Adult ADHD Evaluation for Women in New York and New Jersey

Many women who ask about ADHD in their 20s, 30s, 40s or later were described as dreamy, chatty, disorganized or anxious as girls, and no one connected it to attention. Others did well in school with a lot of hidden effort and started to struggle only when work, a household or children added more to keep track of. This page covers why ADHD in women is often recognized late, what research on hormones does and does not show, what is worth bringing to an evaluation with Dr. Shershow, and which New York and New Jersey rules matter if treatment includes medication.

Why ADHD in women is often recognized late

A 2020 expert consensus statement in BMC Psychiatry, written by 22 clinicians and researchers, set out several reasons girls and women are missed:

• Quieter symptoms. Community studies point to more inattentive-type ADHD in girls than in boys. Less visible symptoms are less likely to lead to a referral, so inattentive girls are more often missed.
• A different diagnosis first. Women may be more likely to receive a primary diagnosis of an internalizing condition such as anxiety or depression, and the authors note it is not uncommon for adults with ADHD to be treated for anxiety or depression first.
• Coping that hides the problem. Some girls and women become good at camouflaging their struggles with compensatory strategies, which can delay referral.

The same paper notes that boys outnumber girls in childhood clinic referrals by ratios from 3 to 1 up to 16 to 1, while in adult samples the sex difference is more modest or absent. That gap is consistent with many women being diagnosed later rather than not having ADHD.

National data point the same way. In the CDC's 2023 survey of US adults, 55.9% of adults with a current ADHD diagnosis had received it at age 18 or older, and women made up 44.2% of adults with a current diagnosis. An earlier CDC analysis of commercially insured patients found that stimulant prescription fills among women rose 13.9% from 2020 to 2021, with increases of 15.9% to 17.5% in each five-year age group from 25 to 39. The authors could not tie that rise to any single cause.

None of this means that a woman with attention problems has ADHD. Trouble finishing tasks, losing track of time, a sense of constant mental effort, or being told "you are so capable, why is this hard?" can be signs worth discussing with a clinician. The guide to ADHD in women covers the symptoms in more detail, and the adult ADHD self-test is a screening tool, not a diagnosis.

Hormones: what the research shows and what it does not

The consensus statement says ADHD symptoms may be made worse by hormonal changes during the menstrual cycle, pregnancy and menopause. The research behind each of those is still limited, and it helps to know how limited.

The menstrual cycle

A 2018 study in Psychoneuroendocrinology followed 32 naturally cycling women aged 18 to 22 for 35 days, with saliva hormone samples and nightly symptom ratings. Inattentive symptoms were higher in the phase after ovulation than in any other phase, and lower estradiol combined with higher progesterone or testosterone predicted more ADHD symptoms the next day, especially in women high in impulsivity. The sample was small, young and not a clinical ADHD group. In practice, two or three months of notes on symptoms by cycle day give a clinician something concrete to work with.

Pregnancy and breastfeeding

A 2018 JAMA Psychiatry study of 1.8 million US pregnancies, with a replication in 2.56 million Nordic pregnancies, found no increase in overall malformations with early-pregnancy amphetamine use. For methylphenidate, the pooled estimate for cardiac malformations was a relative risk of 1.28, which the authors described as a small increase. FDA labeling also differs from drug to drug: the current Adderall XR label says breastfeeding is not recommended during treatment. Decisions about medication before conception, in pregnancy and while breastfeeding are made case by case with the obstetric clinician involved. The New York guide's article on ADHD in pregnancy and after birth goes through the evidence.

Perimenopause and menopause

A 2025 Icelandic population study found severe perimenopausal symptoms in 54.2% of women who reported an ADHD diagnosis, compared with 30.1% of women without one. A 2026 review in Drugs and Aging found no randomized controlled trials of ADHD medication specific to perimenopausal or menopausal women, so treatment in this stage relies on expert consensus and data from younger groups. Because ADHD criteria require several symptoms before age 12, attention problems that appear for the first time in midlife are also checked for other causes. More detail is in ADHD, perimenopause and menopause.

What to bring to an evaluation

Dr. Shershow's evaluation reviews current symptoms, childhood and work history, health, and other explanations. For women, a few items make that history much clearer:

If no childhood records exist, a parent, sibling or partner who knew you then can often fill in the picture. See evaluation without childhood records.

New York and New Jersey rules that apply

Dr. Shershow is licensed in both states, and the state that governs a visit is the one where you are physically located during it.

The New Jersey rule comes from P.L.2026, c.40, effective July 8, 2026, and it applies whatever life stage you are in, including pregnancy and the months after birth. The office will explain how visits are arranged for patients located in New Jersey. For video visits in either state, you need to be in New York or New Jersey at the time of the visit.

Costs and insurance

Fees and insurance arrangements are not listed on this page. The office can tell you the current fees and how insurance works with the practice, and the fees and insurance page has general information. When you are ready, call the office or use the call-back form, and see new patients for what to expect.