✎ Written by: Dubravka Rebic
Your mom, friend, sister, or colleague might feel bad about themselves right now but have no idea what the reason is behind those insecurities.
Maybe this morning they forgot to reply to an important email or pick their clothes up off the floor. And they probably feel ashamed because they believe the people in their circle who tell them they're lazy, erratic, or have some kind of severe character flaw. But what many girls and women don't realize is that their behaviors might result from struggling with undiagnosed inattentive ADHD symptoms.
ADHD stands for attention deficit hyperactivity disorder, a neuro-behavioral disorder characterized by an ongoing pattern of inattention and/or hyperactivity/impulsivity. During their lifetime, 13% of men will be diagnosed with ADHD whereas just 4.2% of women will be diagnosed.
This is not because more men have ADHD than women; the reason behind these statistics is that so many women go undiagnosed due to a combination of factors, such as diagnostic criteria that are based on observations of men as well as a lack of understanding of symptoms in women.
Let's go over some common experiences of women with ADHD and the unique struggles they face.
1. Women Tend to Be More Inattentive Than Hyperactive
There are three types of ADHD: hyperactive/impulsive type, inattentive type, and combined type. And even though the symptoms can vary by type, they are also not the same for every person and can present differently between genders.
For example, women and girls with ADHD are usually less hyperactive and more inattentive than boys and men with the disorder. They also tend to be less disruptive.
In girls, the inattentiveness may appear as frequent daydreaming, difficulty processing information or following directions, and being easily distracted, forgetful, and introverted.
When a girl with ADHD does have hyperactive type, her behaviors may often look very different than they do in a boy with hyperactive type. For instance, a girl may be hyperverbal or hyperreactive (crying often or slamming doors) – behaviors one may not typically think of as being associated with ADHD.
And because these symptoms don't look like “typical” ADHD symptoms, they're often dismissed, which may result in women and girls being blamed for their mood swings or for being too distracted.
As a result, rather than question their behavior as being caused by something more serious or receiving a proper diagnosis, they’re subject to harsh criticism or rejection. For years, their ADHD can go undiagnosed and, even though their symptoms won’t hinder them from living a functional life for years to come, they can potentially lead to anxiety, low self-esteem, and depression.
2. Hormones Can Influence ADHD Symptoms in Girls and Women
Studies have shown that for most women and girls, the severity of ADHD symptoms will fluctuate throughout the month, tied closely with their hormonal cycles and estrogen levels. These fluctuations can cause a premenstrual syndrome that involves decreased frustration tolerance and feelings of negativity, which may exacerbate ADHD symptoms.
But, instead of recognizing the symptoms as related to underlying ADHD, many women and girls are being misdiagnosed solely with a mood disorder or PMDD (a severe form of premenstrual syndrome).
During pregnancy, for example, estrogen levels rise and, for women with ADHD, this increase can help ease their symptoms.
However, in the weeks after childbirth, estrogen levels drop, which can decrease dopamine levels and cause mood swings. Estrogen levels also drop throughout menopause, causing a drop in dopamine levels, which are already low in a brain affected by ADHD. As a result, women may experience increased inattention.
3. Women Are Underdiagnosed Compared to Men
For many girls and women, behavioral issues become more evident around puberty as estrogen levels increase. This pattern contrasts with many boys, whose hyperactivity decreases significantly after puberty that, for decades, it was even believed that they "outgrew" their ADHD.
Up until 2013, the requirement held by the Diagnostic and Statistical Manual was that symptoms must appear by the age of seven. Since girls' symptoms have been shown to increase with their estrogen levels, it was unlikely for most girls to meet that criterion.
And even though the DSM changed the age to 12, many girls are still left undiagnosed. This is likely because girls' ADHD symptoms would typically become more prevalent when they would move away from home for the first time to go to college. During this challenging period, girls with ADHD would usually face difficulties with independent living or maintaining a healthy lifestyle, and these struggles would make the symptoms more evident.
According to Dr. Patricia Quinn, author of Understanding Women with ADHD, the average age of diagnosis for women with ADHD who weren't diagnosed as children is 36 to 38 years old. Before that time, girls and women are often misdiagnosed as having depression or an anxiety disorder.
Without an accurate diagnosis and the resulting treatment plan, women can't treat their symptoms and are deprived of the opportunity to improve the quality of their lives. As a result, living with an undiagnosed condition can lead to years of low self-esteem and shame until a diagnosis shines a light on why everything has been so hard for so long.
4. Women Have More Trouble With Social Interactions
In "The Secret Lives of Girls with ADHD", Dr. Littman states that girls often internalize their inability to meet social expectations by seeing their struggles with reading social cues accurately as a character flaw.
For example, due to processing difficulties, girls with ADHD may feel intimidated by rapid verbal interplay while talking with a group of friends. They might miss punchlines or misread social cues and feel ashamed as a result.
Additionally, because their impulse-driven feelings can be overpowering, they may appear oblivious to others' feelings and be judged as selfish. For instance, they may blurt out hurtful things, interrupt others, or abruptly walk away from a conversation. While this may look or feel hurtful to an onlooker, the impulsivity of these actions are due to ADHD and not the person’s intention to be hurtful.
Furthermore, through observational studies in the classroom, researchers found that girls with ADHD are generally less physically aggressive than boys with ADHD. Still, they can be verbally aggressive (teasing, taunting, name-calling) compared with girls without ADHD – a behavior that will likely result in increased rates of peer rejection.
5. Women May Have Different Coping Strategies
According to this meta-analysis, girls with ADHD show less physical aggression and other external behaviors than boys, but their rates of depression and anxiety are higher.
Instead of externalizing, many girls with ADHD show avoidance behaviors. For example, they may react to the distress experienced in the classroom by developing avoidance behaviors exhibited by headaches or stomach aches. They often become shy and withdrawn within the classroom by not answering questions or participating in class discussions. In more extreme cases, they may even refuse to attend school altogether.
Women and girls with ADHD have different experiences than boys and men with the same condition and, as a result, they are more likely to go undiagnosed. If their symptoms are disregarded or if they're diagnosed incorrectly, they will continue to struggle with ADHD symptoms well into adulthood, which can leave them feeling anxious, overwhelmed, insecure, and powerless.
However, by learning how to recognize the mistaken, misunderstood symptoms of ADHD in girls and women, you can help women with ADHD (whether diagnosed or not) feel more validated, seen, heard, and understood. This can help them feel more secure and supported through their experiences and lighten the burden that women with ADHD are unfairly forced to carry.
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About the author:
Dubravka Rebic puts a lot of time and energy into researching and writing in order to help create awareness and positive change in the mental health space. From poring over scientific studies to reading entire books in order to write a single content piece, she puts in the hard work to ensure her content is of the highest quality and provides maximum value.
Quinn PO, Madhoo M. A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01596. doi: 10.4088/PCC.13r01596. Epub 2014 Oct 13. PMID: 25317366; PMCID: PMC4195638.
Antoniou E, Rigas N, Orovou E, Papatrechas A, Sarella A. ADHD Symptoms in Females of Childhood, Adolescent, Reproductive and Menopause Period. Mater Sociomed. 2021 Jun;33(2):114-118. doi: 10.5455/msm.2021.33.114-118. PMID: 34483739; PMCID: PMC8385721.
Kathleen M. Nadeau and Patricia O. Quinn, Understanding Women with AD/HD, 2002.
Cook NE, Braaten EB, Surman CBH. Clinical and functional correlates of processing speed in pediatric Attention-Deficit/Hyperactivity Disorder: a systematic review and meta-analysis. Child Neuropsychol. 2018 Jul;24(5):598-616. doi: 10.1080/09297049.2017.1307952. Epub 2017 Mar 27. PMID: 28345402.
Abikoff HB, Jensen PS, Arnold LL, Hoza B, Hechtman L, Pollack S, Martin D, Alvir J, March JS, Hinshaw S, Vitiello B, Newcorn J, Greiner A, Cantwell DP, Conners CK, Elliott G, Greenhill LL, Kraemer H, Pelham WE Jr, Severe JB, Swanson JM, Wells K, Wigal T. Observed classroom behavior of children with ADHD: relationship to gender and comorbidity. J Abnorm Child Psychol. 2002 Aug;30(4):349-59. doi: 10.1023/a:1015713807297. PMID: 12109488.
Gaub M, Carlson CL. Gender differences in ADHD: a meta-analysis and critical review. J Am Acad Child Adolesc Psychiatry. 1997 Aug;36(8):1036-45. doi: 10.1097/00004583-199708000-00011. Erratum in: J Am Acad Child Adolesc Psychiatry 1997 Dec;36(12):1783. PMID: 9256583.