Ever have that feeling that you cannot sit still for long and have trouble focusing? Or feeling impulsive, easily distracted and even forgetful? We often joke about how this is the shit we have to deal with when we get older. Brain farts, mommy brain, and even menopause,  we have lots of reasons why we can’t think straight. Perhaps you’ve even wondered if you might have Attention Deficit Hyperactivity Disorder (ADHD) as an adult but have not been clinically diagnosed. You’re not alone.

Natasha Meadus, Senior Program Manager, Frida, Canada’s leading healthcare platform for accessible clinically-proven diagnosis and treatment for adults with ADHD in Canada. Natasha is a seasoned Nurse Practitioner focused on mental health. She has dedicated her career to increasing access and improving health for vulnerable and marginalized communities. 

“Women tend to experience their adult ADHD diagnosis as a lightbulb moment. For their whole lives, they’ve often given an external explanation for their struggles, and a diagnosis allows them to accept themselves more fully,” said Natasha.

So, where do we start? We chatted with Natasha recently to help us clarify and navigate what ADHD in adults looks like.

What are some key signs of someone having ADHD?

Natasha: We all share common behaviours that may or may not indicate ADHD.  At the same time, with a backlogged public healthcare system, it can be exceptionally tough to get an adult ADHD diagnosis from your doctor or a psychiatrist. 

Most doctors are strapped for time and don’t specialize in diagnosing adult ADHD, psychologist wait lists are months to over a year, and other private options can cost more than an average Canadian’s monthly salary. 

My goal as a nurse practitioner overseeing the clinical operations at Frida is to help bridge that gap so that concerned Canadians aren’t left guessing.

“I’ve seen time and time again how knowing whether or not you have a clinical diagnosis of adult ADHD can lead to a better quality of life.”

With ADHD, it’s all about the frequency and severity of certain behaviours. 

How do those symptoms impact your everyday life?

Natasha: These nuances underscore the importance of obtaining a clinical diagnosis, rather than going with a gut feeling that you may have adult ADHD. 

When assessing adult ADHD, we examine symptoms with standardized testing, supported by our team’s extensive education and experience in mental healthcare. 

For example: 

A persistent pattern of inattention, hyperactivity, and impulsivity that interferes with function, meaning their everyday lives.

Inattention:

  • Making careless mistakes or having trouble organizing tasks 
  • Consistently losing things is easily distractible or forgetful
  • Missing deadlines, appointments or commitments, forgetting daily activities or are often running late 
  • A disorganized workspace

Hyperactivity:

  • Restlessness and fidgeting 
  • Impulsivity
  • Interrupts impulsive decision-making. Blurts out an answer before the question is completed

We also look carefully if these symptoms present in two or more settings. 

Are there varying grades or levels of ADHD?

Natasha: There’s a lot of talk across the media landscape about ADHD lately, but it’s vital for people to understand it’s not a one-size-fits all condition. It must be assessed by a healthcare practitioner with ADHD experience and training. 

There are three different subtypes of ADHD: inattentive, hyperactive-impulsive; and combined, which is both hyperactive and inattentive symptoms.

There are also different categories of mild, moderate or severe: Varying class of severity based on the extent to which symptoms impact a patient’s functioning in school, work, relationships, daily life.

Mild

  • Minimal impact to daily functioning 
  • Symptoms may be noticeable but they don’t warrant extensive intervention or support

Moderate 

  • a person may struggle more noticeably and often needs intervention/support

Severe

  • Significant impairment across multiple aspects of life
  • Hard to maintain employment, succeed academically, maintain relationships

Is it possible to have lived with ADHD for years and it’s gone under the radar?

Natasha: Prior to diagnosis, our adult women patients at Frida, frequently report feeling “different,” “stupid,” or “lazy” and blaming themselves for their underachievement. 

While this is heartbreaking, the prognosis of treatment is overwhelmingly positive. For example, data from over 10,000 patients treated by Frida shows 80 percent reported clinically significant improvements in feelings of hopefulness and self-worth within six weeks. Patients also see a 34 percent improvement in their ADHD symptoms by month four. 

Women and girls are less likely to be diagnosed with ADHD. The guidelines used to assess individuals have traditionally been focused on boys and men. 

For example, a recent CADDAC survey of Canadian women with ADHD found that 46% were misdiagnosed with another disorder prior to being diagnosed with ADHD

Women are also generally better at masking the stereotypical behaviours of ADHD. Their symptoms are also often overshadowed by their tendency to internalize their symptoms. This can cause misdiagnosis of anxiety and depression. 

Women also tend to develop coping mechanisms to compensate for challenges associated with ADHD symptoms, like overplanning, overstudying or perfectionism. 

What are some interesting recent findings particularly with women and ADHD?

Natasha: At Frida, we serve adult women and men of all ages but most of our patients are 35 to 65 years old, from across Canada.

There is growing evidence about the link between ADHD in women and hormonal factors, especially during pregnancy, and perimenopause/menopause . 

Our care team is highly trained and experienced in examining and treating women who may be in each of these stages. For example: 

Pregnancy

  • ADHD symptoms decrease due to increased estrogen but estrogen rapidly decreases postpartum, leading to increased symptoms and dopamine also decreases
  • Symptoms worsen as they focus on their new role

Perimenopause/Menopause

  • Estrogen decrease, ADHD symptoms become more severe
  • The decline of estrogens that until then affected the release of neurotransmitters serotonin and dopamine induces various changes in the biochemistry of the brain. Dopamine deficiency is responsible for the presentation of ADHD symptoms whereas serotonin deficiency leads to depressive mood.

Given that dopamine is the trademark of ADHD, this additional change can lead to even greater difficulties with focusing and concentration.

Specifically, estrogen can affect dopamine, serotonin, and norepinephrine. These neurotransmitters play a role in ADHD as they have a strong impact on memory, focus, and mood.

Attention and executive thinking skills can improve when estrogen levels are higher. On the other hand, ADHD symptoms can worsen when estrogen levels are lower.

ADHD Photo by Brooke Cagle on Unsplash
Photo by Brooke Cagle on Unsplash

Does ADHD present differently between women and men?

Natasha: Missed ADHD diagnosis in girls and women can be due partly to a special profile of more subtle symptoms (inattention – low self-esteem) compared to the impulsiveness/hyperactivity of boys.

For instance, instead of engaging in physical activities like running and climbing, girls might manifest their hyperactivity through subtler behaviors such as twirling their hair, chewing their cuticles, or being overly talkative. This distinction sheds light on the varied manifestations of hyperactivity in girls.

When girls become women with adult ADHD, these symptoms can intensify due to hormonal fluctuations during the menstrual cycle, pregnancy, and menopause. (see above). 

See more in A4.  

We often don’t talk enough about it and maybe even don’t want to get tested for fear of being labeled — what advice would you have?

Natasha: Try to reframe your mindset and think of how a diagnosis may be a life-changing tool to self-understanding,and acceptance that can lead to effective tools to dramatically reduce your symptoms. 

At Frida, we’re focused on reducing stigmas and are often told by our patients we represent their first experience in feeling heard. 

My advice is that for anyone who thinks they may have ADHD, to educate themselves with credible resources. While information on places like TikTok helps reduce the stigma around ADHD, no two people with ADHD are the same. 

I oversee a team of healthcare practitioners who are experienced in mental health and adult ADHD. We all undergo continuous training to stay updated. Diagnosing and treating adult ADHD is all we do, day in and day out. 

Frida provides access to healthcare professionals within 1-2 weeks, starting at $599. Some great resources for people in the initial stage of looking for information are: 

Can it be possible we are just overwhelmed and stressed? 

Natasha: A better question to ask is: is stress impacting daily function?

Stress can certainly exacerbate ADHD symptoms but it isn’t the root cause. This is why a healthcare professional, specializing in ADHD, is trained to differentiate between stress-related symptoms and ADHD. 

How can we tell the difference?

Natasha: The symptoms of stress and adult ADHD can overlap but normal levels of stress are often situational and fluctuate versus remaining a constant. Stress usually dissipates when the stressor resolves. 

‘Stress overwhelm’ is more often related to difficulty concentrating, feeling anxious or tension and fatigue, whereas with ADHD, there are challenges with attention, impulsivity and hyperactivity. 

When there is a diagnosis, our team can trace back ADHD to childhood behaviours that have remained a constant into adulthood. 

***

I was interested in learning how adults can manage daily life when diagnosed with ADHD. It doesn’t always necessarily mean turning to medication to help manage. It may just be tips to change your lifestyle. There’s lots of insight on the site that is fascinating to explore and learn more.

Check this out: Recognize symptoms of ADHD in adults

Interested in learning more? Visit talkwithfrida.com