ADHD in Women

Women with ADHD: No More Suffering in Silence

Research shows that ADHD exacts a greater toll on women than it does on men. Clinicians need a different set of tools for diagnosing and treating the disorder across genders — and women deserve a better understanding of how the disorder affects them.

woman with adhd no longer suffering in silence
woman in white shirt walking in woods

Most mainstream research on attention deficit disorder (ADHD or ADD) tells us that there are no significant differences in how the disorder presents in men versus women. That is, on most measures, data suggests that the sexes experience the same type, number, and severity of symptoms, the same academic struggles, the same number of comorbid disorders, and the same efficacy of medication.

But the lived experiences of real women make it clear that this isn’t the whole story. Women with ADHD face many of the same symptoms as their male counterparts, it’s true — but they also labor under the added burden of restrictive gender roles, fluctuating hormones, and a greater tendency towards self-doubt and self-harm. And emerging research reveals that while their daily symptoms may mirror each other, in the long-term, men and women with ADHD actually face dramatically different outcomes.

It may be time for the ADHD establishment — and women themselves — to accept that gender differences play a more significant role in life with attention deficit than previously thought. Here’s how we can start to make sense of the female ADHD experience.

How Can We Shift Our Model to Include Women?

ADHD was first defined based on the behaviors of hyperactive boys. Indeed, until 2013, ADHD was grouped with the Disruptive Behavior Disorders of Childhood in the Diagnostic and Statistical Manual (DSM I-IV). The presumption remains that the diagnostic criteria for ADHD pertain as accurately to inattentive women as they do to hyperactive boys. Quantitative assessments still focus on external behaviors that interfere with other people. However, most women struggle with an internalized sense of impairment that affects their sense of self and qualitative life management skills. To accommodate the newest data on women’s experiences, the conceptual ADHD model has to shift away from behavior and toward impairment.

The differences in both presentation and impact reflect a gap in our evolving understanding of women and ADHD. Due to their inattentive symptoms and tendency to internalize their feelings, women’s subtle presentations can easily be misinterpreted. A woman’s despairing about unfinished laundry or being late to her child’s recital might be dismissed as anxiety and/or a mood disorder. However, the chronic underlying feelings of inadequacy and shame are difficult to acknowledge and articulate, and more challenging for clinicians to recognize or quantify. Striving to hide their differences and reluctant to ask for help, women second guess themselves and retreat when their credibility is questioned.

[Self-Test: Could You (or Your Daughter) Have ADHD?]

What Is the Power of Gender Roles?

Many women feel that conforming to gender role expectations is the route to acceptance. Societal demands for communication and cooperation require perfect choreography of the executive functions. However, women with ADHD are thwarted by unpredictable executive functions. Overwhelmed and frantic, they accept that they are not entitled to a support system, but that, in fact, they are the support system.

Why Do Women with ADHD Have a Negative Sense of Self?

Women with ADHD blame themselves for being too distracted to “catch up” with daily responsibilities. They allow their lack of motivation, disorganization, or lateness to define them, and anticipate criticism or rejection. Ashamed of their emotional reactivity, many censor themselves rather than risk inappropriate responses. Nonetheless, when less guarded at home, their frustration triggers outbursts directed at partners or children. Such unintended episodes leave them feeling demoralized and overwhelmed with regret. Without a neurobiological explanation, they attribute these inadequacies to flawed character.

How Do Hormones Connect to ADHD Symptoms?

Beginning at puberty, monthly hormonal fluctuations bring high levels of estrogen and progesterone, enhancing neurotransmitters and improving cognitive functioning following menstruation. However, when premenstrual hormone levels drop, women experience an exacerbation of ADHD symptoms along with typical premenstrual changes. Low estrogen triggers greater irritability and disruptions of mood, sleep, and concentration. These observable symptoms can easily lead to a diagnosis of PMDD, without consideration of underlying ADHD.

As estrogen levels drop throughout menopause, ADHD symptoms intensify. In combination with age-related cognitive changes, confusion, memory, concentration, and sleep become even more impaired. Since women now spend about a third of their lives post-menopause, it is critical that research explore the impact of hormonal cycles on ADHD symptoms.

[Why Women with ADHD Feel Disempowered — And What We Can Do About It]

Why Women with ADHD Are Often Perfectionists

Many women acquired self-esteem through early academic successes. As adults, they still rely on intellect to help them compensate, but the difficulty of sustaining attention makes them question their abilities. Success now requires tremendous investments of time and energy. Comparing themselves harshly to peers who seem to achieve effortlessly, they are determined to present a seamless façade. However, rigid perfectionism comes at a high price. Relentless self-monitoring is fueled by exhausting anxiety. Some women stay up most of the night immersed in obsessive preparations. But when something falls through the cracks, their high standards leave them feeling demoralized and undeserving of compassion. Their façade is only successful if no one suspects the desperation that consumes them. However, this mask of conformity never allows them to be known; their struggles are secret, but no less damaging.

How Do Comorbid Conditions Complicate the Picture?

By adulthood, women with ADHD are usually struggling with more than one comorbid problem, and those symptoms are often the most observable. Consequently, women are often misdiagnosed and treated for anxiety and mood disorders as primary diagnoses. Their physiological expressions of anxiety may manifest in bodily complaints ranging from headaches and nausea to nail-biting or cuticle-picking. They are more likely to present with dysregulated eating patterns, and with a higher BMI. They are more likely to have personality disorders, with Borderline Personality Disorder being the most common. They may present with substance abuse or compulsive shopping or gambling. They may describe sensory overload, with hypersensitivity to touch, sound, light, or smells. They are more likely to have experienced early physical or sexual abuse, and may manifest symptoms related to PTSD. Any combination of these comorbid issues creates a complex diagnostic picture.

What Are Potential Outcomes for Undiagnosed Women?

As women’s responsibilities increase, their psychological distress increases as well, but low self-esteem rarely allows their needs to come first. Distracted from their own self-care, women with ADHD postpone checkups and procedures, and function with serious sleep deficits. Inconsistent eating patterns, shaped by inattention and impulsivity, can result in complications. Chronically stressed, they may depend on prescription medications to manage anxiety, mood disorders, sleep, or pain, or they may self-medicate with alcohol or drugs.

As women mature, they learn to appear less symptomatic, yet their suffering continues as their well-guarded secret. They may distance themselves from friends, and hide their despair from partners. Believing in their unworthiness, they may endure relationships involving emotional and physical abuse. Such hopelessness, combined with impulsivity, contributes to significantly more self-harm compared to men. Even more concerning is their much greater likelihood of suicidal thoughts and attempts. Recent population studies suggest that women with ADHD are more likely to die earlier of unnatural causes, especially due to accidents.

These starkly elevated risk factors merit attention as a public health crisis. But these outcomes are avoidable. Healing begins with a safe connection to one person who  becomes a lifeline to acceptance and support.

Take-Home Messages for Women with ADHD

It is critical that research explore why ADHD exacts a far greater toll on women. Perhaps the perfect storm of internalized symptoms, hormonal fluctuations, and the pressure of societal expectations combine to create a context of stressors unique to females. Attributing their difficulties to their own character failures feeds the shame and demoralization that can undermine them. Because women with ADHD are more reactive than proactive, they gradually lose confidence in their own judgment since it often betrays them.

Compared to men, women with ADHD perceive themselves as more impaired, and their experience of negative events as more painful. They are more likely to blame themselves for their difficulties, and feel lucky if things turn out well. They are more likely to struggle with low self-esteem and shame. It appears that women with ADHD are more vulnerable to their perceived failures in self-regulation than men. But what if the experience of men is not considered the standard? These differences suggest that studies comparing women with ADHD to women without ADHD would yield greater specificity about the impact of ADHD.

We cannot direct the wind, but we can adjust our sails. Women with ADHD cannot change their brain wiring, but they can reframe their experiences through a different lens. They can learn to embrace their unique strengths and aptitudes, celebrate the creativity of non-linear thinking, establish new priorities based on self-acceptance, and find ADHD-friendly environments in which they can thrive. Ideally, an ADHD diagnosis is the first step toward reversing their destructive belief system: It offers a neurological explanation for why things are so hard, and offers validation that allows them to own their successes.

[ADHD Is Not a Male Disorder]

For Women: How to Increase the Chances of Getting the Right Diagnosis

When you go to a clinician for an evaluation, describe the relevant evidence-based issues and ask that he/she consider the possibility of underlying ADHD:

  • Inattentive symptoms
  • Internalizing symptoms
  • Emotional dysregulation
  • Late adolescent onset
  • Low self-esteem
  • Eating dysregulation
  • Chronic anxiety
  • Chronic relationship problems
  • Perfectionistic behavior
  • Substance dependence
  • Sensory hypersensitivities
  • Chronic restlessness
  • Reluctance to read
  • Episodes of rage or tears
  • Frequent irritability
  • Picking behaviors
  • Intense premenstrual symptoms

For Clinicians: How to Increase the Chances of Diagnosing ADHD in Women

To improve diagnostic accuracy, explore these evidence-based issues in your evaluations. Beware of gender bias:

  • Shift from a behavior model to an impairment model
  • Hormonal mediation
  • Later appearance of symptoms
  • Minimal childhood symptoms
  • Impairments worsen over time

Teasing apart a complex presentation:

  • Subtle, less-impaired presentation
  • Internalized qualitative impairments
  • Distinguish between primary vs. secondary anxiety, mood disorders
  • Impulsive sexual history
  • Comorbidities secondary to ADHD
  • Motivated to mask symptoms
  • Use subjective plus objective measures
  • Use trauma-informed interviews
  • Commit to long-term monitoring

16 Comments & Reviews

  1. Women with ADHD have been ignored for a long time even though it was and has been there.Because of how it affects general behavior females are not seen or even thought of as “being a priority to use caution” type of individual.

    1. Ignored? Yeah. Does the medication change adhd/add appearance or cause adults non add/adhd’s to hear voices often enough give people a right to never give a person rest? Gawd darn they treat m e like a criminal when I take meds.

  2. There seems to be a huge jump in women claiming to either having a ‘terrible time’ with ADD partners or now ‘suffering in silence’. It’s a proven fact men generally suffer with this condition at a lot higher percentages than women, but it seems the ladies are getting far more vocal about how hard it is for them and how terrible the men are to live with, deal with, understand. I’m not trying to make this a competition but out of either gender we as males are expected to ,deal with it’ whereas women get the softly softly help.

    1. Well Nik79, what really do you expect? For all their lives and up until not that long ago, ‘experts’ believed that only men were ADHD. And when a women finally got the courage up to talk to a practitioner, they were dismissed as being ‘overly sensitive’, ‘depressed’ or ‘anxious’ and presented with antidepressants, Valium, told to ‘take some time for themselves and relax’ or dismissed altogether. The ‘suffering in silence’ is what women have been doing since their childhood. In fact, women have NOT been given the “softly softly”; in fact, they’ve were given NO help for a LOT of years. Women have had to ‘deal with it’ all along without anyone believing their symptoms or struggles.

      1. @ ceebee Sensitivity is a common symptom of ADHD. Is your anxiety based on real fear of something or would you consider it unexplained. If unexplained it may be hyperactivity. For me hyperactivity was everything I thought anxiety was. I worried or thought so much I couldn’t sleep. Once you can’t sleep everything goes to hell. Hang in there.

    2. To be honest and accurate you would have to say men are diagnosed more often than women. When hard studies are done with accurate diagnosis women have the same rate as men. As per the norm women will have different display of symptoms and much more commonly have their concerns dismissed. Boys tend to have the classic symptoms that have been adopted as diagnosis criteria. Girls were more likely to be labeled with just attention deficit because doctors didn’t and mostly still don’t know how hyperactivity displays in girls and women. There is no longer a diagnosis of just ADD because there is always a hyperactive component. I cannot say for sure how girls and women would diagnose differently, but I can describe how ADHD affected me as testosterone normally drops with age. I was a child before ADHD was screened. There is no question I had the classic “boy” symptoms when I was six years old. I adapted, I survived, and I lived my life thanks to a high IQ and determination. As I approached age 60 and very much when I hit 60 I had symptoms that eventually led to a diagnosis and treatment because the symptoms were unbearable. There was no help connecting my symptoms with ADHD and proper medication until I read an article by a doctor on this site. I wish I could remember his name to give him credit. I believed I had anxiety so bad I couldn’t sleep. Sounds like a woman problem doesn’t it. Well this doctor asked the question “what are you afraid of?” He said if you are not afraid of anything it is not anxiety, it doesn’t fit the definition. It was hyperactivity seeming to be anxiety. Within a couple days of taking a very small dose 10mg of adderall my sleep problems disappeared. After a dosage increase to 20 mg and good counseling my life started coming together including quitting a life long gambling problem. After a year the medication was slightly less effective and sleep problems returned. Standard advice is to make sure you have no meds late in the day because it keeps you up. Again on this site I read an oddball account of people taking amphetamines before bedtime to improve sleep. With my doctors permission I tried taking my late dose really late and it worked like a charm. Trust me none of the doctors wanted to believe me and I know in some small part what it feels like to be treated like a woman. I hope the doctors can make some sense of this and I hope women and girls start getting the help they need. It is getting brutal to try to get the prescription for the amphetamines that actually work 88% of the time.

  3. I agree heartily that women are diagnosed less than men. It also seems to be true that the better the screening the higher the percent of women found. I have also not heard any biological explanation of why men would be 2-3 times more likely to have the disorder. I had symptoms of what I thought was anxiety and I seem to be overly sensitive. I found something on this site that gave me a clue that my “anxiety” was really just a hyperactive mind. Long story short I was able after a difficult process to try the medication and confirm a diagnosis of ADHD. This happened at age 60 and if I had not had the typical “boy” symptoms when I was six I would not have gotten treatment because I or my prescribers never would have known. Look for hyperactivity in other forms in women! There is no longer a diagnosis for ADD for a reason, if you don’t have any form of hyperactivity you don’t have the disorder according to the people that decide this. Anxiety and sensitivity is just too easily dismissed as “womens” problems. Treatment has been life changing for me and women should have the same opportunity. Anti depressants were a disaster for me and I was pretty much ordered to try them before they would give me the right medicine.

  4. This article is good writing, yet it’s a first aid cream for raw injury. I am scrutinized for having medication and belittled when I take my meds, then someone steals them. I am no thief, yet I am made to feel guilty if I walk away with a paper clip or pen at work. The crappy deal is that I feel like the scape goat. They steal from me.

    I had some of the ADHD symptoms before diagnosis and meds, not all of the symptoms. The medicine helped, just like the pot people who claimed pot help them. I am treated bad. When I had bulimia I was treated like a child, then rewarded for recovering and now I can’t get the bully off of me. It’s like a game oftornado bully for the sport of breaking my recovery down. And now thing is to make me quit taking adhd med’s. What are they going to do for sport after the initial recovery, all jump on me and beat me?

    1. Oh I hope you got help. I have a daughter that died from a heart arrhythmia as a result of never being diagnosed and treated. Learn to lie like the junkies do if you have to in order to get the medication and do not skip the counseling. One does not work without the other. You are not going to get the right meds if you have a prior abuse problem which is cruel beyond belief. They will give you something with less than a 40% chance of working instead of amphetamines that work 88% of the time. I look at it like showing up at the emergency room with a shattered leg and having the doctors say “you walk around for a year and we will consider treating you. If you volunteer that pot helps, which it can, they are not supposed to give you the medicine. It is extremely hard to get the medicine even if the doctor wants to help. I hope this gets to you. Peace and Love

  5. Thank you so so much for writing this article! It perfectly verbalized what I’ve gone through as a woman who was miss-diagnosed at age 20 and put on horrible meds for bipolar disorder… Because I was a loud high-energy “all-over-the-place” female. The HORROR right? It took me 5 yrs of mushed brain chemistry but I was lucky to have eventually found a wonderful female mental health practitioner who got me on the right dosage of ADD meds and eventually worked with me to teach me how to be a happy, functioning adult with or without medication. Keep shedding light on this issue! We owe it to our little girls to get this right.

  6. This article was one of the most important validating and clarifying articles I’ve come across in a long time. I am a 55-year old woman who was diagnosed with ADHD only 6 years ago. As a child, I learned to do exactly what this article says that women do. I saw the same behavior in my mother. I got into so much trouble as a kid in school, and I really had no idea what I was doing wrong. As I grew older I learned the hard way to conform or simply not be accepted in neurotypical society. To this day I often keep quiet for fear of overreacting, although I am learning (still often the hard way) to modulate my passion and express myself in a way that people will hear me. I compensate by expending every ounce of energy I have to run our home, when the tasks are much easier for neurotypicals, but I give myself no credit for it, and when I screw up I blame myself. I also am just learning how to speak about my unique nervous system with ADHD without feeling like I’m making bullshit excuses. I needed to see and read this article to have these things clarified for me. Thank you Dr. Ellen Littman and to ADDitude magazine for publishing it. I hope to see many more articles on this topic.

  7. This is me exactly, under the radar as a kid, (the hyperactivity was in my head) now I’m 47 with a 5 and a 10 year old…(10yr old adhd/asd) I have not been officially diagnosed because I thought just by knowing I have ADHD that was enough, but it’s not.

    I’ve felt chronic stress for years and every sense is hypersensitive, it makes me constantly cranky with my kids. So I was wondering if there are meds that deal especially with the stress/anxiety aspect? because I think I can handle the rest, I just can’t stand being constantly snappy with my kids, even I don’t want to be around me…

  8. I struggle so much. I am 56 and my whole life has been crazy. I need someone who understands me. My male partner gets so mad because i am messy when i cook or bake or make beeswax products. I clean up but not quick enough. My spirit is crushed. How can I get him to understand? Someone pleade help.

  9. I’ve been very frustrated with how publications and information sources for people with ADD (and the professionals who help them) have overlooked women, and I’m delighted to see this article. It delves into some of the specific issues that make living with ADD challenging for women, without reducing us to wives and mothers. I’m so sick of the typical ADD discourse that doesn’t go any further than, “ADD is different for women because PERIODS and because it’s more difficult to keep our houses clean.” I’m much more complex than that, thank you. This article goes much further though.

    To the editors of Attitude: I hope this article represents is shift in your coverage of gender issues for adults with ADD. We are not children. Many of us struggle even after being diagnosed. The havoc the changes in hormones can bring to our symptoms and experiences at midlife are serious and must be addressed. The article notes that women spend 1/3 of their lives post menopause and that research must focus on the impact of hormones on symptoms. But what about popular publications such as this? It starts here too. Tell me how fluctuating levels of estrogen and progesterone influence the effectiveness of stimulants used to treat ADD. Give us information that we can show our clinicians to help us make better choices about hormonal birth control and hormone therapy. Give me information that I can use to help those who treat me. Help me advocate for myself. Show me that the lives and minds of middle-aged (and older) women living with ADD are important and worth reporting on.

  10. Many years ago, I had to come to grips with my ADHD. I joined a support group (pre-COVID) and was stunned to hear these women talk about getting some help through contracted organizers, adhd assistants, etc. At the same time, they felt ashamed to have to rely on such help — to the point where most of the meeting was dedicated to discussing and mitigating this shame. So… I shared that at the time, I sat next to the executive assistant to my boss, the VP of Product at a well established cyber security company. I heard her organizing his schedule, taking and deflecting calls on his behalf, reminding him about appointments, work-related and personal, reminders about his kids skating classes, and so on. She was essentially functioning as an ADHD assistant! Of course, her boss being an extroverted male in a position of power, nobody would think of shaming him for that service. yet here I was, surrounded by countless women feeling shame for the exact same help they were getting!

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