ADHD in Women: Why It Is So Often Missed

ADHD has historically been viewed as a condition that mainly affects young boys, which has contributed to many women and girls being overlooked or diagnosed later in life. Although ADHD affects both men and women, many women are not diagnosed until their 30s, 40s or even 50s. For some, managing work, relationships and household responsibilities can become increasingly difficult, with struggles around organisation, anxiety and self-doubt often dismissed as stress or being overly sensitive. ADHD in women can be harder to recognise because symptoms may appear differently and can sometimes be hidden through coping strategies or masking.

ADHD symptoms in women

Research suggests that women with ADHD may be more likely to experience internalised symptoms, which can include:

• Chronic anxiety
• Low self-worth
• Emotional dysregulation
• Perfectionism
• Burnout

These experiences can sometimes hide the underlying ADHD, making it harder to recognise and potentially leading to misdiagnosis or support that does not address the underlying difficulties.

Why ADHD is often overlooked in women

The underdiagnosis of ADHD in women is the result of several overlapping factors.

First, the diagnostic criteria for ADHD were developed primarily based on research in boys, which means they capture the hyperactive, externalising presentation more readily than the inattentive, internalising presentation that is more common in women.

Second, ADHD in women more commonly presents as the inattentive subtype rather than the hyperactive-impulsive subtype, meaning the symptoms are internal and less visible to others. A girl who sits quietly in class but cannot retain what she has read, or a woman who appears organised but is secretly overwhelmed, does not fit the cultural stereotype of ADHD.

Third, women are more likely to develop masking behaviours, strategies that hide their difficulties at the cost of significant mental effort and emotional exhaustion. Girls are socialised to be compliant and organised, which can further mask ADHD traits in childhood. By adulthood, many women have spent years compensating for their difficulties without understanding why everything feels so much harder than it appears to be for others.

How ADHD presents differently in women

Women with ADHD may experience a range of difficulties that can differ from the more commonly recognised symptoms of ADHD in men:

• Difficulty maintaining attention and mental focus, especially during tasks that are not naturally engaging.
• Emotional dysregulation, with intense emotional reactions that may feel overwhelming and difficult to control.
• Rejection sensitive dysphoria (RSD), with intense sensitivity to perceived criticism, rejection or failure.
• Chronic disorganisation despite significant effort and the appearance of having it together
• Ongoing difficulties with organisation, even with significant effort to stay on top of daily responsibilities.
• A lasting feeling of not achieving as much as expected despite having the ability and putting in considerable effort.
• Anxiety and depression as co-occurring conditions (present in up to 70% of women with ADHD)
• Difficulties in relationships, particularly with managing emotions and communicating effectively.
• Sleep difficulties, often linked to a busy mind and trouble settling down at bedtime.

Masking and its consequences

Masking means consciously or unconsciously hiding ADHD symptoms to fit in and appear like everyone else. This is common among women with ADHD. It may involve relying heavily on to-do lists and reminders, preparing carefully for meetings or social situations, using humour to cover difficulties, or putting in extra effort to keep up with others.

Keeping up this effort over time can be exhausting and may lead to burnout, anxiety, depression and a loss of confidence in your sense of self. For many women, receiving an ADHD diagnosis can bring a sense of relief, as it helps explain why everyday tasks have often required so much effort.

ADHD and hormonal changes

Oestrogen interacts with dopamine in the brain, which may influence how ADHD symptoms change during different stages of the menstrual cycle. Some women notice their symptoms become more noticeable before or during their period, while hormonal changes during perimenopause can also affect ADHD symptoms.

These changes are not always recognised, and some women may seek help for anxiety, low mood or other difficulties without ADHD being considered. If you have noticed a significant change in your ADHD symptoms during perimenopause or other hormonal changes, it may be helpful to discuss this with your clinician.

Late diagnosis

Receiving an ADHD diagnosis as an adult woman can be a complex experience. Many women describe feeling grief for the years spent struggling without understanding why, alongside a sense of relief and validation. A diagnosis can also open the door to appropriate treatment and support, which may have a meaningful impact on daily life.

Treatment for women with ADHD follows the same general principles as for men, including medication, psychological support and lifestyle changes. However, treatment may also need to consider hormonal changes, masking and the challenges that can come with receiving a diagnosis later in life.

Getting assessed

If you recognise yourself in this article, the most important step is to seek a formal ADHD assessment. You do not need a GP referral to book a private ADHD assessment. A comprehensive assessment will review your symptoms in the context of your life history and consider all relevant factors, including the ways in which ADHD presents differently in women.

Conclusion

ADHD in women can be difficult to recognise, particularly when symptoms are masked or mistaken for anxiety, stress or other difficulties. Inattentive symptoms, emotional challenges, hormonal changes and years of coping strategies can all make the condition less obvious.

Recognising these patterns can help women understand their experiences and seek the right support. If you think ADHD may be affecting your daily life, a comprehensive assessment can help explore your symptoms, history and individual needs and provide a clearer understanding of what may be contributing to your difficulties.