ADHD in Women

Medical providers diagnose ADHD in 5.9% of children and teens and 2.5% of adults. According to the U.S. Centers for Disease Control and Prevention, an ADHD diagnosis happens more than twice as often (13% compared to 6%) in boys than girls. However, this ratio evens out in adulthood.

Researchers attribute the under-diagnosis of ADHD in women and girls to several factors, including referral bias and poor symptom recognition by providers and caregivers. Additionally, females often present symptoms differently and have different comorbidities. Girls may also mask their symptoms to adapt and stay focused.

However, research suggests similar causes of ADHD in adult women and men. Genetics plays a role in the disorder, and children of mothers with ADHD are more likely to develop the condition.

ADHD in adult women can become more apparent if symptoms manifest into harmful coping mechanisms such as substance abuse, eating disorders and self-harming behaviors. Untreated, ADHD makes it more challenging for men and women to pursue educational and professional goals.

ADHD in Girls vs. Boys

A study released in 2021 showed that among children, boys are 2.5 to 4 times more likely to show symptoms of ADHD. Clinicians sometimes misdiagnose children with a learning disability, such as dyslexia, when the actual condition is ADHD.

Researchers suggest that one reason more boys than girls receive an ADHD diagnosis is because of the ease of recognition of hyperactivity symptoms in boys.

Doctors and clinicians aren’t alone in missing the signs and symptoms of ADHD in women. Parents have the same issue, tending to overrate symptoms among boys and underrate them among girls.

Inattentiveness is a predominant sign of ADHD in women, but they typically display fewer signs of hyperactivity. As a result, women receive fewer mental health interventions to address poor behavior. In addition, data suggests women experience fewer learning disabilities than men, so they may not be evaluated as often.

Throughout life, signs of ADHD can mimic symptoms of bipolar disorder, sometimes leading to a misdiagnosis. During major hormonal stages of a woman’s life — puberty, pregnancy, post-pregnancy and menopause — many women with ADHD report changes in their symptoms.

Men and women with ADHD have an increased risk of mental illness and substance abuse, but women are particularly vulnerable to alcohol and marijuana abuse. One Norwegian study also showed that women with ADHD were 50% more likely to develop the comorbidity of psoriasis, a skin condition. For men, the rate was more than 30%.

Medical providers sometimes struggle to diagnose ADHD in women and girls. Among children, hyperactivity is more often linked to boys, making for a more straightforward diagnosis. In addition, women may develop protective “camouflaging” techniques that allow them to be high-functioning, but hinder an accurate view of their disorder.

Researchers also note significant diagnostic bias. For example, in two studies, teachers were given ADHD-like vignettes of students with scrambled names and personal pronouns. On paper, boys were more apt to be identified as needing support. Although ADHD symptoms are similar for boys and girls, girls seem better at masking them, making teachers less likely to assume a girl has ADHD.

From a purely medical perspective, diagnosing ADHD in women is no different than in men. The same criteria apply to both genders. But multiple studies suggest clinicians should pay more attention to “collateral information” in diagnosing girls and women.

This additional data comes from interviews with parents and teachers, examinations of report cards and neuropsychological test results. The diagnostic process may also include a closer look at other co-existing conditions, including eating disorders, mood disorders, tics, chronic fatigue syndrome and fibromyalgia.

Treatment for ADHD is generally the same for women and men. Any differences may stem from age (for example, puberty coming earlier for girls than boys) or pregnancy. The most effective long-term treatments combine prescription medication with long-term psychological therapy. Treatment is guided by the patient’s symptoms rather than by gender.

ADHD is associated with increased encounters with the judicial system, including incarceration, but ADHD medication helps, especially for women. One Swedish study found a 40% decline in criminality among women who took medication for their disorder. The drop for men was less significant (33%).

However, women must be cautious of certain ADHD drugs when pregnant, trying to become pregnant or while breastfeeding. This is because some medications increase the risk of birth defects, including malformation of the fetal heart, when taken in the early stages of pregnancy. For that reason alone, doctors may ask pregnant patients with ADHD to schedule more appointments so they can monitor symptoms and emotional responses.

Physicians should review treatment a woman’s results, and a change in drugs or therapy, during stages of life when hormonal changes such as puberty, pregnancy and menopause occur.

All people with ADHD face challenges managing their condition, but women should be aware of several factors. Women can expect specific hurdles related to hormone fluctuations. For example, ADHD symptoms can increase during puberty, during and immediately after pregnancy, during a woman’s menstrual cycle and again in middle age with menopause.

Women with ADHD are more likely to develop anxiety, depression, borderline personality traits, impulsivity and self-harming behavior than men. Women who have been diagnosed with ADHD may need to seek help from a qualified mental health professional to manage their symptoms.