ADHD in Women

ADHD in Women

If you feel like you’re hearing about more and more women being diagnosed with ADHD recently, you’re not wrong! Many women don’t receive a diagnosis until well into their 30s or 40s, while the average age of diagnosis for men is much younger.

ADHD affects men and women equally, but many young girls go undiagnosed for years, only to have their symptoms recognized in later years. Let’s talk through what ADHD is, and why there have been challenges in identifying and diagnosing it properly in women.

First, we’ll look at some of the classic symptoms of ADHD, which are commonly broken up into two main categories: hyperactivity and inattention.



  • Restlessness
  • Being uncomfortable sitting still
  • Talking excessively or out of turn
  • Interrupting others or having difficulty waiting your turn
  • Fidgeting



  • Difficulty focusing
  • Trouble staying organized
  • Distractibility
  • Forgetfulness


There are three main types of ADHD: primarily inattentive type, primarily hyperactive type, and combined type. What previously used to be known as ADD (Attention Deficit Disorder) now falls under the umbrella of ADHD.

These diagnostic criteria seem pretty straightforward, but for many people, especially people who are assigned female at birth, it’s not so simple.


Diagnostic Bias

When ADHD was first being understood, researchers focused heavily on symptoms seen in young boys, there was even a time when it was thought that young girls couldn’t have ADHD!  These young boys showed symptoms like having trouble staying seated, causing major disruptions in class, and having behavioral issues.

To put it frankly, researchers just didn’t see these same concerns in young girls as often, so the diagnostic criteria that resulted didn’t consider how young girls might be struggling. When a young girl started struggling with what we now know to be ADHD, she wouldn’t fit the criteria for ADHD, and then would go undiagnosed and untreated.



Another major reason women are either undiagnosed or diagnosed later in life is because of social conditioning, and a phenomenon known as masking. If you’ve ever felt like you had to put on an act to get through a social situation, you were likely masking.

For many girls and women with ADHD, the strict social rules of how women are “supposed” to act cause them to mask ADHD symptoms that wouldn’t be viewed positively. Masking to get through a short social interaction isn’t necessarily detrimental, but many women with ADHD end up masking all the time, sometimes even so much so that they don’t realize they are doing it until they learn about their symptoms and let themselves drop the masks.


So what does ADHD look like in women?

The symptoms of ADHD are essentially the same between men and women, but the way they present can be very different.

Women with ADHD often experience things like:

  • Rejection sensitivity dysphoria (severe emotional pain to perceived rejection or exclusion)
  • Fears of judgment for symptoms of disorganization, forgetfulness
  • Self-esteem issues from perceptions of laziness or trouble with motivation
  • Sensory issues and being easily overstimulated
  • Sleep issues
  • Changes in symptoms and severity of concerns in alignment with menstrual cycles
  • Mental exhaustion from ongoing masking/symptom management
  • Identity issues after struggling to know who they are authentically vs. who they felt they had to be


How is ADHD being diagnosed in women?

 ADHD is formally diagnosed in the same way for men and women. A mental health care provider provides an assessment based on historical and current symptoms, but again many of these diagnostic assessments are focused on male-centric symptoms, so it takes a trained provider to notice the ways this might show up in women.

Many women first acknowledge ADHD symptoms after a major life transition. Moving to college, living on their own, and having children can all be common times for this. It’s not that the symptoms weren’t present prior to these life changes, it’s that the person may have lost systems of support that previously helped them cope, or their responsibilities have increased to a level that they can no longer manage with previous coping skills or masking. For some women, it’s not until they notice symptoms in their own children that they reflect on their own childhood/development!


If any of this sounds familiar, reach out to one of our ADHD specialists for support!

Meet Your Therapist: Alyx Aiello

Meet Your Therapist: Alyx Aiello

I had the pleasure of talking with one of Star Meadow’s newest therapists, Alyx Aiello, who focuses their work on the impact of trauma, especially the intersection between religious trauma and marginalized groups.

Alyx was born and raised in Portland and received their bachelor’s degree from Southwestern Oklahoma State University and their master’s in Clinical Psychology from Northwestern State University of Louisiana. They are a Licensed Mental Health Counselor, seeing adult clients with a wide range of concerns including their specialty areas of religious trauma, those with experiences with cults and high-control groups, LGBTQ+ clients, and more general concerns like depression, anxiety, and self-esteem challenges. Keep reading for a Q&A with Alyx, and if they sound like a good fit for your needs, reach out to schedule an appointment!


Q: Tell me a little about your clinical specialties or particular areas of interest?

A:  I think depression and anxiety are really common for marginalized groups and that’s something I’m very comfortable working with. Figuring out their comfort of presentation, whether that’s just presenting themselves as someone with a sexual orientation that isn’t straight or a specific gender presentation, whatever that means for them. I’m interested in helping people achieve their gender euphoria.

 As far as modalities, I’m very eclectic, but generally gestalt and existential.


Q: Can you tell me a bit more about what you mean by religious trauma?

 A: There’s a lot of folks who come into my office who struggle to have positive beliefs about themselves based on the harmful experiences they’ve had with religion. Fear of doing something wrong and fear of being bad or that you are a bad person because of XYZ. Doubting every choice and decision and even sometimes not trusting yourself.

It feels like a highly gendered trauma to me. What is religious trauma and what presents as religious trauma in different people I think probably has to do with the gender that either they are or they presented at the time of the trauma.

One of the things that I want to stress to future or present clients is that I am not anti-religion. I’m just not. I believe that each person has to make their own choice and if that choice for them is to stay within or even just believe some of the things that they were taught or believed from the religion that hurt them- that’s okay! We can work with that too! You don’t have to be an atheist or even an agnostic, you can come from anywhere and still deal with the trauma and move forward. I want to make it so it doesn’t feel like they have to completely divorce themselves. Especially if it’s a cultural experience because I know for a lot of people it really is, so I want to be culturally sensitive. I’m so excited to help them figure out what that looks like, but above all, help them believe that they are good inherently and that there’s nothing wrong with them just the way they are.


Q: What’s a typical session with you look like?

A: I use humor a lot, I’ve noticed it helps people feel more comfortable and it’s just part of who I am as a person. As far as formality, I don’t use a ton of self-disclosure, and I really encourage clients to speak the way that they speak. So, if they swear, that’s great, I don’t mind at all. However they communicate is what I want!

Some clients like a week-to-week check-in, that’s what they come in for and I appreciate the benefits in that. Other clients have long-term, overarching treatment goals that they want to work on, and getting lost in the week-to-week stuff can be challenging. I try to have clients talk about their week for 10 minutes or so, then recap the last session to learn how it went for them. Then we dive into the meat of the treatment goals and end with a 5-minute cooldown, thinking about “how are you going to take care of yourself after this session?”, especially if it’s really intense. I try to respect each client’s preferred structure and work with that, but I if I had to suggest something to a client the structured approach would be my preference


Q: Are you conducting sessions in person or by tele-health?

A: Both!


Q: What do you believe about therapy?

A: Therapy is work. It can be really hard work, but also has the potential to be tremendously rewarding, in my experience. I believe my job is to help clients in that work with pacing, taking on a manageable amount, and overall making things as easy and fluid as possible. Therapy is also safe. This is your time. Oftentimes, therapy is some of the only time and space just for the client, and I want to honor that as much as possible with a safe and validating atmosphere.


Q: A phrase or quote clients will likely hear me use is _____. 

A: I actually have it on my wall- Kristen Neff “self-compassion wants well-being”, and so when my clients are really like resisting and saying “I don’t deserve nice things” I’ll say “do you want to be well?”.


Q: When you come into my office I hope you feel _____. 

A: I hope you feel safe! I strive to provide a safe, warm, and validating space for each client who comes my way. I want you to feel that you’re able to fully express yourself in session and be received with warmth and empathy.


Q: Can you tell me about you as a person outside of the therapy room?

A: l love animals, exploring the PNW, and bouldering. I like traveling and I come from a big family!


Alyx is now scheduling new client appointments!

Schedule an appointment with Alyx Aiello today!

Seasonal Depression and The PNW Rainy Season

Seasonal Depression and The PNW Rainy Season

What is SAD?

Seasonal Affective Disorder (SAD), often called seasonal depression, is estimated to affect roughly 5% of the population at any given time. Although it can occur with any seasonal change, the predominant timeframe is depressive symptoms starting with a fall to winter onset, and a spring to summer remission.

For areas of the country that experience harsh fall and winter weather, SAD can be especially prominent or severe. For example, research shows that the estimated prevalence in Florida is only 1%, but that number rises to 9% in Alaska. With the Portland-Vancouver metro area receiving an average of 140-160 days of rain a year and especially limited sunlight in the late fall and winter, it’s no wonder we experience some of the highest rates of depression (and seasonally related depression) in the country. Many people who live in the Pacific Northwest find comfort and peace in the gloomy, rainy days, but for others, the seasonal change can bring dread for the impending shift in mood and overall happiness.

If you notice you struggle significantly during the fall to winter months, you are not alone. Some people struggle with a less severe version of the same symptom profile, often called the “winter blues”. If these symptoms start to become intense enough to impact your daily life, it’s worth checking in with a mental health professional and/or primary care provider to help you find the right support.


What does SAD look like?

Symptoms of seasonal affective disorder can look very similar to other forms of depression, but they markedly follow a seasonal pattern. AFAB (assigned female at birth) people appear to be affected at a great rate, though the reason for this difference is unknown. The average age of onset of symptoms is around 20 years old, but it can affect people of all ages. Some symptoms to look out for as we move into fall and winter include:

  • General feelings of sadness
  • Fatigue despite increased sleep
  • Loss of interest in previously enjoyed activities
  • Difficulty concentrating
  • Carbohydrate cravings and increased appetite
  • Irritability
  • Changes in libido
  • Feelings of hopelessness


What causes SAD?

While it is unknown what specifically causes SAD, research shows that sunshine certainly plays a factor, and circadian rhythm, hormonal factors, serotonin levels, genetic factors, and preexisting depression symptoms may all play a role. Some theories speculate that reduced sunlight exposure causes the body to produce and release more melatonin, a naturally occurring hormone that induces sleepiness and helps regulate circadian rhythms.

We may not know the exact biological mechanisms or reasoning for seasonal affective disorder, but because so many people experience similar symptoms, we do have some options can be done to reduce their severity.


What helps?
  • Light therapy and more time outside

Because we know that SAD is at least partially due to reduced sunlight exposure and changing daylight patterns, it stands to reason that increased sunlight can help manage symptoms. In places where natural sunlight is difficult to come by during the fall-winter months, devices called lightboxes can be a great option to try. Check out this guide to picking an appropriate light therapy box.

  • Therapy

Support from a mental health professional is important any time you’re experiencing depressive symptoms that are interfering with your daily activities or quality of life. A variety of therapy modalities can be effective in managing seasonal depression, but cognitive-behavioral therapy has specifically been shown to reduce symptoms. There is strong evidence that the impact of CBT is even greater than that of light therapy and has the power to provide protective benefits in seasonal changes even in future years after initial treatment.

  • Medical Assessment

If you notice symptoms of SAD, it’s important to see a medical provider to rule out other causes (things like anemia, vitamin deficiencies, thyroid issues and other health conditions can present in symptoms that look like depression). If they conclude that SAD is the presenting concern, they may be able to suggest lifestyle or medication changes to support you through this time. They may also refer you to a mental health prescriber (like a psychiatrist or psychiatric nurse practitioner). In some cases, psychotropic medication can be a helpful supplement, and a prescriber with a specialty in this area can help you weigh your options.

If you or someone you care about seems to be experiencing depressive symptoms, (seasonally or otherwise) don’t delay in reaching out for help. There are treatment options available, and people ready to help you get back to feeling well – even during rainy season!

Seasonal Depression and The PNW Rainy Season

Seasonal Depression and The PNW Rainy Season

What is SAD? Seasonal Affective Disorder (SAD), often called seasonal depression, is estimated to affect roughly 5% of the population at any given time. Although it can occur with any seasonal change, the predominant timeframe is depressive symptoms starting with a...

Teen Mental Health: Post-Pandemic Edition

Teen Mental Health: Post-Pandemic Edition

It’s no secret that the pandemic has had profound effects on the mental and emotional well-being of our society. Rates of mental health struggles have skyrocketed in response to experiences of isolation, grief and loss, economic hardship, safety fears, and increasing uncertainty about how the future will unfold.


Prior to the pandemic, it was clear we were facing a youth mental health crisis, but the experiences of a pandemic have proved to amplify this already concerning situation. For teenagers, experiencing a pandemic has caused an uptick in mental health concerns during a developmental period that in the best of times is already fraught with stress, self-esteem concerns, and constant change.


These youth have missed out on normative and expected experiences of high school like after-school clubs, dances, sporting events, and graduations.  They’ve received substantially less in-person support from teachers and support staff, clubs and support groups for marginalized identities, and for some kids, tangible support like food assistance and access to supplies.  Without regular contact from professionals trained to notice early signs and symptoms of mental health concerns, many children went without care for significantly longer than they would otherwise, leading to more severe symptoms and potential safety concerns.


The effects of the pandemic disproportionately affected communities of color, amplifying stress for those teenagers. Experiences of racism and discrimination, both those related to and co-occurring with the pandemic, have continued to erode youth mental health.


Ask any teenager or teacher, parent, or mental health therapist who regularly interacts with teens, and they’ll have anecdotal evidence of these increases. Now, nearly 3 years after the pandemic began, we are finally able to collect and analyze data on how teenagers have been affected. Here are a few key points:


37% of high school-aged students reported they experienced poor mental health during the pandemic1.


44% reported feeling persistently sad or hopeless during this time1.


Emergency room visits for suicide attempts were 51% higher for female identifying-youth, and 4% higher for male-identifying youth when compared to the same time period prior to the pandemic in 2019 2.


What can we do?

Seeing these statistics can be frightening, especially when they are the result of something beyond our control and related to responses that were critical to maintaining physical safety within our communities, but it does also give us insight into how to begin improving this crisis.


  • School

The data, combined with years of anecdotal experience from school staff, has spurred many school districts into action to increase support programs and access to mental and emotional well-being resources. In the same study, school connectedness, defined as “a sense of being cared for, supported, and belonging at school” was a clear protective factor. High school students who felt connected to support at school were 20% less likely to report persistent sadness and hopelessness, 12% less likely to consider suicide, and 6% less likely to attempt. Working to create a safe supportive school environment is a crucial step for all communities.


  • Home

Treat your teens with care. The pandemic has affected us all, but teens have experienced a version of difficulty that is nearly impossible for adults to fully comprehend. Make space regularly to talk about how they’ve been affected, and acknowledge how challenging this has been for them without diminishing it in relation to others’ struggles. Support their efforts to maintain relationships and be a safe place to process uncertainty, fear, and sadness.



  • Professional Supports

If they aren’t already, now is the time to get your teen connected to a therapist. While the role of a supportive family is paramount, having a specific, private space to process their emotions and fears is vital in helping improve their mental health. A trained professional can offer tailored coping skills, referrals to other providers as needed, and above all, the feeling that their emotional struggle has been seen and heard. Even if your teen has not been showing obvious signs of a mental health struggle, ask them. Many teens cope by keeping things bottled up, and they may not know how to ask for help. Offer to connect them to a therapist regularly, and if or when they say yes, follow through until they find a match.










Seasonal Depression and The PNW Rainy Season

Seasonal Depression and The PNW Rainy Season

What is SAD? Seasonal Affective Disorder (SAD), often called seasonal depression, is estimated to affect roughly 5% of the population at any given time. Although it can occur with any seasonal change, the predominant timeframe is depressive symptoms starting with a...

Deep Breathing: Why Do It?

Deep Breathing: Why Do It?

If you have ever felt frustrated by being told to just "take a deep breath" when you are feeling angry or anxious, you aren't alone. It's difficult to heed this advice when, in the moment, the mind and body are distracted or dysregulated. The adage of "just breathe"...

The Young Adult’s Guide To Navigating Family Boundaries

The Young Adult’s Guide To Navigating Family Boundaries

Healthy boundaries are the building blocks of healthy, successful relationships, but they can be a challenge to navigate, especially as relationship dynamics change and evolve. In many families, children grow up with a clear sense of the family hierarchy and an understanding that the parents set the expectations and family “rules”. It can be a struggle then, when that child grows into an adult, to know how to navigate a new relationship dynamic. Even in loving and healthy families, many young adults struggle with feeling pressure to conform to their family’s expectations from earlier years, but stifling their own needs and wants for the sake of keeping the status quo can quickly lead to resentment and relationship issues. 


Let’s explore a few scenarios. You’ll notice in each one of these that the example of a boundary that could be set is more focused on what you will do in response to their choices. We cannot force other people to change their behaviors to be in alignment with our needs, but we can express our needs, and inform them what we will do if those are not respected.  


1.  Your family dresses modestly and chooses to not express themselves through clothing, hair, etc.  You have recently found joy expressing yourself in this way, but find yourself dyeing your hair back to your natural color, covering tattoos with makeup, and dressing in clothing that you don’t like when you visit them because they make harsh comments or quietly shake their head when they see you.

The intention: “I tone my self expression down so I don’t make anyone uncomfortable and I don’t draw negative attention to myself. 

What you’re reinforcing: “I can’t be myself with these people, they won’t understand me”

A boundary that might need to be set: “This is how I have chosen to express myself, and as long as my appearance is appropriate for the event and the weather, this is how I will look. 

The outcome of that boundary: Powerful authenticity, showing up as yourself regardless of what others think. 


2. Your family is very extroverted and enjoys large gatherings that go late into the evening. You are an introvert and find that after a few hours, you are wanting to leave, but tell yourself you have to stay. 

The intention:  “This is what our family does, I need to stay so I don’t offend anyone”

What you’re reinforcing: “Everyone else’s needs are more important than my own.”

A boundary that might need to be set: “I love you all and have had fun, just letting you know I’ll be heading out at 10”. 

The outcome of that boundary: Signaling that your needs are important and that you do not need to explain yourself. 


3.  You are parenting your children in a different way than you were parented. When your child refuses to eat dinner or has a meltdown after a conflict with a cousin, other family members jump in and attempt to discipline them. You are uncomfortable, but don’t want to speak up. 

The intention: “If I jump in, I’ll offend them because they’re disciplining exactly how I was raised. I’ll seem ungrateful or like I think I’m better than them”. 

What you’re reinforcing: “They don’t see me as a capable parent. My child is seeing me not step up even though I”m teaching them something different at home.” 

A boundary that might need to be set: “I am their parent, so any discipline or behavior management is my job, even if it looks different than how you would do it. If you continue to try to discipline him, we will need to head home early. ”

The outcome of that boundary: Confirmation that you get to make the parenting choices with your own children, and your child sees a healthy boundary being modeled. 


4.  When you spend time with your extended family, they routinely make rude comments about your weight and eating habits. In the past, if you ask them not to, you’re met with comments like “learn to take a compliment!” or  “we’re just worried about your health”. You eventually fake a smile or laugh and go along with it. 

The intention: “They don’t mean any harm, so I’ll just be quiet when they do it.” 

What you’re reinforcing: “I’m forcing myself to be ok with these comments so I don’t upset anyone else.”

A boundary that might need to be set: “Regardless of your intention, I’m not comfortable with you commenting on my weight or eating habits. If you continue to make those comments, I’ll have to excuse myself from the event”. 

The outcome of that boundary: An act of self-love, creating an environment for yourself that does not include shaming from family members. 



Boundaries, especially those that are disrupting long-standing patterns, are almost always met with some level of shock or surprise, some level of pushback, as well as some awkwardness. Managing the discomfort that comes with setting the boundary and staying firm in what you need, is usually worth what’s on the other side; authenticity, confidence, peace, and healthier relationships.  So, if no one has offered you this before, here is your official permission to redefine your boundaries, to say no, and to value your own needs and wants.