When the puzzle only fits together at 38
“I was never hyperactive – I was just the dreamy one.” – “For twenty years it was called an anxiety disorder, then depression. Now they tell me it’s ADHD?” – “On TikTok I recognise myself in everything. But does that actually mean anything?”
Hardly any mental-health topic is discussed as much right now as adult ADHD – and hardly any as sloppily. On one side are women who spent decades carrying the wrong labels. On the other, a feed that turns every bit of absent-mindedness into a diagnosis. Both are real, and both call for care – including from a coach who is neither a physician nor a psychologist. So here are the facts, the boundaries, and what coaching can contribute.
What ADHD is and how common it is
ADHD (attention deficit hyperactivity disorder) is a neurodevelopmental condition with a neurobiological basis that begins in childhood and persists into adulthood for a proportion of those affected. Its core areas are inattention, hyperactivity and impulsivity – in varying proportions. The international consensus statement of the World Federation of ADHD (Faraone et al., 2021) summarises the evidence like this: around 5.9 per cent of children and adolescents and around 2.5 per cent of adults meet the criteria. The disorder has not become more common over the past three decades – what has risen is the number of diagnoses, because clinicians recognise ADHD more readily today. In Switzerland, too, ADHD has long been an adult topic: according to projections by the health insurer Helsana for SRF, more adults than children and adolescents now hold a prescription for the relevant medication.
Why boys stand out and girls slip through
This is where it gets interesting. In childhood, significantly more boys are diagnosed than girls: in population samples the ratio is roughly 2:1 (Faraone et al.) to 3:1 (Young et al.), in clinical referrals sometimes 3:1 to 16:1. In adulthood, by contrast, sex differences are “more modest or absent” – according to the expert consensus statement on females with ADHD (Young et al., 2020, BMC Psychiatry). If the ratio evens out so markedly with age, there is little to suggest ADHD is rarer in girls – and a lot to suggest it is recognised later.
The paper names several reasons:
- A less conspicuous presentation. Girls and women more often show the predominantly inattentive type. That doesn’t look like a fidgety child; it looks like daydreaming, disorganisation, feeling overwhelmed or an apparent lack of motivation.
- Symptoms directed inward. In females, internalising problems are reported more often – anxiety, low mood, self-doubt – and these then take centre stage.
- Compensation and masking. Many girls learn early to function at enormous cost: lists, double-checking, adapting, overtime in the head. These strategies conceal the impairment – and, according to Young et al., delay referral.
- Wrong labels. Women more often first receive a diagnosis from the anxiety, depression or personality-disorder family. These diagnoses can be true at the same time – but if they obscure the ADHD, the wrong lever gets pulled for years.
One cliché worth pushing back on: none of this means women are “simply more emotional”. It means the observation grids in schools, families and clinics were calibrated to the loud picture for a long time.
Hormones: what is known and what isn’t
Many women report that concentration, irritability and mood get noticeably worse before menstruation, after giving birth or in perimenopause. The research on this is young. A Dutch case series (de Jong et al., 2023, Frontiers in Psychiatry) describes premenstrual worsening of ADHD symptoms in nine women; the team itself stresses that there was no control group and that larger studies are needed. The Young et al. consensus statement likewise rates the evidence for hormonal influences as preliminary. So: a pattern worth taking seriously, one you can observe and describe to your clinician – not established textbook fact. What the research shows about cycle and mood in general is covered in Cycle and mood.
TikTok, self-tests and the business of self-diagnosis
That many women first recognise their symptoms in social-media videos is understandable. The quality is still worth a sober look. An analysis of the 100 most popular TikTok videos about ADHD (Yeung et al., 2022, Canadian Journal of Psychiatry) concluded: 52 per cent misleading, 27 per cent personal experience, only 21 per cent useful from a professional standpoint. The most common error, in 37 of the 52 misleading videos: experiences such as anxiety, anger, mood swings or relationship conflict are explained as “typical ADHD”, although they occur in many mental-health conditions. Not a single one of the misleading videos recommended a professional assessment.
Hence three levels that should be kept apart:
- Trait: distractibility, forgetfulness, sensitivity to stimuli – everyone has these to some degree.
- Burden: only when these traits persistently cause suffering or impairment across several areas of life does it become clinically relevant.
- Diagnosis: made exclusively by a specialist – a psychiatrist or a clinical psychologist – according to DSM-5-TR or ICD-11 criteria, with a history reaching back into childhood, exclusion of other causes and attention to co-occurring conditions.
Questionnaires such as the WHO’s ASRS are screening tools: they pre-sort, they do not diagnose. More on how to use such tests sensibly in Gaining clarity with self-tests.
High sensitivity is not ADHD
Because this is where things get mixed up online most of all: high sensitivity (sensory processing sensitivity) is a personality trait from personality research – not a diagnosis in ICD or DSM. ADHD is a clinical diagnosis. Both can come with overstimulation and exhaustion, and studies show that self-reports on the two scales correlate (for instance Panagiotidi et al., 2020, in a non-clinical sample of 274 people). That does not mean they are the same thing – it means a questionnaire on its own cannot tell them apart. Calling yourself “highly sensitive” does not explain away ADHD; having ADHD does not make you “just highly sensitive”. What the trait actually is you can read in What is high sensitivity? and HSP test results explained: what your score means.
The boundary: what belongs with a specialist
Stated plainly, because there is no grey area here:
- Diagnosis and treatment of ADHD – including the question of medication – belong with psychiatrists and clinical psychologists. Your GP can be the first point of contact. Coaching does not diagnose, neither on suspicion nor “unofficially”.
- Depression, anxiety disorders, PMDD, postpartum depression, addiction problems – frequent companions or alternative explanations – belong in medical or psychotherapeutic hands. How PMS and PMDD differ is explained in Cycle and mood: PMS or PMDD?. Whether coaching or therapy is the right fit is covered in Coaching or therapy?.
- Cycle-related or perimenopausal complaints that intrude heavily on everyday life are a matter for gynaecology or your GP. What changes in the mind in midlife is covered in Perimenopause and the mind.
What coaching can contribute
Coaching can accompany you on the way to an assessment – helping you sort out the concern and lower the threshold. After a (late) diagnosis, and alongside professional treatment, it can help with structure and self-organisation: the architecture of the day, priorities, realistic systems instead of heroics. And with the hardest part: looking back on twenty years of self-reproach (“I’m just chaotic, lazy, too sensitive”) that turn out in hindsight to have been attempts to explain something unrecognised. Self-compassion instead of self-criticism fits here. Which topics I work on and how coaching with me works is set out under coaching topics, process and prices.
How to prepare for an assessment
If you are considering an assessment, keep a short log for two weeks beforehand: where exactly does it break down (work, household, relationships, finances), since when, and what compensation have you built up? Concrete examples like these are worth more to the clinician than any test score – and they show you yourself whether this is about a trait or a burden.
Conclusion
That women often only get their ADHD diagnosis as adults has less to do with their brains than with our search images: the quiet type, symptoms turned inward, years of compensation, other diagnoses first. At the same time, not every bit of absent-mindedness is ADHD, and a video is not a finding. The good news lies in between: a careful assessment is possible, and whatever comes out of it – the way you deal with structure, energy and self-criticism can be worked on.
Do you recognise yourself and don’t know where to start? In an introductory session we sort out together what you are observing, which parts of it need a professional assessment – and where coaching can genuinely support you.
Your progress is my joy.
