Attention Magazine February 2024

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I remember arriving home after delivering my firstborn son. I sat on the couch gazing into his eyes and prayed that the years would last and last before he left home, committed to being a terrific parent. High hopes, great motivation, and passionate love were my driving forces.

Fast-forward thirty-five years and three kids later. They were all successfully launched, my nest was empty—yet I found myself riddled with guilt, regrets, and pangs of longing for a do-over. Why? Some of it, I’m sure, was the adjustment and transition to a different season of life, but at that point in time, as I grieved the end of those years, I could only recall the times that I was overwhelmed, disorganized, and emotionally dysregulated. And I asked myself, “What will they remember? Do they know how much I love them? Why was it so hard?”

I came “late to the game” so to speak, as an adult woman diagnosed with ADHD in my late forties after several of my children had been diagnosed. It explained a lot! And now, after years of studying and working in the field, I have learned a few things about the condition, which puts my lived experiences into a new perspective. It’s a perspective I wish I’d understood a long, long time ago, and which I’ll share now from the vantage point of an empty nest. Consider it a love letter to my children, my spouse, but most of all to you—the sisterhood of women living and loving with ADHD.

Women and ADHD
Thanks to the brilliant work of leaders like Kathleen Nadeau, Ellen Littman, Terri Matlen, and others, we have a growing awareness and understanding that ADHD presents with unique challenges for women.

Starting with a different and often later presentation than boys, and the ability to mask their symptoms—at quite an emotional cost—girls with ADHD are not infrequently misdiagnosed, diagnosed later, and receive lesser treatment than their male counterparts. As a result, untreated girls with ADHD often enter adulthood carrying the baggage of shame, anxiety, depression, and other behavioral health issues.

It is well documented that many of us receive our own diagnosis when our children are diagnosed. But what has happened in the interim? What’s it like to do “adulting,” and in particular “parenting,” when you are a woman with ADHD? We have learned a lot!

It all works until it doesn’t
I can sum it up in one short phrase that I learned at a conference presentation on women with ADHD: It all works… until it doesn’t!

I did well in school. I got good grades and was involved in choir, theater, cheerleading, and student government, never understanding that my hours and hours of extra studying to get those grades wasn’t normal, and that the pit in my stomach (all day every day) and an inability to fall asleep most nights wasn’t just adolescent emotions. I got overexcited when around friends and became “hyper-silly,” blurting out and saying things which may have been entertaining to some, but mostly served to embarrass myself. It was awkward. School and social life were hard, but I pushed through (largely due to loving parents and a strong extended family) and made it.

I moved onto college and that was even harder. I still wanted and needed those good grades, but to do so meant giving up all social life to have time to study the amount I needed to truly pack it all in my tightly wound brain—though I didn’t know that was it at the time. I found strength, comfort, and solace in a strong faith community on campus, but centered my schedule and life around my studies, surviving on hyperfocus, caffeine, several fabulous roommates, and prayer.

I knew I was different, and it was stressful. Fortunately, I made it through. I can’t imagine how demoralizing it would be for those who work just as hard but do not experience the fruit of their labors, which can often be the case in adults with ADHD. That was not my story, but it most certainly is what happens to others.

Then came college graduation, a long-awaited day! I knew I was at last moving onto freedom, unconstrained by the rigors of constant academics. Maybe now, I can start my life. I began working in the intensive care unit. ICU nursing is wonderful, combining deep knowledge and intense skills in a fast-paced environment. It was dopamine hit after hit all day every day for several years—until we switched to twelve-hour shifts.

Suddenly, my day-to-day routine began to unravel. Work got hard—my brain couldn’t stay sharp that long—and I began to feel yet another failure that had to be masked and kept secret. I dropped to part-time status and switched to a department with eight-hour shifts. It wasn’t a bad choice at all, but the feeling of failure clung to me like a shadow.

You are perhaps seeing a pattern here—a pattern not atypical for women who are undiagnosed or undertreated for ADHD. We are often anxious, depressed, high achieving, and can figure out ways to work around those things that are hard for us and seem so simple for everyone else. But usually we do so at a cost. We know we are underperforming according to our abilities, and it is frustrating. So, we adapt, make changes, quit jobs, scale back, and drop out of school or work, anxiously creating lists and schedules, systems and workarounds, white-knuckling it all day, every day, in an effort to match our limited executive-function capacity with the demands of our lives. It reminds me of a mural on the tunnel wall in my college dorm, which said, “Be a duck, calm on the surface and paddling like mad underneath.” If we’re lucky, while it’s just us and our time, it all works… until it doesn’t.

Marriage, children, and a household… oh my!
Marriage and the birth of our first child were dreams come true. I savored and relished all the moments of both. It was novel, new, exciting, and purposeful. As the years flew by and more beautiful children came into the fold, I treasured being a mother and loved with a ferocity that was unwavering. However, as much as I found love, purpose, and passion, I also became more and more short, irritable, frustrated, angry, depressed, confused, and frankly overwhelmed. My years of carefully laid systems and hacks to avoid my embarrassing deficiencies unraveled under the demands of parenthood.

According to family therapist and writer Sari Solden, motherhood and household maintenance can be some of the most unfriendly lines of work for women with ADHD. Clinical psychiatrist and ADHD specialist Sasha Hamdani explains that “motherhood has a way of making symptoms of ADHD bigger and harder to deal with.” I think the opposite is also true. ADHD makes motherhood bigger and harder to deal with as well.

While it was challenging as a single person to put together organizational systems and strategies for my own executive function needs, a family and a household now meant doing so for more and more people. It’s not just multitasking but repetitive, daily doldrums without dopamine hits. That is hard for a brain that is by definition already underaroused. I still held high hopes, motivation, and passionate love in raising my kids and co-managing our household, but unlike my earlier ideals, in the face of my as-of-yet-undetected ADHD, it wasn’t enough.

Disorder compounded as the pressures of motherhood built. The distractions were many and the mistakes real. Like the time I accidentally left the laundry room sink running while I went to answer the phone. Distracted after the call, I had forgotten about my previous task until I heard water running along the floor which was now pouring down the vents into the newly refinished basement bedroom below. I knew I was in serious trouble when I hollered out to the kids playing below to check the back bedroom, and heard the now-infamous response, “Wow, cool!!,” as water rained down through the light fixture destroying, bed, carpet, and sheetrock in the process.

Then there was the time I was asked to help a sick mom by taking her child home in the carpool for a week. My routine had been set so this was a new thing. And yes, I forgot the poor child at school, not once but twice in five days! I burnt candy cane Christmas cookies promised for the kids’ holiday concert because the multi-step process was too much for me. I often had to frantically run missed permission slips fifteen miles to the kids’ school. Sports uniforms seemed to never be laundered on time, and sometimes weren’t bought in time. I ran out of gas in the car (or skirted into the station on fumes) more times than I can remember. It was a frantic, chaotic way to live.

I hated letting down my kids, my spouse, the school, the coach, and my fellow parents with my all-too-frequent lapses and frantic down-to-the-wire near misses. I knew people were annoyed and didn’t know how to convince them that I was trying, wasn’t stupid, did care, and was capable—if only I could get it together. But willpower to change wasn’t enough, and I couldn’t seem to get there. I accrued deeply hidden feelings of inadequacy, which I tried to assuage with things I hoped I was good at—like a little teaching (nursing education) on the side, or serving on the school board, church committees, and being the team parent. But no matter how successful I might have been at those efforts, the home front still felt chaotic, and underneath it all, because I prized my roles as wife and mother most, I fought prevailing feelings of constant inadequacy.

The toll of an overwhelmed brain, additionally tapped by the emotional energy of masking and feelings of defectiveness, can cause many women with ADHD to develop clinically significant anxiety, depression, and emotional and physical exhaustion. I’m not proud to say that the resultant frustration I experienced with my own brain-based deficits was manifest in all-too-often shrieking tantrums at my children, all-too-ready displays of annoyance, and an abiding sense of futility with the housework. The “tone of the home,” as they say, certainly had moments of tenderness, spontaneity, caring, and love (in fact I was quite intentional about providing those), but in my mind, there was also an undercurrent of prevailing anxiety, quick flare-ups, and the sense of always waiting for the next ball to drop. It was a world of contradictions, so well described by Sasha Hamdani in a Momwell newsletter as:

• Wanting spontaneity but needing structure and organization
• Being understanding, nurturing, and attentive but feeling constantly overwhelmed
• Needing to be present for your partner and children but having your mind pulled and distracted all day every day

Motherhood has its treasures and challenges for all women. There are hills and valleys to navigate in all households. But motherhood when one has ADHD, according to an anonymous blogger I once came across, is like negotiating those hills and valleys on rollerskates.

Mom with ADHD with kids with ADHD?! Uh-Oh!
It doesn’t take a lot of imagination to picture a mom with ADHD (known or not known) who already has a hard time remembering appointments, the grocery list, and providing any form of daily consistency, having difficulties with the everyday management of any child. But what about when that child also has ADHD? Did you know that ADHD is as inheritable as height? Did you know that research suggests that children who were adopted have a higher likelihood of ADHD? If you have ADHD, it is highly possible that one or some of your children whether biological or adopted, will also have ADHD. I call this ADHD-squared.

Parenting when you have ADHD is hard. Parenting a child with ADHD when you also have ADHD is even harder.

If you are a mother in a household with ADHD-squared, it’s not just about remembering which day is your day to do the carpool line, it’s also about remembering to have your child take their medication every day, and get and pick up the prescription every couple of weeks, and keep and schedule the appointments needed to get continued treatment, and so on. Juxtaposing one’s own struggles with consistency, frustration tolerance, organization, and memory against your child’s same deficits and their needs for consistency, patience, organization, and structure to thrive can feel like a tsunami of complex obstacles in day-to-day life. For a child who requires intentional patience and calm to manage outbursts, a mother who tends to have a reactive and short emotional fuse is not the obvious choice for the best fit and a positive outcome.

Furthermore, studies have shown that interventions for kids with ADHD are often less effective if a parent has ADHD and even worse if the parent has untreated ADHD. It cannot be put more plainly. Parenting when you have ADHD is hard. Parenting a child with ADHD when you also have ADHD is even harder (of course). But here’s the thing. There is hope, there is help and when you know better, you do better.

There’s hope and help—education and strategies
In my search for the best information to guide us in helping our children navigate the world of ADHD, I was constantly looking for the magic bullet, the one thing I could hang my hat on and give full throttle to ensure successful outcomes for my kids. It’s no surprise that a magic answer simply doesn’t exist. However, in my search I happened upon a compelling repeated finding from the literature, paraphrased as: The greatest predictor of successful outcomes in kids with ADHD is the emotional health of the primary caregiver. That is some takeaway message if there ever was one, and that message is: You matter! If you want your child with ADHD to do well, pay attention to you!

If you are a woman whose struggles have led you to suspect you may have ADHD, go and get assessed. If it is ADHD, the diagnosis can be life-altering as you begin to make sense of the challenges and struggles you have had all your life. If you find you have ADHD, be sure you get well educated and optimally treated. According to much of the literature on parenting and ADHD, the best support you can give yourself, your partner, and your children (with and without ADHD) is threefold:

• Understanding how your brain works
• Playing to your strengths by carving your own path and vision of motherhood
• Creating an ADHD-friendly environment in your home (See the blog by Bob Seay.)

The following list is a compilation of more specific tips from recent literature:

• Get assessed and embrace the diagnosis if you have one.
• Understand how your brain works.
• Get treated by discussing management options with a qualified licensed professional.
• Learn all you can about ADHD and educate others. (See the blog by Keath Low.)
• Address ADHD as a family issue.
• Take a problem-solving approach to household and personal challenges.
• Explore and investigate specific strategies for putting routine, organization, and structure into an ADHD friendly home. (See the article by Sari Solden.)
• Play to your strengths! Carve out your own path.
• Be flexible with yourself and others understanding capacity shifts from day to day and even within a day. (See the Momwell interview with Sasha Hamdani.)

Asking my grown children
These are the things I wish I had known about my ADHD when I became a mother. I didn’t learn about them until much later in the child-rearing years, hence perhaps, my empty-nest regrets and wishes for a do-over. Knowing what I do now and with my children grown and gone, I have wondered, how do my children remember me as their mother?

Shortly after my nest emptied, as I wrestled with the adjustment and my emotions, I channeled my impulsivity and fired off a little survey to all my children, asking them, “Growing up, did you know your mother loved you? What memories (good or bad) do you have of being with your momma?” I braced myself for the responses. Here is how they replied:

These reflections are kind, sweet and fill my heart. Without taking away from what I know are possible unspoken harder memories and scars from the mistakes I made as a mom dysregulated by ADHD, for which I will always beg pardon, I pause to let those sweeter sentiments sink in and say to myself, “Whaddaya know? The love prevailed!”

These are the things I wish I had known about my ADHD when I became a mother. I didn’t learn about them until much later in the child-rearing years, hence perhaps, my empty-nest regrets and wishes for a do-over.

Having ADHD doesn’t make you a bad mother, but it may make you a mother with challenges to overcome. Rather than struggling and later wishing for a do-over, embrace the diagnosis, get treated, find and employ strategies, and instead, do a do-forward!

Jane Indergaard, DNP, RN, is an associate professor of nursing at Concordia College in Moorhead, Minnesota, and a licensed registered nurse in North Dakota and Minnesota. A recognized regional, national, and international speaker on ADHD, she has presented on the underdiagnosis of ADHD in women, the impact of hormonal fluctuations on ADHD symptoms across the lifespan, the impact of ADHD on siblings, and the enhanced impact of comorbidity with ADHD and family stress. Dr. Indergaard is a long-standing passionate provider of education, advocacy, training, and outreach for individuals living with ADHD. She provides consultation for multidisciplinary psychoeducational programming for providers treating individuals with ADHD. Her current research and clinical interests focus on the impact of hormonal fluctuations on women with ADHD, neurocognitive disorders and ADHD, clinical practice guidelines for adult ADHD, and the design and implementation of psychoeducational programming into provider treatment for ADHD. Dr. Indergaard is the co-founder of the award-winning Red River Valley CHADD, and she currently serves on CHADD’s board of directors and the editorial advisory board of CHADD’s Attention magazine.

ADDITIONAL READING

Erica Djossa interviews Sasha Hamdani, Advice for Moms with ADHD: Challenges, Solutions, and How to Find Your Own Path, Momwell: Ontario, Canada, December 2022.

Keath Low, Parents with ADHD Raising Children with ADHD, Verywell Mind, updated November 2023.

Bob Seay, SuperMom Is Overrated! ADDitude.com; updated 2022.

Sari Solden, Overwhelmed Mom Syndrome—It’s a Real Thing, in ADDitude magazine, October/November 2007; updated 2021.