Why ADHD In Women Is Often Undiagnosed
Many women in their mid to late twenties and mid to late thirties are discovering they have ADHD for the first time. This realization can be both illuminating and overwhelming, as it suddenly brings clarity to struggles they may have carried for years including difficulty focusing, chronic overwhelm, emotional exhaustion, and a persistent sense that something has always felt harder than it should.
So why are so many women diagnosed later in life? One major reason is that the diagnostic criteria that ADHD is based on has not been updated since 1994. This stagnation in the criteria means that the understanding of ADHD has not evolved to encompass the full spectrum of how it presents in different populations, particularly among women. The study that was used to determine the criteria only included 21% females, skewing the understanding of how ADHD manifests in both men and women. Research published in The Lancet Psychiatry further highlights how this early gender imbalance shaped diagnostic expectations, contributing to the continued underrecognition of ADHD in girls and women (Martin, 2024).
In childhood, boys are more likely to be diagnosed due to the visible symptoms that often accompany the condition, such as hyperactivity and impulsivity. These symptoms are more easily observed and recognized by parents, teachers, and healthcare professionals. The more subtle or inattentive subtypes of ADHD, which are often seen in girls, are not as easily noticed or understood, leading to a significant number of undiagnosed cases.
Oftentimes, due to deeply ingrained gender role stereotypes, women learn to mask and compensate for their symptoms at an earlier age than men. Studies have long noted that girls with ADHD are more likely to internalize symptoms and develop coping strategies that hide their struggles until demands exceed their capacity (Quinn & Madhoo, 2014). From a young age, societal expectations often encourage girls to be more compliant, organized, and attentive, which can lead them to develop coping strategies that conceal their ADHD symptoms. This learned behavior can result in a façade of normalcy, making it even more challenging for them to seek help or be recognized as needing support.
Experts emphasize that many girls compensate so effectively that their ADHD remains hidden until emotional distress or burnout becomes impossible to ignore (Young et al., 2020). As a result, many women navigate adulthood unaware of their ADHD, often attributing their struggles to personal failings rather than a neurodevelopmental condition that has gone undiagnosed for far too long.
Another common reason is misdiagnosis. Women will often first be diagnosed with depression or anxiety, conditions that often occur alongside ADHD. To treat the depression and anxiety they undergo multiple medication trials or therapy sessions trying to target these symptoms. As a result, they spend years feeling stuck or that “nothing works,” since the root cause of their symptoms remains unaddressed.
As awareness of ADHD continues to grow, numerous women have shared their stories on social media. This leads to other women seeing their stories and finding that they relate to the symptoms discussed. Or, their family or friends have pointed out behaviors linked to ADHD. These experiences prompt them to pursue an ADHD diagnosis. Once diagnosed and treated for ADHD, they often experience a reduction in depressive and anxious symptoms (due to being treated for the actual underlying causes). This can be transformative, as many women start to understand and connect their past experiences, realizing that the difficulties they encountered were due to ADHD.
If you’re curious about whether you might have ADHD, take a look at my post “ADHD Symptoms in Women” to see if pursuing a diagnosis could be your next step!
Sources
Martin, J. (2024). Why are females less likely to be diagnosed with ADHD in childhood than males? The Lancet Psychiatry, 11(4), 303–310. https://doi.org/10.1016/S2215-0366(24)00047-5
Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls. The Primary Care Companion for CNS Disorders, 16(3), 1–9. https://doi.org/10.4088/PCC.13r01596
Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., … Woodhouse, E. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach. BMC Psychiatry, 20, 404. https://doi.org/10.1186/s12888-020-02707-9
