You’ve created a to-do list, made yourself a cup of tea, and sat down to work. You’re staring at the laptop screen and watching it stare back, your thoughts spiraling in multiple directions. 

Why is it so hard to just… start?

According to Lotta Borg Skoglund, a general practitioner and psychiatrist specializing in ADHD, you’re not alone in this feeling. 

In her book ADHD Girls to Women: Getting on the Radar, she reports that many women with ADHD “ask why their engine won’t start when they know they have important things to get done. Or why they start one thing, forget another, flounder over a third, and drop a fourth to the floor.”

“Many feel banished, as if they can never fit in, and, ultimately, many will experience extreme and tormenting loneliness,” Skoglund continues. 

The good news is, Skoglund’s book makes for an enlightening read that can help any girl or woman struggling with ADHD symptoms realize that there is nothing wrong with them, their brains are just hardwired differently, and there are plenty of people out there who are in the same boat.

In this article, we’ll go over Skoglund’s explanation of what ADHD is, why it’s underdiagnosed in women, and which symptoms to look out for if you’re not quite sure whether you have ADHD.

ADHD: Why is it underdiagnosed in women?

A neurodevelopmental disorder, ADHD can be described as having “persistent problems of sustained attention and/or impulsiveness and hyperactivity.” This can manifest in a variety of ways, from struggling to focus for longer periods of time to experiencing difficulty starting and accomplishing tasks or sitting still. 

As Skoglund explains, ADHD has historically been underdiagnosed in women — one girl is diagnosed with ADHD to every 3–16 boys, with this distribution leveling out in adulthood. 

The question is, “Why?” 

Here are just some of the explanations Skoglund provides:

• Girls are diagnosed with inattentive ADHD more often than hyperactive ADHD, and inattentive symptoms may be more difficult to perceive and understand (it is easier to recognize ADHD in a boy who can’t sit still or be quiet than in a girl who struggles to concentrate).

• Symptoms of hyperactivity and impulsivity in girls can look different than those in boys, including emotional dysregulation, self-harm, and sexual risk-taking. These are often attributed to social factors, such as upbringing or negative peer influence, rather than ADHD.

• ADHD often presents with comorbidity in internalized disorders like anxiety or depression and compensatory strategies like perfectionism, which are diagnosed as the primary issue, potentially overshadowing ADHD itself.

• Many girls with ADHD attempt to fit in by conforming to societal gender standards. They try to be compliant and reserved, internalizing their struggles and turning feelings of inadequacy inward, resulting in shame and guilt. This makes it more difficult for their ADHD to be recognized.

• On a psychosocial level, girls usually mature earlier than boys, which means they understand what is expected from them and how to behave in various contexts at a younger age, suppressing their external ADHD symptoms.

“Girls’ ADHD symptoms seem to be harder for others to detect and interpret than boys. Part of the explanation for this is probably due to a tendency to lay a cultural and social filter over our interpretation of girls’ and boys’ behaviors and problems,” summarizes Skoglund. 

She asks, “What do we need to know to be able to detect and diagnose girls and women with ADHD earlier and prevent years of struggle?”

Let’s take a closer look at some of the symptoms described in her book — symptoms you may not have necessarily realized are linked to ADHD in girls and women.

Beyond executive dysfunction: 4 ADHD symptoms girls & women may silently struggle with

One of the most common ADHD signs is executive dysfunction, which is the difficulty in planning, organizing, and carrying out tasks, among other things. 

Skoglund compares this to a flight control tower at a large airport: “Our executive functions, much like the staff working in the control tower, will keep track of the myriad signals that the brain is exposed to at any given moment… If the control tower is understaffed, all the incoming information quickly becomes overwhelming and unmanageable.”

She drives this point home when she says, “ADHD is not about knowing what has to be done; it’s about not being able to do what has to be done, despite knowing that you have to do it.”

This manifests as a number of symptoms, the combination of which is unique to each person. Symptoms of inattentiveness, for example, can sound like this:

• “When I read stuff, I always jump around in the text, and I lose myself and miss important details. I often have to read it all over again, so even though I try to hurry, it still takes me longer.”

• “I write long lists to help me remember what I must do. It calms me down in some strange way. But then I never follow them and end up writing new ones.”

As for hyperactivity, you may relate to some of these phrases:

• “Even when I want to be careful, I rush to get things done. I may miss a few details, but I’m almost always the one who finishes first.”

• “I’m allergic to slow pace; I get bored so easily. I’d do almost anything to avoid being bored.”

• “If I don’t say what I think straight away, it’s gone. And I’m left with a horrible feeling that I’ve forgotten something.”

While executive dysfunction is a common struggle, there are many more ADHD symptoms that are closely related to being a woman and that may sometimes be overlooked. 

Here are the 4 we’ve picked out from Skoglund’s book.

• Your executive functioning worsens during the luteal phase of your menstrual cycle. While not enough studies have been conducted on how hormonal fluctuations affect ADHD symptoms in women, Skoglund points out that the female hormones estrogen and progesterone have been shown to impact everyday functions of the brain. What’s more, some research indicates that ADHD symptoms may worsen in the week before menstruation, and Skoglund’s clients’ reports support this.

• You’re struggling with other conditions in addition to your ADHD. About 80 percent of adults with ADHD have at least one other psychiatric diagnosis, Skoglund reports. This comorbidity can be attributed to both biological factors and personal & situational circumstances affected by ADHD. For instance, verbal impulsivity — a common sign of hyperactive ADHD in girls — can lead to decreased self-esteem and social anxiety. In general, girls with ADHD are at a much higher risk of developing anxiety and mood disorders, as per the book.
  
  

• You find it hard to understand, restrain, or tolerate your emotions. In her practice, Skoglund has met many women who say their emotional dysregulation is a major problem-creator in their lives. For example, they often struggle to time their emotional responses or handle the emotional turbulence occurring on the inside. Some also experience rejection-sensitivity dysphoria (RSD), an intense and short-lived emotion triggered by a real or perceived experience of rejection, teasing, or criticism. These emotional outbursts may lead to shame, embarrassment, and social isolation.
  
  

• You perform excellently in some areas of life, yet struggle to function overall. “For many with ADHD, performance is often achieved at the cost of other major aspects of life,” Skoglund says. “There are tons of women who are excellent entrepreneurs, artists, or journalists and yet are wholly unable to maintain their health, home, or family.” 

Brilliant performance — externally focused behavior that may be influenced by social gender conditioning, coping strategies, and a desire to excel — does not necessarily translate into brilliant functioning. In fact, it may even hinder it at times. For instance, entering a hyperfocus mode (a common ADHD experience) may be followed up by a crash in energy levels or accompanied by a poor diet and a negative impact on one’s relationships.

Conclusion

“ADHD is still underdiagnosed in girls and women. Outdated and inverted casualty claims, such as ADHD being the outcome of a poor upbringing or over-protective/absent parents, or a reluctance to ‘get one’s act together,’ prevent many people from obtaining a viable and credible explanatory model for their lifelong impairments,” writes Skoglund in closing.

And that is precisely why ADHD Girls to Women: Getting on the Radar is such an important read. It not only provides girls and women with eye-opening ADHD symptoms they may not have even realized were linked to ADHD, but it also explains how ADHD works on a biological level, which treatments are recommended, how ADHD differs from or overlaps with other conditions, and how it may impact family dynamics.

If you think you or someone you know may have ADHD, or if you have received your diagnosis and would like to learn more about ADHD and its impact on women, give this book a go.

As Skoglund says, “The right diagnosis and explanation are often invaluable and it may make all the difference when the pieces fall into place and someone understands why they have ‘behaved’ so awkwardly their entire life, why they have constantly ended up in the same rut, and why ‘good’ advice of others and interventions of healthcare professionals have failed.”

She highlights that there are many girls and women who, in receiving their diagnosis, “have been able to bring about change, access self-care tools, and do so based on their own needs and priorities.”

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