For decades, Attention Deficit Hyperactivity Disorder (ADHD) looked like a hyperactive boy who couldn’t sit still in class, got in trouble for talking out of turn, and had parents and teachers throwing their hands up saying “boys will be boys.”
This image mostly came from studies focused on boys with ADHD and children with ADHD, creating a limited understanding of differences between male and female presentations.
This picture was so ingrained in our understanding of ADHD that we missed an entire population of people struggling with the same condition…they just looked different.
If you’re a woman who got diagnosed with ADHD as an adult, you probably have a story about feeling “different” your whole life but not knowing why.
Maybe you were the daydreamer who got called “spacey” or “ditzy.” Maybe you were the perfectionist who worked twice as hard as everyone else just to keep up. Maybe you were the one everyone thought had it all together on the outside while you felt like you were drowning on the inside.
As someone who works with people navigating ADHD diagnoses, I’ve seen how profoundly sex and gender stereotypes have shaped who gets identified, when they get help, and what kind of support they receive.
The research is clear: ADHD affects all genders, but the way it shows up and gets recognized is significantly different depending on whether you’re perceived as male and female.
The “Typical” ADHD Story We All Know
When most people think of ADHD, they picture what we now know was a very narrow representation: a young boy who’s bouncing off the walls, can’t focus in school, gets in trouble for being disruptive, and whose symptoms are impossible to ignore.
This presentation is real and valid, but it’s just one way ADHD can look like.
This traditional understanding of ADHD was based on research on gender differences that was predominantly done on males with ADHD. The diagnostic criteria for ADHD, the criteria for ADHD symptom checklist, even the treatment approaches were all developed around how ADHD typically presents in males.
For decades, this meant that females with ADHD and girls with ADHD were overlooked, misdiagnosed, or told there was nothing wrong with them.
The problem wasn’t that female ADHD didn’t exist. The problem was that their ADHD looked different, and we weren’t looking for different.
How ADHD Symptoms Show Up Differently Across Genders
The Internalizing vs. Externalizing Divide
One of the biggest sex differences in ADHD relates to internalizing versus externalizing symptoms.
Males with ADHD: More likely to show externalizing symptoms such as hyperactivity, impulsivity, and disruptive behaviour – obvious signs that meet traditional expectations for symptoms of ADHD in deficit hyperactivity disorder in children.
These behaviors are hard to miss because they affect other people and disrupt classrooms or workplaces.
ADHD in Females: Tend to have more inattentive symptoms like daydreaming, withdrawal, and perfectionism. They might appear engaged but mentally drift off.
They might work incredibly hard to compensate for their difficulties, leading to exhaustion and anxiety rather than obvious behavioural problems.
Because these differences in ADHD symptoms are less visible, ADHD are more likely to go unnoticed in females than in males. This contributes to an under diagnosed population.
The Perfectionist Mask
Many women with ADHD – and especially females with ADHD diagnosed later in life – develop what researchers call “masking” behaviors.
They learn to hide their symptoms and overcompensate for their difficulties.
This might look like becoming a perfectionist, working twice as hard as their peers, or developing elaborate organizational systems to manage their challenges.
From the outside, it might look like they have everything together. They might be high achievers in school or work, but the cost is enormous internal stress, anxiety, and exhaustion.
Because they’re not failing in obvious ways, their ADHD goes unrecognized while they suffer in silence.
This often happens more in females than males due to societal expectations, hiding difficulties with elaborate systems. While effective in appearances, the emotional cost is high.
Emotional Dysregulation
Women with ADHD often experience intense emotional reactions, rejection sensitivity, and difficulty managing their emotional responses.
But instead of these being recognized as ADHD symptoms, they’re often misattributed to being “too sensitive,” “dramatic,” or having anxiety or mood disorders.
This emotional component of ADHD is real and significant, but it doesn’t fit the traditional hyperactive model, so it gets overlooked or misunderstood.
Why Girls and Women Get Missed
Societal Expectations Shape What We See
Societal expectations for male and female behaviour shape how ADHD is noticed.
Boys with hyperactivity are seen as needing intervention, girls with ADHD may be called dreamy or creative rather than having a neurodevelopmental condition.
A girl who’s hyperactive might be told she’s “too much” or needs to “calm down,” but she’s less likely to be referred for ADHD evaluation.
Boys who display hyperactive or disruptive behaviours are more likely to be seen as having a problem that needs intervention. Girls with the same underlying neurology might just be told to try harder or be more organized.
Additionally, differences in ADHD symptoms and differences in symptom presentation mean gender differences in adult ADHD are real, with diagnostic systems slow to adapt.
The Quiet Struggle Goes Unnoticed
Inattentive ADHD…the type that involves difficulty focusing, being easily distracted, and struggling with organization…is much less disruptive to others than hyperactive-impulsive ADHD.
A child who’s quietly daydreaming in the back of the classroom doesn’t disrupt the lesson the way a child who’s getting up and moving around does.
This means that many girls and women with ADHD slip through the cracks not because their symptoms are less severe, but because their symptoms are less obvious to others.
Hormones Complicate the Picture
ADHD symptoms can fluctuate with hormonal changes, and women experience more dramatic hormonal shifts throughout their lives than men.
Hormonal changes during puberty, throughout the menstrual cycle, in pregnancy, and during menopause can influence ADHD symptoms, often making them more difficult to recognize and manage.
Many women first notice their ADHD symptoms becoming unmanageable during major hormonal transitions, but because these changes coincide with life stressors (like having children or going through menopause), the ADHD often gets overlooked in favour of situational explanations.
Hormones complicate recognition. In child and adolescent years, puberty changes ADHD impact, but this has rarely been considered in ADHD clinical setting until more recently.
The Misdiagnosis Pipeline
Because women’s ADHD symptoms often look different from the traditional presentation, they frequently get misdiagnosed with other conditions before anyone considers ADHD.
Anxiety and Depression
Women are often diagnosed with anxiety or depression before ADHD is considered, despite the prevalence of ADHD being similar between male and female populations. This is partly due to sex differences in symptom presentation and a lack of clinician training in gender differences in adult cases.
Women with undiagnosed ADHD often develop anxiety and depression as secondary conditions. When you’re constantly struggling to keep up, feeling like you’re not meeting expectations, and working harder than everyone else just to function, anxiety and depression are natural results.
But these secondary conditions often get treated as the primary problem, while the underlying ADHD continues to go untreated.
Someone might spend years in therapy for anxiety without anyone realizing that the anxiety is partly driven by untreated ADHD.
Eating Disorders
There’s a significant overlap between ADHD and eating disorders, particularly in women. People living with ADHD may face challenges like acting impulsively, finding it hard to manage emotions, and striving for perfection, which together can increase the likelihood of developing unhealthy eating patterns.
But again, the eating disorder might be treated without addressing the underlying neurodivergence.
Borderline Personality Disorder
The emotional intensity and rejection sensitivity that many women with ADHD experience can sometimes be misinterpreted as borderline personality disorder.
While some people may have both conditions, it’s important that ADHD gets considered as a potential explanation for emotional dysregulation.
The Late Diagnosis Experience
Many women don’t get diagnosed with ADHD until they’re adults, often after their own children are diagnosed or after a major life change makes their symptoms impossible to ignore anymore.
The Relief and the Grief
Getting an ADHD diagnosis as an adult often brings a complex mix of emotions. There’s relief at finally having an explanation for lifelong struggles, but there’s also grief for all the years of feeling different, trying harder than everyone else, and not understanding why things that seemed easy for others were so difficult.
Many women describe feeling angry about all the opportunities they might have missed, relationships that suffered, or potential that went unrealized because their ADHD wasn’t recognized and treated.
Reframing Your Life Story
An adult ADHD diagnosis often requires reframing your entire life story. Suddenly, things that you blamed yourself for (being disorganized, struggling in school despite being smart, having difficulty maintaining friendships, or feeling overwhelmed by daily tasks) start to make sense in a different way.
This reframing can be incredibly healing, but it can also be disorienting as you adjust to understanding yourself through a new lens.
Men’s ADHD Isn’t Always Obvious Either
While we’ve focused primarily on how women’s ADHD gets missed, it’s important to acknowledge that men can also be misunderstood or misdiagnosed, particularly if they don’t fit the hyperactive stereotype.
Inattentive Men Fly Under the Radar
Men with primarily inattentive ADHD might also be overlooked, especially if they’re not disruptive.
They might be seen as lazy, unmotivated, or just not living up to their potential, without anyone considering that attention difficulties might be the underlying issue.
Different Masking Strategies
Men with ADHD might develop different masking strategies than women.
They might become class clowns, focus intensely on specific interests, or channel their hyperactivity into sports or other physical activities. These strategies might help them cope but can also delay recognition of their ADHD.
Emotional Symptoms Get Overlooked
Men with ADHD also experience emotional dysregulation and rejection sensitivity, but these symptoms might be even less likely to be recognized in men due to societal expectations about male emotional expression.
The Intersection of Gender and Other Identities
It’s important to recognize that gender doesn’t exist in isolation…it intersects with other aspects of identity that can further complicate ADHD recognition and treatment.
The Intersection of Gender and Other Identities
It’s important to recognize that gender doesn’t exist in isolation…it intersects with other aspects of identity that can further complicate ADHD recognition and treatment.
LGBTQ+ Considerations
Transgender and non-binary individuals may face unique challenges in getting appropriate ADHD care, particularly if their gender identity isn’t respected by healthcare providers or if their symptoms don’t fit traditional gender-based expectations.
Socioeconomic Factors
Access to ADHD evaluation and treatment is significantly affected by socioeconomic status. Girls and women from lower-income families might be less likely to receive comprehensive evaluations or ongoing treatment, even when their symptoms are recognized.
Moving Toward Better Recognition and Treatment
The good news is that awareness of gender differences in ADHD is growing, and diagnostic practices are slowly evolving to be more inclusive and comprehensive.
Updated Diagnostic Criteria
Mental health professionals are becoming more aware of how ADHD can present differently across genders.
Updating diagnostic criteria for ADHD to reflect differences between male and female experiences – including those without ADHD for comparison will improve outcomes.
Greater attention to sex and gender research, differences in ADHD symptoms, and ADHD in girls ensures clinicians better understand the reason for these gaps.
Specialized Assessment
Some clinicians now specialize in evaluating ADHD in women and girls, using assessment tools and approaches that are more sensitive to how the condition presents in these populations.
Comprehensive Treatment Approaches
Treatment for ADHD is increasingly recognizing the need for comprehensive approaches that address not just the core symptoms, but also the secondary effects like anxiety, depression, and self-esteem issues that often develop when ADHD goes unrecognized.
If You’re Wondering About Yourself
If you’re reading this and recognizing yourself in these descriptions, it might be worth exploring whether ADHD could explain some of the challenges you’ve experienced. This is particularly worth considering if:
● You’ve always felt “different” but couldn’t explain why
● You work much harder than others to achieve the same result
● You struggle with organization and time management despite trying numerous systems
● You have difficulty focusing, especially on tasks that aren’t immediately interesting
● You experience intense emotions or rejection sensitivity
● You’ve been diagnosed with anxiety or depression but treatments haven’t fully addressed your symptoms
● You have a child or family member with ADHD and you’re noticing similarities
Here is an ADULT ADHD Self-Rated Symptom Checklist that you can use as a prescreener.
Getting Proper Evaluation and Support
If you suspect you might have ADHD, it’s important to work with a mental health professional who understands how the condition can present differently across genders. Look for someone who:
● Has experience evaluating ADHD in adults
● Understands gender differences in ADHD presentation
● Uses comprehensive assessment tools, not just brief questionnaires
● Considers your full history, including childhood experiences and family history
● Looks at how symptoms affect your daily functioning, not just whether you fit a narrow stereotype
What to Expect from Evaluation
A comprehensive ADHD evaluation should include detailed interviews about your current symptoms and childhood history, standardized rating scales, and consideration of other conditions that might explain your symptoms. The process might take multiple appointments and should feel thorough rather than rushed.
Treatment is Individualized
If you are diagnosed with ADHD, remember that treatment should be tailored to your specific needs, symptoms, and life circumstances. What works for someone else might not work for you, and that’s okay. Treatment might include medication, therapy, lifestyle changes, or accommodations at work or school.
The Importance of Accurate Diagnosis
Getting an accurate ADHD diagnosis (whenever it happens in your life) can be transformative. It’s not just about getting access to treatments (though that’s important). It’s about understanding yourself, reframing your struggles, and developing strategies that actually work with your brain rather than against it.
For women who have spent years feeling like they were failing at things that seemed easy for everyone else, understanding that their brain works differently can be incredibly validating. It doesn’t excuse challenges, but it explains them and opens up new possibilities for support and success.
The goal isn’t to use ADHD as an excuse or to lower expectations for yourself. The goal is to understand how your brain works so you can develop strategies that actually help you thrive, rather than continuing to struggle with approaches that weren’t designed for your neurology.
Your struggles are real, your experiences are valid, and you deserve support that acknowledges and addresses how your brain actually works…not how other people think it should work.
If you’re wondering whether ADHD might explain some of your lifelong struggles, or if you’ve been recently diagnosed and need support navigating this new understanding of yourself, you don’t have to figure it out alone.
At Get Reconnected Psychotherapy Services, Sep Nikmanesh and Adam Adivi provide comprehensive support for adults with ADHD, including help processing late diagnoses and developing strategies that work with your unique brain.
Book a Free 15 Minute consultation with Adam and a Free 15 Minute Consultation with Sep to explore how Sep and Adam can support you in understanding and managing your ADHD.
source https://getreconnected.ca/blog/adhd-gender-differences-women-undiagnosed/
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