ADHD in girls and women

By Olivia Guy-Evans, published July 04, 2022 | Fact Checked by Saul Mcleod, PhD


Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition associated with deficits in attention, impulsivity, and hyperactivity. Whilst it is common for everyone to experience difficulties with attention or controlling impulses to some degree, for those with ADHD, these problems are so pervasive to the point where it interferes with every aspect of their lives.

ADHD is a condition which is more commonly diagnosed in males than females, typically three times as many males are diagnosed. This may have led to some stereotypes that ADHD is a condition associated with boys who cannot keep still and are disruptive.

However, it is likely that there are many girls and women who are not diagnosed because their symptoms of ADHD are being missed.

The discrepancy that males are diagnosed more than girls on a ratio of 3:1 highlights that a large number of girls with ADHD are likely to remain unidentified and untreated. This leads to implications that without a diagnosis, girls are likely to suffer more long-term social, educational, and mental health outcomes.

Girls often tend to display less severe symptoms of ADHD than boys, especially when it comes to hyper-activity and impulsivity. More girls with ADHD may fall more into the predominantly inattentive presentation of ADHD.

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The inattention symptoms may present as being easily distracted, overwhelmed, lacking in effort, and motivation.

Girls who struggle with inattentive issues are often overshadowed by hyperactive boys who are more likely to demonstrate more stereotypical hyperactive ADHD behaviour. Girls and women are also more likely to mask their symptoms of ADHD.

A reason for this may be that girls are often expected to be more social than boys and so they learn to present in ways which are deemed more acceptable, which can make it harder for girls to get a diagnosis.

Three Types of ADHD

The categorisation of ADHD has changed over the years and given several names, one of which being attention deficit disorder (ADD). Although ADD is often still used today, the DSM-5 only uses the term ADHD to describe individuals with this condition, regardless of whether the person displays symptoms of hyperactivity. 

The DSM-5 criteria for ADHD now states that there are three separate presentations of the condition, and each person falls into one of the following categories: predominately inattention presentation, predominantly hyperactive-impulsive presentation, and combined hyperactive-impulsive and inattentive presentation. Below are the different types of ADHD and the traits associated with each.

Inattentive

  • Significant difficulty sustaining attention

  • Find themselves easily distracted

  • May not appear to be listening in conversations

  • Struggle to follow directions or instructions 

  • Fail to give close attention to details, or may make careless mistakes

  • Difficulty with organisation

  • Tend to lose things often such as their keys or phone

  • Can be very forgetful in daily activities

  • Often procrastinates from tasks

  • Dislikes tasks which require sustained mental effort and may avoid these tasks

  • Find difficulty in completing tasks from start to finish 

Impulsive and Hyperactive

  • Extreme restlessness

  • In children – often running about or excessively climbing 

  • Has difficulty remaining seated

  • Fidgets with their hands or feet

  • Talks excessively

  • Acts as if driven by a motor

  • Has difficulty engaging in activities quietly

  • Gives or shouts out answers before they have finished being asked

  • Difficulty waiting or taking turns

  • Interrupts others

  • Behaviours can be loud and disruptive

  • Excessively high levels of activity which may be physical and/or verbal

  • Tendency to dominate conversations 

ADHD combined presentation

The combined presentation is where individuals meet the criteria for both the inattentive and hyperactive-impulsive presentations. 

What does ADHD look like in women and girls?

Not all women and girls with ADHD will exhibit all the following symptoms, but some of the common ones include:

  • Appearing withdrawn or shy

  • Forgetful

  • Difficulty maintaining focus

  • Hyper-talkative

  • Being disorganised and messy

  • Appears to be unmotivated

  • Daydreaming often

  • Crying easily

  • Verbally impulsive such as interrupting others

  • Not appearing to be trying

  • Highly sensitive to noise, fabrics, and emotions

  • Hyperreactivity 

  • Poor time management

  • Looking to be making careless mistakes

  • Problems completing tasks 

  • Shifting focus from one activity to another

  • Taking time to process information and directions

Women and girls with ADHD are believed to have more inattentive symptoms rather than hyperactive symptoms. This does not mean that they never experience this symptom, but that it may look different.

Females may present their hyperactive symptoms internally as racing thoughts, or outwardly as being very talkative and interrupting conversations. 

To compensate for their inattention, females with ADHD may hyperfocus on something they enjoy or are good at. They may put forth so much effort and concentration that their parents or teachers may dismiss the possibility that they have ADHD.

Sometimes this hyperfocus is a coping strategy to keep them entertained when something is boring, while other times they may not feel as if they have any control over it. Females with ADHD may hyperfocus in the sense of working overtime on tasks to succeed well, which can be a type of perfectionism. 

Another common symptom of ADHD in females is the social differences they have. They may struggle to make and keep friends and their social world may be more complicated than that of males.

Girls may feel more pressure to pay close attention to their friend’s feelings or that they feel like they have to pick up on subtle social cues, which can prove hard for them. 

Females with ADHD are often more likely to have an internal locus of control compared to males. For instance, they may be more likely to blame themselves for when things go wrong, whereas males may be more likely to blame external factors. 

The importance of ADHD diagnosis

Often, girls and women who have undiagnosed ADHD get diagnosed as having a mood disorder. This may be because their undetected symptoms can lead to complications such as anxiety and depression, which can be flagged up more easily by professionals. A lot of the time, girls and women do not seek help for their ADHD until they have developed comorbid conditions.

It is important that women and girls with ADHD receive an accurate diagnosis that addresses both symptoms and other important issues with functioning and impairment. This can help determine appropriate treatment and strategies for individual women with ADHD. Educating girls about ADHD may help them to avoid:

  • Feeling ashamed and blaming themselves for their symptoms.

  • Feeling like they have failed in life.

  • Seeking stimulation that can negatively affect them.

  • Coping strategies that are unhelpful and not more harm than good.

A diagnosis of ADHD can help women and girls have clarity on their behaviours, both past and present, and can reduce feelings of guilt about how their behaviour. Before the diagnosis, girls may have been attributed labels such as ‘chatterbox’, ‘drama queen’, or ‘tomboy’ due to their symptoms. Having a diagnosis of ADHD can help free them from these labels and other people may be more compassionate and accommodating as a result. 

When a clear diagnosis is delayed, these individuals can experience worse outcomes over the course of a lifetime, including:

  • Less academic and career achievement

  • Higher levels of anxiety and depression

  • More conflict in relationships

  • Lower self-esteem

  • Physical symptoms such as headaches and abdominal distress

  • Sleep problems

When accurately diagnosed, ADHD can be better managed, leading to increased satisfaction in life and significant improvements in daily functioning. Many people with ADHD can lead successful and happy lives, but an accurate diagnosis is the first step to effectively manage the disorder. 

What is the impact of ADHD in women and girls?

Academic/occupational 

The academic functioning of women and girls with ADHD is thought to be similar to males with ADHD. The impact is that they may complete tasks later than those without ADHD, they are more likely to repeat years at school, get suspended, drop out, or have specific learning difficulties.

The occupational functioning of females with ADHD is also similar to males with ADHD. They may be more likely to have a high turnover of jobs, frequently change the type of work they do, and have lower productivity levels than those without ADHD. 

Home life

Women with ADHD may find that they struggle with maintaining an organized home life. their finances may be chaos, paperwork and record-keeping are often poorly managed, and they may feel less able to keep up with the daily tasks of meal planning, cleaning, and other aspects of life management. Some women may manage to hide their struggles and may work on tasks late into the night to get things done.

Relationships

Women and girls with ADHD are more likely to have a high turnover of friendships, experience social isolation, peer rejection, and more bullying than those without ADHD.

They may find that they seek a social network by forming damaging relationships such as joining a gang or increasing their sexual availability as a way to make relationships, thus, the quality of their relationships may be poorer.

They may also find it difficult to navigate being in romantic relationships with others, especially if ADHD is undiagnosed and their partner cannot offer understanding.

Even made aware, research suggests that husbands of women with ADHD are less tolerant of their spouse’s ADHD patterns than wives of men with ADHD. As a result, women with ADHD may be more likely to experience break ups, or divorce as an impact of their ADHD. 

Mental and physical health

Whether a woman’s life is in chaos, or they are able to hide their struggles, they often describe themselves as feeling overwhelmed and exhausted. Compared to women without ADHD, women with ADHD are more likely to suffer depressive symptoms, are more stressed and anxious, and have lower self-esteem and feelings of shame.

Co-existing anxiety may result from procrastination/avoidance and concern about failure to perform or meet expectations. Over time their self- esteem and self-image are likely to suffer from repeated experiences of failure, alienation, and inadequacy. 

Many clinicians are findings significant concerns and other co-existing conditions in women with ADHD such as compulsive overeating, alcohol abuse, and chronic sleep deprivation. There is also an alarming link between ADHD and non-suicidal self-injury (NSSI) and suicidal behaviour.

For NSSI, it is thought that adolescent externalizing behaviours, poor executive function and peer victimization are mechanisms for this (Hinshaw et al., 2012). For suicidal behaviour, early internalizing problems and peer rejecting are documented mediators (Meza, Owens, & Hinshaw, 2021). 

Chronic stress can also take its toll on women with ADHD, affecting them both physically and psychologically. Chronic stress associated with ADHD makes someone more at risk for diseases related to stress such as fibromyalgia.

Therefore, it is becoming clear that the lack of appropriate identification and treatment of ADHD in women is a significant public health concern.

Social judgement

Women and girls are often encouraged to exhibit both traditional ‘feminine’ qualities such as being empathetic, good with relationships, and nice, as well as traditional ‘masculine’ qualities such as being assertive, academically driven, and career focused.

So, when they display impulsive, disorganized, or disruptive behaviours, they are at risk of harsh social judgement since these traits violate the norms for female behaviour. 

ADHD also tends to carry a strong social stigma, the negative effects of which add significantly to the impairments caused by the disorder itself. Some variables which can contribute to the stigma include:

  • Public’s uncertainty regarding the validity and reliability of the diagnosis.

  • Interpretations of impairments as trivial or caused by a lack of will power or a resistance to conform.

  • If ADHD is not perceived as a real disorder, a diagnosis of the disorder is less likely to give rise to empathy and understanding. 

In an attempt to avoid social judgement, many women and girls with ADHD may spend excessive amounts of energy trying to hide their problems, which in turn go unrecognised by others. 

Parenting

In a lot of families, the primary parent in the mother. The mothers are usually expected to be the household and family manager, roles that require focus, organization, and planning, as well as the ability to juggle multiple responsibilities. ADHD typically interferes with these abilities making the job of a mother with ADHD very difficult. 

Women with ADHD are also more likely to have a child that also has ADHD, which further increases parenting challenges.

Frequently, a woman comes to recognise their own ADHD after one of their children has received a diagnosis. When learning about the child’s diagnosis, the mother may begin to see similar patterns in their own behaviour.

How to cope with ADHD

The following strategies can be incorporated into life without the guidance of a therapist, to reduce the impact of ADHD:

  • Letting go of perfectionism – spending too much time on things that don’t have a big impact on life can create unnecessary stress and anxiety. 

  • Understanding and accepting the challenges of ADHD instead of putting blame and judgement on yourself.

  • Identify any unnecessary sources of stress in daily life and systematically make life changes to lower your stress levels.

  • Seek structure and support from family and friends.

  • Schedule regular times out, especially when things get overwhelming.

  • Develop health self-care habits such as getting enough sleep and eating well.

  • Get organized where possible, such as writing down the top priorities for the day and creating a schedule. 

  • Identify your strengths and weaknesses such as looking at what you know you can do quickest, with little trouble, and what can take the most time. 

  • Allow yourself extra time to complete tasks if needed. 

  • Use the Pomodoro technique – this is a time management system that breaks down the work or study day into chunks, separated by regular short breaks. For instance, you can work on a task solely, without any distractions, for 25 minutes, followed by a 5-minute break. This technique encourages people to work with the time they have and makes the day feel more manageable. 

  • Incorporating physical exercise into a daily routine can not only help people with ADHD feel focused and calm but is also good for coexisting mental health conditions. 

Treatment

Those girls and women who are fortunate enough to receive an accurate diagnosis of ADHD often face the challenge of finding a professional who can provide appropriate treatment. There are few clinicians experienced in treating adult ADHD, and even fewer familiar with the unique issues faced by women with ADHD.

Consequently, most clinicians use standard psychotherapeutic methods, although these can be helping in providing insight into emotional and interpersonal issues, they may not help a woman with ADHD learn to better manage her ADHD on a daily basis, or to learn strategies to lead a productive and enjoyable life.

Effective treatment for women may involve a multimodal approach that includes medication, psychotherapy, stress management, as well as group therapy.

Medications

Stimulants are mostly used to manage the symptoms of ADHD. Research shows that 70% of adults and 70-80% of children with ADHD have fewer symptoms while taking these medications (Advokat & Scheithauer, 2013). 

Stimulants can help those with ADHD as these individuals and believed to have chronically under aroused brains. A type of stimulant includes methylphenidates which is found in Ritalin. This type of stimulant is known as a dopamine reuptake inhibitor, meaning it stops dopamine from being absorbed back into the neuron which released it, meaning there is more circulating the brain. 

Amphetamines are another type of stimulant found in Adderall and Vyvanse. These stimulate the neurons so that they release more dopamine. Both types of stimulants increase levels of dopamine to a more ‘neurotypical’ level so there is less of a need to find stimulation from the environment, making it easier to focus. 

All aspects of a woman’s life need to be taken into consideration when prescribing medicative treatment, including the treatment of any coexisting conditions. Medication may be further complicated by hormone fluctuation across the menstrual cycle and across the lifespan (including puberty, menopause) so these factors need to be considered before starting treatment. 

Behaviour therapy

For some, behaviour therapy can help people with ADHD learn the skills required to control their symptoms and help them manage tasks. The aim of behaviour therapy is to replace negative behaviours with positive ones.

People with ADHD can learn strategies to improve problem areas such as organization, focus, impulse control, among others. Many find that behaviour therapy can help them effectively manage their ADHD symptoms without the use of medications. 

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) involves working with a therapist to identify patterns of behaviour and unhelpful thought patterns that can make ADHD symptoms worse.

Once identified, these thoughts and behaviours can be challenged, changed to more realistic thinking, and new behaviours can be learnt to manage stress, obligations, coping, and managing many aspects of everyday life. As well as helping with ADHD symptoms, CBT can be helpful for women with ADHD to manage other conditions which can coexist alongside their ADHD, such as depression and anxiety. 

Group therapy

As many women with ADHD may feel shame and rejection as a result of their symptoms, psychotherapy in a group setting designed for women with ADHD may provide a beneficial experience. This can provide a place where women can feel understood and accepted by other women and provides a safe place to begin their journey towards accepting themselves more and learning to better manage their lives. 

Parent management programmes

Evidence-based parent management programmes are found to be effective in children with ADHD and are also recommended for parents with ADHD. However, these approaches have shown that parent training may be less effective if the mother has high levels of ADHD symptoms. Therefore, it may be useful to incorporate adult ADHD life management strategies into parent training programmes for mothers with ADHD. 

Why is ADHD often undiagnosed in women and girls?

The ratio of boys to girls diagnosed with ADHD is around 3:1. Interestingly, by adulthood, the male/female ratio for those with ADHD is closer to 1:1. ADHD symptoms are present in childhood, but these ratios suggest that the disorder goes undiagnosed in girls, or that the presentation of ADHD in girls is different to those displayed by boys and persists differently that it gets missed by others. 

A significant proportion of women receive their diagnosis in adulthood, or they do not get diagnosed at all. When ADHD remains unidentified, the prospects of understanding the person’s problems and getting access to adequate treatment options are also lost. 

There are several factors which may play a part in explaining why ADHD is often undiagnosed in women and girls. As most of the information on ADHD refers to cisgender males and females and rarely those who are not cisgender, for the purpose of this article, the terms used will refer to cisgender males and females. 

Research on ADHD

The diagnostic criteria and general understanding of ADHD today is mainly based on observations of how the disorder manifests in young boys.

Much of the clinical research on ADHD have studied samples of boys, meaning that rating scales are also based predominantly on male samples, which may disadvantage their use on females. Without sufficient research into girls and women with ADHD, our ideas on how ADHD should present itself will be based on how it manifests in males. 

Different presentation

From the research that exists on girls with ADHD, it is now understood that these girls are more likely to present with inattentive symptoms, rather than hyperactive symptoms, which are more common among boys (Hinshaw, 2021). Common symptoms of inattention in females include forgetfulness, low arousal, daydreaming, and disorganization. 

Females are still believed to have impulsive symptoms of ADHD, although these may manifest as a tendency to disrupt others, say whatever comes to mind, act on impulses and suddenly change direction in life.

Whilst these symptoms may also be present for boys, if these are present in girls without obvious hyperactive symptoms, many may misinterpret these as signs of emotional difficulties or disciplinary problems, rather than symptoms of ADHD. 

Research has found that girls with ADHD predominately have the inattention type of the disorder, alongside associated internalizing problems, whilst boys with ADHD predominately have the hyperactive-impulsive type with associated externalizing problems.

It is also thought that many of the ADHD symptoms and externalizing problems only become more salient in girls as they reach puberty, in contrast to boys whose symptoms and externalizing problems are more noticeable in earlier childhood. 

The externalizing problems, hyperactive and interruptive behaviours often seen in boys are most likely to lead to a referral. The combination of mostly inattentive symptoms, alongside fewer externalizing problems mean that the symptoms of these girls can be easily missed by teachers and parents or misunderstood to be something else. 

Societal expectations

Since boys with ADHD are more likely to receive a referral for a diagnosis, statistics based on clinically referred samples will naturally reflect an image of ADHD as a predominantly male disorder.

As there is often an understanding that ADHD is a condition associated with boys who are ‘disruptive’, if a girl displays similar symptoms, people may not be as inclined to consider she may have ADHD.

Likewise, hyperactive symptoms are commonly judged to be less socially acceptable in girls than in boys, and their hyperactive symptoms in girls may be misinterpreted as emotional problems. 

In many societies, girls are often expected to be polite, quiet, and obedient. It is thought that girls with ADHD will often mask their symptoms so that they fit in with their peers. If girls are effectively masking their symptoms, this can make it harder for others to notice that they have any difficulties, making it less likely that they will be referred for a diagnosis. 

Misdiagnosis 

Internalizing problems such as depression and anxiety are often more prominent in girls with ADHD. Sometimes, these internalized problems can be more noticeable than the other ADHD symptoms, meaning that they can mask the presence of ADHD and delay a diagnosis.

Moreover, not receiving an earlier diagnosis and missing out on appropriate support may make the internalized problems worse or lead to the development of a co-existing mental health condition, which can mean that ADHD is even less noticeable. Often, it may not be until adulthood when women realise for themselves that they have ADHD. 

Fact Checking

Content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication.

About the Author

Olivia Guy-Evans obtained her undergraduate degree in Educational Psychology at Edge Hill University in 2015. She then received her master’s degree in Psychology of Education from the University of Bristol in 2019. Olivia has been working as a support worker for adults with learning disabilities in Bristol for the last four years.

Cite this Article (APA Style)

Guy-Evans, O. (2022, July 04. ADHD in girls and women. Simply Psychology. www.simplypsychology.org/adhd-in-girls-and-women.html

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