The Underdiagnosis of ADHD in Women

Historically, ADHD has been viewed as a disorder that only impacts men.¹ As a result, ADHD in females has often been overlooked, leading to missed diagnoses, incorrect diagnoses, or delayed diagnoses. However, as the misconception that ADHD primarily affects boys and men continues to decline, there has been a growing recognition of ADHD in females.This is an important move in the right direction, as undiagnosed ADHD can have a serious impact on a person’s life, both in childhood and adulthood³ and can cause particular challenges in the postpartum period.

The Myth of a "Boys Only" Disorder

A major reason why ADHD was unrecognized in females for so long is because of how symptoms frequently present differently along the lines of sex. There are three main classifications of ADHD based symptoms: inattention, hyperactive-impulsive, or a combination of the two. Males are most likely to show hyperactive symptoms like the inability to sit still, restlessness, talking a lot, and interrupting–all behaviors that when present in children, lead to disruptions in a classroom setting.³  Females, on the other hand, are more likely to show inattentive symptoms–think daydreaming, distractedness, or forgetfulness–all symptoms that also impact day-to-day functioning but aren’t externally disruptive. The male student standing on his chair poses more of an interruption than the female student who is quietly daydreaming, and so the male student's behavior triggers an evaluation for ADHD. Research also shows that girls who do display hyperactive-impulsive behaviors are more likely to be referred for an ADHD evaluation than those with inattentive symptoms.³ Additionally, because ADHD has been viewed as a “boys disorder” for so long, teachers, parents, and professionals may simply be unfamiliar with female symptoms. In short, less disruptive symptoms lead to less diagnoses.¹ 

In boys, ADHD often presents with hyperactive-impulsive symptoms, whereas girls often present with inattention.

Gender Bias and ADHD

Whether explicitly or implicitly, societal expectations often place pressure on girls and women to behave in ways that align with gender norms. This can lead to masking ADHD symptoms in girls and women, a process one set of researchers called “sophisticated camouflaging strategies.”⁴ These masking tactics are, at least partially, the fallout of patriarchal messaging that suggests “boys will be boys” and girls are made of “sugar and spice and everything nice.” When girls display external symptoms of ADHD like impulsivity and hyperactivity instead of behaving “nicely,” they risk judgment for violating traditional gender norms. Thus, “to avoid social sanctions, many girls with ADHD exert considerable effort to mask symptoms."³ Additionally, because most past medical research about ADHD used male samples, knowledge of of the disorder in females is lacking, comparatively. Some researchers are critical of current diagnostic criteria for ADHD, arguing that given parameters are not sufficiently effective to detect ADHD in females.¹ Because the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders are based on androcentric research and providers are viewing ADHD through that lens, it follows that boys would be more likely to be diagnosed than girls, even after a referral.⁵

“Whether explicitly or implicitly, societal expectations place pressure on girls and women to behave in a way that fits gender norms. This can lead to masking ADHD symptoms."

Additional Challenges of the Diagnostic Process

Comorbid conditions, such as depression, anxiety, and substance use, present additional barriers to ADHD diagnosis in women. It should be stated that comorbid conditions are often present in both male and female populations with ADHD, but the added layer of gender bias means that, for females, these comorbidities can further complicate the assessment of ADHD.³ After a diagnosis in adulthood, many women realize their symptoms were mislabeled as anxiety, depression, or blamed on hormonal fluctuations.⁵ In one study focused on the experiences of women who received an ADHD diagnosis in adulthood, many reported that their symptoms were frequently dismissed by others as a lack of effort or simply not taken seriously, putting ADHD in a category of an “illness you have to fight to get.”³ For many women, it's the role of motherhood that leads to an ADHD diagnosis as the increased cognitive load of motherhood coupled with poor sleep which impacts cognitive ability can exacerbate symptoms. Because ADHD is highly hereditary, many women begin the process of getting a diagnosis only after their child has been diagnosed with ADHD.³ 

Why Early Diagnosis Matters

When a person’s symptoms are continuously dismissed or minimized, they may begin to internalize the message that they need to “pull it together” and start to blame themselves for challenges, ultimately resulting in low self-esteem.⁵ People with undiagnosed ADHD often struggle with relationships and self-control, putting women with ADHD at a higher risk for unsafe sexual behavior and unplanned pregnancy than women without ADHD.³ A proper diagnosis is critical so women can gain the skills and medical intervention they need to help mitigate some of these negative outcomes.

Life Post-Diagnosis

Receiving a diagnosis of ADHD in adulthood can create a mixed emotional response. On one hand, many women report feelings of “what could have been,” grieving how they think their lives may have been different with an early diagnosis.⁵ On the other hand, many women express a positive pivot in self-perception. Without a diagnosis, many women blame themselves for what they see as shortcomings; with a diagnosis, women may experience “a lightbulb moment, giving an external explanation for their struggles and allowing them to accept themselves more fully.”³ Missed or late diagnosis, in short, is damaging for a woman’s self-esteem, mental health, and overall wellbeing whereas a timely, proper diagnosis can lead to a more fulfilling life. 

Anchor Perinatal Wellness recognizes that the perinatal period can be particularly challenging for people with ADHD. We offer multiple resources to help people struggling, including free maternal mental health screenings, intensive outpatient therapy, and outpatient therapy.

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References

¹ Slobodin, O., Sinay, M. H., & Zohar, A. H. (2025). A controlled study of emotional dysfunction in adult women with ADHD. PLoS One, 20(12), 16. https://doi.org/10.1371/journal.pone.0337454

²Madsen, K. B., Bliddal, M., Skoglund, C. B., Larsson, H., Munk-Olsen, T., Madsen, M. G., Thomsen, P. H., Bergink, V., Srinivas, C., Cohen, J. M., Brikeli, I., & Liu, X. (2024). Attention-Deficit Hyperactivity Disorder (ADHD) Medication Use Trajectories Among Women in the Perinatal Period. CNS Drugs, 38(4), 303-314. https://doi.org/10.1007/s40263-024-01076-1

³Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of attention disorders, 27(7), 645–657. https://doi.org/10.1177/10870547231161533

⁴ Avdeeva, A. M., Parfenenko, M. A., Bryzgalina, E. V., Muminova, K. T., & Khodzhaeva, Z. S. (2025). Pregnancy and Childbirth in Neurodivergent Women: Shift Towards Personalized Maternity Care. Journal of Personalized Medicine, 15(11), 557. https://doi.org/10.3390/jpm15110557

⁵Holden, E., Kobayashi-Wood, H. Adverse experiences of women with undiagnosed ADHD and the invaluable role of diagnosis. Sci Rep 15, 20945 (2025). https://doi.org/10.1038/s41598-025-04782-y

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Written by Bridget Bell

Reviewed by Veronica Kemeny, LCSW, PMH-C.