The big issue: Women, ADHD and the missing years
Therapy Today, July-August 2026

Sally,* 65, was in her late 40s when she had her first episode of burnout. It made her so unwell she gave up her teaching job. A few years later she burned out again and became depressed. 

It was a conversation with a friend that first alerted Sally to the idea that she might have ADHD. Her friend had been diagnosed herself but Sally dismissed it at first until she started looking into it and it made sense. She was experiencing problems with self-regulation, especially around food and alcohol, was aware of talking too much, oversharing and trying to fit a lifetime into every conversation. She really struggled, and after a lifetime of feeling like it’s all her fault she started to recognise that she wasn’t alone and there might be an answer for all of this. 

Midlife

Sally is one of many women being diagnosed with ADHD in midlife. Statistically she belongs to the increasing group of women whose symptoms of ADHD were not detected in childhood due largely to it historically being considered an issue for boys who, according to recent figures from the Royal College of Psychiatrists, are twice as likely to be diagnosed as children than girls, with boys presenting with more classic symptoms of hyperactivity and girls being more prone to masking.¹  

She is also one of a growing group opting to pay for a private diagnosis. For many the diagnosis is life-changing, helping to explain a lifetime of struggles in relationships, work and life in general. But not everyone agrees the trend is positive – last year now former Health Secretary Wes Streeting declared that we have a problem with overdiagnosis.² Others suggest that private clinics are simply out to make money from the latest ‘trend’. 

Meanwhile, behind the hype and the headlines, midlife women are often left to navigate the impact of their diagnosis – however much it was welcomed – on their own. As someone who is still dealing with this after being diagnosed with autism and ADHD four years ago I know the crucial role that therapists can play in supporting clients like me. So what does the therapy profession need to know about ADHD in midlife women to work ethically and effectively?  

Risk factors 

Thanks to the growth of both awareness and availability of private diagnosis more women than ever are seeking an ADHD diagnosis in midlife, but it’s happening at a time in their life when other major life events such as perimenopause, menopause, empty nesting, caring for elderly parents and divorce are happening, the convergence of which makes this client group especially vulnerable. 

Indeed, perimenopause is understood to be a specific trigger for ADHD recognition in women where fluctuations in hormones make it difficult for them to hold it together anymore. At its most serious, women in perimenopause with ADHD are a very high risk for suicide; adults with ADHD are already five times more likely to attempt suicide than the general population and one in six women in perimenopause report suicidal thoughts, making the two combined unsettling.^3-7 

The consequences for a lack of diagnosis are hard to ignore: midlife women are more likely to have already suffered a lifetime of mental health difficulty starting from school, with school absences, increased risk of anxiety, depression, teenage pregnancy, self-harm, alcohol use and drug use compared to girls who are diagnosed in early childhood.⁸ 

Hormonal links 

Dr Helen Wall, a GP, menopause specialist, author of Menopause and ADHD: how to navigate hormone flux and neurodivergence (Penguin) and public health leader in Greater Manchester adds that women have ‘a clear pattern of crisis going on long before midlife’ and are especially reactive to hormonal change. Many are prone to premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome that brings its own challenges of emotional dysregulation and its most serious form self-harm and suicide ideation. It’s estimated that up to 47% of women with ADHD suffer from PMDD.⁹ 

Postmenopausal herself, Sally suffers with brain fog, extreme fatigue, lethargy and an underactive thyroid. She struggles with weight gain, is pre-diabetic and her prior alcohol and drug use has given way to food addiction. What isn’t being widely acknowledged is that physiological experiences such as these can be knock-on signs of exhaustion and burnout born out of decades-long undiagnosed ADHD. With many of those symptoms overlapping menopause, spotting the ADHD can make things especially hard to identify. 

‘I started to see women in my menopause clinic who’d spent years back and forth in the system with treatment-resistant anxiety, depression and postnatal depression,’ says Dr Wall, who runs her clinic across six practices. ‘They arrived in complete burnout, exhausted and unable to function, and belonged to the sandwich generation of women wedged between elderly parents and children and teenagers and trying to hold down jobs.’ Dr Wall noted the links between perimenopause and ADHD. Luckily she spotted signs of ADHD in her own daughter once she went through the hormonal shift of puberty. Dr Wall pushed for a diagnosis and her daughter was diagnosed with inattentive ADHD with autistic traits when she was 15 – something many women in midlife never got to benefit from. 

Understanding this hormonal link is vital, but studies around it are still in relative infancy. Practitioners such as Dr Wall are seeing that severely painful periods (dysmenorrhea) are linked to higher symptom severity and hormone fluctuations affecting dopamine. If you’re struggling with hormones and the resulting lack of dopamine then clearly you’re going to seek more dopamine. Prevalence of both PMDD and postnatal depression is also three to four times higher in women with ADHD than in women without.¹⁰ Pregnancy can be a relatively calm time as the oestrogen kicks in, but after birth oestrogen drops and women with ADHD are more at risk of postnatal depression and, in its worst form, postpartum psychosis.¹¹ Meanwhile a 2025 King’s College study confirmed that where ADHD symptom scores were higher, difficulties with menopause increased.¹² 

Dr Pippa Moran, clinical psychologist

Medication 

This all matters for therapy because there are implications for women around medication. Growing evidence tells us how ADHD medication interacts with women’s bodies. Francesca,* 45, tried ADHD medication but it gave her heart palpitations and she had to stop. Hormones impact medications for ADHD because of hormonal fluctuation within the month, and doses often need to be adjusted accordingly. HRT is the other frontline treatment. Antidepressants have developed a bit of a bad reputation amid the menopause conversation but can be extremely effective in treating women with PMDD. They can also help to regulate neurodivergent perimenopause symptoms where HRT isn’t an option. 

Therapists need to recognise that GPs are essential for addressing hormonal issues as they can give the necessary medication, and for this reason neurodivergence in midlife women needs to be understood through a biopsychosocial lens. 

Kelly* is a therapist who works within a GP surgery psychotherapy service. She explains how helpful it can be for there to be a therapy presence in GP surgeries as it means that patients are more easily referred directly and the door of communication between GP and therapists kept open. The issue here once more is that there is a gap in who gets to have a local surgery that offers this; with so little funding there are very few. 

Of course not all women feel comfortable going to their GP and talking about menopause, never mind neurodiversity. GPs tell me that while many women request help there are plenty who don’t seek it. Medical misogyny is rife, with many women dismissed or not believed, especially for women from ethnic minorities.¹³ Dr Farah Ahmed noticed that women from her South Asian community often weren’t coming to her London menopause clinic and women’s health hub about perimenopause, so she contacted local community leaders and went out to talk to them in mosques, temples and community centres. It wasn’t that the women didn’t have questions; they did. They just hadn’t felt comfortable coming to ask, or hadn’t recognised what their symptoms were. 

Inequality 

Investigation shows that many of the conversations we’re having about ADHD today are primarily focused on middleclass, usually white Western cis-women, meaning that despite the raised awareness whole groups of women are still being left out of the equation without a voice. 

Research shows that when comparing women with a later ADHD diagnosis and women without ADHD, those with a later ADHD diagnosis also have evidence of early childhood socio-economic deprivation.⁸ 

Emma Hodgson, a trainee educational and child psychologist, and former specialist teacher for children in care and multisystemic therapist, says that young women living with addiction and exploitation, prone to violence themselves and who show signs of impulsive behaviour ‘are surrounded by chaos, unpredictability, no routines, no boundaries… all those things that would help the ADHD brain to flourish.’ For these women, she says, they just become more and more vulnerable as they get older rather than receiving help. 

And Dr Wall tells me how women from more affluent environments come to her better informed than women of lower socio-economic status because they have had the time and resources available to access education and research and read up on it. Less-well-off women meanwhile are less likely to seek a private diagnosis for financial reasons; in some cases they might borrow the money and, as Hodgson points out, often not be able to pay it back. 

The result is what appears to be a class and race divide over who gets to receive a diagnosis and who doesn’t. 

Gabrielle Treanor, ADHD coach

Private assessments 

Sally herself researched the Right to Choose pathway and then chatted to her GP about a private diagnosis. She found it a relatively simple process: filling in online forms followed by an hour-long assessment via Zoom, resulting in a diagnosis of ‘combined ADHD’. Nine months on she’s still on the waiting list for ADHD medication and titration. Because she went through Right to Choose her GP cannot prescribe it. 

The clinical validity of some diagnoses of course has been questioned. A person might have an hour-long assessment for ADHD, like Sally, and be given the results at the end of it, but clinical psychologist Dr Pippa Moran explains that when she does an ADHD assessment it’s a case of excluding any other possible reasons along with it. In other countries the processes can differ wildly: in Italy, where I live, ADHD assessments can only be carried out by psychologists or neuropsychiatrists, and many have specialist training in neurodiversity. 

Precise statistics are tricky to find for the level of boom that the UK has seen in private assessment for ADHD, but it’s not difficult to see why there’s a turn towards it. In March 2025 the NHS referred up to 20,000 people for ADHD diagnosis, an increase of 13.5% from the previous year.¹⁴ It’s unclear how many of those account specifically for women in midlife but there is a clear trend coming from women’s testimonies, online discussions and media conversations to indicate that the demand for assessment is huge. Meanwhile waiting lists for NHS assessment can be more than two years; in some areas as long as 10 to 15 years!¹⁵ 

Long NHS waiting lists and a postcode lottery all go some way to explaining the increase in the number of private clinics offering assessment. Even then, if you do go private you might find that the NHS doesn’t accept your diagnosis, or that you have to pay for ADHD medication yourself as it takes time to get back into the system and there’s no guarantee of getting back in anyway. 

Meanwhile GPs are working within the challenging confines of 10-minute appointments. If you only have 10 minutes, in contrast to a full 50-minute therapeutic hour, there isn’t going to be much time to explore ADHD in the way that we could as therapists if only the patients were able to access us. So for many women in midlife turning to therapy is a lifeline. 

Therapy role 

Therapists are neither qualified to diagnose nor dismiss a label of ADHD or autism, but therapy is often the only place that clients have to discuss the possibility of ADHD or navigate the aftermath of a diagnosis, which therapists have the capacity to provide. The crucial role is to give these women a containing space where they can feel validated and not allow label, or lack of label, bias to get in the way of that. 

We never know how our client is going to feel about this,’ says therapist Georgina Sturmer, who feels it’s important for us not to make assumptions about what different diagnoses and labels mean for people. 

For some women it’s worth noting that a diagnosis is the only ticket through the system. Very often getting access to therapy or reasonable adjustments at work relies on receiving a formal diagnosis first as a way into receiving help. 

Hodgson also wants us to recognise that midlife women have been historically missed. She notes that the impact of ADHD can really affect women who’ve had unrealistic expectations placed on them since girlhood, regardless of status. She’s observed birth mothers in situations where their children were placed in foster care. ‘What gets missed is the vulnerability of these mothers.’ 

The socialisation of girls and women plays a huge role in why we have been missed. Neurodivergent girls find it difficult to thrive at school. Often they are intelligent and do well academically, but nobody sees the struggle and cost to mental health involved. Being at school in the 1980s I too was considered ‘clever’, and so no one thought that I found things difficult. They didn’t see the meltdowns when I got home from school. It wasn’t until I left the structure of school and went to university that problems emerged. I didn’t know that I was different – I just didn’t understand and rebelled against it wherever I could. I got into trouble a lot: always the difficult one, the problem. 

Women of my age were brought up to understand social rules and cues and follow them. Just because we weren’t jumping up and down like boys it didn’t mean that the hyperactivity wasn’t internalised. Girls of my generation especially were told to be quiet, sit still and not make a fuss. 

Clinical psychologist Dr Valentina Pasin, who specialises in neuroscience, tells me that research is struggling to catch up, but the experience of practitioners working with neurodivergent people and neurodivergent people with lived experience themselves can tell us so much already. 

She recommends therapists explore continued professional development about both menopause and neurodivergence in order to have the base to explore how the two interact. 

For Sally, once she was able to understand her experiences as linked to ADHD she was able to see how invaluable therapy would be: supporting her to understand her past as a function of ADHD converging and helping her to start to set boundaries. But Dr Michelle Garnett, a leading expert on neurodivergence, advises that neurodivergence has to be recognised for the client to feel seen and heard. If not, many will stop therapy. I certainly know that being told, ‘No, you’re not mad, there’s a reason for it all, or possibly a reason for it all’ after a lifetime of being misunderstood made a difference to me. 

Professor Tony Attwood sees the therapist as having a very central role as companion or guide on the journey for these women. He says they’re the ones who can broach the subject, signpost, help clients make sense of information accessed online and weigh up how life could be enhanced by diagnosis and also how the client may be at risk by confirmation. 

His latter point feels crucial: there is still an awful lot of stigma and prejudice around ADHD in midlife women especially. One of the hardest things I remember about getting my diagnosis was being at first really pleased then the realisation hitting me that the world still wouldn’t accept me for who I am. I had to learn that in many situations I still wouldn’t be understood. For a time I felt angry and frustrated about it all; the experience was bittersweet. 

On this note midlife women could benefit in therapy from learning ways to protect themselves outside therapy: even if they’re having therapy in a neurodivergentfriendly environment they can’t ensure that in every aspect of their life. 

Susie Masterson, psychotherapist and ADHD coach

Autism overlap 

When ADHD intersects with autism (itself its own diagnosis), like it does for me, the implications are even more profound and complex. Professor Attwood and Dr Garnett, both experts on autism, say that it’s usual for women to have symptoms of many different conditions simultaneously, even at different times in their life, with ADHD and autism overlapping at sensory input, hyperfixation, OCD tendencies, auditory processing, interrupting, executive dysfunction, emotions, impulsivity, rejection sensitivity, insomnia, repetitive thoughts, restlessness, stimming and difficulty with making friends. Ultimately it’s like having membership of two groups while not fitting in either. Dr Garnett says this brings ‘more struggles and more problems with daily living skills’, with it being more difficult to get a job, stay employed and finish degrees. ‘The research is telling us the presence of both is associated with more suffering in terms of mental health, so it seems to bring greater challenges in menopause.’ 

GP therapist Kelly reports seeing an increase in patients being referred with a diagnosis of both autism and ADHD, increasingly being labelled ‘AuDHD’. While not officially a clinical diagnosis on the DSM-5-TR, Kelly tells me more midlife women are identifying with this term, and it is becoming increasingly popular on autism forums online, where women are turning to for support. ‘I’ve certainly spotted an increase in the use of this term on referral forms in the past year. For many they describe themselves as high functioning. They mostly hold down good jobs and are highly skilled at masking. A lot of the work in the therapy room can be in noticing how their masking shows up in therapy and unpicking the fear that they might get “therapy wrong”. Years of conditioning gets unpacked and much of our work can be about supporting this client group to feel safe enough to share their vulnerability around shame. It doesn’t happen overnight though.’ 

Kelly notes that in a GP setting, where patients are given maybe six to 10 sessions, there’s always a sense of never quite getting there, or the structure of clinical appointments meaning they can’t always show up. ‘That’s where long-term therapeutic work can really help. A therapist can start to notice those absences and engage with it in a relational way where there is actually time. That can be deep, transformational work. Whether the client has an official diagnosis or not, allowing the client to recognise how their lifelong pattern plays out in the therapy room, which they’d never previously had words for, can be hugely beneficial for this work to begin.’ 

Georgina Sturmer, therapist

Staying informed 

Dr Emma Craddock, a senior lecturer in health research at Birmingham City University, believes it’s crucial for therapists to remain aware of such diversity within neurodiversity and to challenge neurotypical assumptions that underpin practice. ‘An ADHD person isn’t necessarily interrupting the conversation in a bad way,’ she says. ‘Often they’re trying to share and build on what you’re talking about.’ Similarly, asking a neurodivergent person to sit with their feelings can be problematic because of differences in proprioception (the body’s ability to sense its position in the environment) and interoception (ability to detect internal physiology like temperature), and if they have alexithymia they’ll find feelings very difficult to name. 

Being uninformed risks harming clients. In my case a previous therapist couldn’t see my neurodivergence and so didn’t account for this, which meant having therapy made things worse for my life and I lost faith in the whole system. But now I have the right therapist; she fully understands how my brain functions and I have never been so happy or confident in my life as I am now. This is what makes the difference between practitioners being neurodivergentinformed or not. 

Certainly some therapists are successfully navigating assessment and eventual diagnosis. Psychotherapist and ADHD coach Susie Masterson works exclusively with women. Like many women she sought diagnosis after her son was diagnosed. She talks openly about ADHD in her coaching work, whereas therapy differs in that ‘pure therapy work is going on that journey and helping the client understand where they are at in terms of what matters to them about diagnosis’. She asserts that ADHD is a complex, nuanced and fluid condition. Understanding this through research and training from a range of professionals including psychiatrists, neurologists, endocrinologists and other health professionals is key to informed work. 

A useful resource for women is also online groups where they can learn about ADHD and share experiences. ADHD coach Gabrielle Treanor set up The Quiet ADHD Club after her own ADHD diagnosis and has seen positive feedback. ‘Women say they don’t feel alone anymore, they feel understood and seen. And that’s the whole reason I do it. All these years I had been helping women with people pleasing and perfectionism and procrastination and overthinking and overdoing and overwhelming and now I realise that a lot of them may have had undiagnosed ADHD.’ 

Where next? 

For me, I ultimately just wanted someone who really understands what it all means. In my case it’s autism plus ADHD plus high learning potential as well as probable dyscalculia and dyspraxia. It’s a huge ask for therapists to have to work with all this without specific neurodiversity training. It’s also not easy to identify individual diagnoses. It’s the combination of it all that makes the person you have in front of you. 

Having said this, psychotherapist Uruj Anjum rightly advises that it’s OK not to be an expert in everything and to recognise when specialist skill, more training or referral are needed ‘We can’t be experts in every area a client might bring, but as therapists it’s important that we have some training and understanding of neurodiversity.’ 

Ultimately the picture is complex, but therapy offers something tangible provided therapists acknowledge our limitations. If anything, investigation highlights the gaps inherent within our current health system. As it stands, when it comes to ADHD in midlife women we’re at the tip of the iceberg, and research is being pushed forward as we speak. As the picture continues to fully unfold perhaps a key message to leave therapists with is to caution against assumption, stay engaged in the evidence and validate midlife women when they say they’re struggling. 

*Real names not used.

Uruj Anjum, psychotherapist