Why do so many women and girls go undiagnosed with ADHD?
ADHD presents differently in females, often leading to misdiagnosis or late diagnosis, impacting academic, social, and emotional well-being.
This blog post explores the unique ways ADHD manifests in women and girls, the latest research, practical strategies, and possible next steps to support the experiences of females with ADHD.
The Science of ADHD in Women and Girls
While ADHD may typically present differently in some females, neurodivergent experiences are highly individualized and not strictly gendered. According to the Centers for Disease Control, boys (15%) were more likely to be diagnosed with ADHD than girls (8%). This difference is influenced by a variety of environmental factors that make the female presentation and impact different than that of male ADHD.
The following summary is a collection of facts about ADHD and gendered differences that are important to know for the remainder of the article:
- Boys are more likely to receive an ADHD diagnosis compared to girls. This may be because their symptoms, especially hyperactive and impulsive symptoms, are perceived to be more noticeable.
- There are differences in symptom presentation between males and females. Boys with ADHD diagnoses tend to show more impulsivity compared to girls. However, both girls and boys experience inattention at a similar rate.
- Girls are more likely to be diagnosed with ADHD in childhood if they present with severe symptoms. This same pattern is not as pronounced in males with ADHD.
- Research on ADHD continues to develop as we learn more about the presentation in girls. What we know today may change as studies continue to capture female experiences.
Gender Gaps in Medical Research
Our limited understanding of the female presentation of ADHD (and other conditions) has a history. In 1977, the Federal Drug Administration (FDA) released a guideline where women considered to be of “childbearing age” were excluded from medical research. This was not reversed until 1993, when the FDA instead asserted that women were mandated to be represented in medical research. It wasn’t until 2001 that biological sex was considered a variable in research. As of 2019, Harvard Medical School found that women continue to be underrepresented in medical research. This suggests that female involvement in research has a very long road ahead, with much more to be learned.
Differences in Experience and Presentation
Internalizing Experiences
Women with ADHD are more likely to blame themselves for their struggles, which can lead to an increased risk of anxiety and depression. Because they are less likely to receive a diagnosis and proper treatment, they may experience growing distress over time. leading to an increased risk of symptoms associated with anxiety and depression. Women, given they are less likely to receive an ADHD diagnosis, are more likely to go untreated. As they encounter more difficulties with daily living skills, they are more likely to experience building distress. Without any formal answers for why they experience the struggles they do, all the blame tends to be turned inward and viewed as a negative reflection of their abilities.
Masking
Masking is when someone hides or covers up their symptoms, often to fit in or avoid being judged by others. For example, a person with ADHD might “mask” or try very hard to act “normal” by pretending to be calm, focused, or organized, even if they feel distracted, chaotic, or frazzled on the inside.
This process of pretending to fit into expectations is exhausting and overwhelming, which can lead to stress and frustration. Masking is a coping strategy that may help individuals fit in socially, but it is often exhausting and unsustainable. but it is often exhausting and unsustainable. While it may provide temporary relief from external judgment, it does not address the underlying needs or teach the skills that a person with ADHD or executive dysfunction may find beneficial for long-term well-being.
Social Relationships
Men and women tend to form friendships in different ways. In friendships, women tend to share more personal details and express more affection than men. They often prioritize communication and emotional support and often strengthen ties through deep conversations. Women with ADHD tend to struggle more to create strong networks and may feel isolated, overwhelmed, or stressed. This can be further intensified by feeling rejected by others.
Hormonal Changes Over Time
Some research suggests that hormonal changes due to menstruation, puberty, pregnancy, and menopause may also impact ADHD symptomology. At certain points in a woman’s cycle, ADHD symptoms have been reported to worsen for certain individuals. Fluctuations in estrogen and progesterone may contribute to higher levels of hyperactivity and impulsivity through risk-taking or reward-seeking behavior. For others, individuals experience more negative emotionality and lessened executive functioning than typical. Girls going through puberty are more vulnerable to these changes, as the body undergoes various changes in addition to the stress and changes in relationship dynamics that accompany adolescence. It’s important that girls monitor any differences in their ADHD symptoms over time before making decisions about the impact of biological changes on their daily functions and experiences.
Executive Function Differences
Research suggests that there does not appear to be a significant difference between the executive functioning skills of males and females. Both genetics (e.g., brain development, hormones, and aging) and the environment shape executive function. As the brain develops over time, early support is necessary to make sure our executive functions develop in a positive way.
Difficult early-life experiences such as trauma, instability, chronic stress, health complications, and substance abuse can impact executive function development in all individuals, not just those with ADHD. Executive functioning varies widely among neurodivergent individuals, and these factors may interact differently based on a person’s unique neurological makeup.
Advocating For Yourself
Advocating for oneself can be challenging, especially when dealing with ADHD or executive dysfunction. Understanding your needs and knowing how to communicate them effectively can make a significant difference.
Women who believe they may have ADHD or executive dysfunction can advocate for themselves by taking the first step to recognize their challenges and then asking for help. In medical settings, it’s important to speak openly with a doctor about the difficulties you’re facing, such as trouble focusing, staying organized, or managing time. Writing down specific examples of how these challenges impact daily life can help explain the situation clearly.
At school or work, women can also request accommodations like extra time for tasks, a quiet space for concentration, or help with organizing tasks. Advocating for the right support is key to getting the tools needed to succeed, and women should feel confident in asking for assessments or accommodations that can make life easier. By speaking up and seeking help, women can receive the support they need to manage ADHD or executive dysfunction more effectively.
Additional Resources and Tools
When someone you care about is struggling with focus, organization, or self-control, it can be hard to know where to start. Life Skills Advocate offers valuable resources to help families, teachers, and individuals better understand and support loved ones who may have undiagnosed ADHD or executive dysfunction. Our free executive function assessment helps identify challenges with skills like time management, emotional regulation, and task completion. This can be a great first step in recognizing whether ADHD or executive function difficulties may be affecting daily life.
Life Skills Advocate’s Resource Hub provides easy-to-understand guides, strategies, and tools for managing executive function struggles at home, school, and work. For those who need extra support, our coaching services offer personalized help to build skills and confidence. Whether you’re a parent trying to help your child, a teacher looking for better ways to support students, or an adult struggling with focus and organization, these resources can make a big difference. Understanding ADHD and executive function challenges is the key to providing the right support, and Life Skills Advocate is here to help every step of the way!
TL;DR – (Too Long; Didn’t Read)
ADHD often presents differently in women and girls, leading to misdiagnosis or delayed diagnoses. Girls with ADHD may be quieter or internalize their experiences more than boys, causing their symptoms to be overlooked. They are more likely to experience anxiety, depression, and struggles with social relationships. Masking, or hiding symptoms to fit in, is common among women, making them feel exhausted and misunderstood. Hormonal fluctuations during menstruation, puberty, and menopause can also worsen ADHD symptoms.
Women who suspect they have ADHD can advocate for themselves by being open with professionals, asking for specific accommodations at school or work, and seeking support from friends and family when needed. In addition, Life Skills Advocate provides valuable resources like free executive function assessments, coaching, and guides to help individuals, families, and educators understand and support ADHD challenges. ADHD in women and girls is often misunderstood, but with awareness and the right strategies, they can navigate challenges successfully.
Further Reading
- ADDitude (2024) – High and Low Estrogen Exacerbate ADHD Symptoms in Females: New Theory
- Boundless Sociology (2020) – Gender Differences in Social Interaction
- Centers for Disease Control (2024) – Data and Statistics on ADHD
- Grissom & Reyes (2019) – Let’s Call the Whole Thing Off: Evaluating Gender and Sex Differences in Executive Function
- Harvard Medical School (2022) – More Data Needed
- Hatoum (2023) – The Etiology of Executive Functioning is Nature & Nurture
- Liu & Mager (2016) – Women’s involvement in clinical trials: historical perspective and future implications
- Nadeau (2023) – Why ADHD Is More Challenging for Women
- Life Skills Advocate (2024) – How to Build a Support Network: Practical Strategies for Neurodivergent Individuals
- Life Skills Advocate (2024) – Practicing Real-World Self-Advocacy: A Guide for Neurodivergent Individuals