Attention-Deficit/Hyperactivity Disorder (ADHD) has long been associated with hyperactive boys, but growing evidence suggests that many women also have ADHD, and their symptoms often go unnoticed or are misdiagnosed. While ADHD affects both genders, women are frequently overlooked because their symptoms can present differently than the classic traits typically associated with the disorder. This article explores the reasons behind the underdiagnosis and misdiagnosis of ADHD in women and offers insight into how this condition manifests in females.[1]
The Traditional Understanding of ADHD
ADHD is a neurodevelopmental disorder that is typically characterized by inattention, hyperactivity, and impulsivity. Historically, most research and diagnostic criteria have been based on studies of boys. As a result, the stereotypical image of a person with ADHD is often a young boy who is hyperactive, restless, and disruptive in class. The reality, however, is that ADHD can affect anyone, and it manifests differently across genders and age groups.[2]
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies ADHD into three types:
- Predominantly inattentive presentation (often associated with daydreaming and difficulty maintaining focus),
- Predominantly hyperactive-impulsive presentation (characterized by restlessness and impulsivity), and
- Combined presentation (a mixture of both inattentive and hyperactive-impulsive traits).
Boys tend to display more overt hyperactive and impulsive behaviors, which are more likely to be noticed by teachers and parents. On the other hand, girls and women often exhibit more subtle symptoms, especially in the inattentive form of ADHD, which can easily be mistaken for other conditions.
Why ADHD in Women Is Often Misdiagnosed
Several factors contribute to the misdiagnosis or underdiagnosis of ADHD in women. These include societal expectations, symptom presentation, hormonal changes, and a lack of awareness among healthcare providers.
1. Societal Expectations and Gender Norms
One of the major reasons ADHD is often missed in women is due to societal expectations of gender behavior. From a young age, girls are often socialized to be more compliant, organized, and quiet. This can lead to girls masking their ADHD symptoms, as they strive to meet societal expectations of being "good" or "well-behaved." While boys with ADHD might be more likely to act out in ways that draw attention, girls may internalize their struggles, leading to anxiety, depression, or low self-esteem without addressing the root cause—ADHD.
In adulthood, the pressure to juggle multiple roles—such as maintaining a career, managing a household, and caring for children—can exacerbate ADHD symptoms in women. Yet, because many women feel a societal obligation to meet these standards, they may overcompensate, further masking their symptoms and delaying diagnosis.[3]
2. Different Symptom Presentation
The symptoms of ADHD in women tend to be more internalized than in men. Women with ADHD often struggle with:
- Inattention: Difficulty focusing, forgetfulness, and disorganization. Women may appear to "daydream" or seem absent-minded.
- Hyperactivity: In women, hyperactivity may manifest as restlessness, fidgeting, or an inability to relax rather than the overt hyperactivity often seen in boys.
- Impulsivity: Rather than physical impulsivity, women may exhibit verbal impulsivity, such as interrupting others or difficulty holding back thoughts and emotions.
- Emotional Dysregulation: Women with ADHD often experience intense emotions and mood swings, which may be mistaken for anxiety, depression, or even a mood disorder.
- Executive Dysfunction: Many women with ADHD struggle with planning, time management, and organization. This can be particularly frustrating as women are often expected to excel in these areas both at home and at work.
Because these symptoms don't always align with the stereotypical view of ADHD, women may be misdiagnosed with other conditions, such as anxiety or depression, while their underlying ADHD goes untreated.[4]
3. Hormonal Changes
Hormonal fluctuations throughout a woman's life can affect the severity of ADHD symptoms, contributing to delayed or missed diagnoses. Estrogen, in particular, has a significant impact on dopamine levels in the brain, which are closely tied to ADHD.
- Puberty: Many girls first experience noticeable ADHD symptoms during puberty, when hormone levels fluctuate dramatically. However, these changes may be attributed to typical teenage behavior, leading to missed opportunities for diagnosis.
- Menstrual Cycle: During the menstrual cycle, estrogen levels drop, which can worsen ADHD symptoms such as inattention, irritability, and emotional instability.
- Pregnancy: ADHD symptoms may temporarily improve during pregnancy due to elevated estrogen levels but can return or worsen postpartum when hormone levels fluctuate again.
- Perimenopause and Menopause: As women enter perimenopause and experience a decline in estrogen, they may notice a significant worsening of ADHD symptoms, particularly in terms of memory, focus, and emotional regulation. These changes are often attributed to "normal aging" rather than a sign of ADHD.
Because hormonal changes can exacerbate symptoms, women may seek help for issues like mood swings or difficulty focusing, but their ADHD may be overlooked as the true underlying cause.[5]
4. Comorbid Conditions
Women with ADHD often experience co-occurring conditions, such as anxiety, depression, or eating disorders, which can complicate diagnosis. Since these conditions tend to overshadow ADHD symptoms, healthcare providers may focus on treating the comorbidities without considering ADHD as the root cause.[6]
For example, a woman who presents with chronic anxiety and overwhelm may be prescribed medication for anxiety without a full evaluation for ADHD. This can leave the ADHD untreated, allowing symptoms to persist or even worsen.
The Impact of Misdiagnosis
The misdiagnosis or delayed diagnosis of ADHD in women can have significant consequences. Many women spend years struggling with undiagnosed ADHD, which can lead to a variety of personal and professional difficulties. These can include:
- Chronic stress: The constant feeling of being overwhelmed by everyday tasks can take a toll on mental and physical health.
- Low self-esteem: Women with undiagnosed ADHD may feel as though they are constantly failing to meet expectations, leading to feelings of inadequacy and self-doubt.
- Relationship difficulties: Struggles with impulsivity, emotional regulation, and communication can affect relationships with partners, friends, and family.
- Underachievement: Women with ADHD may struggle to reach their full potential in their careers, often feeling that they are "underperforming" despite their best efforts.
When ADHD is misdiagnosed or overlooked, treatment is often ineffective. Addressing the wrong condition can leave women feeling frustrated and hopeless, as they continue to struggle with the core symptoms of ADHD.[7]
Getting a Proper Diagnosis
If you suspect you or a loved one may have ADHD, it's important to seek a comprehensive evaluation from a healthcare provider familiar with how ADHD presents in women. Diagnosis typically involves a thorough assessment of symptoms, a review of personal and family history, and input from people close to you, such as family members or friends.
A proper diagnosis can be life-changing. Once diagnosed, women with ADHD can access a range of treatments, including medication, therapy, and lifestyle modifications, to help manage their symptoms and improve their quality of life.
Conclusion
ADHD in women is often misdiagnosed or undiagnosed due to societal expectations, subtle symptom presentation, hormonal influences, and comorbid conditions. Understanding the unique ways ADHD manifests in women is key to improving diagnosis and treatment. By raising awareness and challenging stereotypes, we can ensure that more women receive the help they need to thrive.
Common Questions About ADHD and Women
Why is ADHD often missed in women?
ADHD is often missed in women because their symptoms tend to be more subtle and internalized than in men. While men frequently display hyperactive and impulsive behaviors, women often experience inattention, emotional dysregulation, and anxiety, which can be mistaken for other mental health issues like depression or anxiety. Additionally, societal expectations pressure women to mask their symptoms, making it harder for healthcare providers to recognize ADHD.
How do ADHD symptoms differ between men and women?
Men with ADHD are more likely to display hyperactivity, impulsiveness, and disruptive behaviors, while women tend to exhibit inattention, forgetfulness, and emotional instability. Women are also more prone to feelings of overwhelm, low self-esteem, and difficulty managing daily tasks. These differences in symptom presentation can lead to misdiagnosis or a lack of diagnosis in women.
Can hormonal changes affect ADHD symptoms in women?
Yes, hormonal changes significantly impact ADHD symptoms in women. Fluctuations in estrogen levels, such as during the menstrual cycle, pregnancy, and menopause, can exacerbate symptoms like inattention, mood swings, and emotional dysregulation. These hormonal influences make diagnosing ADHD more complicated in women.
Why are women with ADHD often diagnosed with anxiety or depression instead?
Women with ADHD frequently experience emotional dysregulation, low self-esteem, and chronic stress, which can resemble anxiety or depression. Because healthcare providers may not always associate these symptoms with ADHD, women are often misdiagnosed with mood disorders instead of receiving an accurate ADHD diagnosis.
What are the consequences of undiagnosed ADHD in women?
Undiagnosed ADHD in women can lead to chronic stress, low self-esteem, relationship difficulties, and underachievement in personal and professional areas. Many women struggle with managing daily tasks, experience feelings of overwhelm, and may even develop comorbid conditions like anxiety, depression, or eating disorders due to their untreated ADHD.
How can women with ADHD seek an accurate diagnosis?
Women who suspect they may have ADHD should consult a healthcare provider familiar with the condition's presentation in women. A thorough evaluation will typically include a review of symptoms, personal history, and input from family or friends. Understanding the unique challenges that ADHD presents for women is crucial for receiving a proper diagnosis.
Can ADHD in women improve with treatment?
Yes, treatment options for ADHD, such as medication, cognitive behavioral therapy, and lifestyle changes, can help women manage their symptoms. Treatment can improve focus, emotional regulation, and time management, enhancing quality of life in both personal and professional settings.
Sources
https://www.verywellmind.com/add-symptoms-in-women-20394
Stibbe, Tina et al. “Gender differences in adult ADHD: Cognitive function assessed by the test of attentional performance.” PloS one vol. 15,10 e0240810. 15 Oct. 2020, doi:10.1371/journal.pone.0240810
https://www.additudemag.com/gender-differences-in-adhd-women-vs-men/
Smari, U.J., Valdimarsdottir, U.A., Aspelund, T. et al. Psychiatric comorbidities in women with cardiometabolic conditions with and without ADHD: a population-based study. BMC Med21, 450 (2023). https://doi.org/10.1186/s12916-023-03160-7
Stibbe, Tina et al. “Gender differences in adult ADHD: Cognitive function assessed by the test of attentional performance.” PloS one vol. 15,10 e0240810. 15 Oct. 2020, doi:10.1371/journal.pone.0240810
