Attention deficit hyperactivity disorder (ADHD) is often understood as a 'boy's disease', as boys are diagnosed with it far more often than girls — but research indicates that it's just as common in girls and women as it is in boys and men. The reason for this disparity? ADHD is different for women compared to men in the way it presents, meaning doctors are less likely to pick up on it as a diagnosis.
ADHD symptoms often show up in early childhood, where children can be one of three types: hyperactive-compulsive ADHD, inattentive ADHD, or a mix of the two. A combination of factors, including diagnostic criteria that's based on observations of men, a lack of understanding of symptoms in women and the influence of female biology, mean that women and girls with ADHD often have very different experiences than boys and men with the same condition. (Transgender, intersex, and non-binary people can also all experience ADHD, but fewer studies exist to show how ADHD presents in people with these identities.) And these differences can mean women lack a proper understanding of their condition, sometimes for years.
The division between these experiences of ADHD can be pretty stark. While 13% of adult men in the U.S. will be diagnosed with ADHD in their lifetimes, only 4.2% of women will have the same diagnosis, according to Healthline. There isn't one 'female' and one 'male' type of ADHD; there's a reason that it's identified as the same disorder in both genders. Hopefully, as science learn more about ADHD and the way it works, we can fix its diagnosis gap. For now, here are five ways ADHD presents differently in girls and women, compared to men.
1. Girls Tend Towards Introspection Rather Than Hyperactivity
The more widely-known kind of ADHD is the hyperactive-compulsive type, which tends to involve symptoms like impulsive actions, mood swings, and trouble sitting still. Boys, research indicates, are more likely to experience that type of ADHD, while girls are more likely to have the inattentive type, which has much more internalized symptoms. Inattentive ADHD involves a lot of daydreaming, inability to focus, forgetfulness, and having trouble staying organized. Because that doesn't look like 'typical' ADHD — and can be mistaken for simple scatterbrained-ness — it's often not diagnosed as such.
This may not be the case universally, though. In one study in 2013 of ADHD symptoms in boys and girls, the only difference was that girls reported feeling more anxious.
2. Girls Are Under-Diagnosed Compared To Boys
One of the big factors that influences how sex impacts ADHD? Diagnosis. Girls are less likely to be diagnosed with ADHD — despite being just as prone, according to research — because all the diagnostic criteria are based around boys. "As with all diversity issues, the danger lies in assuming that these more typical patterns characterize all children with ADHD. Therefore, while there appears to be an abundance of information available on ADHD, we may have a false sense that we know more about the experience of girls with ADHD than we really do," ADHD expert Ellen Littman PhD told the American Psychological Association.
For many women and girls with ADHD, this leads to under-diagnosis and misdiagnosis. Women with undiagnosed ADHD may be diagnosed with anxiety and depression, and have comorbid disorders — illnesses that show up at the same time as ADHD — including sensory overload, substance use disorder, borderline personality disorder, or eating disorders, according to ADDitude Magazine. Women who weren't diagnosed as children have an average diagnosis age of 36.
3. Hormones Can Influence ADHD Symptoms In Girls & Women
ADHD symptoms also differ in girls once they start to menstruate. "When premenstrual hormone levels drop, women experience an exacerbation of ADHD symptoms along with typical premenstrual changes," explains ADDitute Magazine. "Low estrogen triggers greater irritability and disruptions of mood, sleep, and concentration." A study published in 2018 confirmed this, indicating that ADHD symptoms shift noticeably across the menstrual cycle in girls, particularly in those who actually have combined or hyperactivity ADHD.
4. Girls May Have Different Coping Strategies
Along with a different common ADHD type, girls with ADHD may have different ways of coping with the condition. A study published in 2010 suggested that teen girls with ADHD in particular diverged from boys: "Adolescent girls with ADHD have lower self-efficacy and poorer coping strategies than adolescent boys with ADHD; rates of depression and anxiety may be higher, and physical aggression and other externalizing behaviors lower in girls and women with ADHD."
Healthline notes that research indicates that undiagnosed ADHD often appears along sex lines: "Boys with ADHD typically externalize their frustrations. But girls with ADHD usually turn their pain and anger inward. This puts girls at an increased risk for depression, anxiety, and eating disorders. Girls with undiagnosed ADHD are also more likely to have problems in school, social settings, and personal relationships than other girls."
5. Women With ADHD May Feel Out Of Control
As adults, women with ADHD often have markedly different experiences to men. The typical male features of adult ADHD often involve hypersensitivity, an inability to concentrate, a tendency to change jobs and difficulty with responsibility. For women, however, the picture looks quite different. VeryWell Mind notes that "psychological distress, feelings of inadequacy, low self-esteem, and chronic stress are common," and that the profile of adult ADHD in women is often one of crisis, chaos and a lack of organization. According to the American Psychological Association, adult women with ADHD "typically present with tremendous time management challenges, chronic disorganization, longstanding feelings of stress and being overwhelmed, difficulties with money management, children or siblings with ADHD, and a history of anxiety and depression." Many may not realize they have ADHD themselves until middle age or later.
According to Psych Central, a 2005 study on gender differences in ADHD found that women were more likely to experience "separation anxiety disorder" than men, while men with ADHD were more likely to have "oppositional defiant disorder". A lot of this may be influenced by gender roles and the ways in which women are allowed to express anger and cope with chaos, but more work needs to be done to examine that.
Being a woman with ADHD is often very different to being a man with the same diagnosis — to the point where getting a diagnosis at all can be far more difficult. If you suspect you may have ADHD as an adult, it's a good idea to chat to your doctor about what that might mean for you and your mental health in the future.
If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Health (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.