When you hear the acronym ADHD, what images spring to mind?

Many people envision rambunctious schoolboys bouncing off the walls, disrupting class, and talking excessively. In reality, ADHD (Attention Deficit Hyperactivity Disorder) is a condition that affects both men and women. It is characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Some common traits of ADHD include difficulty sustaining focus, staying organised, sitting still, and considering the long-term consequences of actions.

Underdiagnosis of ADHD in Women

Many perceive ADHD as a primarily male issue. This is partly because more males than females are diagnosed with ADHD— Approximately 12.9% of boys aged 3-17 are diagnosed with ADHD, compared to 5.6% of girls in the same age group from a 2024 report published in the Journal of Clinical Child & Adolescent Psychology. This discrepancy can be attributed to the fact that historically, most ADHD studies have been conducted on white males. Findings from these studies shaped the diagnostic criteria and assessment tools used in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the handbook healthcare professionals rely on for diagnosing disorders. Since females and non-white males often display different symptoms, they are frequently overlooked during diagnosis.

Boys are more likely to be diagnosed with ADHD because they often exhibit externalised symptoms such as hyperactivity and disruptive behaviour—hence, the “naughty schoolboy” trope. Women, on the other hand, tend to internalise their ADHD traits, creating fewer obvious problems for those around them. While some women do exhibit hyperactive tendencies, they are more likely to experience symptoms related to inattention and emotional dysregulation.

Another reason women often go undiagnosed is due to societal expectations. Women are generally expected to be more organised, attentive, and self-disciplined than men, which can lead them to mask their ADHD symptoms in an effort to “fit in” or be “easy.” Masking involves hiding symptoms or mimicking others to blend in with societal norms. Children are likely to start masking by copying the behaviours of their peers as early as age 3. As a result, many women with ADHD adopt behaviours such as over-preparation, perfectionism, and people-pleasing. When women do display disruptive, impulsive, or hyperactive behaviours, they face harsher social judgment, as these actions defy expectations of femininity. Unsurprisingly, masking often leads to chronic stress, negative thoughts, overwhelm, and burnout.

According to the Journal of Consulting and Clinical Psychology, young women with ADHD are at a higher risk for self-harm and suicide. They also tend to suffer from lower self-esteem and are more susceptible to peer pressure during adolescence and young adulthood. Internalising painful emotions—one of the hallmarks of ADHD in women—can lead to anxiety and depression. Moreover, ADHD symptoms often correlate with hormonal changes. Women are most likely to be diagnosed around age 12 (after the start of menstruation), in their 30s to 40s (due to hormonal fluctuations after childbirth), or in their 40s to 50s as they transition into perimenopause or menopause. During these times of intense hormonal changes, women are frequently misdiagnosed with depression, anxiety, or even bipolar disorder before receiving an ADHD diagnosis. Because of their emotional dysregulation and the stereotype that women are “highly emotional,” they are more likely to receive a mental health diagnosis rather than being identified as having ADHD.

Women with ADHD and self-image

Being misdiagnosed can significantly impact a woman’s self-image. Women tend to doubt their abilities more than men, and before they are aware of their ADHD, they may worry about being seen as incompetent, lazy, or disorganised. These women often become accustomed to criticism and rejection of their behaviours. According to scientific research published by the American Psychological Association, women diagnosed with ADHD in adulthood responded more negatively to criticism, a phenomenon known as Rejection Sensitivity Dysphoria (RSD). The research shows how this emotional response creates a cycle of negativity and frustration, leaving women feeling incapable and inadequate. Girls may isolate themselves from their peers in response to negative comments and could struggle with sleep and eating disorders. Boys, on the other hand, are more likely to express their frustrations through aggression, making their ADHD symptoms more noticeable.

How can we help women with ADHD?

The unique experiences women face due to hormonal and social factors means a more comprehensive approach is needed to support them. They face challenges such as late diagnosis, higher rates of depression and anxiety, and managing multiple roles (e.g., mother, worker, carer, etc), which require more tailored support.

1. Raising awareness and reducing stigma:

• Educate about ADHD in women: Raise awareness about how ADHD manifests in women and why they tend to go undiagnosed.
• Encourage open conversations: Support open discussions around neurodiversity to reduce the stigma associated with seeking help.

2. Facilitate Early and Accurate Diagnosis:

• Screen females for ADHD: Encourage healthcare providers to use ADHD screening tools specifically designed for women, as their symptoms may be more subtle than men’s.
• Conduct more studies on women:, We need more diverse studies to better understand how symptoms manifest in women and other intersections such as racially minoritised groups.

3. Tailor Treatment and Coping Strategies:

• Skill-building and coaching: Coaching tailored to women can help them break tasks down into manageable steps, develop routines, and set realistic goals.
• Mindfulness practices: Women with ADHD are prone to anxiety. Mindfulness techniques like meditation and yoga can help manage emotional dysregulation and feelings of overwhelm.

Women with ADHD have borne the brunt of misdiagnosis for far too long. By acknowledging the unique needs and challenges faced by women with ADHD, we can offer more personalised, compassionate support that empowers them to thrive in all areas of life. While this article has only lightly touched on this topic, it is of utmost importance that we also explore how other characteristics such as race, disability and gender identity intersect with ADHD.