Verified by 
Key points
- Diagnostic criteria for ADHD have primarily been based on the research of boys.
- Girls and women are consistently under-identified and under-diagnosed for ADHD.
- Without a formal diagnosis, many women struggle until later in adulthood.
.jpg?itok=ZgJRmu_7 "Tara Winstead / Pexels")
Gender has been considered a significant factor in attention deficit hyperactivity (ADHD) research for many years [1], yet for decades the experiences of girls and women with ADHD were largely discounted. Consequently, our theories, clinical approach, and diagnostic criteria for ADHD have been primarily based on studies of cis-gender boys, leaving little understanding of the various presentations of ADHD, and leaving countless girls and women undiagnosed and untreated.
Why Women Go Unseen
Several factors contribute to the under-diagnosis of ADHD in women:
- Differences in presentation: Women with ADHD may display symptoms differently than men. Instead of hyperactivity, they might exhibit internalizing symptoms like inattentiveness, daydreaming, and anxiety. These can be easily overlooked or mistaken for other conditions.
- Socialization and masking: Societal expectations often pressure women to appear calm and collected, leading them to mask their ADHD symptoms. This masking can be exhausting and contribute to feelings of inadequacy.
- Lack of awareness: Healthcare professionals, teachers, and parents likely hold unconscious biases about ADHD, leading them to miss the symptoms and diagnosis in girls and women who don't fit the stereotypical image.
The Impact of Untreated ADHD
Undiagnosed and untreated ADHD can significantly impact the lives of girls and women, leading to:
- Academic and professional struggles: Difficulty concentrating, staying organized, and meeting deadlines (in addition to peer rejection) can hinder academic and professional success.
- Relationship challenges: Communication difficulties, emotional dysregulation, and difficulty managing time can strain relationships with family, friends, and partners.
- Low self-esteem: Feeling misunderstood and constantly struggling can lead to feelings of inadequacy and low self-worth [4].
- Mental health issues: Undiagnosed and untreated ADHD frequently results in additional mental health issues, further complicating diagnosis in adulthood. Anxiety, depression, substance abuse, non-suicidal self-injury, and suicidal behavior can co-occur with untreated ADHD [3], [2], [5].
However, with the recognition and validation that comes with a formal diagnosis, many women experience a sense of relief and empowerment. This new information about themselves allows women to reframe past experiences, develop effective coping strategies, and seek appropriate treatment and support. It also allows many to let go of the shame that often accompanies undiagnosed ADHD.
Moving Forward
To address the issue of late diagnosis in women, the mental health field needs to challenge stereotypes and promote awareness of ADHD beyond conventional narratives. By recognizing the diverse ways ADHD can manifest in women, we can better support early identification and intervention.
Fostering a neurodiversity-affirming culture is crucial in creating inclusive environments where all individuals with ADHD feel understood and valued. This involves challenging stigma, providing education, and advocating for accessible resources and accommodations.
References
Arnold L. E. (1996). Sex differences in ADHD: conference summary. J. Abnorm. Child Psychol. 24, 555–569.
Guendelman, M., Owens, E., Galán, C., Gard, A., & Hinshaw, S. (2016). Early-adult correlates of maltreatment in girls with attention-deficit/hyperactivity disorder: Increased risk for internalizing symptoms and suicidality. Development and Psychopathology, 28, 1–14.
Hinshaw, S.P., Owens, E.B., Zalecki, C., Huggins, S.P., Montenegro-Nevado, A.J., Schrodek, E., & Swanson, E.N. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: Continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of Consulting and Clinical Psychology, 80, 1041–1051.
Hinshaw, S.P., Nguyen, P.T., O’Grady, S.M., & Rosenthal, E.A. (2022). Annual research review: Attention-deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions. Journal of Child Psychology and Psychiatry, 63, 484-496.
Meza, J., Owens, E., & Hinshaw, S. (2021). Childhood predictors and moderators of lifetime risk of self-harm in girls with and without attention-deficit/hyperactivity disorder. Development and Psychopathology, 33, 1351–1367.
