By Olivia L. Baylor, LCPC, NCC, BC-TMH, CFMHE
There are times when a caseload quietly shifts. Things slow down, and the slower pace reveals what the rush was hiding.
When that happens, many clinicians notice the same thing. Midlife women, bright, capable, and accomplished, start arriving with a version of the same complaint.
"I am falling behind. I cannot hold a thought. I do not know who I am becoming."
If you have heard those sentences in your office, this post is for you.
What she is describing is real
Start here, because everything else depends on it.
What these women are describing is real. Something is happening in the body and in the brain. It is not a failure of effort, and it is not a story she is telling herself.
Most of us were never trained to see it clearly. That is not a personal failing either. It is a gap in what we were given.
Two things arriving at the same address
Perimenopause and ADHD can show up at the same point in a woman's life. So can the overlap of the two.
They arrive at the same address in midlife. They produce cognitive and emotional symptoms that look nearly identical from the chair across the room. A woman who cannot hold a thought could be describing either one, or both.
For some women, ADHD has been there all along and was never recognized. Midlife is when it finally gets noticed.
This is why I call it one of the most missed clinical patterns in adult women's mental health.
How it gets missed
The path is predictable.
The symptoms look like anxiety. They get treated as stress. And the underlying pattern goes unaddressed for years.
Look at how reasonable each step is. She says she is overwhelmed, and she is. She says she is worried about falling behind, and that worry is real. You have a framework for anxiety and a framework for stress, so you reach for them.
Nothing about that is careless. It is simply incomplete. You are treating what you were trained to recognize, and the thing underneath stays where it is.
Listen to the third sentence
Go back to what she said.
"I am falling behind" is about performance. "I cannot hold a thought" is about cognition. Both of those will pull you toward a symptom checklist.
The third sentence is different. "I do not know who I am becoming" is about identity.
A woman who has built her sense of self on being capable is telling you that the ground has moved. If you answer only the first two sentences, you will miss the person saying the third. Trauma-informed pacing matters here. Slow down enough to let her say all of it before you decide what it is.
What you need in order to see it
Closing this gap does not require you to become a medical provider. It requires a clearer picture and better tools. In my experience, clinicians need five things:
The neuroscience, in plain terms. Enough to understand why the two can look alike, and enough to explain it to a client without overwhelming her.
A differentiation framework. A structured way to think about what points toward perimenopause, what points toward ADHD, and what points toward both. A side-by-side guide helps.
Midlife-informed screening tools. Screening that takes her stage of life into account.
An equity and inclusion lens. Midlife women are not one group. Your recognition and screening have to work for the woman who is in front of you.
A care-planning approach. Recognition is the beginning. She needs to leave with a plan.
Clinical interview prompts belong on that list too. The right question, asked at the right moment, often does more than a form.
These are the pieces we built into The Hidden Wave: Perimenopause, ADHD & Adult Women in Clinical Practice, which comes with a participant workbook, interview prompts, and a side-by-side differentiation guide.
The posture that helps most
Before any tool, there is a posture.
Believe her. Assume the complaint is describing something real. Stay curious a little longer than is comfortable before you settle on anxiety or stress as the whole answer.
When you do name what you are seeing, name it without shame. She came in saying she is falling behind. Let her hear that what she is describing has a shape, and that it is not a verdict on her effort.
Try this
Take these into your next week of sessions, or into supervision.
Think of the midlife women on your caseload. Has anyone said some version of "I am falling behind," "I cannot hold a thought," or "I do not know who I am becoming"?
For each of those clients, write down what you are currently treating. If the answer is anxiety or stress, ask what else could be producing the same picture.
Notice which of the three sentences you tend to respond to first. Then make room for the one about identity.
Check your screening. Does it take midlife into account, or does it assume every adult client is the same?
Ask yourself whether your client has a plan, or only a label.
Where to go next
The same habit of looking for what you were not trained to see runs through my premarital work, and you can read how couples experience it in the book, The Before I Do Method™. If premarital work is a specialty you want to build, the CPMS™ certification is the pathway to the Certified Pre-Marital Specialist™ credential. If you already serve engaged couples, they can find you through the Premarital Counseling Directory™. The Hidden Wave and our other trainings are listed with the courses at My Mental Health University®.
CE credit eligible through an Approved Continuing Education Provider (ACEP #7739).
