Men and women can have any and/or all symptoms of attention-deficit/hyperactivity disorder (ADHD), but current research, based on self-reports, suggests that women may perceive they struggle more with certain symptoms or areas in life, including inattention, organization, time management, emotional regulation, dating, shame, and more.
What Is ADHD?
ADHD is a neurological, mental health disorder in which individuals experience chronic issues with inattention, hyperactivity, and/or impulsivity.1 The onset of ADHD is in childhood and symptoms typically persist into adulthood. Adults with ADHD can experience an impact in their ability to perform in school or at work as well as have difficulty managing social relationships.
ADHD runs in families and is attributed to genetic and environmental factors, but it is typically a result of the combination of the two.2 The newest version of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5), the guide to mental health diagnoses, notes that ADHD may or may not include symptoms of hyperactivity and impulsivity and may present as more inattention in some individuals.1
ADHD Symptoms In Women
Men and women can have any and/or all symptoms of adult ADHD, but self-reports suggest that women may perceive they struggle more with certain symptoms or areas in life, including inattention, organization, time management, procrastination, dating, and shame.3
It is important to keep in mind the role that gender bias plays in diagnosing ADHD. The level of impact a mental health condition may have on someone is based on the perception of suffering, either by individuals with such conditions or the professionals diagnosing them, as many women may have found ways to function “well” despite ADHD.
For adults struggling with ADHD, the stakes can have a massive impact in all areas in life, including academic, occupational, and social. ADHD is often misdiagnosed or overlooked in childhood. For adults who have never been accurately diagnosed or properly treated for their symptoms, it may feel highly distressing to consistently struggle, all the while thinking their symptoms are “normal.”
ADHD in women may present with these symptoms more often:
- Inattention: many studies suggest that women struggle with inattentive symptoms of ADHD more often. People who struggle with inattention may feel like they are daydreaming a lot and have difficulty retaining information. Inattention is subtle and easily goes unnoticed in childhood, leading biological females to be diagnosed later in life.3
- Talkative: ADHD women may present as being “overly talkative” or blurting out responses quickly. This may be a reflection of the mind moving quickly and impulsively before choosing to speak.
- Listening: ADHD women who report more difficulty listening may find they struggle in higher education settings and feel they cannot focus or retain information as they want to. They may zone out or feel like they are in a different world.
- Staying organized: some women report that they have a difficult time managing concrete things, such as finances, or more subjective experiences such as a work life balance. When someone’s bucket feels like it is overflowing, it can feel really distressing and disorienting.
- Time management: with difficulty focusing comes a sense of time blindness or losing track of time. This symptom of ADHD in women may look like being chronically late, likely due to lack of focus and ability to ground and difficulty finishing tasks and managing appointments.
- Poorer emotional regulation: poor emotional regulation may be due to shifts in hormones and fluctuating moods that appear to be more drastic than men with ADHD. Poor self-esteem also plays a role here, with women getting the sense that they are on display and being judged more critically.
- Chronic procrastination: due to the symptoms mentioned above, chronic procrastination can be an additional concern. Women struggle to manage their time and emotions, as well as stay organized. This can contribute to feelings of frustration and inadequacy.
- Dating: rejection sensitive dysphoria is a highly debatable symptom of people with ADHD, and for women in particular. Anyone with ADHD can experience difficulty managing emotions or struggle with the pain of rejection. This is not a diagnosis on its own, but rejection sensitivity may look like a more extreme reaction to being teased or feeling like you are a disappointment to your partner, family, or friends.
- Shame: the cultural expectations prescribed to women can make neuro-typical and atypical women feel like they are failing, not meeting standards, or the opposite of perfect. Since many women report they feel they have to work hard to prove themselves, it can feel defeating to have to battle a neurological disorder on top of managing high expectations of performance.
ADHD In Women vs. Men
When we discuss differences between men and women with ADHD, it’s important to note that there is the biological sex assigned at birth (i.e., boy or girl) and then the gender that an individual chooses to express (female or male, among others). Biologically-born males are diagnosed with ADHD more often than females, with some research suggesting the ratio is as high as 10 to 1.3,4
With research supporting that women with ADHD typically display more inattention than hyperactivity or impulsivity, their needs are easily missed. It’s common for many adults to be diagnosed with ADHD in adulthood, feeling like they’ve always struggled and didn’t know why. Over time, adults who haven’t received proper treatment may innately normalize their experience and assume by default “it must just be me” or that they can’t keep up.
There is a lot of research that supports the idea that there is gender bias involved in the diagnostic criteria for ADHD, with younger boys being labeled hyperactive for big behaviors and girls with ADHD who are assumed to be emotional, shy or not confident.3,4,5,6,7
Why Does ADHD Go Unnoticed in Women?
With children and youth, ADHD is more commonly diagnosed in biological males than females4 Gender bias and expectations certainly play a role in the diagnostic process. For example, it’s believed in the mental health community that women with ADHD tend to demonstrate more inattentive symptoms rather than the impulse/conduct symptoms that are prevalent in males diagnosed with the condition.4,5
“Many people don’t realize that difficulties with inattention and impulse control are often due to disorders that can be treated, says Professor Stephen Faraone. “Those with undiagnosed ADHD will blame themselves for not doing better or not trying hard enough. Indeed, many had been told in childhood that they were ‘lazy.’ This type of stigmatizing communication makes it difficult to get treated. If we add to that the misinformation about ADHD on the Internet, it is no surprise that many women are undiagnosed.”
When looking at comorbidities or the presence of more than one mental health concern, women with ADHD are more likely to be diagnosed with major depression. Depressive symptoms are often treated before considering ADHD.5 With procrastination symptoms in ADHD like distractibility, disorganization, and poor concept of time, one might assume someone is depressed or “lazy,” when in fact, that’s an assumption based on incomplete information.
It’s important to keep in mind that men and women are expected to display behaviors differently, based on culturally created norms.
Treatment For ADHD In Adult Women
For decades, the first line of treatment or medication for adult ADHD has been prescription use of stimulants like ritalin or adderall. There are also other medications, such as non-stimulants or third line antidepressants. Research supports that women don’t display as many overt, behavioral symptoms that men do and therefore, they don’t have as many referrals for medication treatment.7 Instead, women who internalize may try to overcompensate, want to adapt or meet expectations, and be diagnosed with a mood or personality disorder in return.
Prior to taking medication to treat ADHD, you should discuss symptoms and medical history with your prescribing doctor to determine whether stimulants or non-stimulants are the best choice for you, and discuss any potential medication side effects specific to women.
There are many types of therapy that support the treatment of ADHD. Cognitive behavioral therapy (CBT) for ADHD is a cognitive-behavioral approach that therapists use to examine the connection between unhelpful thoughts and unwanted behaviors. With CBT, a therapist works with a client with ADHD to examine how much their personal thought patterns impact functioning or ability to complete certain tasks.
Other therapies that may provide skill development include DBT skills work, acceptance and commitment therapy (ACT) values work and general psychoeducation on ADHD. A good therapist will take a validating, understanding approach to your unique symptoms and your desire to make changes.
Some therapists do not treat neurodiverse populations, so it is important to consult with a provider and confirm that they’re skilled and experienced in working with someone who has ADHD. You can also see a therapist if you question that you may have ADHD and your symptoms have been overlooked since childhood. A neurodiverse affirming therapist will have special knowledge of different neurotypes and nuances associated with your diagnosis.
How Sex Affects ADHD Treatment
There are many schools of thought on the use of stimulant medication during pregnancy, but many doctors feel stimulant use is relatively safe, especially if the mother has already been on medication. Going off medication can be extremely distressing for expectant mothers, causing stress that may lead to other complications during pregnancy.
There are many studies out there that provide mixed information and no real answer on whether or not medication is actually safe; some providers will advise against use due to fear of birth defects, premature birth, and cardiac issues in newborns, among other concerns. Conversely, some research suggests that overall risk of fetal malformation is extremely low.9
Just like other mental health disorders, hormones play a role in the timing of symptoms and impact medication. During the 3rd or 4th week of the menstrual cycle, some women experience a decrease in medication effectiveness due to hormone fluctuation.9 With some women experiencing more severe premenstrual symptoms, it’s been said that contraceptive use may help regulate or decrease severity of ADHD symptoms in women.9
Final Thoughts
ADHD is difficult to deal with but there are effective treatments. It’s important to have an honest conversation with your therapist and doctor when discussing your personal symptoms and where in life you feel the most impact. It may be worthwhile to ask whether they have experience treating ADHD in women and are aware of diagnostic gender bias.
ADHD in Women Infographics
