ADHD Diagnosis in Women
Leading psychologists are warning that gender bias is leaving many women with attention deficit hyperactivity disorder undiagnosed. A late diagnosis can have a negative impact on relationships and careers, as well as increase the risk of mental health problems such as anxiety, depression, and eating disorders. Women often receive attention deficit hyperactivity disorder (ADHD) diagnoses later in life than men. This is because the symptoms can present differently in women and because research into the condition in women is lacking.
ADHD is a neurodevelopmental disorder. It often appears in childhood but can last into adulthood. In some cases, people with ADHD do not receive a diagnosis until they are adults. Doctors usually diagnose ADHD during childhood. In 2019 in the United States, 11.7% of boys received a diagnosis of the condition. This is compared with just 5.7% of girls. Women with ADHD are more prone to eating disorders, obesity, low self-esteem, depression, and anxiety.  Women’s ADHD sometimes gets overlooked until college, when they begin to show a lack of self-regulation and self-management.
The underlying mechanisms of ADHD are the same in males and females. Both have difficulties with planning, organization, recalling details, and paying attention.
But how ADHD plays out in symptoms is where the gender differences often lie. And the reason for that is likely social.
Because inattention is much more subtle than hyperactivity, this may be why boys are almost three times more likely than girls to be diagnosed with ADHD. By the time they reach adulthood, however, that gap shrinks to two to one. This is likely because girls are often diagnosed later in life, compared to boys.
For women, responsibilities including family and work can make it difficult to cover up or manage ADHD. But there are some things women can do to cope with life’s demands.
Common ADHD Symptoms in Women
ADHD has three main presentations:
- Hyperactive-impulsive type
- Inattentive type
- Combination type, which involves combined symptoms of the other two types
While girls can have any of the three types, girls who do get an ADHD diagnosis more commonly have the inattentive type. ADHD symptoms in women of this type include trouble with concentration, organization, and learning and processing new information.
To put it another way, not everyone with ADHD will seem hyperactive, fidgety, impatient, or impulsive. When kids don’t act out or disrupt others, it may take more time for parents and teachers to notice the symptoms they do have.
Some key ADHD symptoms in women and signs in girls include:
- Talking frequently or excessively, even when parents or teachers ask them to stop
- Extreme emotional sensitivity and reactivity, such as crying or becoming upset easily
- Extreme focus on things that interest them
- Trouble paying attention to directions at home or school
- A tendency to daydream or seem lost in their own world
- Slow or distracted movements
- A habit of blurting out thoughts or acting on impulses without thinking things through
- Frequent forgetfulness
- A habit of abandoning goals or plans halfway
- Disorganization, which might show up as a messy bedroom, desk, or backpack
- Constantly interrupting peers during conversations and activities
- Trouble forming and maintaining friendships
- Difficulty completing schoolwork on time
- Trouble sleeping, including difficulty falling asleep or waking up too early
- Relational aggression toward peers, including gossip, bullying, intimidation, and other controlling behaviors
- A preference for strenuous outdoor activities and sports that require a lot of energy
Some girls may notice more severe symptoms just before and during their period.
Evidence suggests that girls often have less severe symptoms, especially hyperactive-impulsive symptoms. When parents and teachers do notice these signs, they might link them to personality differences or immaturity.
The ADHD symptoms in women listed above aren’t the only signs, just examples of the ways the condition often shows up in girls.
Common Signs of ADHD in Women
You may notice signs of ADHD in many different areas of your life. Some of these symptoms may be worse or more noticeable in certain contexts, such as at work or school. You may find that you spend a lot of time and effort to appear “normal.”
You may wish you were able to be a better friend, partner, or mom, and that you could do the things that other people do. For example, you may wish you could remember birthdays, bake cookies, and arrive on time for a date.
Because you’re not able to do the things that society expects women to do, people may think you don’t care.
Growing up, you may have been described as a tomboy because you had so much energy and liked to be busy. As an adult, friendships can be difficult to navigate because social rules seem complicated. People may say that you talk more than anyone else they know.
While you may be talkative, you may dislike going to parties and other social gatherings because they make you feel overwhelmed and shy. Your mind drifts during conversations unless you’re the one talking or it’s a topic you find very interesting.
Being at the office feels difficult. The noise and people make it hard to get work done. You may choose to stay late or come in early because the only time you can work effectively is when everyone else has left and it’s quiet.
Your desk at work is piled high with papers. Even when you make a big effort to tidy it, it only stays clear for a day or two.
In school, ADHD symptoms in women may get overlooked because women are more likely to have inattentive ADHD, which doesn’t have the visible behavior problems that hyperactive/impulsive ADHD usually does. Girls with ADHD may also hyperfocus on things that interest them, which may lead teachers and parents to overlook the possibility of ADHD.
As an adult, you may feel frustrated that people you went to school pass you by with their achievements, even though you know you’re just as smart.
With ADHD, it may feel like each day is spent responding to requests and limiting disasters rather than moving forward with your goals. You may feel crushing sadness and frustration that you haven’t met your potential. Other daily struggles may include:
- Paper clutter: It often feels like you’re drowning in paper. At work, home, in your car, and even in your purse. You have an uneasy feeling that unpaid bills and forgotten projects are hiding under all the paper. You don’t feel organized with money and are usually behind with bills.
- Overspending: You often overspend to compensate for other problems. For example, when you don’t have a clean outfit to wear for an office party, you buy a new one. Or when you forget someone’s birthday, you buy an expensive present to make up for it. Shopping trips make you feel better in the moment, but you feel regretful later when the credit card bill arrives.
- Disorganization: You may spend a lot of time, money, and research on products to help you be more organized, but then you don’t use them. You may feel embarrassed to have guests visit your home because it’s so cluttered and disorganized.
- Indecision: Grocery stores overwhelm you, and you may find it hard to make decisions about what to buy. You often forget a key ingredient for a meal even though you take longer in the store than most people do.
Relaxing is often difficult for people with ADHD. Little things can push you over the top and you may become emotional.
ADHD symptoms in women often don’t improve without treatment, and undiagnosed ADHD can worsen over time. Even milder symptoms can cause plenty of distress and affect daily life at school or home, along with friendships and relationships.
Plus, girls who never get a diagnosis may end up blaming themselves for the difficulties they experience. Instead of accepting these symptoms as signs of a mental health condition that requires professional support, they might:
- Feel frustrated with their lack of success
- Believe they need to try harder
- Frequently feel overwhelmed and exhausted by their efforts
- Wonder why they “can’t do anything right”
- Have difficulty achieving goals and lose their motivation to keep trying
Over time, this internalization can affect self-esteem and self-worth. It can also lead to self-punishment and an overall sense of hopelessness.
Other possible complications  include:
- Regular conflict in relationships with parents, teachers, and friends
- Rejection or bullying from classmates and peers
- Social isolation, or few close friendships
- Increased chance of eating disorders
- Persistent sleep problems
- Trouble succeeding at school or work
- Increased chance of other mental health conditions, including substance use disorders and depression
It’s also worth keeping in mind that treatment for anxiety, depression, and other mental health symptoms might have less effect when ADHD symptoms in women go unaddressed.
Types & ADHD Symptoms in Women
ADHD is a mental health condition that affects the ability to do some or all of these tasks:
- Paying attention, focusing, or concentrating for prolonged periods
- Noticing some details
- Breaking activities and goals into steps or stages
- Staying organized
- Managing schedules
- Remembering things
- Sitting still
- Managing impulses
People with ADHD typically have symptoms that fall into one of three categories.
The following are signs of inattentive ADHD:
- Difficulty concentrating
- Being easily distracted
- Regularly making careless mistakes
- Often losing necessary items
Hyperactivity-impulsivity presents in the following ways:
- Difficulty remaining seated
- Excessive talking
- Frequent interruptions during conversation
A combination of both inattentive and hyperactive-impulsive symptoms characterize combined ADHD.
ADHD and Hormones
In both sexes, changes in hormone levels can influence ADHD symptoms.  Regardless of their sex assigned at birth, individuals may experience a shift in symptoms around puberty when sex hormones influence physical symptoms and behavior. Fluctuating hormones can affect symptoms in other ways:
- Experts in a 2020 statement agreed that hormone levels in pregnancy and menopause can also increase symptoms.
- A small 2017 study found that inattention can increase after the ovulation phase of your menstrual cycle.
- Changes in estrogen levels across your cycle can increase ADHD symptoms, especially for women with ADHD who may experience more impulsivity.
Psychological and emotional effects of ADHD on women
- A 2014 research of girls with ADHD showed that their self-esteem is often lower than boys with ADHD — even well into adulthood.
- Research from 2016 comparing girls who have ADHD with girls who do not have ADHD suggests that those with ADHD often have more conflict in their social relationships than those without ADHD.
- A 2017 study of women and girls suggests that women diagnosed with ADHD have a higher risk of experiencing symptoms of depression, anxiety, and eating disorders. Additionally, borderline personality disorder is more likely to be reported among women previously or concurrently diagnosed with the hyperactive-impulsive type of ADHD.
Other conditions can also be present along with ADHD. When you have more than one condition, they are called comorbid conditions or coexisting conditions.  Here are some conditions that women often have in addition to their ADHD:
- Substance use disorders, such as addiction to alcohol or drugs
- Anxiety disorders, such as social anxiety disorder (SAD) or obsessive-compulsive disorder (OCD)
- Sleep disorders
- Eating disorders, such as anorexia or bulimia
- Mood disorders, like depression or bipolar disorder
It’s good to be aware of these coexisting conditions because they can cause symptoms that look similar to ADHD. This, in turn, can make diagnosing ADHD more complex. However, an experienced clinician will be aware of this challenge.
Adults with ADHD can experience depression or anxiety, problems with family, sexual behavior, work, and substance abuse. It is important to obtain an assessment to learn ADHD symptoms in women and treatment options so as to best support your loved one with ADHD. 
Call today to speak with one of our treatment specialists.
Your call is private and confidential and there is never any obligation.
 Women and ADHD – https://www.webmd.com/add-adhd/features/adhd-in-women
[2,3] Why ADHD Is Underdiagnosed in Women – and What We Can Do About It – https://www.healthline.com/health/adhd/adhd-in-women
 ADHD in Women – https://www.verywellmind.com/add-symptoms-in-women-20394
 We Level Up – Mental Health » ADHD Treatment