Sarah was 34 when she finally got her ADHD diagnosis. For years, she’d struggled with focus at work, felt overwhelmed by daily tasks, and had a nagging feeling that something was different about how her brain worked.
Sarah’s story reflects a massive problem. Research shows that during childhood, boys are diagnosed with ADHD at a 3:1 ratio compared to girls. But in adulthood, that ratio becomes 1:1 between men and women¹. This dramatic shift reveals that countless women are missed during childhood and only get diagnosed much later in life.
The Hidden Crisis: Why Female ADHD Gets Missed
Research Was About Boys
Early ADHD research had a huge problem – 80% of participants were boys, with 29% of studies exclusively studying males². This created diagnostic criteria that worked for boys but completely missed how ADHD shows up in girls and women.
The criteria focused on:
- External, disruptive behaviours
- Physical hyperactivity
- Obvious attention problems
This missed the quieter, internal struggles many girls and women experience.
Women Learn to Hide It (Masking)
From a young age, girls face different expectations. They’re expected to be:
- Quiet and well-behaved
- Organised and responsible
- Good at following rules
This pressure means girls with ADHD learn to hide their struggles. They:
- Appear organised outside whilst feeling chaotic inside
- Work twice as hard to manage basic tasks
- Develop anxiety and perfectionism to cope
- Feel exhausted from constantly hiding their difficulties
How ADHD Shows Up Differently in Women
The Quiet Type (Inattentive ADHD)
Many women have inattentive ADHD, which is less obvious but equally challenging.
Attention struggles:
- Can’t focus on boring or routine tasks
- Get distracted by their own thoughts
- Lose important things regularly
- Start projects but struggle to finish them
Organisation difficulties:
- Look put-together but feel disorganised
- Always running late despite trying
- Can’t prioritise when there’s lots to do
- Leave everything until the last minute
Mental symptoms:
- Daydream or “zone out” frequently
- Feel mentally foggy
- Get overwhelmed easily
- Forget conversations or tasks
Internal Hyperactivity
Boys often show hyperactivity by running around and being disruptive. Women more commonly have:
- Racing thoughts
- Feeling “revved up” inside
- Can’t stop talking or need to fill the silence
- Fidget with jewellery, hair, or clothes
Emotional Struggles
Women with ADHD often experience:
- Rejection Sensitive Dysphoria (RSD). This is Intense emotional pain from criticism or rejection
- Big mood swings throughout the day
- Reactions that seem too strong for the situation
- Trouble managing stress and feeling overwhelmed
How Hormones Affect Female ADHD
Hormones have a massive impact on ADHD symptoms in women. Research shows that lower estradiol combined with higher progesterone predicted increased ADHD symptoms³.
Monthly Cycle Changes
Many women notice their ADHD gets worse at certain times of the month, especially during:
- Early follicular phase (just after period starts)
- Early luteal phase (week before period)
This happens because estrogen enhances dopamine production, which is crucial for ADHD symptom management. When estrogen drops, ADHD symptoms worsen.
Life Changes
ADHD often gets recognised during major hormonal shifts:
- After having a baby (many women first seek help at this point)
- During perimenopause and menopause
- When starting or stopping the contraceptive pill
Exciting new research shows that increasing medication by 30-50% before periods can significantly improve symptoms, with minimal side effects⁴.
Common Wrong Diagnoses
Female ADHD often gets misdiagnosed as:
Anxiety and Depression
ADHD creates constant stress and frustration, leading to anxiety and depression. But if you only treat these without addressing the underlying ADHD, the core problems remain.
Eating Problems
There’s a connection between ADHD and eating disorders in women. This might include:
- Impulsive eating
- Using food restriction for emotional control
- Hyperfocusing on food, exercise, or body image
What Good Assessment Looks Like
What to Look For
- Clinicians who understand how ADHD appears in women
- Assessment that considers hormonal influences
- Understanding of masking behaviours
- Evaluation for other conditions that might occur alongside ADHD
Questions Your Clinician Should Ask
- Were you called a daydreamer at school?
- Do you feel exhausted from trying to appear organised?
- Do your symptoms get worse at certain times of the month?
- Have you created complicated systems to manage daily life?
- Do you avoid situations that feel overwhelming?
Red Flags in Assessment
Be careful of assessments that:
- Dismiss your symptoms because you seem successful
- Only focus on childhood hyperactivity
- Don’t consider hormonal influences
- Don’t look at masking behaviours
- Don’t check for other conditions like autism
The Massive Increase in Recognition
Recent data shows a 344% increase in ADHD medication prescriptions for women ages 15-44 between 2020-2021⁵. This reflects growing recognition of previously missed diagnoses, not a sudden increase in the condition itself.
Many women are finally getting the help they’ve needed for years.
What Happens After Diagnosis
Women who get a proper ADHD diagnosis often experience:
- Finally understanding lifelong struggles
- Access to helpful treatments
- Better performance at work
- Improved relationships
- Better emotional regulation and self-esteem
Think you might have ADHD?
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- Speak to specialists who understand women’s presentations.
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References:
- Attoe & Climie (2023). Journal of Attention Disorders. DOI: 10.1177/10870547231161533
- Young et al. (2020). BMC Psychiatry. DOI: 10.1186/s12888-020-02707-9
- Roberts et al. (2018). Psychoneuroendocrinology. PMC5803442
- de Jong et al. (2023). Frontiers in Psychiatry. DOI: 10.3389/fpsyt.2023.1306194
- CDC data cited by CHADD (2024)