ADHD IN FEMALES
What is ADHD and what does it look like in females?
ADHD, according to the DSM-5 criteria, is a neurotype marked by distinct patterns of attention, hyperactivity, and impulsivity. While it has long been recognized, our understanding of it continues to evolve. Today, an estimated 8.4% of children and 2.5% of adults have ADHD, with 13% of boys being diagnosed by adolescence compared to only 4.2% of girls. Historically, it has been more commonly diagnosed in males, but growing research highlights differences in how ADHD presents in females. These differences mean many females may have been overlooked due to outdated diagnostic criteria and limited awareness, leading to missed or delayed diagnoses.
While ADHD is the same diagnosis regardless of gender—affecting the same brain regions and neurotransmitter systems—the symptoms can appear differently in males and females. The ADHD stereotype of a “young boy with hyperactivity, constantly moving around” allows people with differing presentations, particularly women and girls, to fly under the radar and go undiagnosed and unsupported.
Girls often exhibit different behaviours and more internalized experiences, such as:
Mental hyperactivity e.g. racing thoughts, emotional impulsivity and overwhelming feelings that aren’t always visible to others
Fidgeting. Girls sometimes display the urge to be in motion more “quietly” e.g. doodling, hair twirling, skin picking, nail biting etc.
Daydreaming, difficulty focusing, or “zoning out”. These symptoms are less disruptive and may be mistaken for laziness, lack of interest, or being “in their own world”.
Disorganization, forgetfulness and time-blindness.
Oversharing, talkativeness and interrupting often.
Perfectionism is a common coping mechanism for girls with ADHD. They may struggle with planning and organization but compensate by putting in ten times more effort to avoid making mistakes. Though they may perform well in school, they often feel less intelligent because they had to work so hard. This can lead to anxiety, stress and emotional strain.
Low self-esteem. When a person is constantly corrected or in trouble for behaviour they have little control over the constant criticism which can lead to self-esteem issues and self-doubt.
Emotional regulation. Many girls with ADHD are shamed for being “too much” or “too sensitive” because of their emotional regulation struggles.
Hyper focusing on things of interest.
Highly creative, intuitive and passionate. May be “outside the box” thinkers and problem solvers.
Difficulty maintaining relationships.
Novelty seeking as a way to increase dopamine and escape feelings of boredom e.g. impulse spending, gossiping, substance use, risky driving or sexual behaviour.
More likely to have comorbid conditions such as anxiety, depression, addictions and eating disorders, which can overshadow ADHD symptoms and complicate the diagnostic process
These differences in presentation compared to their male counterparts, can make it more difficult for women to receive an early and accurate diagnosis. While it is true that ADHD can be comorbid with several other diagnoses including autism, anxiety and Specific Learning Disorders (SLD’s) - women with ADHD are often misdiagnosed with mood or personality disorders and depression.
The feminist issues behind underdiagnosis of ADHD in females
The underdiagnosis of ADHD in women is a feminist issue for several reasons.
Most ADHD research has been conducted on males. Women weren’t included in ADHD studies until the late 1990s, and it wasn’t until 2002 that we had our first long-term study focused specifically on women. Additionally, the DSM criteria for ADHD are based on male presentations, which often don’t align with the female experience.
ADHD symptoms in women may change during certain stages of life, such as puberty, pregnancy, and menopause, due to hormonal fluctuations. ADHD symptoms can intensify during certain parts of the menstrual cycle, something which is not often talked about or factored into treatment.
Society’s gender norms often expect women to be good at organising, planning, and other executive functions, and be less forgiving when they struggle in these areas. As a result, women with ADHD often work harder to "fit in" due to these social pressures and their ADHD presentations go undetected until later in life or when life demands increase (e.g. late high school or university, motherhood) and strain their capacity to cope with their executive functioning and attention differences.
Masking
Masking is a survival strategy for many neurodivergent people including ADHDers and especially common in females. Neurodiverse individuals often feel the need to perform in ways that are considered neurotypical in order to feel accepted. Society tends to place higher expectations on girls and women to be polite, well behaved, and accommodating, which can lead to increased pressure to hide behaviours that might be seen as disruptive or different. Girls tend to develop more refined social and communication skills, enabling those with ADHD to use sophisticated strategies to hide their struggles. For instance, they might pay close attention to social cues, meticulously prepare for tasks and have an excess of to-do lists and calenders to appear organised, or suppress their hyperactive impulses in social situations. They may not exhibit the 'big behavioural outbursts' that we have grown to associate with ADHD and remain quiet, reserved, and well-behaved in public. All day they may be feeling overwhelmed and overstimulated and manage to keep it all together while in front of others. What teachers, colleagues and friends may not see are the shutdowns, meltdowns or messiness that is suppressed until they are in the safety of their home (or car). This is masking.
Impact of undiagnosed ADHD
Misdiagnosis or missed diagnosis of ADHD in females can have long-lasting consequences, including:
Low self-esteem due to years of feeling misunderstood or failing to meet expectations
Increased risk of mental health issues such as anxiety, depression, and sometimes substance abuse
Strained relationships due to differences in communication styles and emotional regulation.
Academic and career challenges such as underperformance, missed opportunities and burnout when symptoms are misunderstood and unsupported.
It is imperative that health professionals, and society as a whole, better understand what ADHD can look like in females, so that they can be diagnosed earlier, receive support earlier, be understood and understand themselves better. Female ADHDers have so many strengths and wonderful qualities that benefit our community, but they can’t harness what they don’t know they have – unless we do better.
Our team at Better Together Therapy are skilled in completing ADHD assessments and understand how ADHD presents in girls and women. Get in touch with us to find out more about our assessment process!