Why ADHD in Women Is Underdiagnosed

Discover tips, treatment options, and support strategies from the Finding Focus Care Team

Last Update: June 2nd, 2025 | Estimated Read Time: 8 min

The Overlooked Faces of ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) has historically been perceived as a condition that predominantly affects hyperactive boys. This perception, reinforced by early diagnostic frameworks and research focused primarily on male children, has contributed to a systemic underrecognition of ADHD in females. Girls and women with ADHD are more likely to be underdiagnosed, misdiagnosed, or diagnosed later in life, often after experiencing years of functional impairment, emotional exhaustion, or mental health challenges.

This article explores the gendered disparities in ADHD diagnosis, with a focus on how the presentation of ADHD in women differs from traditional diagnostic models. It further examines the impact of these disparities and offers evidence-based insights for improving recognition and support for women with ADHD.

A Diagnostic Framework Built Around Male Presentation

Much of the foundational research on ADHD has focused on externalizing behaviours such as hyperactivity and impulsivity, behaviours more commonly observed in boys. As a result, the diagnostic criteria for ADHD have tended to reflect these external traits, inadvertently overlooking the more internalized symptom profiles often exhibited by girls and women. These may include inattentiveness, emotional dysregulation, chronic disorganization, and excessive daydreaming.

Research suggests that girls with ADHD are more likely to be referred for assessment only when their academic performance significantly deteriorates or when comorbid mood disorders arise (Quinn & Madhoo, 2014). In contrast, boys displaying disruptive behaviours are often flagged earlier by educators and caregivers. This disparity contributes to a significant delay in diagnosis for females, with many not receiving appropriate identification or support until adolescence or adulthood.

Additionally, the social expectations placed on girls to conform, comply, and avoid drawing attention to themselves may cause them to mask or internalize symptoms. This tendency further obscures clinical recognition and may lead to the misattribution of symptoms to anxiety, depression, or personality-related difficulties.

The Role of Masking and Compensatory Strategies

Women with undiagnosed ADHD frequently develop complex compensatory mechanisms to manage their symptoms. These strategies may include overworking, perfectionism, excessive self-monitoring, and social mimicry. Although these behaviours may temporarily obscure impairments, they often result in elevated levels of stress, fatigue, and emotional strain.

Over time, the cognitive and emotional labour of maintaining appearances can lead to a breakdown in functioning, particularly during periods of increased life demands, such as post-secondary education, full-time employment, or parenting. When internal resources are depleted, previously masked ADHD symptoms may become more visible, often prompting a diagnostic inquiry.

However, because many of these women have developed strong self-monitoring habits, they may still appear functional to others despite significant internal distress. As a result, they may not be perceived as individuals in need of clinical attention. Quinn and Madhoo (2014) argue that this invisibility effect contributes to the chronic underdiagnosis of ADHD in women, with important consequences for mental health and quality of life.

Hormonal Influences and Fluctuating Symptoms

An emerging area of research points to the role of hormonal fluctuations in the presentation of ADHD symptoms in women. Oestrogen, a hormone involved in modulating dopamine levels, may influence the severity of ADHD symptoms throughout the female lifespan. During puberty, the menstrual cycle, pregnancy, and perimenopause, fluctuations in oestrogen can impact neurotransmitter activity, potentially exacerbating attention deficits, emotional lability, and executive dysfunction.

While oestrogen appears to enhance dopaminergic activity, which is central to attention and impulse control, drops in oestrogen levels can diminish dopamine availability in the brain. Nicolson and Castellanos (2000) found that such hormonal influences may intensify symptoms in adult women, particularly during premenstrual phases or menopausal transitions. These symptom fluctuations are often misattributed to mood instability or hormonal sensitivity rather than recognized as manifestations of ADHD.

Despite these findings, hormonal considerations are rarely incorporated into the diagnostic process for ADHD, further contributing to the underrecognition of the disorder in women.

Common Misdiagnoses and Overlapping Presentations

Another factor contributing to the underdiagnosis of ADHD in women is the high rate of misdiagnosis. Women with ADHD are frequently diagnosed with anxiety disorders, major depressive disorder, or borderline personality disorder. Although these conditions can co-occur with ADHD, focusing solely on mood or emotional regulation may obscure the broader neurodevelopmental context.

Mowlem et al. (2019) highlight that the presence of emotional symptoms, such as mood instability, low self-esteem, and high sensitivity to perceived rejection, are often viewed as evidence of affective disorders, despite being common features of ADHD in females. When ADHD is not considered, women may receive treatments that are ineffective for managing their core symptoms, resulting in persistent impairment and a prolonged sense of confusion or failure.

Clinicians must be trained to recognize how ADHD can manifest differently across genders and life stages. A comprehensive assessment that includes developmental history, executive functioning challenges, and daily life patterns is essential for accurate diagnosis and intervention.

Subtle but Significant: Signs of ADHD in Women

For many women, the signs of ADHD are not loud or disruptive, but they are deeply impactful. These can include:

• Chronic procrastination and difficulty initiating tasks
  
  
• Frequent forgetfulness, including misplacing items or missing appointments
  
  
• Persistent disorganization, especially in personal or domestic tasks
  
  
• Intense emotional responses to criticism or perceived failure
  
  
• Difficulty maintaining focus during unstructured or repetitive tasks
  
  
• A tendency to ruminate or experience racing thoughts
  

Because these traits may be interpreted as character flaws rather than symptoms of a neurodevelopmental disorder, women often internalize blame and develop negative self-perceptions. Over time, this can lead to heightened stress, burnout, and the development of secondary mental health conditions.

Hinshaw and Ellison (2016) emphasise the importance of early intervention and psychoeducation to reduce the burden of untreated ADHD in women. Increasing awareness among clinicians, educators, and the general public is a critical step toward improving outcomes for this underserved population.

Moving Toward Better Recognition and Support

Improving the recognition of ADHD in women requires a multifaceted approach. Clinicians must adopt gender-sensitive assessment practices that consider internalizing symptom profiles, hormonal influences, and masking behaviours. Educational materials and diagnostic tools should be revised to reflect diverse presentations of ADHD across genders and ages.

For individuals who suspect they may have ADHD, it is important to document symptom patterns over time and seek evaluation from a qualified mental health professional with experience in adult ADHD. Reframing persistent challenges as symptoms rather than personal failings can be a powerful first step toward accessing appropriate support.

In addition to clinical intervention, peer support networks and psychoeducational resources tailored to women can provide valuable validation and guidance. Cognitive-behavioural therapy, ADHD coaching, and executive function training have all demonstrated efficacy in helping individuals with ADHD develop practical coping strategies and improve daily functioning.

Conclusion

ADHD in women remains underdiagnosed due to historical biases in diagnostic criteria, gendered social expectations, and a lack of awareness regarding how symptoms manifest across the lifespan. Women with ADHD are often left to struggle with internalized symptoms, compensatory exhaustion, and misdiagnosis, resulting in years of unmet needs.

By advancing our understanding of gender differences in ADHD, integrating hormonal and developmental considerations into diagnostic practices, and creating inclusive support systems, we can begin to close the recognition gap and offer timely, effective interventions for women affected by this complex condition.

Finding Focus Care Team

We are a group of nurse practitioners, continuous care specialists, creators, and writers, all committed to excellence in patient care and expertise in ADHD. We share content that illuminates aspects of ADHD and broader health care topics. Each article is medically verified and approved by the Finding Focus Care Team. You can contact us at Finding Focus Support if you have any questions!  

References

Hinshaw, S. P., & Ellison, K. S. (2016). ADHD: What Everyone Needs to Know. Oxford University Press. Link  

Mowlem, F., Agnew-Blais, J., Taylor, E., & Asherson, P. (2019). Do different factors influence whether girls versus boys meet ADHD diagnostic criteria? Journal of Attention Disorders, 23(10), 1046–1053. Link  

Nicolson, R., & Castellanos, F. X. (2000). Neurodevelopmental trajectories, mental illness and the developing brain. Development and Psychopathology, 12(3), 601–614. Link  

Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: Uncovering this hidden diagnosis. The Primary Care Companion for CNS Disorders, 16(3). Link