How ADHD Is Different in Women
Evidence suggests that Attention-deficit hyperactivity disorder (ADHD) takes a greater toll on women than it does on men. But are the symptoms of this disorder actually different between genders?
The guidelines for diagnosing ADHD are the same for men and women–but the lived experience of ADHD among women tells a different story. If you feel like you might be impacted by ADHD, keep reading to learn how ADHD symptoms differ in women and how you can get a diagnosis at any age.
Table of contents
What is ADHD?
ADHD is a neurodevelopmental disorder, meaning its origins are in the way your brain develops, and its symptoms are usually lifelong–affecting thinking, behavior, and learning.
ADHD can be diagnosed at any age but is usually diagnosed in childhood. A child with ADHD will experience an array of symptoms such as difficulty paying attention, being disorganized, problems sitting still and having a hard time controlling impulses.
What are the types of ADHD that affect women?
Contrary to popular belief, you don’t actually have to be hyperactive to be diagnosed with ADHD. The disorder is classified into three distinct categories–hyperactive/impulsive type, inattentive type or combined type.
Hyperactive/impulsive type: are more likely to be restless, act without thinking, and behave disruptively.
Inattentive type: are characterized by having difficulties with focus, organization, or frequent daydreaming.
Combined type: have qualities of both groups.
Women and girls with ADHD have several unique symptoms
The core symptoms used to diagnose ADHD in the DSM-5 have been built on a history of research in males. As such, many of the symptoms that women and girls commonly experience aren’t even used to diagnose the disorder.
Research shows that the following characteristics of ADHD are unique to women:
Difficulty with peer relationships
Co-existing anxiety and depression
Masking (coping strategies that hide underachievement and performance issues)
Women are also more likely to internalize their symptoms, becoming anxious, depressed, and struggling with emotional regulation. Because they have fewer DSM-5 symptoms, females are less likely to get diagnosed but experience the same level of impairment as males with ADHD.
Does ADHD occur equally among genders?
Although ADHD is believed to occur nearly equally among genders, it is diagnosed three times more frequently in boys. As a result of this gap, many girls find themselves growing up without access to treatment and carrying symptoms that impact their self-esteem, relationships, and ability to pursue their goals into adulthood.
Fortunately, in recent years, there has been a shift to shed light on the gender differences with ADHD and how we can better identify this condition in all affected groups. This has led many adult women to seek a diagnosis and find treatment plans that allow them to regain control of their lives and lean into the strengths of their unique wiring.
How symptoms of ADHD differ in women
You may or may not be surprised to learn that until recent years, most research on ADHD has primarily focused on boys. In fact, the criteria for diagnosing ADHD was originally based on hyperactive boys.
In spite of this, there is plenty of overlap in the actual symptoms of ADHD across genders, although women tend to be more likely to experience inattentive type. The key differences in ADHD presentation between men and women appear to be due to other factors–including coping mechanisms, hormones, and societal sex norms.
Most people have an image of ADHD in their minds–a loud, boisterous kid wreaking havoc in classrooms, constantly being asked to take a seat. As it turns out, the daydreamer in the back of the classroom with the messy locker may be struggling just as much; they are just less likely to be noticed.
As opposed to boys with ADHD who act out or externalize their symptoms, young girls and teens with ADHD tend to internalize their symptoms–leading to a presentation of symptoms that are more subtle and often misinterpreted.
This secret inner struggle can mold the internal landscape of young girls, often leading to low self-esteem and a higher incidence of mental health conditions such as depression, anxiety, and eating disorders. As an adult with ADHD, you may be plagued by a constant sense that you are falling short or never quite fitting in.
Without an understanding of the differences in how your brain functions, you’ll begin to feel inadequate and exhausted from constant self-monitoring and perceived failures. Instead of reaching out for support, you beat yourself up internally as you do your best to choreograph an existence that feels like a constant struggle.
As young girls develop and hit puberty, hormones play a significant role in the symptoms of ADHD. Monthly fluctuations in levels of estrogen, progesterone and testosterone, can have a major impact on severity and presentation. You might have already noticed you experience a worsening of your ADHD symptoms along with other premenstrual symptoms. This is a result of dropping hormone levels during your cycle.
The natural fluctuations that occur in women can make ADHD presentations appear or feel unstable. You may have your symptoms dismissed as “hormonal” or “that time of the month.” As women approach menopause, the lower levels of estrogen can lead to further impairments in sleep, memory, and concentration, which are often also mislabeled.
Sex norms and gender stereotypes
The pressure to conform to gender roles has a huge impact on how we develop and view ourselves in the world around us. For women living with ADHD, gender norms and stereotypes affect how you interpret your symptoms and how others label the way you cope.
In a classroom setting, symptoms like inattentiveness or impulsivity are more likely to get you labeled as “spacey” or “chatty” by teachers. Young girls with ADHD who do get flagged as needing help often get misdiagnosed with anxiety or depression.
The burden doesn’t end in childhood. As grown women, we continue to be pressured to fit into certain stereotypes such as neat, well-behaved and organized. These standards can feel impossible to meet, leaving you with the impression that you aren’t good enough or as if you’re always struggling to keep up. You may find yourself continuously stressed by the unpredictability of your impulses and behaving in ways that land far outside the societal expectations set for women.
Men living with ADHD find it more socially acceptable to cope with chaos and outbursts, whereas many women end up masking their symptoms and developing compensatory behaviors to hide their struggles. It’s normal to feel like there is a constant state of tension inside of you due to chronic feelings of inadequacy. Without a diagnosis, understanding and articulating these struggles feels nearly impossible.
What is masking in ADHD?
Masking is a term used to describe the coping strategies people develop to hide their symptoms of ADHD. The motivation is often to feel like they fit in with others. While masking is known to be more common in women, it can occur in any gender.
Here are some common ways that people with ADHD engage in masking:
Spending excessive time verifying and proofreading to ensure there are no careless mistakes
Using multiple forms of reminders for one event (i.e. calendar alert, sticky notes, self-emails, and writing on hand)
Showing up extremely early to avoid being late
Holding back from speaking or sharing ideas for fear of coming across impulsive or “weird”
Keeping duplicates of things around to compensate for forgetfulness
Overworking to avoid being seen as lazy
Self-deprecating jokes to make light of struggles
Masking takes a lot of energy and can leave you feeling very drained, especially after a day with a lot of interactions. Building a support system of people who understand your challenges is helpful for being able to take off your mask and letting your true self shine.
The diagnostic gap for women with ADHD
Since most ADHD is diagnosed in childhood, getting noticed as needing help is critical to receiving proper care. In a classroom setting, girls who are struggling to pay attention or experiencing quiet distractibility are less likely to be flagged by teachers, parents, or healthcare providers as needing any intervention.
Another complicated factor among kids with ADHD is that boys are more likely than girls to have accompanying disorders that get them singled out as needing help. It’s common to have learning disabilities and behavioral disorders, such as oppositional defiant disorder, which generally require a lot of resources and attention.
When do most females get diagnosed with ADHD?
Currently, women are most likely to be diagnosed with ADHD in their 30’s. Many of these women report seeking out their ADHD diagnosis after recognizing their own symptoms in their children.
As research continues to broaden our understanding of the gender differences in ADHD presentation, there has been an increased focus on updating tools, screening methods, and standards to decrease the number of young girls who go undiagnosed in the school system.
However, there are still millions of women worldwide who have never received a proper diagnosis and live their adult lives without truly understanding the origin of their struggles. For these women, accessibility to proper diagnostic procedures and treatment plans is essential to help them live the life they deserve.
What does ADHD look like in women?
We now know that women are more likely to go undiagnosed with ADHD. Women are also more likely to have inattentive type, develop coping mechanisms such as internalization, and be molded by certain gender norms. But exactly how is your day-to-day life impacted as an adult woman living with ADHD?
In addition to dealing with low self-esteem and chronic stress, you may also go through unique struggles across all areas of functioning, including relationships, work or school life, and daily tasks.
ADHD symptoms can disrupt relationships in subtle and not-so-subtle ways. You may often feel inadequate in your relationships for failing to fit traditional female stereotypes. Forgotten birthdays, unfinished projects, and missed or late appointments can lead to interpersonal conflict and feelings of failure. You are more likely to get labeled as flippant or not caring as a result of these symptoms.
The constant need to censor yourself in public can also leave you exhausted in your home life. With little left in your emotional regulation tank, minor frustrations at home can then lead to outbursts and irritability toward your family.
Relationships may also be strained from difficulties such as chronic disorganization or losing things. Undiagnosed adult ADHD can leave you feeling like you have shortcomings and failures because you’re holding yourself to standards that don’t highlight your own strengths. Learning how to have compassion for yourself and effectively navigating your strengths and weaknesses is pivotal to improving your relationship with yourself and others.
Work or school life
Life with ADHD can be a bit of a paradox. While a topic of interest often leads to hyperfocus, uninteresting or boring tasks can feel almost physically painful to engage in. You might find that shifting your attention between projects feels nearly impossible in school or work, leading to labels such as “lazy” or “careless” as things fall through the cracks.
In daily work or school life, it is normal to have a messy desk, unfinished projects, or to get side-tracked to the point that you miss important deadlines. You may also get passed by for promotions or awards that are well-deserved due to the challenges you face living with undiagnosed ADHD.
Another paradox in ADHD is that a sense of perfectionism can plague your work or school life. Many women compensate for their ADHD difficulties by overachieving, which can leave you drained and exhausted from comparing yourself to others. Learning how to effectively access and express your intellectual and creative gifts is an essential part of ADHD treatment.
You likely find that mundane daily tasks can feel especially daunting with ADHD, leading to feeling stuck or overwhelmed by everyday life. Seeing those around you sail through these daily tasks with ease might leave you feeling even more frustrated.
It’s also quite common for women with ADHD to have a difficult time relaxing. You might take on many projects but struggle to see them through to completion. Life feels like it’s constantly moving but you’re making little progress.
In everyday life, it can be hard to re-focus energy once it’s been diverted to an activity or topic that is compelling. Some days, even just attempting to complete a single chore can end in a multi-hour side journey that never sees your original task completed. Many women living with ADHD feel as though they are moving in circles, not meeting their potential, or spending all of their time cleaning up messes.
ADHD Quick Tips: Do it now! Seriously.
Making a habit of doing tasks immediately can really help you limit feeling overwhelmed by your workload. It’s especially important with ADHD as we’re prone to procrastinate and then forget.
What if you can’t do it now?
Pick a time to complete the task and set a reminder on your phone
Make sure your phone alerts you with sound when it’s time to complete it
Don’t rely on motivation, lean into discipline and just get it over with
What other mental health conditions commonly occur with ADHD in adult women?
It is common for other mental health conditions to occur along with ADHD, known as co-morbid conditions. These conditions can sometimes mask or exacerbate symptoms of ADHD and make it harder to get a clear diagnosis. It is important to get a diagnostic assessment with an expert in ADHD in order to properly understand the origin of your symptoms.
Some common co-occurring conditions with adult ADHD in women include:
Substance use disorders
Factors such as chronic stress, feeling misunderstood, understimulation, and impulsivity associated with ADHD can all lead to an increased rate of substance use disorders in this group. Addiction or abuse of substances, such as drugs or alcohol, is also commonly used to deal with low self-esteem and feelings of inadequacy that many women with ADHD experience.
Social anxiety, Obsessive-Compulsive Disorder, Separation Anxiety Disorder, and Generalized Anxiety Disorder are all common comorbidities in women living with ADHD. It is estimated that around 50% of adults with ADHD have a co-occurring anxiety disorder.
Depressive disorders such as Major Depressive Disorder and Seasonal Affective disorder, as well as Bipolar Disorder, commonly occur along with ADHD. Many of the symptoms of mood disorders, such as irritability, may overlap with ADHD making it essential to seek out a diagnosis with a person trained in recognizing both disorders.
Women with ADHD are much more likely to develop eating disorders, especially Bulimia Nervosa. The severity of certain ADHD symptoms such as impulsivity seems to negatively affect the presentation of eating disorders. Women with ADHD are also more likely to engage in disordered eating patterns, such as binging and extreme dieting, with or without fully developing an eating disorder.
Other Disorders and Adult ADHD in Women
Other co-occurring issues such as sleep problems (i.e. insomnia, narcolepsy) and personality disorders can also add challenges to living with ADHD. Fortunately, there are many effective treatment options to help to reduce symptoms and improve quality of life. The vital first step is to seek out a diagnosis and begin working on a treatment plan with a healthcare professional.
ADHD has long been underdiagnosed in women due to differences in presentation, societal norms, and coping mechanisms that young girls develop to mask their symptoms. Living life without a proper diagnosis means not getting adequate interventions, which can lead to lifelong struggles in relationships, school, work, and daily tasks. Additionally, undiagnosed ADHD can severely hamper your self-esteem and coping mechanisms–contributing to an increased risk for anxiety and depressive disorders.
Getting a diagnosis
As our understanding of ADHD continues to grow, more and more women are seeking out diagnostic assessments to help them better understand their symptoms and begin treatment for adult ADHD. Using online services such as Frida allows women to rapidly get an accurate diagnosis and receive a unique and customized treatment plan tailored to their specific needs.
Living with adult ADHD doesn’t have to be so frustrating. You are not scatterbrained, lazy, or inadequate. You are unique and deserve to learn how to lean into your strengths and overcome your weaknesses with the help of qualified professionals who want to see you begin living your best life. If you think you may have ADHD, try reaching out to a professional today to set up an assessment.