Decades of undiagnosed ADHD in Gen X girls created a “lost generation” of women

How ADHD symptoms impact us throughout our lives, from puberty to menopause

BOSTON FOLKS: I’m joining WBUR Cityscape on March 4 for “Cognoscenti Presents: Menopause—A New Approach.” I’ll be talking all things menopause with

Pooja Lakshmin MD

, Morra Aarons-Mele (

Morra’s Substack

), and Dr. Sherrie-Ann Burnett–Bowie. RSVP today!

ADHD FOLKS: Our next Playing with Fire Zoom meetup will take place this Thursday, February 27. After interviewing dozens of women who said they had undiagnosed or untreated ADHD while researching my upcoming book, along with the overwhelmingly positive response to the piece below, I knew there was a bigger conversation to be had. So I’m thrilled to host this upcoming conversation with Kaitlin Soule, an ADHD therapist. She’ll answer your questions (click here to submit). Details and the link to join us on Thursday can be found here.

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While writing my upcoming book, “Fired Up: How to Turn Your Spark Into a Flame and Come Alive at Any Age,” I interviewed over 70 women and during those discussions, I noticed a pattern emerge: over and over again, the women told me—unprompted—that they’d either been diagnosed with ADHD (attention-deficit hyperactivity disorder), or they believe they have it. In total, over a quarter of the mostly Gen X women I spoke to, from different backgrounds and parts of the country, attributed their distraction and disorganization—as well as their struggles in school, in the workplace and at home—to ADHD.

Like me, these women have been on a long and often painful journey from frustrated kids to differently functioning adults. And also like me, most of these women said that they’ve come to view ADHD, the bane of their existence growing up, as the secret sauce to their uniqueness and success as adults.

In the 1970s and 1980s, Gen X girls with ADHD (ADD was omitted from the DSM-5 in 1987 after researchers didn’t find significant differences between the two types) were rarely diagnosed or treated. In fact, 40 years ago, the ratio of ADHD-diagnosed boys to girls was less than 10 to 1. Instead of giving girls the tools they needed to navigate the system—namely the educational system—we were forced to figure it out on our own and learn how to conform in a society built for neurotypical people; and when we failed to do so, many of us were punished for being neurodiverse.

The more girls like me struggled to meet the expectations of teachers, peers, and parents, the more shame we felt about our perceived inadequacies. And because we never received the medical care we needed and deserved, we internalized our ADHD symptoms as fatal flaws.

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My conversation with Lisa Ling, American journalist and television personality, about how she views her ADHD

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As far back as I can remember, I’ve struggled with profound, debilitating ADHD, a chronic, neurobiological disorder that affects the brain structurally and chemically. In grade school, I couldn’t stay in my seat and distracted other kids with my talking. I couldn’t remember or follow the rules. As I got older, those impulse control issues worsened, and I began to show symptoms of common ADHD comorbidities, including obsessive-compulsive disorder (OCD) and generalized anxiety.

I had physical tics, like repetitive blinking and throat clearing; I had intrusive thoughts and dark ruminations; my separation anxiety made me flee friends’ sleepovers in the middle of the night; I compulsively picked at my skin, leaving open sores on my scalp. On top of all that, there was the disorganization, impatience, inattentiveness, emotional fluctuations, and dyscalculia (math dyslexia, an ADHD-related learning disability). I began failing classes in eighth grade, and barely graduated from high school and college.

I was the “weird girl,” not just at school, but at home, too. And I have a lot of resentment—toward my parents, my teachers, and my doctors—who found it easier to assume I was lazy or difficult instead of diagnosing the learning disabilities and mental health issues I was struggling with. Without help, I figured out how to overcome the obstacles set up by the system—partly due to maturity in my twenties, partly because I realized what I was passionate about, and partly by seeking out and partnering with people who have the left-brain skills I lack.

Thankfully, more girls are getting diagnosed with ADHD today (the ratio is now somewhere between 4 to 1 and 2 to 1), but boys are still more than twice as likely to be diagnosed with ADHD than girls. This chronic underdiagnosis and undertreatment among girls is not because they’re less prone to the disorder, but because it presents differently based on gender.

Of the three subtypes of ADHD—inattentive, hyperactive/impulsive, and mixed—girls often have inattentive, a type that’s easier to mask. Girls with ADHD who aren’t treated are at higher risk for self-harm and suicide attempts, for risky sexual behavior that leads to strikingly high rates of unplanned pregnancies (more than 40 percent versus 10 percent for young women without ADHD), and they’re significantly more likely to experience major depression, anxiety, and eating disorders than girls without ADHD.

When girls with ADHD become women, they still typically don’t receive an accurate diagnosis of ADHD until their late 30s or early 40s, and the hormonal changes they experience, which can span two decades, can worsen their symptoms. Many women after age 50 with ADHD report feeling more overwhelmed, inadequate, misunderstood, and distressed than ever—and at a time in their lives when they often have the greatest demands on their energy. Half of women recently surveyed said memory problems and feeling overwhelmed are “life-altering” in their 40s and 50s, and over 80 percent said they experienced at least some of their ADHD symptoms for the first time in perimenopause and menopause.

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Lisa Ling on the system she designed for herself to cope with the struggles of ADHD.

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When I went through menopause at age 49 I also felt my symptoms worsen. Even though I’d found ways to cope without taking medicine for decades (not by choice, but because my parents wouldn’t allow me to), suddenly my strategies for overcompensating no longer worked. My brain was foggy, I had a hard time remembering details and thoughts without writing them down; my hyperorganization gave way to chaos, and I started feeling anxious, especially in the middle of the night. I was prescribed Adderall, but even in the smallest doses, it made me feel nauseous and spaced out. Ultimately, what did help me was starting hormone replacement therapy—the increase in estrogen and testosterone helped with brain fog, and the progesterone helped me sleep. But there are many treatment approaches to help manage ADHD symptoms in women, including:

• Stimulant medications: Stimulant medications are the traditional treatment for ADHD. One recent study of ADHD medication showed women were the fastest-growing population. Between 2008 and 2012, the number of Americans using medication to treat ADHD rose 36 percent; among women aged 26 to 34, the figure rose 85 percent.

• Non-stimulant medications: This includes some antidepressants as well as non-stimulants specifically made for ADHD. Non-stimulant medications for ADHD include Strattera, Qelbree, Kapvay, Tenex, Bupropion, and Effexor. Non-stimulants like Strattera and Intuniv have been found to improve symptoms of ADHD, reduce oppositional behavior, and have fewer side effects compared to other medications.

• Therapy: Research shows that therapy, with or without medication, can be an effective part of treating and managing ADHD symptoms by helping patients learn new ways to control and manage their symptoms. It can also address the low self-esteem issues that many people with ADHD struggle with.

In the 1980s, researchers thought ADHD was solely a childhood disorder, but they now know it persists into adulthood in the majority of cases. Medication and treatments aren’t a cure-all, but when paired with a diagnosis—no matter how late in life—they can help make the symptoms of ADHD more bearable and less shameful.

Now that I’m 54, I know what my ADHD limitations and advantages are. I won’t be able to find the grocery store in my town that I’ve driven to hundreds of times without Google Maps, but I will be able to sit down and write a 2,000-word essay in under four hours. I’m not going to be able to find that email you sent me two hours ago, but I can tell you dozens of obscure facts about the life of Harriet Tubman. I’m quirky, but it works for me, and I no longer feel shame about my ADHD; my neurodiversity is part of who I am and it’s given me a unique ability to focus that’s helped me succeed—first in crisis communications and then as an activist and author. I wish others had recognized and honored my uniqueness instead of punishing it when I was younger, but the suffering I experienced has helped me be a better mom to my kids, all of whom also have ADHD.

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My upcoming book, Fired Up: How to Turn Your Spark Into a Flame and Come Alive at Any Age, is now available for preorder! This book is my guide to figuring out what lights you up and will show you how to live on fire every day. Click here to preorder and get locked into some incredible bonuses.