Overlooked and Undiagnosed: ADHD in Women and Girls

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental conditions, yet for years it has been predominantly associated with boys. This misconception has led to countless girls and women being undiagnosed or diagnosed much later in life. Recognizing how ADHD shows up differently for girls and women is crucial for improving diagnosis, treatment, and quality of life.

The Gender Gap in ADHD Diagnosis

According to a national survey, approximately 11.4% of U.S. children between 3–17 years old have been diagnosed with ADHD. However, boys (15%) are nearly twice as likely as girls (8%) to receive this diagnosis. This disparity arises not because ADHD is less common in girls, but because its symptoms often appear differently, are less understood, or minimized.

What Does ADHD in Women and Girls Look Like?

While some girls with ADHD may present similarly to boys with the condition, others don’t fit the stereotypical image of a hyperactive, disruptive child. Instead, their symptoms tend to be more internalized and subtle, leading to missed diagnoses.

Common ADHD Symptoms in Girls

1. Daydreaming: Girls with ADHD are often labeled as “spacey” or inattentive due to frequent daydreaming and trouble staying focused.
2. Forgetfulness: They may struggle with forgetting homework, appointments, or daily tasks.
3. Emotional Sensitivity: Heightened sensitivity to rejection or criticism can lead to emotional outbursts or internalized shame.
4. Social Challenges: Impulsivity can cause difficulties in maintaining friendships. They might interrupt conversations or struggle to keep up with social cues.

Masking and Compensation

Girls may develop strategies to hide their struggles out of fear of being judged. For example, they may work extra hard to stay organized or mimic peers’ behaviors. While these coping strategies help them “blend in,” they can lead to exhaustion, frustration, and feelings of inadequacy over time.

Common Signs of ADHD in Women

ADHD often presents differently in women than in men, which can contribute to it being underdiagnosed or misdiagnosed. While men are more likely to exhibit the hyperactive-impulsive symptoms commonly associated with ADHD, women often display more inattentive symptoms, such as:

• Daydreaming or being easily distracted.
• Difficulty following through on tasks: ****Chronic procrastination and difficulty starting or completing tasks, even when they’re important, can result in missed due dates or opportunities.
• Emotional sensitivity: Rejection sensitivity, overwhelm, shame, or self-doubt.
• Perfectionism: Used as a coping skill to mask struggles with attention and focus.
• Disorganization: Feeling perpetually behind on tasks like managing schedules, finances, or household responsibilities. Constantly "playing catch-up" can lead to high levels of stress and anxiety.
• Hyperfocus: Completely absorbed in specific tasks or projects, losing track of time or neglecting other priorities.
• Difficulty prioritizing: Deciding what to tackle first can feel overwhelming, often leading to either doing nothing or jumping between tasks without completion.

Other signs may include:

• Relationship challenges: Impulsivity, forgetfulness, or difficulty listening can strain romantic relationships, friendships, and parent-child relationships.
• Self-esteem struggles: Years of feeling "different" or "not good enough" can lead to imposter syndrome or deeply rooted feelings of inadequacy.

Why Do ADHD Symptoms Worsen for Women During Major Life Transitions?

Symptoms often become more pronounced in women during big changes, such as becoming a mother, starting a new job, or managing increased responsibilities at home. These shifts bring new demands on executive functioning (e.g., organizing, planning, and multitasking) which is already challenging for individuals with ADHD.

Hormonal changes in pregnancy, postpartum, and menopause can also exacerbate symptoms. Fluctuations in estrogen levels can directly impact dopamine leading to increased distractibility, emotional dysregulation, or difficulty focusing.

Additionally, societal expectations and the "mental load" many women carry often heighten feelings of overwhelm or inadequacy, making ADHD symptoms more noticeable and impactful. Recognizing these patterns is vital to addressing the unique ways ADHD presents in women and ensuring they receive the support they need during these pivotal moments.

Why is ADHD in Women and Girls Missed?

Much of the underdiagnosis of ADHD is rooted in societal expectations, diagnostic biases, and systemic inequities.

Factors Leading to Undiagnosed ADHD In Girls

Gendered Expectations of Behavior

Girls are often socialized to be polite, quiet, and attentive. As a result, they may suppress hyperactive or impulsive tendencies, making their ADHD less noticeable to parents and teachers. Behaviors like daydreaming or being overly talkative get dismissed as personality quirks rather than signs of ADHD.

Inattentive Symptoms Are Overlooked

Many girls have the inattentive subtype of ADHD, which lacks the disruptive behaviors typically associated with the disorder. Symptoms like forgetfulness or difficulty focusing are often dismissed as a lack of effort.

Cultural and Societal Biases

There is a pervasive misconception that ADHD is a “boy’s disorder.” This stereotype leads to fewer referrals and evaluations for girls, despite similar levels of impairment.

Factors Leading to Undiagnosed ADHD In Women

Mental Health Misdiagnoses

Women with ADHD are more likely to be diagnosed with anxiety, depression, or borderline personality disorder instead of ADHD. Emotional dysregulation or overwhelm is often misinterpreted as a mood disorder.

Assumptions About Hormonal Influences

Hormonal changes during puberty, pregnancy, postpartum, and menopause may worsen ADHD symptoms. However, these signs are often attributed to hormonal imbalances rather than ADHD.

Internalized Shame and Stigma

Many women internalize their struggles, believing they should be able to manage responsibilities better and need to try harder. Shame can prevent them from seeking help or considering ADHD as a possibility.

Systemic Barriers

Girls and women, especially those of color or from historically oppressed communities, often go undiagnosed due to gender, racial, and socioeconomic biases within healthcare and school systems. Their symptoms are often dismissed or misunderstood. Additionally, past mistreatment and ongoing inequities in healthcare make it less likely for communities of color to receive screenings or evaluations for ADHD.

To address these disparities, we need greater awareness of how ADHD shows up in diverse populations and systemic changes in education, healthcare, and cultural attitudes to ensure everyone has equitable access to diagnosis and care.

The Impact of a Missed Diagnosis

Living with undiagnosed and untreated ADHD can result in:

• Mental Health Challenges: Increased risk of anxiety, depression, low self-esteem, and substance use disorders.
• Academic and Career Struggles: Difficulty meeting expectations can lead to frustration and underachievement, and hinder career advancement.
• Relationship Strain: Misunderstandings stemming from impulsivity or forgetfulness can cause tension in friendships and romantic relationships.
• Missed Treatment Opportunities: Delayed diagnosis means delayed access to therapy, medication, and coping strategies that could improve quality of life.
• Chronic feelings of inadequacy or failure: Years of untreated symptoms and the impact of ADHD on one’s life can create a sense of falling behind peers and feeling like something is wrong with them.

Addressing the Gender Gap in ADHD Care

Bridging the gap in ADHD diagnosis and care for women and girls requires systemic changes and increased awareness.

Steps Forward:

1. Education: Training parents, teachers, and healthcare providers to recognize the unique ways ADHD presents in females.
2. Inclusive Diagnostic Criteria: Ensuring that ADHD diagnostic tools account for gender differences.
3. Advocacy: Encouraging women to seek evaluations and advocate for their needs without fear of stigma.
4. Accessible Care: Addressing socioeconomic and cultural barriers that limit access to ADHD evaluations and treatment.

Potential Coping Strategies

While living with ADHD can be challenging, there are effective strategies and supports available:

• Workplace Accommodations: Flexible schedules, prioritization tools, and quiet spaces.
• Personal Strategies: Using ADHD tools like time or task management apps or visual timers, practicing mindfulness, and seeking therapy or coaching to help manage symptoms.
• Medication: When appropriate, ADHD medications can help improve focus, organization, and emotional regulation.
• Support Networks: Joining ADHD support groups or online communities can provide validation, connection, and resources.

The journey to an ADHD diagnosis can be a long and frustrating one for many women and girls, but understanding the unique ways ADHD presents is an important step in breaking down gender biases. If you suspect that ADHD may be a factor in your life or a loved one’s, don’t hesitate to seek support. An accurate diagnosis can open the door to effective treatment, better understanding, and an improved quality of life.

Treatment for ADHD in Women | Seattle, Washington

Existential Psychiatry provides comprehensive treatment for ADHD, including diagnostic assessment, therapy, and medication management. Dr. David Zacharias has been providing personalized patient-centered care for over 20 years. Reach out today for a free consultation and find the support you need.

Written by Existential Psychiatry Staff

Sources

• Danielson, M. L., et al. “ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment.” Journal of Clinical Child & Adolescent Psychology, 2024. Accessed December 27,  2024.
• Young, S., et al. “Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women.” BMC Psychiatry, August 12, 2020. Accessed December 27, 2024.