to the hyperactive boy who is frequently disrupting class. But they both deserve help with their ADHD symptoms.

Misunderstanding how ADHD looks in different demographics leads to missed diagnoses, inadequate treatment, and years of unnecessary struggle. Research suggests that women and girls are historically underdiagnosed, often receiving help only later in life after developing secondary issues like anxiety or depression.

ADHD in Children: The Early Signs

ADHD symptoms begin in childhood, whether we notice them or not. When we do see the symptoms it is often because they are interfering with functioning at school, home, or both. In children, symptoms usually fall into three categories: predominantly inattentive, predominantly hyperactive-impulsive, or a combined presentation.

The Hyperactive-Impulsive Child

The hyperactive-impulsive child is often spotted early on in the classroom. They struggle to sit still, keep their hands and words to themselves, and often fidget. Many say these children are “driven by a motor” indicating the constant movement these children present with. These children often show their impulsiveness by blurting out answers, struggling to wait their turn, and interrupting others. These children mean no harm; they are simply struggling to manage their impulses.

The Inattentive Child

Inattentive symptoms are much easier to miss. These children do not interrupt the classroom but often appear disconnected. These children struggle to keep their attention on a task or lesson. They often struggle to give close attention to details resulting in careless mistakes in schoolwork. These children also struggle to finish tasks like schoolwork or chores. They are often not organized and this leads to losing items easily.

Combined Presentation

The most common diagnosis in children is combined presentation. This child might struggle to focus on homework (inattention) while also being unable to stay seated during dinner (hyperactivity). Unlike the primarily inattentive presentation, these children disrupt the classroom and home leading to adults recognizing the symptoms even if the inattentive symptoms are harder to notice.

ADHD in Women: The Hidden Struggle

Until recently, ADHD was understood to be a male disorder. Even though we now know this is not true, it has created great barriers for women struggling with ADHD. Because women do not “fit the mold” for ADHD they often live feeling overwhelmed and misunderstood.

Internalized Symptoms vs. Hyperactivity

Some women to experience hyperactivity but it often presents differently than it does in children and men. While most children and men will present with gross motor movement, women will present with fidgeting, excessive talking, and internal restlessness. Because women often present with inattentive symptoms, such as daydreaming, disorganization, and forgetfulness, they are often overlooked because they are not disrupting their environment. Instead of disrupting the environment; they are quietly falling behind.

The Art of Masking

One of the most significant reasons women go undiagnosed is “masking.” Because the social norms say that women are to be organized, polite, and accommodating, women are often masking their symptoms to fit expectations. Women often hide their ADHD symptoms out of social obligation. They will check the time and their calendars frequently to avoid being late or they will suppress the urge to fidget so they are not perceived as awkward. The constant effort to suppress their symptoms and to fit the social norms is exhausting. Women will often appear to have it together in public but come home and collapse from exhaustion.

Hormonal Fluctuations

It is incredible how significantly hormones play a role in how ADHD symptoms will present in women. Because estrogen increases dopamine in the brain, a neurotransmitter that is often low in ADHD brains, it is no surprise that symptoms worsen when estrogen drops. Estrogen drops in the luteal phase of the menstrual cycle, postpartum, and in perimenopause. During these times, typical coping mechanisms and masking start to fail. Often, women in perimenopause with ADHD will seek diagnosis due to their coping mechanisms failing.

Emotional Dysregulation

Often the emotional dysregulation part of ADHD is hardest to deal with. It can look like mood swings, irritability, or low tolerance for frustration. A minor setback that might annoy a neurotypical person can feel catastrophic to someone with ADHD, leading to emotional outbursts or shutdowns.

ADHD in Men: Beyond the Classroom

Even though men are diagnosed more frequently than women, the changes that occur in the transition from childhood to adulthood leads to new challenges. New challenges in the workplace and in relationships occur due to the changes of the physical hyperactivity.

The Evolution of Symptoms

The “textbook” boy who couldn’t sit still often grows into a man who feels a constant sense of inner restlessness. This inner restlessness often leads to shaking his leg under the tables or mentally checking out to manage the discomfort of the restlessness. The impulsivity in childhood looked like interrupting games and conversations but in adulthood often looks like risk-taking behaviors. The adult male with ADHD may drive recklessly, use substances, or change jobs frequently. Their need for stimulation can drive them toward high-intensity hobbies or careers, but it can also lead to instability.

Workplace Challenges

In the professional world, men with ADHD often face specific hurdles. “Time blindness” can lead to chronic lateness or missed deadlines. Executive dysfunction makes long-term projects difficult to manage without immediate external pressure.

Although, men with ADHD can also be incredible assets in the workplace. Men with ADHD are often creative problem solvers. They are often able to think outside the box and hyper-focus on things they are interested in. Men with ADHD, in careers that feed their special interests and creativity will often excel in the workplace.

Seeking Professional Help

If you recognize the patterns above in yourself or your child, seeking a professional evaluation is the next step. A diagnosis is not a label to limit you; it is a key that unlocks understanding and access to the right tools.

When to Consider an Evaluation

You should consider an evaluation if symptoms are negatively impacting multiple areas of your life, such as work, school, home, or relationships. If you feel like you are working twice as hard as everyone else just to keep your head above water, it is worth asking for help.

The Assessment Process

There is no single way to test for ADHD and each provider has their own way of doing it. Although, an assessment typically involves a comprehensive clinical interview. The provider will ask about current symptoms and look at your history of these symptoms dating back to childhood. They may use standardized rating scales for you, your teachers (for children), or your partner/parents to complete. They will also look to rule out other causes for the symptoms, such as thyroid issues, sleep disorders, trauma, or other mental health disorders.

Who Can Diagnose?

Several types of professionals can diagnose ADHD:
• Psychiatrists and Psychiatric Nurse Practitioners: Medical doctors and nurse practitioners who can diagnose and prescribe medication.
• Psychologists: Can conduct deep psychological testing and provide therapy, but cannot prescribe medication.
• Neurologists: Specialists in the brain who can diagnose ADHD and prescribe medication.
• Primary Care Physicians: Some are comfortable diagnosing and treating straightforward cases, though many refer out to specialists.

Moving Forward with Clarity

ADHD is a lifelong neurodevelopmental condition, but it does not have to be a life sentence of struggle. With the right combination of medication, therapy, lifestyle changes, and accommodation, people with ADHD can thrive. Those with ADHD are often the innovators, the creators, and the dynamic thinkers of our world. The goal of diagnosis isn’t to fix a broken brain, but to understand and adapt to a unique one.

If you suspect you or a loved one has ADHD, reach out to In Focus First today. Clarity is waiting.

Medically Reviewed by Olanyi Osuntokun, M.D.