ADHD in Women: Why It’s Missed & How to Get Help

ADHD in Women — the abbreviation and the ‘ADHD iceberg’ below the surface 

What does ADHD stand for? Attention-Deficit/Hyperactivity Disorder. 

In today’s medical manuals the official name is ADHD, even when hyperactivity is mild or absent. Many people talk about ADHD as if only attention and hyperactivity issues were ‘the ADHD’ — and everything else wasn’t. 

The ‘ADHD iceberg’ 

You’ve probably seen the ‘ADHD iceberg’ diagram, with impulsivity, hyperactivity, inattention and concentration difficulties at the tip. Below the waterline lies the huge hidden part with all sorts of things: sleep difficulties, relationship problems, issues at work, financial strain… You may also have spatial orientation issues and a sense of being ‘clumsy’ (spilling things on yourself, bumping into objects), plus a not-so-friendly relationship with time. You’ve been late your whole life — not out of disrespect or carelessness, but because you can’t feel how long a task will take. Or you arrive 20–30 minutes early for meetings. Breaking a big task into smaller steps can also be difficult. When you leave home, you check the door several times, then go back to make sure every electrical appliance has been switched off. 

In other words, that’s a lot. In women, ADHD is often even less ‘visible’. 

ADHD in Women — why is it diagnosed less often? 

Statistics show boys and men are diagnosed with ADHD three to four times as often as girls and women. That’s puzzling, because most research suggests such a large — especially global — gap shouldn’t exist. The areas where differences show up are the same, and they function in broadly similar ways. 

Why is it still like this? 

Historically, descriptions were written to fit a ‘boy template’. Boys were the ones brought to clinics for impulsive–hyperactive behaviour; that’s where they were observed and studied. Girls were barely represented in those samples. Who disrupted the lesson? The loud boy. He was in everyone’s way — so the write-ups focused on him. The girl sat quietly — she bothered no one. For her, ADHD often appeared as inner restlessness: instead of outward hyperactivity, anxiety was ‘spinning’ on the inside. 

So, the first reason: the earliest ADHD tests and categories were built mainly around hyperactive boys. And even in Russell Barkley’s early books (1990s and early 2000s) — still one of the most respected ADHD experts — women’s ADHD received very little focus. 

This led to a second problem: it wasn’t very clear how ADHD presents in women. In recent years (particularly from around 2018 onwards) the lens has widened, and experts have started to discuss the specific features of ADHD in women. Now it’s recognised that girls more often show inattention and less hyperactivity: difficulties handling detail, careless/inattentive mistakes, and problems sustaining attention and with memory have come to the foreground. 

All right, but what does this look like day to day? 

• You jump from task to task, constantly switching, and by the end of the day you collapse with exhaustion. 

• Everything is a concentration issue: you keep losing things, forget a lot, and get distracted easily. 

• Or you can write correctly, but often leave out letters or syllables, double letters or syllables, and drift into the margin. 

• Straightforward problem-solving papers are easy — you might finish two versions in an hour and still have five minutes left to be bored. 

• But multiple-choice tests or timed assessments are personal hells: worry and doubt are so high that if wrong answers lose marks, you can end up with negative marks. 

• You make lots of fidgety ‘waste movements’ — fixing your hair, scratching your nose, rubbing your fingers… 

In other words, these are the things people label: ‘clever girl, capable, but perhaps lazy? Or inattentive?’ They point at the messy exercise book and ask: ‘Can a girl write like this? Something’s not right with her; she should try harder, study more, and then she’ll come to her senses’. Yet you drown in details, slide into perfectionism, and only finish everything late at night. 

But, as we know, a person with ADHD cannot ‘just’ pull themselves together. There are anatomical, physiological and genetic factors that mean you can’t simply start thinking and acting differently. Such a girl suffers a great deal, while no one realises what she is facing. She can’t deliver stable results: even if she knows something well and has done it many times, roughly one time in five she will slip. So, girls often find it harder to fit in socially as well. 

ADHD in Women — sensory overload  

Many women experience strong sensory overload: bright lights, noise, smells, clothing labels, textures, crowds — all hitting at once. There’s an excellent book on this: Elaine N. Aron, The Highly Sensitive Person. The foreword opens with a woman’s case study in a shopping centre — and for many readers that’s the moment of recognition: ‘hang on — could it actually be completely normal to react like this?’ 

When stimuli arrive all at once, the system overloads: the body sounds the alarm (‘out of here, now’) — you either faint or run. You can’t tolerate scratchy fabrics, can’t do certain things, and have little patience with particular stimuli, especially when they last. This is common in women with ADHD, and it is not ‘put on’. 

ADHD in Women — gender role expectations and the cost of masking 

We’ve arrived at gendered role expectations. Closely linked to this is a concept: masking. In ADHD, masking can mean appearing cheerful and ‘functional’ on the outside — while, for example, living with depression. With boys, ‘messy, loud’ may still pass; for girls it doesn’t fit the template, so they mask more. Society’s message is: be ‘small’, take up less space. 

The load of expectations 

What a woman is ‘supposed’ to do often comes as a long list: 

• managing the family 

• caring for the home 

• arranging safe travel 

• handling family admin 

• raising children 

• maintaining extended-family relationships 

• doing paid work — and more besides 

Many women with ADHD are less inclined towards these demands; under pressure they smooth their behaviour, take on more, say ‘yes’, carry everything — and end up with the feeling: ‘I don’t even know who I am’. Then comes the icing on the cake: your child is diagnosed — with pronounced hyperactivity, major attention difficulties — and you feel like the ‘worst mother’, and ‘not good enough’ as a woman. 

Women with ADHD are curious, playful, imaginative. Yet they carry more emotional load and keep constant watch to avoid acting too impulsively. You’re always ‘not quite right’: not attentive enough, not feminine enough, not kind enough, not gentle enough, not well-groomed enough… It’s exhausting — and it hurts inside. A disproportionate amount of energy goes into maintaining the appearance of ‘normal functioning’. 

ADHD in Women — anxiety as compensation 

Over time, anxiety can turn into a coping strategy: hiding, keeping strict order, never being late, losing nothing — always on guard. That breeds tension, which can tip into an anxiety or depressive disorder. In other words, neurobiological features are at play; you may not be aware of them, so you try to cope like everyone else, it doesn’t work, failures stack up, and an inner story forms: ‘I’m unlucky — nothing works for me’. The negative filter starts to reshape how you see the world, yourself, and the future — and that’s how depression takes hold. 

When you mask, you also filter what you tell the doctor — through self-esteem and inner experience — and they may not notice the symptoms you hide because of gender roles. Sadly, many doctors still think there’s nothing alarming if a girl is scattered or forgetful — ‘well, she’s a girl’. 

What can a doctor do? 

• Tailor diagnostic descriptions to women so the criteria fit everyone, not only men. 

• Recognise masking in women as a distinct diagnostic cue.  

• Recognise that anxiety and depressive disorders are not always ‘primary’; they are often linked to ADHD. 

ADHD in Women — social challenges and strengths 

There’s now plenty of research on women’s social difficulties and skill gaps. Society places strong expectations on women: maintaining long-term romantic relationships, monogamy, having children, and so on. Building a healthy relationship can still be hard: in hyperfocus you can ‘smother’ your romantic partner, and at other times you may seem indifferent. Because of this, many women with ADHD avoid relationships to protect themselves from anxiety and stress — which can feel logical.  

They can motivate and support themselves and others, and they often bring innate creativity, courage, and decisiveness. Those strengths often come with finely tuned emotional radar — a gift in relationships and work, but one that can also make perceived criticism sting more. Don’t forget that rejection sensitivity (often called rejection sensitive dysphoria, RSD) is common alongside ADHD. You might have a brilliant day, then someone says something with a certain tone, you take it personally, and sudden sadness or anger hits. You go through life not understanding these abrupt mood shifts. You worry that if you don’t behave ‘the right way’, you won’t be accepted — so you withdraw further to shield yourself from social impact. 

ADHD in Women — shame, sexuality, and co-occurring conditions 

Shame is often strong for women with ADHD — and it frequently ties into sexuality. Women with ADHD take part in risky sexual behaviour more often than average: 

• unprotected sex 

• early sexual debut 

• more sexually transmitted infections 

• a higher rate of unplanned pregnancies  

It’s easy to ‘blame it on ADHD’ and wave it away — ‘some women are just like that’. But for many women this brings shame, fuels anxiety, and keeps the topic hidden — which makes diagnosis harder. 

Women are also ‘less fortunate’ in that co-occurring conditions are more common. Eating disorders show up more often; amid everyday chaos, hurried eating appears: you eat quickly, chew poorly, end up eating more than you need, and find it very hard to regulate food intake. Personality disorders are reported more often — including borderline personality disorder — as well as obsessive–compulsive disorder and autism-spectrum traits. All this makes the diagnosis of ADHD in women even more complicated. 

ADHD in Women — hormones and life stages 

Puberty, pregnancy and menopause can change attention, mood and medication response. Hormones influence dopamine and emotion regulation. Researchers therefore suggest paying more attention to hormonal factors — less relevant for men but strongly shaping women’s experiences. 

Symptoms can shift with phases of the cycle: after ovulation — especially before menstruation — ADHD features may intensify because of hormonal fluctuations. 

Some studies suggest that low oestrogen combined with high progesterone increases the likelihood of deterioration and symptom flare-ups. Remember too that oestrogen begins to act strongly early in adolescence — this is often when symptoms first appear in girls. These experiences can look like ‘increased irritability’ or ‘mood problems’, prompting comments such as ‘you’re overreacting’ or ‘why are you so emotional?’. During PMS, symptoms can worsen to the point that you ‘turn into a monster’; you might find yourself shouting at people — many women describe this as a dark, little-known side of the diagnosis that makes them feel even more isolated. 

Important: this may not (only) be anxiety or a mood disorder — it can also be a manifestation of ADHD. Doctors need a more nuanced approach, taking this lens into account when assessing adolescent girls and adult women. 

ADHD in Women — medication, hormones and environmental factors 

Medication can bring its own challenges. In the second half of the cycle, symptoms may intensify and the effect of stimulants can wane. If there’s an anxiety or depressive disorder and an antidepressant is prescribed, potential drug interactions need to be considered. Hormone replacement therapy can also be relevant — for example post-menopause, when oestrogen and progesterone production is reduced. There are many ways to work with this.  

Important: male and female ADHD are similar, yet they can show up a little differently. 

All this is worth building into the treatment plan. In principle, treatment does not differ radically between boys/girls or men/women, but psychotherapy may look quite different, and it helps to target the specific environmental factors you’ve identified. Gender roles vary widely and, if you want to create a comfortable social environment for yourself, it matters to recognise that women are generally asked to do more. It would be odd to adapt only to symptoms studied in men while half of humanity is female. We should aim for a real balance of demands and rights — that is part of treatment too. 

So, what’s the takeaway? 

… for anyone who’s now thinking, ‘Look, maybe it really is worth getting assessed — and finding a way to get a few things straight with myself?’ 

If you truly feel your behaviour and thinking differ sharply from the norm — and it makes life harder — know that you’re not alone, and you’re not ‘broken’. These are traits to get to know and befriend. 

If your anxious mind questions everything, skip the trap of piling on false self-diagnoses and try a gentle first step: Free ADHD Simple (not a diagnosis; quick self-screen) → https://adhdsimple.co.nz/quiz-landing. If several statements ring true, speak to your GP; they can refer you to a specialist if needed and discuss next steps. 

Know that you already have a lot on your side: evidence-based approaches, other people’s lived experience, and your own resources. You can live with this, grow — and even find joy in your identity. 

Last updated November 2025
Written by Olga Karolyi for ADHD Test 

Important: This article is for information only. Diagnosis and treatment are determined and overseen by a qualified clinician. If you feel affected, contact your GP. 

References: 

Key UK guidance 

• National Institute for Health and Care Excellence. (2018, last reviewed 2025). Attention deficit hyperactivity disorder: Diagnosis and management (NG87). https://www.nice.org.uk/guidance/ng87 

• National Health Service. (2025). ADHD in adults. https://www.nhs.uk/conditions/adhd-adults/ 

• Royal College of Psychiatrists in Scotland. (2022). ADHD in adults: Good practice guidance (CR235). https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/cr235-adhd-in-adults---good-practice-guidance.pdf 

Further reading  

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Association 

1) ‘Abbreviation & Iceberg ‘— overview and foundations 

• Hallowell, E. M., & Ratey, J. J. (2021). ADHD 2.0: New science and essential strategies for thriving with distraction—from childhood through adulthood. Ballantine Books. (Clear, modern overview of ADHD science plus everyday strategies.) 

• Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in Adults: What the science says. Guilford Press. 
  (Research-heavy cornerstone on adult functioning and impairment.)  

2) Why are women diagnosed less often? 

• Nadeau, K. G., Quinn, P. O., & Littman, E. B. (2015). Understanding girls with ADHD: How they feel and why they do what they do (Updated & Revised). Advantage Books. (Profiles of girls; ‘invisible‘symptoms; school and social contexts.) 

• Nadeau, K. G., & Quinn, P. O. (Eds.). (2002). Understanding women with AD/HD. Advantage Books. 
  (One of the first volumes focused on women; diagnostic patterns and life-course issues.) 

• Williams, T., Horstmann, L., Kayani, L., Lim, A. X. H., Russell, A., Ford, T., John, A., Sayal, K., Thapar, A., Langley, K., & Martin, J. (2025). An item-level systematic review of the presentation of ADHD in females. Neuroscience & Biobehavioral Reviews, 171, 106064. https://doi.org/10.1016/j.neubiorev.2025.106064 

• Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of attention disorders, 27(7), 645–657. https://doi.org/10.1177/10870547231161533 

3) Daily life — what it looks like in practice 

• Matlen, T. (2014). The Queen of Distraction: How women with ADHD can conquer chaos, find focus, and get more done. New Harbinger Publications. (Practical toolkit for focus, time, and task management for women.) 

• Kolberg, J., & Nadeau, K. G. (2016). ADD-friendly ways to organize your life (3rd ed.). Routledge. 
  (Systems and habits designed with ADHD realities in mind.)  

4) Sensory overload 

• Aron, E. N. (2020). The highly sensitive person (25th Anniversary ed.). Citadel Press. 
  (Not ADHD-specific, but an excellent primer on sensory sensitivity often seen in women with ADHD.) 

5) Gender-role expectations & the cost of masking 

• Solden, S., & Frank, M. A. (2019). A radical guide for women with ADHD: Embrace neurodiversity, live boldly, and break through barriers. New Harbinger Publications. (Identity- and strengths-based approach to shame, masking, and self-advocacy.)  

• Nadeau, K. G., & Quinn, P. O. (Eds.). (2002). Understanding women with AD/HD. Advantage Books. 
  (Early mapping of masking patterns and clinical recognition in women.) 

6) Anxiety as ‘compensation ‘ 

• Rosier, T. (2021). Your brain’s not broken: Strategies for navigating your emotions and life with ADHD. Revell. 
  (Emotion regulation, anxiety spirals, and adaptive routines—practical and empathetic.)  

• Rodgers, A. L., & ADDitude Editors. (2025, June 19). We demand attention on understanding why comorbid conditions like anxiety and depression uniquely impact women with ADHD. ADDitude. https://www.additudemag.com/adhd-comorbidity-research-women/ 

7) Relationships, strengths & RSD 

• Orlov, M. C. (2020). The ADHD effect on marriage: Understand and rebuild your relationship in six steps (2nd ed.). Specialty Press. (Concrete steps for communication and co-regulation in couples.) 

• Tuckman, A. (2019). ADHD after dark: Better sex life, better relationship. Routledge. 
  (Evidence-based guide to intimacy and sexuality when ADHD is in the mix.) 

8) Shame, sexuality & co-occurring conditions 

• Tuckman, A. (2019). ADHD after dark: Better sex life, better relationship. Routledge. 
  (Links sexual risk-taking, shame, and relationship dynamics; practical strategies.)  

• Solden, S. (2005). Women with attention deficit disorder (Revised ed.). Introspect Press. 
  (Classic narrative of women’s life-course, self-esteem, and co-occurring issues.)  

• Soldati, L., Deiber, M. P., Schockaert, P., Köhl, J., Bolmont, M., Hasler, R., & Perroud, N. (2024). Sexually Transmitted Diseases and Attention-Deficit/Hyperactivity Disorder: A Systematic Literature Review. Journal of psychiatric practice, 30(4), 259–265. https://doi.org/10.1097/PRA.0000000000000789 

9) Hormones & life stages (puberty–pregnancy–menopause) 

• Mosconi, L. (2020). The XX brain: The groundbreaking science empowering women to maximize cognitive health and prevent Alzheimer’s disease. Dutton. (Not ADHD-specific, but a rigorous backgrounder on female hormonal axes and brain health.) 

• Nadeau, K. G., Quinn, P. O., & Littman, E. B. (2015). Understanding girls with ADHD (Updated & Revised). Advantage Books. 
  (Practical discussion of adolescent presentation and cycle-linked fluctuations.) 

• Siddiqui, U., Conover, M. M., Voss, E. A., Kern, D. M., Litvak, M., & Antunes, J. (2024). Sex Differences in Diagnosis and Treatment Timing of Comorbid Depression/Anxiety and Disease Subtypes in Patients With ADHD: A Database Study. Journal of Attention Disorders, 28(10), 1347-1356. https://doi.org/10.1177/10870547241251738 (Original work published 2024) 

10) Medication, environment & treatment planning  

• Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. Guilford Press. 
  (Evidence base for outcomes; helpful backdrop to clinical decisions.) 

• Hallowell, E. M., & Ratey, J. J. (2021). ADHD 2.0. Ballantine Books. 
  (A practical ‘ecosystem ‘view: medication + psychoeducation + habits + environment.) 

• Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., Tierney, K., van Rensburg, K., & Woodhouse, E. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC Psychiatry, 20, 404. https://doi.org/10.1186/s12888-020-02707-9