'To test or not to test?' ADHD and midlife women – including me (it seems)
Updated: 32 minutes ago
Between recovering from half term, pumpkins, bonfires and autumn's arrival, I’ve been Pausing and Reflecting on a few things this week…
I've been daring to hope that the world is spinning on a slightly more even keel based on the news this week: The bravery of the women in the Russell Brand trial getting some justice for womankind; Donald Trump's massive loss to the Democrats in the mid-terms; and a glimmer of EU hope that barriers might not have to be so impenetrable.
Whether to open a Substack. Is it just me, or is anyone else increasingly frustrated by the noticeable shortening of their attention span? I worry I'm spending too much time scrolling short form on Instagram – ironically, like the carousel I'm just about to post. Is it time to lean into expanding my word count more regularly? Or maybe I just need to blog more here to flex that muscle. What do you think?
And this one has been big for me this week – to ADHD test, or not to test? That is the question. I've been wondering whether an official assessment could explain a lifetime of living a little bit on the edge. Let me explain some more – pull up a pew, dear reader...
The Great ADHD midlife reckoning
I can already picture the well-meaning, yet poorly disguised eye-roll from certain friends and family members when I tell them the news. I suspect they will fall into two camps: “Really?” or, perhaps, “Not another one.”
The flood of midlife women receiving ADHD diagnoses has become a cultural talking point, met, in some quarters, with a healthy dollop of skepticism. So, suspecting my own symptoms brewing over the last few decades, and seemingly coming to head in my fifties, part of me wonders: maybe I won’t bother testing. Or, maybe I just won’t tell them. Or, perhaps they've been thinking this about me all along anyway? In the end, I have decided to write my thoughts down, so we can all read about it here first, and to be a friend to others who are busily suspecting the same. Research shows there's rather a lot of us. I’ll suck up the eye-rolls, because understanding this feels too important to hide.
I know I’m not alone. Data shows a seismic shift in women seeking ADHD answers. Recent health data shows that the surge in adult diagnoses is almost entirely driven by women identifying they are neurodiverse later in life. According to NHS Digital figures, adults now make up nearly three-quarters (73.4%) of all open ADHD referrals in England, with self-reported rates among women climbing. Clinical studies highlight that women are diagnosed on average 5 to 10 years later than men, largely because high-functioning masking, people-pleasing, and coping strategies delay recognition until midlife, when perimenopause causes a severe drop in oestrogen (and subsequently dopamine). In fact, recent NHS data reveals that roughly half of women diagnosed in their 40s and 50s were misdiagnosed first with depression or anxiety before their core neurological traits were finally recognised. This is exactly what happened to me.
Who likes following rules anyway?
When I first paid a visit to my GP in 2021, aged 46, suspecting that a combination of stress and perimenopause was causing my erratic sleep patterns and feelings of overwhelm, I was prescribed the antidepressant Sertraline. It really helped. And I’m not against people finding
support from an antidepressant when it is needed, and in fact when I tried to ween myself off it a year later I found myself hitting a major low point in October 2022 when I teetered to on the edge of full burnout and was signed off work with ‘psychological exhaustion’ - an experience I have written about extensively and forms the inspiration for my new book The PRO Method: Pause, Reflect, Organise, Three Simple Steps To Reinvent Your Life.
Yet when the penny dropped fairly recently that perhaps latent ADHD could also be at work here, I had a quiet cry. We were on a family holiday in Croatia, when, on seeing a sign at the side of the road which clearly illustrated ‘Please Use The Pavement’, I decided to continue walking on the road.
‘Why should I follow the rules and walk on the pavement?’ My husband, Callum, jested. He was ribbing me, but the meaning was clear. It has since become a family joke: ‘Why should I wait for the Green Man?’, ‘Why should I have to do my accounts when it bores me to tears?’ etc etc
It turns out the person who has lived with me every day for 17 years (my husband) had suspected it for a while. The catalyst for my own realisation wasn’t a sudden midlife epiphany, but watching the same unmistakable traits surface in one of my sons. Wanting answers for him led us to embark on the testing process together via the NHS Right To Choose pathway - a route that bypasses traditional multi-year waiting lists by connecting patients directly with accredited diagnostic centres near them.
So after completing a number of online questionnaires, on Friday I had the first video assessment with a kind lady who ran through a series of questions about my current relationship with carrying out tasks, focus and so on, both in childhood and currently.
Looking back, the signs weren’t always written in bold
I don’t remember being particularly fidgety or behaving differently to any normal inquisitive and creative child, and neither do my parents, although they do consider ‘perfectionism’ and ‘busyness’ a key character trait. As a teenager, I drove my parents up the wall to a degree I am told my brother and sister never quite matched. Through sneaking out nightclubbing, telling porkies about my whereabouts on a Saturday night – the Memphis Belle incident is a core memory of being caught out when it became apparent I definitely wasn’t at the cinema watching said film – or quietly helping myself to drinks the moment a bartender’s back was turned. My saving grace was "butter wouldn't melt" looks that somehow insulated me from serious consequences, leaving me with little more than the odd weekend grounding. Back then, I assumed I simply had a ‘naughty streak’ - a penchant for making a bee-line for the edge, but never enough to land in big trouble. Didn’t all teenagers in the 1980s have a hedonistic streak? I mean compared to the kids on Grange Hill I was tame. So I don't imagine I would have been diagnosed with ADHD, even if it was a thing back then.
Later, that neurological wiring became one of my greatest professional assets. As a journalist, when someone was needed to "go from Z-list to A-list in 24 hours" and blag their way into the Oscars, like the feature I wrote for Glamour magazine, there was zero hesitation in putting my hand up for the commission. Of course I was going to do it. With a bright smile, I slunk past red ropes when bouncers looked away. I ended up bagging the money shot: wearing a borrowed Alberta Ferretti gown and Jacob & Co jewels worth more than my tiny London flat, holding an actual Oscar borrowed from a winner inside the strictly no-photography inner sanctum of Elton John’s party. Where others felt panic at breaking the rules, my brain felt a crystalline focus.
That same drive left a trail through my personal life. For years, traditional monogamy held little appeal - it simply didn't offer enough excitement. Sneaking into a St Martin’s Lane Hotel for a late-night rendezvous with a famous rockstar suited my need for novelty perfectly. Even when my now-husband of 15 years proposed, my reflexive response was to run – commitment felt like closing a door on the unknown. Luckily he knew - correctly - what I was yet to see, so I’m grateful he gave me time to come to my senses, and I’m glad I ended up saying yes – once I had made the decision for myself. ("Why should I say Yes, just because you've proposed to me?).
The Science Behind the Spark
What we used to label a "naughty streak" or even an "addictive personality" is rooted in dopamine dysregulation. In a neurotypical brain, dopamine functions smoothly as a reward and motivation signal. In an ADHD brain, baseline dopamine levels are lower, and the brain's baseline transmission of norepinephrine - which governs attention and arousal - is altered. To feel engaged, an ADHD brain actively seeks out high-stimulation environments, novelty, risk, and immediate feedback.
This can lead to high-stimulation strengths, like:
Hyper-focus under pressure
Rapid risk-assessment
Intuitive problem-solving
Entrepreneurial agility
Yet there are also daily challenges, like:
Working memory gaps
Time blindness and fatigue
Emotional dysregulation
Susceptibility to burnout
The Perimenopause Collision
Across the UK, thousands of women in their 40s and 50s are arriving at the same realisation. For decades, ADHD diagnostic criteria were modelled almost entirely on hyperactive young boys. Girls, whose symptoms more commonly present as internal restlessness, chattiness, interrupting others, or being labeled "too much," learned to mask. We compensated through willpower, hyper-vigilance, and busyness, which serves us well up to a point. Then along comes perimenopause.
As oestrogen levels fluctuate and plummet during midlife, dopamine production drops alongside it - oestrogen plays a direct role in modulating dopamine receptors in the brain. The coping strategies that held our lives together through our 20s and 30s suddenly destabilise. What was once managed as "a busy lifestyle" or "being a bit scattered" can escalate into severe brain fog, anxiety, and cognitive fatigue. Many women spend years believing they are failing at midlife, only to discover their brain architecture has been playing by different rules all along.
The Cortisol Cascade and Burnout
In my case, that neurodivergent compulsion to lean into things completely – to chase the thrill of the deadline and the high of scooping the exclusive – were excellent strengths to have when I was editor in chief of HELLO! But the pace eventually took its toll. The 'always-on', constantly evolving news agenda and 24/7 digital media culture didn't just suit me; it fed my brain's craving for intensity.
That is, until 2022, when, 15 years into the job, I hit a wall both cognitively and physically and my body stopped me in my tracks. I was diagnosed with ‘psychological exhaustion’ - one stop before full burnout - and I was signed off work for a few weeks. In my book, The PRO Method, I write about the physical reality of chronic stress - specifically the cortisol cascade and how this impacts wellbeing. When you live with unmasked ADHD, your nervous system relies heavily on stress hormones (adrenaline and cortisol) as an artificial mechanism to generate focus and meet deadlines. You literally drive your brain forward using fight-or-flight energy, but over time, this chronic elevation of cortisol damages sleep cycles, dysregulates immune function, and exhausts the adrenal system. In 2022, my plummet towards burnout wasn't an isolated event; it was the inevitable destination of an ADHD-informed compulsion to run at 100mph without a baseline mechanism to slow down. And I'd been doing this for the best part of three decades working in the media.
I am now realisting why, after all my research into the neuroscience of burnout, which I have poured into my coaching method, The PRO Method. If you've not read it yet, the PRO stands for the three stages of Pause, Reflect and Organise. The phases of Pause and Reflect are so, so critical not only to me but countless others for whom my story resonates, because we’ve spent 90% of our lives in Organise mode. It's no wonder we're exhausted.
So, as I look ahead to the next stage of my ADHD assessment next week, and what the outcome might be, perhaps I’ve already answered my own question. Will a positive result change anything about how I conduct my life? Would I want to medicate myself? I’m not sure I would. I’m actually very content with the way things are turning out, and many of these qualities serve me well in my entrepreneurial journey too, where a portfolio career and ability to wear different hats is a strength at this stage. I can even laugh along with the ribbing from my family. I have learnt to build micro pause moments into my day and I ring-fence 'thrive time' in my diary. It’s all self-awareness and I’m here for that.
I'd love to hear your thoughts on ADHD and midlife women. Have you had a recent diagnosis? Are you thinking about doing the assessment? Please share under my post on this subject on Instagram at @rosiejnixon. Hell, maybe I'll put this on Substack too!
Love
