In midlife, a woman with ADHD makes major transitions. Biologically, she goes through peri-menopause and enters menopause. Interpersonally, family responsibilities are typically waning. In her fifties, a woman with ADHD has new choices before her. Perhaps this is a time to pursue a long-neglected dream — to return to school, to develop a dormant talent, to establish a different lifestyle that is more compatible with her needs as a woman with ADHD.
Biological transitions — Peri-menopause and Menopause
It is critical for a woman with ADHD to be aware of the powerful interaction of ADHD symptoms and declining estrogen levels. Many women whose ADHD symptoms have been successfully treated with psychostimulants report that their stimulants are less effective during peri-menopause and menopause. Because there is little dialogue between physicians who treat adults with ADHD and those who treat women in menopause, the interactions of ADHD symptoms with estrogen levels are not yet widely known or appreciated. It is not unusual for a physician treating ADHD to have little information on this stimulant-hormone interaction. As a result, it may be necessary for a woman with ADHD to help educate her physician about these interactions in order to receive effective medication treatment.
Interpersonal Transitions — Renegotiating Relationships in Midlife
In mid-life, the opportunity to re-design her lifestyle beckons, if a woman with ADHD will heed its call. Whether she is a single parent, renegotiating expectations with newly adult offspring, a married woman, renegotiating with children and spouse alike, or a single woman looking toward a shift in career focus, she has the option to lower her daily stress level by changing her expectations and those of others.
A woman in mid-life may feel entrapped by the expectations of others. She may be the primary caretaker of an aging parent; she may over-function for her young adult children; she may have been a supportive spouse who now wants to focus energy on her own projects; or she may be a career woman whose employer expects workplace demands to take precedence over personal life.
Because people with ADHD tend to be “reactive” to their environment, women with ADHD may face a particularly difficult challenge when they try to stop focusing on the expectations of others and focus more on their own needs and desires.
Finding a new Balance
The primary mid-life goal for a woman with ADHD is to create a new sense of balance in her life — balance within herself, and balance between herself and significant others. The challenge for her is to slow down the merry-go-round she’s been riding for so long — slow it down so that she can go for a walk in the woods, for a soak in the hot tub, or spend a calm moment in meditation or yoga. She needs time to ask herself whether she wants to ride that merry-go-round any more.
Finding new directions after the merry-go-round has stopped
Like other women, many women with ADHD have put hopes or ambitions on hold while raising a family, planning to put more energy into their own projects when they have more time. But when a woman has ADHD, she faces an extra challenge in pursuing a new direction. The skills a woman needs to follow through on her hopes and dreams are often the very skills that are most challenging.
During child-raising years, a woman with ADHD may have felt unable to pursue her own dreams. But now, as time and opportunity open up, she may overwhelmed and directionless. How do I get started? Where should I begin? A woman with ADHD may react to “free” time by feeling paralyzed and unable to move forward. Instead of writing that book she’s always dreamed of, or applying for the graduate program she’s postponed for years, she may find she’s more likely to continue to respond to the needs, requests, or ideas of others.
With ADHD-reactivity, it’s easier to answer the ringing telephone or respond to a request than to stick to your own plans for the day, easier to follow the beaten path than to strike out in your own direction. For a woman who forgets what she intended to do in the time it takes to walk downstairs, developing new habits and setting out toward long-postponed goals can seem impossible.
Support and structure to make changes
To make her dreams come true, she needs support and structure. Structure can come in the form of a partner — someone to share the dream, to be accountable to, someone to plan with, someone to brainstorm with. Structure can also come in the form of a job. For example, if a woman’s ultimate dream is to start her own enterprise, she may begin by working for someone from whom she can learn the skills she needs to strike out on her own.
Groups can also be important sources of structure and support. She can join a group of women with similar goals — stay-at home moms returning to the workplace, women who hope to become artists or writers, women training for the same profession, women starting their own enterprises — such groups can provide support, encouragement, advice and contacts.
Enrolling in a class can provide both structure and support. The regularly scheduled class can help her keep on track, while contact with the teacher and with fellow students can provide her with emotional support and encouragement as she develops or enhances the skills she needs to follow her dream.
Counseling or psychotherapy
Working with a professional in counseling or psychotherapy may be very useful to help a mid-life woman with ADHD take stock in her life, to rekindle old dreams or develop new ones better-suited to the self that she has become. “The way it’s always been” no longer needs to be. Yet habit and expectations can have a powerful pull.
If she’s married or is a mother, she needs to work toward creating a different balance in her relationship with her husband or young adult children. Psychotherapy may help her stay on track as she learns to give herself permission to take care of herself and to renegotiate long-standing patterns with her spouse.
Psychotherapy is often the best approach for understanding the emotional and interpersonal issues that are getting in her way. However, when a woman is clear about what she wants to do, but can’t seem to mobilize herself to do it, coaching may prove very helpful. For example, if a woman has decided to return to school to earn a degree, a coach can help her get on track and stay on track, teaching her to set realistic goals, to break large goals into do-able steps, and to remain focused and motivated as she works toward her goal.
Pulling it all together
Mid-life can be a time of possibility and change for a woman with ADHD, a time to reassess, to find more time for herself, and to set her sights on new goals. With structure, strategies and supports in place, midlife is a golden opportunity for a woman with ADHD — a time to reassess earlier choices that were made without understanding ADHD — an opportunity to reduce chronic stress, to become more balanced, and to accomplish things she only dreamed in earlier years.
More information on women in mid-life with ADHD can be found in Gender Issues and AD/HD: Research, Diagnosis, and Treatment, edited by Patricia Quinn, M.D. and Kathleen Nadeau, Ph.D. and in Understanding Women with AD/HD, edited by Kathleen Nadeau, Ph.D. and Patricia Quinn, M.D.