Understanding ADHD in girls and women
18th September 2024 / Written by Harbor London
“The ADHD brain is not disordered; it’s just different. The key is to understand its uniqueness and nurture strengths, while providing the right tools to manage its challenges.” — Dr. Edward Hallowell, M.D
Attention Deficit Hyperactivity Disorder (ADHD) has long been associated with hyperactivity and impulsivity – traits more commonly recognised in boys 1. However, ADHD presents differently in girls and women, often leading to underdiagnosis or misdiagnosis 1.
While the core symptoms of ADHD – hyperactivity, impulsivity, and inattentiveness 2 – remain the same, they manifest in ways that can be more subtle or overlooked in females 1. For instance, girls with ADHD may be less likely to exhibit disruptive behaviours, and more prone to internalising symptoms like anxiety, mood swings, and difficulties with self-regulation 3.
This disparity in symptom presentation has significant implications for diagnosis and treatment.
Research indicates that many women do not receive a diagnosis until adulthood, by which time they may have developed coping mechanisms, or experienced the emotional toll of undiagnosed ADHD 4. Additionally, comorbid conditions like anxiety and depression are more prevalent in females with ADHD, further complicating the clinical picture.
Understanding ADHD in girls and women is essential for clinicians to deliver effectively-curated, individualised treatment. With a growing body of research addressing these unique patterns, the clinical community can better provide targeted therapeutic strategies and whole-person care which, in turn, harbours enhanced resilience and an improved quality of life.
What female ADHD looks like – and how it differs from male presentations
ADHD in girls and women often presents with subtler, internalised symptoms 3 compared to the more overt, externalised behaviours typically seen in males.
While boys with ADHD may exhibit hyperactivity and impulsivity, girls are more likely to struggle with attention and emotional regulation in ways that can easily be overlooked. This leads to a delay in diagnosis or misdiagnosis 5, with many females not receiving the help they need until adulthood.
Some of the key differences between ADHD presentations in females and males include:
Inattention over hyperactivity |
Girls may tend to display more inattentive symptoms, such as daydreaming, difficulty focusing, and disorganisation 6, rather than the hyperactivity often seen in boys. |
Internalised emotions |
Females with ADHD are more likely to experience anxiety, depression, and low self-esteem 4, rather than the external disruptive behaviours more common among boys. |
Social challenges |
Particularly in childhood, males may show more ‘overt’ social difficulties, while girls are more likely to struggle with maintaining friendships due to forgetfulness, impulsive speech, or emotional sensitivity 7 – but these challenges can be more subtle. |
Masking symptoms |
Girls are more likely to develop coping strategies that mask their ADHD symptoms 8, such as over-preparing or perfectionism, making their struggles less visible to others. |
Why does ADHD affect the female brain differently?
Research suggests that structural and functional differences in the brain, alongside fluctuating hormone levels 9, play a critical role in how ADHD manifests in females. These distinctions can influence symptom severity, emotional regulation, and cognitive functioning, often leading to a more nuanced presentation of ADHD in women and girls.
- One key factor is the role of oestrogen, which impacts dopamine and serotonin levels: neurotransmitters critical to attention, mood, and impulse control. Oestrogen fluctuations – k, particularly during puberty, menstruation, pregnancy, and menopause – , can intensify ADHD symptoms, or trigger new emotional and cognitive challenges 10.
For example, women often report worsening symptoms during times of low oestrogen, such as during the premenstrual phase or post-childbirth.
- Additionally, brain connectivity studies show that females with ADHD may have different neural network patterns 11, particularly in areas linked to attention and emotional processing.
These differences help explain why girls and women are more prone to internalised symptoms, such as anxiety and rumination, as opposed to the externalised behaviours more often seen in boys.
Misdiagnosis and stigma
“Depressive feelings and chronic anxiety are common signs of undiagnosed ADHD in women – symptoms doctors often misinterpret and misdiagnose.
[…] The fact is that most professionals, from medical doctors to psychologists, have little training in ADHD and do not know how to recognise it outside of hyperactive children.” 12
Historically, ADHD has been viewed as a condition that primarily affects boys, with its hallmark symptoms more readily recognised in males 1. This bias has led to an underdiagnosis or “misinterpretation” of ADHD in females, where the condition often manifests more subtly; through inattention, disorganisation, and emotional dysregulation 13, for instance.
For many women, the journey to a correct diagnosis can take years – sometimes well into adulthood 4– as their symptoms may be dismissed or mistaken for anxiety, depression, or even personality disorders.
This delay in diagnosis not only prolongs the struggle with untreated ADHD, but can also exacerbate feelings of inadequacy and frustration. This serves only as a contributory factor towards an individual’s potential low self-esteem and mental health issues.
Moreover, stigma (or the “cycle of shame” 14) around ADHD compounds the problem.
Many girls and women internalise their challenges 4, attributing them to personal failure rather than an underlying neurological condition. As a result, they may resist seeking help, fearing judgement or misunderstanding 15 – notwithstanding this, it should be noted that that resistance to treatment may present in either females or males with ADHD.
Managing ADHD in modern life
For female individuals, the most effective method of dealing with the challenges ADHD can present invariably involves an individualised, curated approach; one that addresses both the mind and body.
Alongside medication and therapy, lifestyle factors such as diet 16, environment 17, and emotional wellbeing 18 play central roles in successfully navigating daily life with ADHD.
Diet and nutrition are critical. Research suggests that certain nutrients – such as omega-3 fatty acids, zinc, iron, and magnesium 19 – can positively impact brain function and help alleviate ADHD symptoms. A balanced diet rich in whole foods, vegetables, and lean proteins, while limiting processed sugars and caffeine 20, is said to support concentration and stabilise energy levels (although much of the evidence behind caffeine’s effect on ADHD remains anecdotal).
Consulting with a nutritionist experienced in ADHD is one step towards tailoring a personalised nutritional plan.
Equally important is the space in which individuals reflect on their struggles with ADHD. With the support of a clinical specialist, a serene, confidential environment can provide the mental clarity needed to develop effective coping strategies. Additionally, therapeutic treatments – such as cognitive-behavioural therapy (CBT), along with mindfulness techniques – help regulate emotions and improve focus 21.
Regular physical activity promotes dopamine release, a neurotransmitter linked to focus and motivation. Studies show that aerobic exercises, such as running or swimming, can improve concentration and reduce hyperactivity 22. Beyond this, sleep is a valuable part of ADHD management. Consistent sleep routines promote brain recovery and enhance attention during the day 23; for many women with ADHD, improving sleep quality is a significant step toward better cognitive function and emotional stability.
Building a strong support network is also important, as a team of understanding friends, family, and professional counsellors can offer valuable encouragement and accountability.
The path forward
As testified by the studies cited, significant strides have been made in recent years in understanding ADHD in girls and women. Researchers have begun to unravel the nuances of how ADHD presents differently across genders 1, leading to better diagnostic tools, and the opportunity for more personalised approaches to treatment 24.
Today, clinicians are more attuned to the subtle signs of inattentive ADHD in females, and the hormonal influences 9, 10 that may exacerbate symptoms during different life stages.
However, there is much still to uncover. Future areas of clinical study will focus on refining treatment protocols that take into account the unique developmental and cognitive needs of individual females with ADHD. Studies on the intersection of ADHD and mental health, hormonal fluctuations, and how ADHD interacts with conditions such as anxiety and depression are constantly pushing the boundaries of what we know. Additionally, increasing our understanding into the role of lifestyle interventions (like diet and exercise), alongside more traditional treatments, present promising avenues for further individualised care.
Ultimately, for all individuals with ADHD, curated and whole-person care is the key to long-term success and symptom management. By addressing every aspect of health – physical, mental, and emotional – individuals can build the resources to lead empowered lives; not defined by ADHD, but enriched by their personal strengths and unique perspectives.
References
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827008/
- https://www.additudemag.com/adhd-symptoms-checklist/
- https://www.additudemag.com/adhd-in-women-misunderstood-symptoms-treatment/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10173330/
- https://www.additudemag.com/women-with-adhd-mental-fatigue-internal-hyperactivity-emotional-dysregulation/
- https://www.additudemag.com/adhd-in-girls-women/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195638/
- https://www.additudemag.com/neurodivergent-women-in-workplace-adhd-masking/
- https://www.additudemag.com/hormonal-fluctuations-adhd-symptoms-pmdd-pregnancy-menopause/#footnote1
- https://www.additudemag.com/hormonal-fluctuations-adhd-symptoms-pmdd-pregnancy-menopause/#:~:text=Hormonal%20fluctuations%20during%20the%20menstrual,development%20of%20girls%20and%20women.
- https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.962911/full#:~:text=Connectivity%20between%20the%20GPe%2C%20frontal,more%20pronounced%20in%20healthy%20subjects.
- https://www.additudemag.com/what-does-adhd-look-like-in-women-misdiagnosis/
- https://ibcces.org/learning/adhd-symptoms-in-women-arent-hidden-they-are-misinterpreted/
- https://www.additudemag.com/adhd-in-girls-shame/#:~:text=Meanwhile%2C%20girls%20with%20the%20hyperactive,Girls%20get%20ostracized.
- https://www.psychiatrictimes.com/view/addressing-challenges-treatment-resistant-adhd-adults
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9322602/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277258/
- https://www.mind.org.uk/information-support/tips-for-everyday-living/adhd-and-mental-health/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2955638/
- https://www.additudemag.com/adhd-caffeine-treatment/
- https://psychcentral.com/adhd/cognitive-behavioral-therapy-for-adhd
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951958/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082190/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930389/