Adult ADHD: Signs, Symptoms, Types, Treatment https://www.additudemag.com ADHD symptom tests, ADD medication & treatment, behavior & discipline, school & learning essentials, organization and more information for families and individuals living with attention deficit and comorbid conditions Fri, 30 May 2025 02:12:06 +0000 en-US hourly 1 https://wordpress.org/?v=6.8.1 https://i0.wp.com/www.additudemag.com/wp-content/uploads/2020/02/cropped-additude-favicon-512x512-1.png?w=32&crop=0%2C0px%2C100%2C32px&ssl=1 Adult ADHD: Signs, Symptoms, Types, Treatment https://www.additudemag.com 32 32 216910310 How to Change a Woman’s Life in 30 Seconds https://www.additudemag.com/domestic-violence-help-ipv-screening-safety-cards-abusive-relationships/ https://www.additudemag.com/domestic-violence-help-ipv-screening-safety-cards-abusive-relationships/?noamp=mobile#respond Fri, 30 May 2025 02:12:06 +0000 https://www.additudemag.com/?p=381214 Intimate partner violence (IPV) is more common than breast cancer, diabetes, or depression, with one in four women affected. Though research on IPV among women with ADHD is limited, the prevalence in this community is thought to be particularly high. According to the Berkeley Girls with ADHD Longitudinal Study (BGALS), women aged 17 to 24 with ADHD were five times more likely than their neurotypical peers to experience physical IPV. Greater ADHD symptom severity in childhood, the researchers found, was associated with increased risk for IPV.1

The ramifications of abuse are dire and, in some cases, life-threatening: half of female homicide victims are killed by current or former partners.2 The consequences of psychological abuse — the most frequent kind of IPV and often a precursor to physical violence — are no less critical. Research shows that psychological abuse is an even stronger predictor of post-traumatic stress disorder and depression than is physical abuse.3

Though intimate partner violence is startlingly common and harmful, many avenues can lead victims to help and health care providers are instrumental in connecting patients to these paths. Though traditional IPV screening is an effective intervention, it’s not the only one. For some providers, distributing safety cards may be a better fit.

The size of business cards, these safety cards contain information about the red flags and health consequences of IPV. They share contact information for hotlines as well as guidance for safely seeking help, and they let people know they’re not alone.

“It takes 30 to 45 seconds to share the card, and it can change someone’s life,” says Tami Sullivan, Ph.D., director of Family Violence Research and Programs and professor at Yale University’s School of Medicine. “We hear from women with lived experience of violence: ‘Why didn’t anyone ever give me something like this? It could have made all the difference to me.’”

[Read: Why Do Toxic Relationships Swallow People with ADHD?]

Obstacles to IPV Screening

With traditional IPV screening, a provider uses a survey like the HITS (Hurt, Insult, Threaten, Scream) to detect if a patient is experiencing violence. This can be transformative.

“If you trust your provider, it can be a very empowering experience to connect with someone who can listen, make you feel less alone, talk to you about making decisions,” Sullivan says.

But several significant obstacles stand in the way of effective screening for IPV. Survivors may be hesitant to disclose their experiences of violence, fearful of retaliation by their partners, or of being reported to police and potentially losing custody of their children. They may worry they’ll be judged, blamed, or shamed. These concerns may be particularly salient for women with ADHD who receive near-constant criticism, correction, and judgement.

[Watch: “How to Avoid Toxic Relationships and Find Your Ideal Match”]

These obstacles contribute to relatively low rates of disclosure in IPV screenings; less than a quarter of women who have experienced IPV report disclosing this to a health care provider.4

The efficacy of screenings also relies on a meaningful response from the provider. Many providers don’t feel comfortable addressing such a sensitive and personal revelation because they’ve not received training in IPV.

“We shouldn’t expect people to develop expertise in responding,” Sullivan explains. “But we want the provider to feel comfortable enough so that they’re not being judgmental, so they can let the person know they’re heard, and connect them to someone who does have expertise.”

If a survivor reveals abuse on a survey and her disclosure is never addressed, or if it’s met with judgement, Sullivan explains, it can discourage her from revealing the abuse to others in the future.

Safety Cards: A Universal Approach

The part of IPV screening that helps survivors most, research has found, is the engagement with support services that happens after disclosure.5 This is where safety cards come in.

IPV safety cards, which are distinct from screening methods, bypass surveys altogether and take a direct path to offering help.

The method is simple: Providers order safety cards like these for free and hand them out to every female patient they see (without their partner present). The cards come in 10 languages and contain information about the red flags and health consequences of IPV. They also connect patients to support and resource hotlines

For providers looking for guidance on how to distribute the cards, Sullivan suggests the following language:

“We’ve started talking with all of our patients about relationship health and abuse in relationships, in case it’s ever an issue for them or for their friends and family. This card talks about healthy and safe relationships, ones that aren’t — and how relationships affect your health.”

Safety cards offer myriad benefits, including:

  • Getting help to the people who need it, no questions asked. Offering resources to everyone, a universal education model, ensures that the women who need help will get access to it – regardless of whether they disclose abuse.
  • Empowering women to help others. Many of the patients who receive cards may not be experiencing IPV, but they may know people who are. Safety cards enable these individuals to recognize abuse in the lives of loved ones, and empower them to offer helpful resources. Research found that people who received universal education were twice as likely as those who did not to share the number for an IPV hotline to someone in need.6
  • De-stigmatizing conversations about IPV. Broaching the topic of intimate partner violence to all patients helps to break the taboo which often keeps women silent about their experience.
  • Planting a seed for future action. It’s important for providers to distribute safety cards at every visit because it may take more than one interaction for patients to recognize abuse in their own lives, or to prepare themselves to consider next steps.  “Often, the cards plant a seed for future action. You give it to patients every time they come in so that it’s routine and becomes comfortable,” Sullivan says. “They come to understand that their relationships affect their health.”

While disclosures aren’t necessary in this IPV intervention, they may happen. When responding, providers should use non-judgmental, validating language, and avoid directing patients to take specific action. “It should never be a provider, trained or not, telling people what they should do,” Sullivan explains. “Though it’s likely well-intentioned, this prescriptive approach mimics the dynamics of abuse and disempowerment.”

Instead, follow the patient’s lead. “Let people know the supports available to them and listen to them,” suggests Sullivan. “You might ask: ‘Have you thought about what you want to do? Do you want help thinking about what makes sense? Would you like to call a helpline from this office?’”

What survivors of abuse need from providers, Sullivan explains, is autonomy, empathy, and information about their options for getting help.

To Order Free Safety Cards

Get Help

If you, or someone you love, is experiencing intimate partner violence, these resources may help

  • National Domestic Violence Hotline, Call 800-799-7233 or text START to 8878
  • Love Is Respect, for people aged 13-26, Call 866-331-9474 or text LOVEIS to 2252
  • National Sexual Assault Helpline, Call 1-800-656-HOPE

Abusive Relationships and IPV Screening: Next Steps


SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

1Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.

2Jack SP, Petrosky E, Lyons BH, et al. Surveillance for Violent Deaths — National Violent Death Reporting System, 27 States, 2015. MMWR Surveill Summ 2018;67(No. SS-11):1–32.

3Mechanic MB, Weaver TL, Resick PA. Mental health consequences of intimate partner abuse: a multidimensional assessment of four different forms of abuse. Violence Against Women. 2008 Jun;14(6):634-54. doi: 10.1177/1077801208319283. PMID: 18535306; PMCID: PMC2967430.

4Black MC, Basile KC, Breiding MJ, et al. The national intimate partner and sexual violence survey: 2010 summary report. Atlanta, GA Natl Cent Inj Prev Control Centers Dis Control Prev. 2011;19:39-40.

5US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Grossman DC, Kemper AR, Kubik M, Kurth A, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: US Preventive Services Task Force Final Recommendation Statement. JAMA. 2018 Oct 23;320(16):1678-1687. doi: 10.1001/jama.2018.14741. PMID: 30357305.

6Miller E, Tancredi DJ, Decker MR, et al. A family planning clinic-based intervention to address reproductive coercion: a cluster randomized controlled trial. Contraception. 2016;94(1):58-67. doi:10.1016/j.contraception.2016.02.009

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How ADHD Is Different for Women: An Expert Roundtable https://www.additudemag.com/video/neurodivergent-women-adult-adhd-guidelines/ https://www.additudemag.com/video/neurodivergent-women-adult-adhd-guidelines/?noamp=mobile#respond Wed, 28 May 2025 20:34:37 +0000 https://www.additudemag.com/?post_type=video&p=379729

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Sex Hormones in Women Impact ADHD Symptoms, Medication Efficacy: Study https://www.additudemag.com/sex-hormones-adhd-inattention-emotional-dysregulation-impulsivity/ https://www.additudemag.com/sex-hormones-adhd-inattention-emotional-dysregulation-impulsivity/?noamp=mobile#respond Tue, 27 May 2025 18:22:18 +0000 https://www.additudemag.com/?p=380991 May 27, 2025

ADHD symptoms are impacted by changes in sex hormone levels in females across the lifespan, finds a new systematic review published in the Journal of Attention Disorders.1 The review included 11 studies that investigated puberty, pregnancy, postpartum, and the menstrual cycle and tracked changes in symptomology and in the efficacy of ADHD medication during these times.

“There is an ADHD experience that is unique to females,” the study’s authors concluded. “Recognizing potential influences of sex hormones on ADHD symptoms in females may have key implications to clinical management and treatment of ADHD.”

The study included several key findings.

Sex Hormones and ADHD During Menstrual Cycle

The research reviewed four studies that explored the fluctuation of ADHD symptoms during the menstrual cycle. The following associations were identified:

  • Early luteal phase: increased impulsivity and hyperactivity2
  • Mid-luteal phase: increased emotional dysregulation, executive dysfunction, inattention3
  • Late luteal phase: increased inattention and executive dysfunction, and mental health symptoms such as depression, irritability and anxiety4

Linking these symptom trends to increase and decrease of specific female hormones, the authors wrote: “Inattention symptoms may be related to decreasing estrogen and moderated by progesterone, whereas hyperactive/impulsivity symptoms may similarly be driven by reducing estrogen levels, though without effect of progesterone.” 5

These significant shifts in symptom severity were vividly described by Chloe, an ADDitude reader, in an article titled “Menstrual Cycle Phases and ADHD.” “The entire week leading up to my period is where my ADHD symptoms get even more intrusive than usual,” she wrote. “My executive functioning dips even lower, distractibility and difficulty focusing is increased, and my mood/energy level is much lower, causing me to feel badly about all the things I’m not being successful at that week.”

The review found that increasing stimulant dosage premenstrually resulted in improvement of ADHD and mood symptoms, including emotional dysregulation. This point was echoed in the lived experience of many ADDitide readers, who reported that their typical medication dosage seems less effective in the luteal phase of their cycle. Norma, a reader from Wisconsin wrote: “The week leading up to my cycle, I might as well not even take my ADHD meds. It’s like my body overrides them.”

Sex Hormones and ADHD in Pregnancy and Postpartum

The review included one study investigating ADHD in pregnancy.6 Three groups of pregnant women were included: those who discontinued ADHD medication, those who continued, and those who took medication as needed.

The study found hyperactivity symptoms were significantly lower and both mood and family functioning were better among the women who continued medication compared to those who discontinued. Other ADHD symptoms did not differ between the groups, leading researchers to theorize that, for some, the high estrogen of pregnancy may ameliorate certain ADHD symptoms. Because just one study was reviewed, and its sample size was small, the authors stressed that more research is required to contextualize the results.

Allison Baker, M.D., lead author for the study included in the review, wrote about her findings in an article for ADDitude, “Treating for Two:” “Women who discontinued stimulant treatment during pregnancy were more likely to experience conflict within their family, rate parenting as more difficult, and report feeling more isolated. Those who discontinued stimulants but did not stop taking their antidepressant medication, experienced a clinically significant increase in depression.”

While the study did not investigate an association between ADHD and postpartum depression, other studies have found that 17% of women with ADHD experience PPD compared to 3.3% of women without ADHD. and 25% experience postpartum anxiety disorders, compared to 4.61% of women without ADHD.7

“New mothers with ADHD face distinct postpartum challenges that are as ubiquitous as they are unstudied,” wrote Baker in “Postpartum Care for Mothers with ADHD.” “The months following the birth of a baby are uniquely difficult, and women with ADHD do not usually receive the medical support and treatments they need during this time.

Future Research on Hormones and ADHD

Understanding the role that sex hormones play on ADHD symptoms in women has far-reaching implications for diagnosing the condition and treating it. The review’s authors put forth the following interventions as possible ways to improve ADHD symptoms exacerbated by female hormones:

  • premenstrual adjustment of stimulant dose 8
  • use of hormonal therapies to stabilize estrogen and progesterone levels during menopause9 for those who struggle with PMDD 10

The main limitation of the review, authors acknowledged, is the small number of studies included, many of which include small sample sizes. “To advance our understanding of ADHD in females, research that seeks to understand the mechanisms underlying how sex hormones may influence ADHD symptoms is essential,” they wrote, calling for a multi-disciplinary approach that combines assessments of hormone levels with neurocognitive, brain imaging, genetic, or neurophysiological investigations.

This call for research was echoed in the ADDitude magazine article “Hormonal Changes in Women with ADHD: 4 Gaping Holes in Research, written by five leading experts on ADHD in women, including Michelle M. Martel, Ph.D., a lead author of several of the studies included in the review. “We know that hormones collide with ADHD to cause heightened mood dysregulation, memory problems, and impulsivity each month,” the authors explained. “But we don’t yet see the big picture of how symptoms manifest during different reproductive stages because research is scant and leaves more questions than answers.”

Sources

1Osianlis, E., Thomas, E. H. X., Jenkins, L. M., & Gurvich, C. (2025). ADHD and Sex Hormones in Females: A Systematic Review. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547251332319

2Roberts B., Eisenlohr-Moul T., Martel M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015

3Bürger I., Erlandsson K., Borneskog C. (2024). Perceived associations between the menstrual cycle and Attention Deficit Hyperactivity Disorder (ADHD): A qualitative interview study exploring lived experiences. Sexual & Reproductive Healthcare, 40, Article 100975. https://doi.org/10.1016/j.srhc.2024.100975

4de Jong M., Wynchank D. S. M. R., van Andel E., Beekman A. T. F., Kooij J. J. S. (2023). Female-specific pharmacotherapy in ADHD: Premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, 14, Article 1306194. https://doi.org/10.3389/fpsyt.2023.1306194

5Eng A. G., Nirjar U., Elkins A. R., Sizemore Y. J., Monticello K. N., Petersen M. K., Miller S. A., Barone J., Eisenlohr-Moul T. A., Martel M. M. (2024). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and Behavior, 158, Article 105466. https://doi.org/10.1016/j.yhbeh.2023.105466

6Baker, A. S., Wales, R., Noe, O., Gaccione, P., Freeman, M. P., & Cohen, L. S. (2020). The Course of ADHD during Pregnancy. Journal of Attention Disorders, 26(2), 143-148. https://doi.org/10.1177/1087054720975864

7Andersson, A., Garcia-Argibay, M., Viktorin, A., Ghirardi, A., Butwicka, A., Skoglund, C., Bang Madsen, K., D’onofrio, B.M., Lichtenstein, P., Tuvblad, C., and Larsson, H. (2023). Depression and Anxiety Disorders During the Postpartum Period in Women Diagnosed with Attention Deficit Hyperactivity Disorder. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.01.069

8de Jong M., Wynchank D. S. M. R., van Andel E., Beekman A. T. F., Kooij J. J. S. (2023). Female-specific pharmacotherapy in ADHD: Premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, 14, Article 1306194. https://doi.org/10.3389/fpsyt.2023.1306194

9Herson M., Kulkarni J. (2022). Hormonal agents for the treatment of depression associated with the menopause. Drugs & Aging, 39(8), 607–618. https://doi.org/10.1007/s40266-022-00962-x

10Appleton S. M. (2018). Premenstrual syndrome: Evidence-based evaluation and treatment. Clinical Obstetrics and Gynecology, 61(1), 52–61. https://doi.org/10.1097/GRF.0000000000000339

 

 

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Treating the Hidden Complexities of ADHD https://www.additudemag.com/comorbid-conditions-with-adhd-treatment/ https://www.additudemag.com/comorbid-conditions-with-adhd-treatment/?noamp=mobile#respond Fri, 23 May 2025 09:01:29 +0000 https://www.additudemag.com/?p=379154 A staggering three-quarters of adults with ADHD have at least one coexisting condition like depression, anxiety, bipolar disorder, obsessive compulsive disorder (OCD), substance use disorder, or an eating disorder.1 Similarly, up to 80% of children with ADHD also have a co-occurring disorder2, which complicates symptom management.

A complex condition requires a thoughtful treatment approach, and multiple diagnoses often require treatment with more than one medication. Unraveling the answers takes time, plus trial and error. Thanks to years of research, however, clinicians are now equipped with highly effective options for addressing tough-to-treat cases of ADHD plus comorbidities.

Use this evidence-based information to begin a conversation with your doctor about treating complex ADHD with combination therapy.

Is Combination Therapy Safe?

The stimulants used to treat ADHD generally have no major drug-to-drug interactions, so they don’t increase the levels of other medications you may be taking, and vice versa. They are safe to use in combination with other medications, including non-stimulants, antidepressants, and antipsychotics. However, some of the non-stimulants, such as atomoxetine (brand name Strattera) or viloxazine (brand name Qelbree), may affect the blood levels of other medications.

Which Condition Do I Treat First?

We generally recommend treating the more sever condition first. If untreated, the symptoms of severe conditions like bipolar or panic disorder can undermine or hijack ADHD treatment. If a patient has mild anxiety, for example, it makes sense to address the ADHD first and then assess any remaining anxiety. Sometimes, anxiety improves when the ADHD is addressed.

Even the most optimized treatment regimen may need to be adjusted over time. After feeling quite stable, a person with ADHD and depression, for example, may feel as though their ADHD is suddenly worse. Worsening depression may worsen the ADHD response. Treating the depression may enhanced the effectiveness of ADHD treatment. Clinicians must take time to sort out such issues when dealing with multiple diagnoses.

[Free Course: The Adult’s Guide to ADHD Treatment]

Anxiety and ADHD

Generally, stimulants don’t worsen anxiety, but they may for some patients. If ADHD symptoms are causing anxiety, stimulants may lessen the anxiety. If the anxiety is unrelated to ADHD, if won’t be improved by stimulants and may, in fact, be exacerbated. A meta-analysis of studies concluded that, in the aggregate, treatment with stimulants significantly reduced the risk of anxiety compared to a placebo.3 The first-line treatment for anxiety is a selective serotonin reuptake inhibitor (SSRI), such as Lexapro, Prozac, or Zoloft.

Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) that can effectively treat both anxiety and ADHD with a single medication. There is a caveat: For reasons we don’t yet understand, atomoxetine is not as effective in patients who have already tried a stimulant. If you’re a new patient, talk with your doctor about trying atomoxetine first to treat both the ADHD and the anxiety.

Autism and ADHD

Addressing ADHD in autistic patients may improve functioning dramatically. However, studies show that ADHD medications may cause more side effects and be less effective for autistic people, particularly those with lower intellectual functioning.4 Research has found that autistic patients taking ADHD medication experienced a 50% response rate for symptoms including hyperactivity and emotional regulation, which is lower than the 70 to 80% response rate found in children with ADHD who do not have autism.5

Begin slowly and monitor closely when increasing the dosage of ADHD medications in autistic patients. It is not uncommon to see an autistic child or adult have a good response to a particular dose of medication, whereas a slightly higher dose may cause many side effects and lessens response. Rather than seeking the “best” ADHD treatment, doctors may aim for good treatment with manageable side effects.

[Read: Interventions for Adult Autism and ADHD]

When severe irritability, aggression, and acute outbursts occur, it may be necessary to stabilize these episodes before addressing ADHD symptoms. Second-generation antipsychotics, such as risperidone or aripiprazole, can work very well to create a calm and controlled context before introducing stimulants or non-stimulants.

OCD and ADHD

Untreated OCD can significantly impede treatment of ADHD, so most practitioners initially prescribe medication and/or psychotherapies like exposure response prevention for OCD, and then tackle the ADHD with stimulant or non-stimulant medication. Both SSRIs and SNRIs are indicated for the treatment of OCD, though SSRIs appear to be more effective. Most medications for ADHD can be used safely in combination with SSRIs/SNRIs.

Depression and ADHD

For children with depression and ADHD, treatment options are limited to an SSRI plus a stimulant or non-stimulant. Adults may benefit from bupropion (brand name Wellbutrin), an antidepressant that is used off-label for ADHD. While depression in adults is commonly treated with SSRIs/SNRIs, some patients report that tricyclic antidepressants help with symptoms of depression and are also quite effective for ADHD.

Eating Disorders and ADHD

Clinicians sometimes hesitate to prescribe ADHD medications to patients with eating disorders due to the common side effect of appetite suppression. These patients’ weight and eating patterns should be monitored closely during treatment, but fear of the side effects should not preclude ADHD treatment, which is shown to improve overall health outcomes.

Though non-stimulants like atomoxetine or viloxazine may be tried first, stimulants need not be ruled out. In fact, the stimulant lisdexamfetamine (brand name Vyvanse) is FDA-approved for the treatment of binge eating disorder as well as ADHD.

Executive Dysfunction and ADHD

The executive function deficits that come with ADHD – difficulties with organization, time management, and sequential thinking – are often burdensome and impairing. For these patients, non-stimulants such as atomoxetine or viloxazine may be used in combination with a stimulant for treating both ADHD and executive function deficits.

Adding an extended-release form of an alpha agonist, like guanfacine or clonidine, to a stimulant is another option that can be useful for executive dysfunction. These medication combinations (e.g., clonidine or guanfacine plus a stimulant) are FDA-approved for treating ADHD in children under 17. They are sometimes used off-label in adults with ADHD.

Research suggests that the Alzheimer’s medication memantine added to the stimulant methylphenidate may improve executive functioning and social cognition, or the capacity to read verbal cues.6 This can be especially helpful for autistic children with ADHD.

Comorbid Conditions with ADHD: Next Steps

Timothy E. Wilens, M.D., is a professor of psychiatry at Harvard Medical School.


SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

1Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry, 17(1), 302. https://doi.org/10.1186/s12888-017-1463-3

2Danielson, M. L., Claussen, A. H., Bitsko, R. H., Katz, S. M., Newsome, K., Blumberg, S. J., Kogan, M. D., & Ghandour, R. (2024). ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 53(3), 343–360. https://doi.org/10.1080/15374416.2024.2335625

3Coughlin, C. G., Cohen, S. C., Mulqueen, J. M., Ferracioli-Oda, E., Stuckelman, Z. D., & Bloch, M. H. (2015). Meta-Analysis: Reduced Risk of Anxiety with Psychostimulant Treatment in Children with Attention-Deficit/Hyperactivity Disorder. Journal of child and adolescent psychopharmacology, 25(8), 611–617. https://doi.org/10.1089/cap.2015.0075

4Joshi, G., & Wilens, T. E. (2022). Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder in Individuals with Autism Spectrum Disorder. Child and adolescent psychiatric clinics of North America, 31(3), 449–468. https://doi.org/10.1016/j.chc.2022.03.012

5Joshi, G., Wilens, T., Firmin, E. S., Hoskova, B., & Biederman, J. (2021). Pharmacotherapy of attention deficit/hyperactivity disorder in individuals with autism spectrum disorder: A systematic review of the literature. Journal of psychopharmacology (Oxford, England), 35(3), 203–210. https://doi.org/10.1177/0269881120972336

6Biederman, J., Fried, R., Tarko, L., Surman, C., Spencer, T., Pope, A., Grossman, R., McDermott, K., Woodworth, K. Y., & Faraone, S. V. (2017). Memantine in the Treatment of Executive Function Deficits in Adults With ADHD. Journal of attention disorders, 21(4), 343–352. https://doi.org/10.1177/1087054714538656

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Testosterone and ADHD in Men: Is There a Link? https://www.additudemag.com/testosterone-and-adhd-in-men-hormones/ https://www.additudemag.com/testosterone-and-adhd-in-men-hormones/?noamp=mobile#respond Mon, 19 May 2025 00:40:09 +0000 https://www.additudemag.com/?p=378635 The principal male sex hormone, testosterone is synonymous with strength, virility, and aggression. But the scientific truth about testosterone’s profile and role over the lifespan for males (and females, who also have testosterone) is more nuanced and complicated. Research exploring testosterone’s impacts on mood, cognition, and behavior has resulted in contradictory, often inconclusive, findings; research investigating testosterone’s impact on ADHD is extremely scant.

Amid this dearth of research, men* are becoming increasingly interested in testosterone’s suspected benefits on strength, energy, and mood. Testosterone replacement therapy, approved to treat hypogonadism (testosterone deficiency), has become more common among men with typical hormone levels. In the last five years, testosterone replacement prescriptions have risen dramatically, from 7.3 million to more than 11 million, and a third of these recipients have not been diagnosed with testosterone deficiency, according to the American Urological Association.

Besides being potentially ineffective at achieving desired outcomes, testosterone supplementation without a medical indication can be harmful for men, and may lead to side effects such as fertility problems, acne, sleep apnea, breast swelling, benign prostatic hyperplasia, and high red blood cell counts, which could increase the risk of blood clots

As these very real risks emerge from a murky landscape, here is a summary of what’s known — and not yet known — about the impact of testosterone on the bodies and brains of men, both with and without ADHD.

Testosterone and ADHD: Is There a Connection?

Is there an association between an individual’s testosterone level and their likelihood of developing ADHD. Is symptom severity impacted by hormones? The answer is: we don’t know. There’s no conclusive evidence to suggest an association, however research is extremely scarce.

[Read: For Men With ADHD — and Those Who Love Them]

Estrogen’s impact on mood and cognition is well-established. It plays a key role in modulating neurotransmitters, increasing dopamine and serotonin, which leads to elevated mood and focus. Recently, researchers have begun to explore the influence of estrogen on ADHD, which is thought to be significant. Women with ADHD experience premenstrual dysphoric disorder, postpartum depression, and perimenopausal challenges at far higher rates than do women without ADHD. Additionally, ADHD symptoms are often more severe and ADHD medication less effective during the luteal phase of the menstrual cycle, when estrogen is low.

Testosterone’s implications on ADHD are far less clear.

In the past, ADHD was thought to be a disorder affecting mostly boys, leading some to speculate that testosterone played a role in the development of ADHD symptoms. Some studies have explored whether prenatal exposure to high testosterone is associated with an elevated risk of ADHD. The results were mixed, with some studies finding a link between high prenatal exposure to testosterone and development of ADHD, and some finding no association.1,2

[Read: When ADHD and Puberty Collide]

No research has been conducted investigating whether testosterone levels are related to ADHD symptom severity.

Research has investigated the influence of testosterone on mood and behavior more generally, including several studies that have tested a potential association between testosterone and depression, with conflicting results. Some studies have found an association between low levels of testosterone and depressive symptoms 3,4 while others have found that both low and high levels of testosterone are linked to risk of depression.5,6 Because of confounding factors, these studies have failed to show a causal relationship between hormone levels and depression. Studies regarding testosterone’s impact on cognition have been similarly inconclusive. 7,8

Even research on testosterone’s most famous behavioral trait — aggression — fails to find a direct cause-and-effect relationship. Experts believe testosterone plays a role in the regulation of aggression, however the exact function it serves remains unclear. Testosterone fluctuates in response to cues of challenge in the environment, and it interacts with other fluctuating hormones such as cortisol, making the tangle of factors very difficult to unknot.9,10

Testosterone research is inconclusive, in part, because testosterone is difficult to measure. Variability in testing and analysis methods, fluctuations in the hormone over the course of the day, and inconsistencies among labs regarding the parameters of “normal” levels all add to the challenge of studying testosterone.11

Testosterone Over the Lifespan

Hormone levels in women rise and fall dramatically on a constant basis for the whole of their reproductive years. This regular menstrual cycle exists in stark contrast to the hormonal experience of men, for whom testosterone levels change significantly during two periods: puberty and in mid-life. While testosterone levels fluctuate slightly throughout the course of the day, their levels remain stable from the end of adolescence until roughly age 40.

Challenging Conventional Wisdom About “Hormonal” Teens

During puberty, testosterone levels in males increase exponentially. Research has found that the average total testosterone level of a male rises from 3 ng/dl to 355 ng/dl over the course of adolescence 12 Testosterone levels reach their peak in late adolescence or early adulthood and remain stable until ages 35 to 40, when they begin to decrease very gradually.
The explosion of hormone production in puberty causes:13

  • development of the male sex organs
  • deepening of the voice
  • appearance of facial and pubic hair
  • muscle size and strength
  • sex drive
  • sperm production

Puberty is also a time of significant emotional, social, and behavioral changes — changes that are generally attributed to the dramatic hormonal escalation. But drawing a direct line between pubertal hormones and mood, behavior, and cognitive changes is an over-simplification of a complex developmental period, says Ben Balzer, M.D., pediatrician in Sydney, Australia, and Conjoint Lecturer at the University of New South Wales.

Balzer and colleagues conducted a systematic review of 27 studies in order to assess what evidence exists on the effects of testosterone on mood and behavior in teen boys. The review concluded that there was insufficient data to confirm a significant association.14

“Hormones are an easy culprit to go after,” says Balzer. “But their role may potentially be small because of the overall cognitive changes and neurological maturation that occurs in that period of life.”

Similar results were found in a 2024 systematic review of 55 studies investigating the role of pubertal hormones on mental health conditions. The review concluded that most of the studies that exist on hormones and mental health outcomes were at high risk for bias and involved many confounding factors. They determined that there wasn’t solid evidence that pubertal hormones cause mental health problems.15

The challenge of conducting this kind of research, Balzer says, is that hormones don’t act in isolation.

“When we study hormones in mice, we can control every aspect of their life,” he explains. “But when you’re looking at adolescents in the community, you’ve got to factor in their genetics, family environment, living environment, school situation, their social media use. It’s a really complicated thing to tease out.”

When Testosterone Tapers Later in Life

Testosterone levels remain more or less steady until midlife, when they begin to decline very gradually, approximately 1% a year. 16

While this decrease in testosterone is sometimes compared to menopause in women, the decline for men is far more gradual and happens over a much longer period of time. While men on average, lose 30% of the testosterone by age 75,17 women on average lose 65% of their estrogen by age 51.

No evidence exists to demonstrate that declines in testosterone due to normal aging cause mood or cognitive issues, as declines in estrogen often do for women in menopause.

Normal declines of testosterone due to aging are distinct from hypogonadism, a condition in which problems with the pituitary gland or the testicles result in the body failing to produce normal amounts of testosterone. Men with hypogonadism may suffer from chronic fatigue, low libido, erectile dysfunction, muscle loss, and weight gain, as well as mood symptoms including irritability and depression. Several studies have found a higher incidence of depression in men with hypogonadism, however research has not shown a causal link between the lack of testosterone and depression.

“The association between depression, testosterone levels, and sexual symptoms in males is difficult to assess, due to numerous confounding factors, such as medical conditions, obesity, smoking, alcohol use, diet, and stress,” according to the authors of a recent study in Frontiers in Endocrinology.18

Testosterone and ADHD in Men: Next Steps

*ADDitude is dedicated to honoring gender diversity and fluidity. For the purposes of this reporting, the terms “men” and “boys” refer to individuals assigned male at birth.


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Sources

1Wang LJ, Chou MC, Chou WJ, Lee MJ, Lee SY, Lin PY, Lee YH, Yang YH, Yen CF. Potential role of pre- and postnatal testosterone levels in attention-deficit/hyperactivity disorder: is there a sex difference? Neuropsychiatr Dis Treat. 2017 May 16;13:1331-1339. doi: 10.2147/NDT.S136717. PMID: 28553119; PMCID: PMC5439987.

2Kocaman O, Aydoğan Avşar P, Kara T, Kuru T. The 2D:4D ratios in the mothers of children with attention deficit hyperactivity disorder. Early Hum Dev. 2025 Feb;201:106203. doi: 10.1016/j.earlhumdev.2025.106203. Epub 2025 Jan 20. PMID: 39855032.

3Joshi D, van Schoor NM, de Ronde W, Schaap LA, Comijs HC, Beekman AT, Lips P. Low free testosterone levels are associated with prevalence and incidence of depressive symptoms in older men. Clin Endocrinol (Oxf). 2010 Feb;72(2):232-40. doi: 10.1111/j.1365-2265.2009.03641.x. Epub 2009 May 25. PMID: 19486021.

4McIntyre RS, Mancini D, Eisfeld BS, Soczynska JK, Grupp L, Konarski JZ, Kennedy SH. Calculated bioavailable testosterone levels and depression in middle-aged men. Psychoneuroendocrinology. 2006 Oct;31(9):1029-35. doi: 10.1016/j.psyneuen.2006.06.005. Epub 2006 Sep 5. PMID: 16908107.

5Booth A, Johnson DR, Granger DA. Testosterone and men’s depression: the role of social behavior. J Health Soc Behav. 1999 Jun;40(2):130-40. PMID: 10467760.

6Määttänen I, Gluschkoff K, Komulainen K, Airaksinen J, Savelieva K, García-Velázquez R, Jokela M. Testosterone and specific symptoms of depression: Evidence from NHANES 2011-2016. Compr Psychoneuroendocrinol. 2021 Mar 10;6:100044. doi: 10.1016/j.cpnec.2021.100044. PMID: 35757365; PMCID: PMC9216439.

7Emmelot-Vonk MH, Verhaar HJ, Nakhai Pour HR, et al. Effect of testosterone supplementation on functional mobility, cognition, and other parameters in older men: a randomized controlled trial. JAMA. 2008;299:39–52. doi: 10.1001/jama.2007.51.

8Cherrier MM, Asthana S, Plymate S, et al. Testosterone supplementation improves spatial and verbal memory in healthy older men. Neurology. 2001;57:80–88. doi: 10.1212/wnl.57.1.80.

9Geniole SN, Bird BM, McVittie JS, Purcell RB, Archer J, Carré JM. Is testosterone linked to human aggression? A meta-analytic examination of the relationship between baseline, dynamic, and manipulated testosterone on human aggression. Horm Behav. 2020 Jul;123:104644. doi: 10.1016/j.yhbeh.2019.104644. Epub 2019 Dec 28. PMID: 31785281.

10Armstrong, T., Wells, J., Boisvert, D. L., Lewis, R. H., Cooke, E. M., Woeckener, M., & Kavish, N. (2021). An exploratory analysis of testosterone, cortisol, and aggressive behavior type in men and women. Biological Psychology, 161, Article 108073. https://doi.org/10.1016/j.biopsycho.2021.108073
[11] Tyagi V, Scordo M, Yoon RS, Liporace FA, Greene LW. Revisiting the role of testosterone: Are we missing something? Rev Urol. 2017;19(1):16-24. doi: 10.3909/riu0716. PMID: 28522926; PMCID: PMC5434832.

11Yao Q, Zhou G, Xu M, Dai J, Qian Z, Cai Z, Zhang L, Tan Y, Hu R. Blood metal levels and serum testosterone concentrations in male and female children and adolescents: NHANES 2011-2012. PLoS One. 2019 Nov 7;14(11):e0224892. doi: 10.1371/journal.pone.0224892. PMID: 31697766; PMCID: PMC6837506.

12Duke SA, Balzer BW, Steinbeck KS. Testosterone and its effects on human male adolescent mood and behavior: a systematic review. J Adolesc Health. 2014 Sep;55(3):315-22. doi: 10.1016/j.jadohealth.2014.05.007. PMID: 25151053.

13Luo D, Dashti SG, Sawyer SM, Vijayakumar N. Pubertal hormones and mental health problems in children and adolescents: a systematic review of population-based studies.
EClinicalMedicine. 2024 Oct 1;76:102828. doi: 10.1016/j.eclinm.2024.102828. PMID: 39403116; PMCID: PMC11472636.

14Cheng H, Zhang X, Li Y, Cao D, Luo C, Zhang Q, Zhang S, Jiao Y. Age-related testosterone decline: mechanisms and intervention strategies. Reprod Biol Endocrinol. 2024 Nov 14;22(1):144. doi: 10.1186/s12958-024-01316-5. PMID: 39543598; PMCID: PMC11562514.

15Decaroli MC, Rochira V. Aging and sex hormones in males. Virulence. 2017 Jul 4;8(5):545-570. doi: 10.1080/21505594.2016.1259053. Epub 2016 Nov 10. PMID: 27831823; PMCID: PMC5538340.

16Indirli R, Lanzi V, Arosio M, Mantovani G, Ferrante E. The association of hypogonadism with depression and its treatments. Front Endocrinol (Lausanne). 2023 Aug 10;14:1198437. doi: 10.3389/fendo.2023.1198437. PMID: 37635965; PMCID: PMC10449581.

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A Woman’s Guide to Pursuing an AuDHD Diagnosis https://www.additudemag.com/audhd-diagnosis-guide-neurodivergence-in-women/ https://www.additudemag.com/audhd-diagnosis-guide-neurodivergence-in-women/?noamp=mobile#respond Wed, 14 May 2025 09:39:33 +0000 https://www.additudemag.com/?p=376412 Q: “I know that I’m autistic, but I require a diagnosis for the support I need. How do I communicate to my clinician in a respectful way that I’m smart and read many of the same materials they do? Trying to get a proper diagnosis has been exhausting.”

First, I would encourage you not to be defensive during your visit. Clinicians have to follow a process to give you a diagnosis. This may seem like a waste of time, but a full differential diagnosis requires more than just asking neurodivergent-related questions. You may be asked questions that you feel are irrelevant, but that are important nonetheless.

There might be something you can learn, and something that you can teach the clinician. I have thanked patients for correcting me about certain things and I think that those interactions have been transformative for them too. I know I’ve learned from them.

[Take the Autism in Women Self-Test]

Having said that, it is important for all of us to feel respected, and that includes respect from your clinician. If you feel your provider is cynical or not listening to you, or they’re not acting in a collaborative way, then you can say thank you and move on.

Q: “What are the common misdiagnoses given to girls and women with ADHD and autism?”

Autistic girls and women with ADHD are often diagnosed with borderline personality disorder. This is a difficult differential diagnosis because it entails so much — dichotomous thinking, emotional reactivity, and fears of rejection and abandonment.

They also get misdiagnosed with bipolar disorder and, more commonly, with obsessive-compulsive disorder (OCD). This is because many neurodivergent individuals like repetitiveness, or like to systematize things, and have trouble interrupting a sequence, but that doesn’t necessarily mean they have OCD. It’s also not uncommon to have co-occurring conditions.

Q: “Are autistic girls with ADHD more likely to experience emotional dysregulation than their neurotypical peers?”

Emotional dysregulation is not part of the diagnostic criteria for ADHD or autism, but it is very much a part of the lived experience for both conditions — and it can be very impairing. Rejection sensitivity (the tendency to intensely react to real or perceived rejection), along with spiraling emotions or thoughts, impairs a person’s functioning and ability to interact and listen.

[Get This Free Download: Your Autism Evaluation Checklist]

According to society’s gender roles, girls and women are not supposed to get upset or display anger. When faced with rejection, we may hold it in and mask — only to eventually explode. So being unable to understand our emotions and know when we need to breathe, or step away, is important.

AuDHD Diagnosis: Next Steps

Karen Saporito, Ph.D., is a licensed clinical psychologist who has been in private practice for more than 20 years.


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Do I Have Autism? ADHD? Both? An Adult’s Guide to Diagnosis and Treatment https://www.additudemag.com/video/do-i-have-autism-adhd-both-an-adults-guide-to-diagnosis-and-treatment-w-benjamin-yerys-ph-d/ https://www.additudemag.com/video/do-i-have-autism-adhd-both-an-adults-guide-to-diagnosis-and-treatment-w-benjamin-yerys-ph-d/?noamp=mobile#respond Tue, 13 May 2025 17:09:38 +0000 https://www.additudemag.com/?post_type=video&p=379189

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Why ADHD Is Different for Women: Gender-Specific Symptoms & Treatments https://www.additudemag.com/video/why-adhd-is-different-for-women-gender-specific-symptoms-treatments-with-ellen-littman-ph-d/ https://www.additudemag.com/video/why-adhd-is-different-for-women-gender-specific-symptoms-treatments-with-ellen-littman-ph-d/?noamp=mobile#respond Tue, 13 May 2025 17:06:21 +0000 https://www.additudemag.com/?post_type=video&p=379185

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Could I Have an Eating Disorder? https://www.additudemag.com/eating-disorder-older-women-adhd-undiagnosed/ https://www.additudemag.com/eating-disorder-older-women-adhd-undiagnosed/?noamp=mobile#respond Tue, 13 May 2025 08:42:07 +0000 https://www.additudemag.com/?p=376647 Some women at midlife adopt extreme measures to stay thin, perhaps because the hormonal changes of menopause have caused them to gain weight, or maybe a divorce has pushed them back into the dating scene. Whatever the reason, eating disorders in midlife and older women are not uncommon, yet they are under-recognized.

In research examining eating disorder symptoms among women aged 45 to 61, body dissatisfaction was cited as a key risk factor.1 I have seen this firsthand. In 2024, more than 21% of calls to the National Alliance for Eating Disorders, a support and advocacy organization I founded in 2000, were from individuals (primarily women) age 40 and older.

Eating disorders are serious, brain-based mental illnesses with a strong genetic link.2 They have the second-highest mortality rate among all psychiatric disorders.3 Yet many middle-aged and older women may not even recognize that they’re struggling with eating disorders due to misconceptions about these conditions and who they affect.

[Self-Test: Do I Have an Eating Disorder?]

An adult might have an eating disorder if they:

  • experience extreme weight loss or dramatic weight fluctuations
  • refuse to eat certain foods or skip meals
  • exercise excessively
  • show signs of purging

Calorie restriction, or bingeing and purging, can have a particularly adverse effect on an older body, possibly leading to poor health outcomes. When eating disorders go untreated, they can lead to bone loss, heart problems, and, in people who force themselves to vomit, lung conditions. And research shows that 11% of women with ADHD, compared to 1% of women without it, have a history of bulimia nervosa, a common eating disorder that involves gorging followed by vomiting or laxative use.
Other eating disorders common in older adults include:

  • anorexia nervosa (extreme food restriction)
  • binge eating (consuming large amounts of food beyond the point of feeling full)

Eating Disorder Triggers

For some women, the battle with eating disorders began in childhood. For others, body image struggles may be triggered by later-in-life events. These include:

  • Perimenopause and menopause. The transition to menopause is now recognized as a high-risk time for eating disorders to develop or redevelop, in part because women are seeking ways to “control” their changing bodies amid significant estrogen shifts.4
  • Aging and unrealistic ideals. The anxiety and stress of aging in a society that values youthfulness provides fertile ground for increased symptoms of disordered eating and dysfunctional attitudes, beliefs, and behaviors around food and physical appearance.
  • Transitions. Divorce, an empty nest, widowhood, and other life events may lead to or reactivate disordered eating.

[Watch: “Eating Disorders Comorbid with ADHD — ARFID, Anorexia, and Others”]

“Too Old” for an Eating Disorder

Eating disorders are considered diseases of the young, and, consequently, they often go unrecognized in older women. Many clinicians believe their mature patients are “too old” to have such conditions.

If you suspect that you or a loved one may have an eating disorder, talk with a doctor trained in this area. The National Alliance for Eating Disorders offers guidance, resources, and referrals for treatment and care. It provides free, therapist-led virtual support groups for women at midlife and older to connect with others who are experiencing or recovering from eating disorders.

Do I Have an Eating Disorder: Next Steps

Johanna Kandel is the founder and CEO of the National Alliance for Eating Disorders and the author of Life Beyond Your Eating Disorder: Reclaim Yourself, Regain Your Health, Recover for Good. (#CommissionsEarned)


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Sources

1Kilpela, L.S., Hooper, S.C., Straud, C.L., Marshall, V.B., Verzijl, C.L., Stewart, T.M., Loera, T.T., Becker, C.B. (2023) The longitudinal associations of body dissatisfaction with health and wellness behaviors in midlife and older women. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph20247143

2Berrettini W. (2004). The genetics of eating disorders. Psychiatry (Edgmont), Nov;1(3):18–25. PMID: 21191522; PMCID: PMC3010958

3van Hoeken, D., & Hoek, H. W. (2020). Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. Current opinion in psychiatry. https://doi.org/10.1097/YCO.0000000000000641

4Khalil, J., Boutros, S., Kheir, N., Kassem, M., Salameh, P. et al. (2022). Eating disorders and their relationship with menopausal phases among a sample of middle-aged Lebanese women. BMC Women’s Health. https://doi.org/10.1186/s12905-022-01738-6

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Change of Heart: Understanding Cardiovascular Disease in Women with ADHD https://www.additudemag.com/heart-disease-in-women-perimenopause-microvascular-disease-cmd/ https://www.additudemag.com/heart-disease-in-women-perimenopause-microvascular-disease-cmd/?noamp=mobile#respond Sat, 10 May 2025 08:10:41 +0000 https://www.additudemag.com/?p=375849 What’s the leading cause of death among women worldwide?

No, it’s not cancer. In fact, the number of worldwide deaths from all types of cancer combined is equivalent to half the number of fatalities caused by heart disease in women.

More than 60 million women in the United States have heart disease — and for the large majority, serious cardiac problems begin in perimenopause when estrogen, which protects the heart, decreases dramatically.

While the risk for cardiovascular disease increases in all women during perimenopause, women with ADHD may face an even greater risk than their non-ADHD peers. Research has revealed that the prevalence of heart disease is higher among adults with ADHD of both genders compared to adults without ADHD: 38% vs 23%.1

While research investigating the prevalence of heart disease among women with ADHD, specifically, remains incomplete, it is reasonable to hypothesize that rates are high because this population faces myriad heart disease risk factors including chronic stress, anxiety, depression, substance use disorders, sleep disorders, obesity, and diabetes.

To test this hypothesis, I partnered with the HeartLife Cardiology Clinic in the Netherlands. Included in the study were 300 women, the majority of whom were of perimenopausal age, as this is commonly the age at which women seek treatment for cardiac complaints.2

[Read: Let’s Talk About Perimenopause and ADHD]

We found that 35% of these patients met criteria for lifetime ADHD symptoms: a rate that is nearly 10 times that found among women in general. We also found that the women with ADHD symptoms experienced cardiac complaints two years earlier than their non-ADHD peers, suggesting that their cardiac problems may be relatively more severe.

This exploratory study indicated to us that further research is needed. To that end, my colleagues and I have launched the Women with ADHD Health Study, which has enrolled more than 3,000 female participants from across the world and is investigating the relationship between female hormones and cardiovascular issues, among other physical conditions. The ongoing research survey is accepting responses until the end of June 2025, and all women with ADHD or who identify as having ADHD symptoms are invited to participate.

Today, research shows that just 44% of women in the U.S. correctly identify heart disease as the greatest threat to their health.3 This lack of awareness is due, in part, to the fact that women often experience significantly different symptoms of cardiovascular disease than men. If patients, and their doctors, aren’t educated about how heart disease presents in women, potentially deadly health repercussions may result.

[Download: Free Guide to Hormones & ADHD in Women]

So, while we wait for research to be completed, we seek to equip at-risk women with the information necessary to protect their hearts from harm.

The Big Impact of Small Vessel Disease

When people think of heart disease, what usually comes to mind is coronary artery disease (CAD). In this disorder, plaques build up in the larger coronary arteries, causing a narrowing that may lead to an obstruction and possible heart attack. CAD is associated with risk factors such as high cholesterol, high blood pressure, obesity, diabetes, smoking, and lack of exercise.

Seldom discussed is another type of coronary heart disease that predominantly affects women, called coronary microvascular disease (CMD). Unlike CAD, which affects the heart’s large arteries and reduces blood flow due to obstruction, CMD also affects the heart’s smallest blood vessels, and reduces blood flow due to spasms.

Symptoms of CAD tend to occur after physical effort, whereas signs of CMD are more erratic in nature. Symptoms frequently occur during rest, even during sleep. They are also more commonly associated with chronic stress, depression, and anxiety.

Heart Attacks in Women Look Different

We are all familiar with the “classic” symptoms of a heart attack; sudden pain in the chest, often after physical effort, sometimes accompanied by pain in the left arm and jaw. These symptoms are real and serious, for women as well as men — but they are not the only signs of a heart attack.

For many women, signs of a heart attack include:

  • tightness in the chest, the feeling of being in a harness or too-tight bra
  • shortness of breath
  • pain in the back
  • indigestion
  • nausea or vomiting

Though these symptoms are sometimes called “atypical,” the truth is that they are only atypical for men. They are quite common, and often under-recognized, in women.

Microvascular disease is much more difficult to diagnose than is CAD. Because it involves the heart’s smallest vessels, it’s not visible via routine angiography. Unlike blockages in the arteries that are fixed and persistent, the spasms associated with CMD come and go. It can be diagnosed through a provocative acetylcholine challenge test, however this is an invasive and uncomfortable procedure that is not often used.

Women with cardiac complaints frequently report going to the emergency room, where an angiogram is performed and finds no evidence of blockage in the arteries. These women are often misdiagnosed with anxiety, and told the problem is not in their heart, but in their head. They’re sent home, their cardiovascular disease unrecognized and untreated.

Female-Specific Risk Factors for Heart Disease

In addition to heart disease risk factors that impact both men and women (high cholesterol, hypertension, smoking, obesity), there are several heart disease risk factors specific and exclusive to women. These include:

  • gestational diabetes
  • a history of preeclampsia
  • endometriosis
  • polycystic ovarian syndrome
  • autoimmune disorders
  • oral contraceptive use
  • premature menopause

Menopause most commonly occurs when a woman is in her early 50s. When it occurs before the age of 40, it’s considered premature menopause, which is a risk factor for cardiovascular disease. This is because the early drop in estrogen exposes the heart to more harm over a longer period.

Women with ADHD may experience premature menopause at relatively higher rates, according to a recent study in Nature Genetics.4 While the reasons for early menopause remain largely unclear, we do know that smoking can be a contributing factor. Surgeries that impact the ovaries can also result in early menopause.

Tailoring Treatment to ADHD Patients

When treating patients with cardiac problems, doctors often start with lifestyle changes. This can prove especially challenging for patients with ADHD. Unless their ADHD, sleep problems, and mood disorder are treated first, they will likely be too exhausted, forgetful, or disorganized to make changes to their lifestyle. For this reason, I advise addressing ADHD and other symptoms first to lay the groundwork for successful changes to diet, exercise, and other habits. Blood pressure and heart rate should be monitored during ADHD treatment, as stimulants may increase both.

I also urge perimenopausal women to address hormonal complaints that may be at play and to consider the protective effect of estrogen on heart function.

Heart Disease in Women: Next Steps

The content for this article was derived, in part, from a plenary address at the 2025 Annual Conference of the American Professional Society for ADHD and Related Disorders (APSARD) delivered by prof. J.J. Sandra Kooij, M.D., Ph.D., titled, “Gender & Endocrine Issues in ADHD.” J.J. Sandra Kooij is a professor on Adult ADHD at Amsterdam UMC/VUMc, the Netherlands.


SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

1Li L, Chang Z, Sun J, Garcia-Argibay M, Du Rietz E, Dobrosavljevic M, Brikell I, Jernberg T, Solmi M, Cortese S, Larsson H. Attention-deficit/hyperactivity disorder as a risk factor for cardiovascular diseases: a nationwide population-based cohort study. World Psychiatry. 2022 Oct;21(3):452-459. doi: 10.1002/wps.21020. PMID: 36073682; PMCID: PMC9453905.

2Ter Beek LS, Böhmer MN, Wittekoek ME, Kooij JJS. Lifetime ADHD symptoms highly prevalent in women with cardiovascular complaints. A cross-sectional study. Arch Womens Ment Health. 2023 Dec;26(6):851-855. doi: 10.1007/s00737-023-01356-7. Epub 2023 Aug 18. PMID: 37594562; PMCID: PMC10632230.

3Cushman M, Shay CM, Howard VJ, Jiménez MC, Lewey J, McSweeney JC, Newby LK, Poudel R, Reynolds HR, Rexrode KM, Sims M, Mosca LJ; American Heart Association. Ten-Year Differences in Women’s Awareness Related to Coronary Heart Disease: Results of the 2019 American Heart Association National Survey: A Special Report From the American Heart Association. Circulation. 2021 Feb 16;143(7):e239-e248.

4Demontis, D., Walters, R.K., Martin, J. et al. Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nat Genet 51, 63–75 (2019).

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Intimate Partner Violence Among Women with ADHD https://www.additudemag.com/ipv-intimate-partner-violence-psychological-abuse-adhd/ https://www.additudemag.com/ipv-intimate-partner-violence-psychological-abuse-adhd/?noamp=mobile#respond Fri, 09 May 2025 06:23:28 +0000 https://www.additudemag.com/?p=376263 With the benefit of hindsight, Candace Rollins* now sees the red flags of intimate partner violence (IPV) in her marriage. “The belittling comments that put me in my place — more and more over time, not letting me have friends over, driving a wedge between me and my family,” explains Rollins, a mother of three in Virginia. “I didn’t know how to deal with it, so I kept on keeping on. What do you do? You finish dinner. You get the kids in the bath.”

The night Rollins left her husband, he knew what she was planning. “He had his hand on the gun in his holster and he threatened me,” says Rollins. “I remember trying to be strong and saying to my daughter, ‘What is happening now should never happen.’”

Rollins is focused now on trying to heal and cut herself some slack. Getting an ADHD diagnosis in adulthood has been an illuminating part of her journey. “It explains everything,” she says. “How self-critical I was, never feeling good enough, always feeling like, ‘Why can’t I just get it right?’ I think, in hindsight, I wouldn’t have chosen who I chose to marry if I’d known I had ADHD.”

IPV and ADHD

IPV can include physical, sexual, and/or psychological abuse executed by a current or former partner. It does not discriminate, and can affect people of any gender, race, socioeconomic status, or level of education, explains psychologist Tami Sullivan, Ph.D., director of Family Violence Research and Programs and professor at Yale University’s School of Medicine. Women, however, are far more likely to be victims. Intimate partner violence is more common among women than breast cancer, diabetes, or depression.

Among women with ADHD, rates of IPV are even higher. Recent research from Berkeley Girls with ADHD Longitudinal Study (BGALS) found that women aged 17-24 who had received a childhood diagnosis of ADHD were five times more likely than their neurotypical peers to experience physical IPV. Greater ADHD symptom severity in childhood was associated with increased risk for IPV. 1

[Read: Why Adults with ADHD Are Particularly Vulnerable to Gaslighting]

“It’s underappreciated how difficult ADHD can be for girls and women because the consequences are more internal,” says Stephen Hinshaw, Ph.D., lead researcher of BGALS and professor of psychology at the University of California, Berkeley. “Girls with ADHD are smart, but they can’t get it together. As they age, the tendency is depression, very low self-image, unplanned pregnancy, intimate partner violence, and non-suicidal self-injury.

Risks, however, are not predetermined outcomes, and information is empowering. Below, learn what intimate partner violence looks like, how its impacts are felt, and what help is available.

The Truth About IPV

What IPV Looks Like

  • Psychological: threatening, intimidating, humiliating, criticizing, insulting, belittling, blaming, invading privacy, extreme jealousy/possessiveness, dismissing feelings
  • Physical: hitting, pushing, slapping, punching, restraining, choking, dragging
  • Sexual: coercing victim to have sexual acts or watch pornography, drugging victim
  • Technological: tracking location, demanding check-ins, excessive texting, monitoring communications
  • Financial: withholding access to bank accounts and credit cards, ruining the victim’s credit, taking the victim’s paycheck

[Read: Why Do Toxic Relationships Swallow People with ADHD?]

Psychological Abuse Is Rampant—and Overlooked

“Media depictions focus on physical and sometimes sexual abuse, showing a woman fearing for her life on a daily basis,” Sullivan says. “By promoting only that stereotype, we do a disservice to women who experience IPV differently, because they think, ‘Well, that’s not me. I’ve never had a bruise or a broken bone.’”

While patterns and specifics of abusive behavior vary widely, psychological abuse is pervasive. Explains Sullivan: “You almost never see physical and sexual abuse alone, without psychological abuse.” Sullivan and her research team collected data from victims of IPV for 90 days and found that psychological violence occurred on 27% of days — 13 times more often than physical, psychological, and sexual violence together. 2

It’s critical to identify psychological abuse because it often appears first, and can lead to physical and sexual abuse, not to mention dire health consequences on its own.

IPV Has Far-Reaching Impact

The health implications of IPV are often severe:

  • 51% of female homicide victims were killed by intimate partners 3
  • 80% of IPV survivors display trauma symptoms
  • 30% of survivors meet criteria for post-traumatic stress disorder (PTSD)

Survivors are at an increased risk for:

  • diabetes: +51%
  • total mortality: +44%
  • cardiovascular disease: +31% 4

IPV is also associated with an increased risk for substance use disorders, depression, anxiety, suicidality, traumatic brain injuries, working memory declines later in life 5, and issues of the gastrointestinal, reproductive, and musculoskeletal systems.6

And, to be clear, psychological abuse can be as serious and detrimental as physical abuse — even more so, in some cases. “Psychological abuse erodes self-worth and self-efficacy, that feeling of, ‘I’ve got this,’” says Sullivan. “It can be a stronger predictor of PTSD and depression than physical abuse.” 7

Healing from Abuse

“Twenty years ago, the mentality was, How do we get her to leave? The approach now is survivor-centered: What does she want to have happen?” explains Sullivan. “Not every person wants the abusive relationship to end; some just want the violence to stop. Providers need to ask, ‘Have you thought about what you want to do?’ This gives the person voice, something that’s often taken away from them.”

Evidence-based therapeutic interventions should be present-centered with a focus on empowerment, Sullivan says. These include Cognitive Behavior Therapy (CBT), STAIR (Skills Training in Affective and Interpersonal Regulation), Interpersonal Psychotherapy (IPT), HOPE (Helping to Overcome PTSD through Empowerment).

Get Help

If you, or someone you love, is experiencing intimate partner violence, these resources may help:

  • National Domestic Violence Hotline, Call 800-799-7233 or text START to 88788
  • Love Is Respect, for people aged 13-26, Call 866-331-9474 or text LOVEIS to 22522
  • National Sexual Assault Helpline, Call 1-800-656-HOPE

*Name has been changed to protect the person’s privacy

Intimate Partner Violence and ADHD: Next Steps

Nicole C. Kear is Consumer Health Editor at ADDitude magazone.


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Sources

1Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.

2Sullivan TP, McPartland T, Armeli S, Jaquier V, Tennen H. Is It the Exception or the Rule? Daily Co-occurrence of Physical, Sexual and Psychological Partner Violence In a 90-Day Study of Substance-Using, Community Women. Psychol Violence. 2012 Apr 1;2(2):10.1037/a0027106. doi: 10.1037/a0027106. PMID: 24349863; PMCID: PMC3859524.

3Jack SP, Petrosky E, Lyons BH, et al. Surveillance for Violent Deaths — National Violent Death Reporting System, 27 States, 2015. MMWR Surveill Summ 2018;67(No. SS-11):1–32.

4Chandan JS, Thomas T, Bradbury-Jones C, Taylor J, Bandyopadhyay S, Nirantharakumar K. Risk of Cardiometabolic Disease and All-Cause Mortality in Female Survivors of Domestic Abuse. J Am Heart Assoc. 2020;9:e014580. doi: 10.1161/JAHA.119.014580.

5Baker JS, Greendale GA, Hood MM, Karlamangla AS, Harlow SD. Self-reported history of physical intimate partner violence and longitudinal cognitive performance in midlife women. Womens Health (Lond). 2024 Jan-Dec;20:17455057241309782. doi: 10.1177/17455057241309782. PMID: 39707890; PMCID: PMC11663271.

6Stubbs, A., & Szoeke, C. (2022). The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature. Trauma, Violence, & Abuse, 23(4), 1157-1172. https://doi.org/10.1177/1524838020985541

7Mechanic MB, Weaver TL, Resick PA. Mental health consequences of intimate partner abuse: a multidimensional assessment of four different forms of abuse. Violence Against Women. 2008 Jun;14(6):634-54. doi: 10.1177/1077801208319283. PMID: 18535306; PMCID: PMC2967430.

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It’s Time to Prioritize ADHD Research Focusing on Women https://www.additudemag.com/adhd-research-gender-differences-women/ https://www.additudemag.com/adhd-research-gender-differences-women/?noamp=mobile#respond Wed, 07 May 2025 06:46:58 +0000 https://www.additudemag.com/?p=376253 Less than 1% of published ADHD research is dedicated to women patients. This inequity is maddening, but less shocking when you consider the fact that ADHD was regarded as a strictly childhood disorder just 20 years ago. ADHD in adults did not exist, according to medical literature published a generation ago.

During my psychiatry residency from 1987 to 1991, I only treated one adult with ADHD, a young man who was having difficulty in his medical school classes. After completing my child and adolescent psychiatry fellowship, however, I joined the United States Air Force, where I saw many enlisted members who had untreated ADHD and could not pass testing to get promoted to the next rank. Clearly, ADHD in adults was real.

ADHD in Women Gains Attention

Still, adult ADHD did not land on the national radar until 2006, when Ronald Kessler, Ph.D., and his colleagues published data from a study in the International Journal of Methods in Psychiatric Research that estimated a prevalence of 4.4 percent in adults. Of those, 38.4 percent were women. 1

[Self-Test: Could You (or Your Daughter) Have ADHD?]

According to that study, only one in 10 adults had been treated for ADHD in the last 12 months. Over the next decade, clinical trials were conducted with amphetamine, methylphenidate, and atomoxetine. More than 40 percent of trial participants were women; clinical studies on ADHD began to show that females were just as impaired as males, and they responded just as well to medication.2, 3, 4

Despite all of this, there was no clinical emphasis on evaluating ADHD in women even a decade ago. Often, I would diagnose mothers with ADHD after diagnosing their children. These patients’ symptoms were typically missed in childhood because they did not include outward hyperactivity. As young adults, many had been misdiagnosed and treated for anxiety and depression. These conditions often did not improve with treatment because ADHD symptoms were not addressed.

In 2020, after experts convened to evaluate data on ADHD in females across the lifespan, Susan Young, Ph.D., and her colleagues published an expert consensus statement “providing guidance for the identification and treatment” of ADHD in girls and women. It cited, in part, a lack of understanding or recognition among clinicians regarding gender differences in ADHD symptom presentation and functioning.5

ADHD Research on Women Falls Short

Today, ADHD diagnoses in women continue to increase — and with good reason. Of the roughly 15.5 million adults with an ADHD diagnosis, 44.2 percent are women, according to recent data by the Centers for Disease Control and Prevention (CDC). Yet, of the 1,737 studies involving ADHD listed on ClinicalTrials.gov, only four were evaluating females only. The research has been slow to catch up.

As a result, there is still much we don’t know about ADHD in women. In recent years, the largest increases in stimulant prescriptions were for women of childbearing age. 6

[Free Download: Women, Hormones, and ADHD]

Research is needed to guide better treatment of this cohort, as well as midlife and older women with ADHD. The opportunity to unlock meaningful improvements to patients’ lives is real — and really overdue.

ADHD Research Studying Gender Differences: Next Steps

Ann Childress, M.D., is a past-president of the American Professional Society of ADHD and Related Disorders ( APSARD) and was the first woman elected to lead the organization.


SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

1 Kessler, R.C., Merikangas, K.R. (2005) The National Comorbidity Survey Replication (NCS-R): background and aims. Int J Methods Psychiatr Res. 13(2):60-8. https://doi.org/10.1002/mpr.166
2 Rasmussen, K., Levander, S. (2009). Untreated ADHD in adults: are there sex differences in symptoms, comorbidity, and impairment? J Atten Disord. https://doi.org/10.1177/1087054708314621
3 Mowlem, F. D., Rosenqvist, M. A., Martin J., Lichtenstein, P., Asherson, P., Larsson, H. (2018). Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. European Child & Adolescent. Psychiatry. https://doi.org/10.1007/s00787-018-1211-3
4 Platania, N.M., Starreveld, D.E.J., Wynchank, D., Beekman, A.T.F., and Kooij, S. (2025). Bias by gender: exploring gender-based differences in the endorsement of ADHD symptoms and impairment among adult patients. Front. Glob. Women’s Health. 6:1549028. https://doi.org/10.3389/fgwh.2025.1549028
5 Young, S., Adamo, N., Ásgeirsdóttir, B.B., Branney, P., et al. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry. https://doi.org/10.1186/s12888-020-02707-9
6 Danielson, M.L., Bohm, M.K., Newsome, K., et al. (2023).Trends in stimulant prescription fills among commercially insured children and adults — United States, 2016–2021. MMWR Morb Mortal Wkly Rep. https://doi.org/10.15585/mmwr.mm7213a1

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“I Was Weighed Down by My Feelings of Inadequacy” https://www.additudemag.com/dawsons-creek-busy-philipps-adhd-diagnosis/ https://www.additudemag.com/dawsons-creek-busy-philipps-adhd-diagnosis/?noamp=mobile#respond Tue, 06 May 2025 08:59:59 +0000 https://www.additudemag.com/?p=375679 Actor Busy Philipps, 45, recently shared her ADHD diagnosis – a revelation that came as her young daughter was being evaluated and diagnosed. Philipps realized that she checked all the boxes for the condition too.

Despite earning the nickname “Busy” as a child because she rarely stopped moving, she had long dismissed her ADHD symptoms as personal weaknesses. Today the Dawson’s Creek, Freaks and Geeks, Cougar Town, and Girls5eva star reflects on life before and after her ADHD diagnosis at age 39.

Q: How has being diagnosed with ADHD as an adult made a difference in your life?
A late diagnosis allows you to look back at all the times when people in your life or career attributed certain ADHD traits – lack of organization or time management – to your not being able to get it together. I spent a great deal of my life not fully understanding why “easy” things were so difficult for me.

[How is ADHD Diagnosed? Your Free Guide]

The diagnosis has changed the way I view my past self. I’m so grateful that I know now. So many feelings of low self-worth have dissipated. With an earlier diagnosis and treatment plan, I probably would not have had the same kinds of struggles that I had in my 20s and 30s.

Q: Juggling motherhood and a career can feel like a precarious balancing act for just about any woman, let alone one with weak executive function skills. How did you manage when you were undiagnosed and untreated?
When I was a young mother and had small kids and was working full time on a network television show, I couldn’t keep appointments straight. I’d find myself double-booked or unable to make it at the last second. You really feel like you’ve let down your kid when you miss gymnastics class by an hour.

[Read: ADHD Symptoms in Women Aren’t ‘Hidden;’ They Are Misinterpreted]

I spent a great deal of my kids’ early lives being very weighed down by my own feelings of inadequacy. I felt I was failing them and myself. I thought that I couldn’t keep these things straight because of my lack of concentration, because I wasn’t trying hard enough, because I was tired, because all these other moms have it figured out and I don’t. I was very hard on myself.

Q: Some people with ADHD struggle with working memory. In your acting career, was it especially difficult to learn a new script and remember your lines?
If it’s something I’m interested in, I have no issue remembering that information. I recall my math teachers saying to me, “You can remember all those lines for the school play; why can’t you remember your times table?” I do think that has to do with my ADHD. I’m actually great at memorizing lines. I have a real gift for it.

Being an actor was something I was interested in, and so my ADHD let me focus on it. Even with time blindness, I was never late for a call time. This career that I loved so much and wanted to do – that took over and it was my only focus.

Q: Do you have any advice to help people with ADHD live better?
Make sure you’re able to get the treatment that works for you. You shouldn’t feel shame or stigma. There’s real power in owning it, even at work, even with people you love.

Adult Women with ADHD: Next Steps


SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.
Carole Fleck is Editor-in-Chief at ADDitude magazine.

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The ADHD Effect on Sex & Self-Worth https://www.additudemag.com/risky-sex-low-self-esteem-hypersexuality-and-adhd/ https://www.additudemag.com/risky-sex-low-self-esteem-hypersexuality-and-adhd/?noamp=mobile#comments Mon, 05 May 2025 08:06:58 +0000 https://www.additudemag.com/?p=376193 Many teenage girls and young women with ADHD come of age feeling different or misunderstood. To fit in, gain acceptance, or feel loved, some engage in sexual activity, mistaking it for intimacy or a gateway to true relationships.

Research suggests that women with ADHD are more likely than their neurotypical peers to engage in sexual exploration at a younger age and to have multiple sexual partners. Their behavior is often an attempt to find validation or soothe the emotional chaos that ADHD can create. For some, it’s a way to fill the void created by low self-esteem or a lack of meaningful connections.

Here’s what that looks like for the women with ADHD who have trouble setting boundaries, misjudge risk, and suffer poor self-esteem: In seeking connection, they find themselves in risky encounters without considering the potential consequences. They tolerate disrespect or unsafe situations to avoid rejection.

Risky Sex and Women with ADHD

Many teen girls and women with ADHD are unprepared to handle the consequences of risky behavior, whether it’s dealing with a sexually transmitted disease or an unintended pregnancy.

Understanding how ADHD affects decision-making, through education and self-awareness, can empower women to take a step back before acting. That can mean practicing how to assert your needs and say “no” under pressure to build confidence in relationships, and using checklists to plan safe dates, manage contraception, and schedule health check-ups.

[Read: How ADHD Impacts Sex and Marriage]

Dealing with Low Self Esteem

From a young age, females with ADHD endure criticism for being impulsive, disorganized, and/or emotionally labile. These experiences can create a narrative of self-doubt, where they internalize the idea that they are the problem. This mindset doesn’t disappear in adulthood and often affects their relationships.

When things go wrong in sexual relationships, due to a lack of intimacy, mismatched desires, or conflicts with a partner, many women with ADHD blame themselves. Self-blame can have a profound impact on self-esteem and emotional wellbeing. It can lead to feelings of shame, guilt, and worthlessness that make it harder to address the real issues in a relationship. Instead of expressing her needs and desires, a woman may withdraw in fear of rejection or criticism.

If you have experienced any of this, here’s how to shift your internal narrative:

[Watch: Are ADHD Symptoms, Medications Affecting Your Love Life?]

Making Healthy Choices

Emotional Hypersensitivity

Women with ADHD are deeply affected by any criticism, real or perceived. If a partner declines intimacy, you interpret it as a rejection because of your low self-worth.

  • Do this: Recognize external factors. Work stress, family pressures, or physical health issues can all influence intimacy. Relationship struggles are rarely the fault of only one person.

Difficulty Communicating Needs

Expressing desires or frustrations can be challenging, especially for women who fear being misunderstood. When conversations about sex go awry, it’s easy to assume you’ve done something wrong.

  • Do this: Communicate openly. Tell your partner how ADHD affects your emotions. Together, explore ways to navigate challenges without placing blame.

Negative Self Talk

Many women with ADHD have an inner critic who harps on their perceived flaws. This voice can be particularly harsh around the vulnerable topic of sex.

  • Do this: Letting go of self-blame begins with embracing your authentic self and recognizing that you deserve relationships in which you feel valued and supported.

Build Intimacy and Healthy Relationships

Breaking the cycle of self-blame is an essential first step toward a fulfilling sexual relationship. Next comes the work of building and maintaining healthy intimacy. ADHD can sometimes create barriers, but you can strengthen your bond by:

  • Planning regular moments together when you intentionally block the distractions that steal your attention.
  • Focusing on what brings you joy. Physical affection, emotional vulnerability, and shared activities all contribute to a sense of closeness. If medication or stress dampens your libido, get advice about alternatives or supplements that can support sexual health.
  • Learning to say “no” to situations that don’t feel right. This empowers you to protect your wellbeing and foster healthy relationships.

You deserve a relationship in which you feel loved, respected, and understood – not despite your ADHD, but because you are uniquely you.

Risky Sex, Hypersexuality and ADHD: Next Steps

Susan Young, Ph.D. is a clinical psychologist in London.


SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

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10 Steps to Unmasking Your ADHD https://www.additudemag.com/slideshows/how-to-deal-with-adhd/ https://www.additudemag.com/slideshows/how-to-deal-with-adhd/?noamp=mobile#respond Fri, 02 May 2025 09:51:55 +0000 https://www.additudemag.com/?post_type=slideshow&p=376028 https://www.additudemag.com/slideshows/how-to-deal-with-adhd/feed/ 0 376028