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Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder. It affects many people, regardless of gender or biological sex.
For many years, ADHD has been notoriously underdiagnosed in girls. Today, we know that women and girls may experience ADHD differently than boys. In women and girls, symptoms may be more internalized than their male counterparts. Symptoms of ADHD in women can include an inability to focus, difficulty staying organized, and anxiety (Young, 2020).
ADHD in women and girls
According to the numbers, it would appear that ADHD is far more common in boys than in girls. Boys in the United States receive an ADHD diagnosis more than twice as often as girls (CDC, 2019). In Europe, the discrepancy is even higher, with boys and girls receiving ADHD diagnoses at rates as high as 16 to one, respectively (Novik, 2006).
However, researchers now believe that a significant number of girls with ADHD have gone unidentified and untreated. This is likely due to several factors, including how ADHD is diagnosed and how symptoms may present in girls (Young, 2020).
Research into ADHD used to focus primarily on boys, whose symptoms were more likely to be considered “problematic” by teachers and parents. This research was incorporated into the official diagnostic criteria for ADHD, outlined by the American Psychiatric Association (APA). However, because the criteria are based on how ADHD presents in boys, girls often fail to meet enough criteria to receive a diagnosis (Mowlem, 2019).
Women and girls with ADHD tend to experience symptoms differently than men and boys. One significant difference between the genders is the overall tendency to display outward-facing signs. Boys may show symptoms easily observable in the classroom and other social settings, while girls may internalize their symptoms (Young, 2020).
For example, boys often demonstrate disruptive behaviors like interrupting and fighting. In contrast, girls are usually more likely to experience anxiety and poor self-esteem—which are far more subtle symptoms.
Women and girls are also more likely to engage in compensatory behaviors, behaviors that attempt to compensate for—or hide—ADHD-related impairments. For example, some girls try to mask social impairments by engaging in high-risk activities like unsafe or unhealthy sexual activity (Young, 2020).
ADD vs. ADHD: what’s the difference?
ADHD and mental health
Women often internalize their symptoms of ADHD, meaning symptoms will show up primarily in their mental state. Internalized symptoms can include things like depressed mood, anxiety, and low self-esteem. Signs like these can easily be mistaken for other conditions, like major depression, anxiety disorders, eating disorders, and personality disorders.
This is further complicated by the fact that women and girls are more likely to have other mental health disorders in addition to ADHD—these are known as comorbid disorders. As a result, it can be challenging for clinicians to determine whether ADHD causes emotional symptoms or whether they result from a comorbid condition (Young, 2020).
Many women and girls with ADHD may develop unhealthy coping strategies to help soothe difficult emotions and feelings of social rejection. This leads to high rates of drug, alcohol, and tobacco use (Young, 2020).
ADHD symptoms in women
The symptoms of attention-deficit/hyperactivity disorder typically begin in childhood before age 12. They continue into adulthood in somewhere between 65% and 80% of cases (Young, 2020). As people age, symptoms tend to evolve. In adult ADHD, hyperactivity typically becomes less pronounced, while symptoms like impulsivity may become more apparent (Magnus, 2020).
When someone receives a diagnosis of ADHD, they are described as having one of three subtypes (Magnus, 2020):
- Predominantly inattentive
- Combined presentation
While people of all genders can be diagnosed with any of these subtypes, research suggests that girls are more likely to have predominantly inattentive ADHD. Also, when girls display hyperactivity and impulsivity, it tends to be less severe and disruptive (Young, 2020).
Signs of ADHD in women and girls can include (Young, 2020):
- Having trouble paying attention
- Experiencing difficulties with academics
- Frequently losing things, making careless mistakes, or forgetting things
- Being chronically disorganized
- Having difficulty with time management
- Frequently feeling overwhelmed
- Lacking motivation
- Mood swings
- Depressed mood
- Low frustration tolerance
- Having trouble fitting in
- Low self-esteem
- Disordered eating
- Frequent car accidents
- Engaging in early and risky sexual activity
- Failing to reach potential
- Hyperactivity (always on the go, can’t sit still)
- Frequently bullied in school
- Behavioral problems and associated consequences (Magnus, 2020)
Is ADHD a disability? A complex question explained
Risks and consequences
Adult women with ADHD are at increased risk of some problematic outcomes. Proper diagnosis and treatment reduce the likelihood of such outcomes. Women and girls with unmanaged ADHD are at risk of (Young, 2020):
- Substance abuse and addiction
- Major depression
- Anxiety disorders
- Sexually transmitted diseases
- Early pregnancies
- Difficulties holding jobs or achieving career advancement
- Trouble managing finances
- Parenting difficulties
- Trouble maintaining relationships
- Criminal activities or incarceration
- Headaches, stomachaches, and other pain
Treatment of ADHD
When ADHD is properly diagnosed and treated, the long-term outlook becomes much brighter. ADHD is typically treated with stimulant medications, including Ritalin (methylphenidate), Adderall (amphetamine salts), and related medications. Treatment with ADHD medications can have the following effects (Young, 2020):
- Reduces the rates of other mental health disorders
- Improves long-term outcomes for education and career
- Reduces rates of committing crimes
- Reduces rates of obesity
- Lowers rates of severe substance abuse
ADHD and depression: what’s the link?
There are also non-pharmacological treatment options that may help reduce negative outcomes. Research has shown that combining these with medication may provide the most impactful results. These treatment options include (Young, 2020):
- Cognitive-behavioral therapy (CBT)
- Occupational therapy and skills training
- Mindfulness interventions
- Family therapy
- Sex education
- Parenting support
Reach out for help
If you think you may have undiagnosed ADHD, there are steps you can take to improve your situation. Talk to your healthcare provider about your concerns. Ask them to recommend a psychiatrist who can provide further testing and treatments. You can also find a psychiatrist by searching your insurance company’s website or by calling the number on the back of your insurance card.
- Centers for Disease Control and Prevention. (2020, November). Data and statistics about ADHD. Retrieved Apr 26, 2020 from https://www.cdc.gov/ncbddd/adhd/data.html#:~:text=Millions%20of%20US%20children%20have,children%20aged%206%E2%80%9311%20years
- Magnus W, Nazir S, Anilkumar AC, et al. (Updated 2020, June). Attention deficit hyperactivity disorder. StatPearls [Internet]. Retrieved Apr 26, 2020 from https://www.ncbi.nlm.nih.gov/books/NBK441838/
- Mowlem, F., Agnew-Blais, J., Taylor, E., & Asherson, P. (2019). Do different factors influence whether girls versus boys meet ADHD diagnostic criteria? Sex differences among children with high ADHD symptoms. Psychiatry research, 272, 765–773. doi: 10.1016/j.psychres.2018.12.128. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6401208/
- Nøvik, T. S., Hervas, A., Ralston, et al. (2006). Influence of gender on attention-deficit/hyperactivity disorder in Europe–ADORE. European child & adolescent psychiatry, 15 Suppl 1, I15–I24. doi: 10.1007/s00787-006-1003-z. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17177011/
- 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). doi: 10.4088/PCC.13r01596. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195638/
- Young, S., Adamo, N., Ásgeirsdóttir, et al. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC psychiatry, 20(1), 404. doi: 10.1186/s12888-020-02707-9. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422602/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.