What are the signs of ADHD in women?

Spotting the signs of ADHD in adult women

Life with ADHD can present issues, and it can be even more difficult if your condition hasn't been identified. This is the case for many adult women who have gone through much of their life without the right support in place.

Without coping strategies, many women and girls with ADHD also struggle with other mental health disorders, such as anxiety disorders, depression, and eating disorders and experience difficulties in all areas of life. For example, they are more at risk of¹:

• Domestic violence.

• Engagement in self-harm.

• Unplanned pregnancy.

• Substance abuse.

• Antisocial behaviour.

• Relationship problems.

• Work-life problems.

The earlier ADHD is detected, the better chance there is of improving someone's quality of life. Below are some common challenges faced by adult women with ADHD. They can also be symptoms of other conditions - or may not even be symptoms of a clinical problem at all. If you recognise a lot of these traits in yourself, and believe you may have undiagnosed ADHD, talk to your doctor or mental health professional for a more accurate evaluation.

Some women become very good at hiding their symptoms from others because they feel shame or fear rejection. A diagnosis can make life a lot easier. Treatment for ADHD may include therapy, lifestyle changes, medications, and helpful adjustments in your workplace.

Why are more women being diagnosed?

There is a significant increase in adult women who are being diagnosed with attention deficit hyperactivity disorder (ADHD) - a behavioural condition that has traditionally been associated with school age boys.

This surge in diagnoses coincides with a greater awareness and understanding of ADHD among the public. What was once thought of as a schoolboy problem with hyperactivity and aggression is now being understood as a multi-faceted condition that can affect both boys and girls in different ways.

Research is now telling us that girls may be just as likely to develop ADHD, but if this is the case, how have so many gone through school and adulthood without having their condition recognised and managed?

There are several reasons at play:

1. The signs of ADHD in women and girls can be different

There are three main subtypes of ADHD and these are responsible for different characteristics:

1. Hyperactive/impulsive ADHD - people with this type tend to be energetic, disruptive, talkative, impulsive, impatient, may fidget more, and can experience mood swings.

2. Inattentive ADHD - people with this type can find it difficult to focus on one task for long, listen for long, pay attention to details, and remember things.

3. A combination of the above two.

Experts now believe that hyperactive/impulsive ADHD is more common in boys and men while inattentive ADHD is more common in girls and women¹. This means that, although girls and boys with ADHD can be more alike in their behaviours than not, there are some important differences when it comes to spotting the signs.

2. Research has focussed on boys and men

The problem has been compounded by the lack of ADHD research for women and girls. In the past, studies have focussed on the typical behaviours that boys present - such as hyperactivity and aggression - and this has led the ADHD symptoms that affect more girls - such as inattention and low self-esteem - to largely be missed and ignored for decades.

3. Gendered stereotypes

Gendered stereotypes and language may also play a role in the underdiagnosis and misdiagnosis of ADHD in women and girls. For example, girls can often be stereotyped as shy, forgetful, or 'spacey' - characteristics that could be signs of inattentive ADHD.

Inattentive ADHD and women - a closer look

Generally speaking, the trend for girls to develop inattentive ADHD and boys to develop hyperactive and impulsive ADHD accounts for a lot of the gender disparity between symptoms and diagnosis:

• More girls/women have more trouble focussing on one thing - the hallmark of inattentive ADHD - rather than struggling with impulsivity or hyperactivity - the traits most often viewed as hallmarks of ADHD by society.

• Girls/women tend to have fewer externalising symptoms than boys/men. These behaviours are directed outward into the world and are therefore more obvious for others to spot. Externalised ADHD traits include antisocial, disruptive, or aggressive behaviour toward others.

• More girls/women internalise their symptoms - turn their feelings inward. As a result, they experience lower self-esteem and higher rates of anxiety and depression than males with ADHD².

Other signs of ADHD in women

The different characteristics of inattentive ADHD and hyperactive/impulsive ADHD are important for understanding ADHD in women and girls compared to ADHD in boys and men - but this isn't the whole story. There are other ways that ADHD presents differently in the two sexes.

Symptoms and puberty

In boys, ADHD tends to present in childhood, and these behavioural traits often calm down at puberty. In girls, research shows that ADHD symptoms in women may in fact become worse during puberty. This is due to an increase of oestrogen - the female sex hormone - which affects the part of the brain the controls ADHD traits and functions³.

Symptoms and the menstrual cycle

In the same way that puberty can spur on ADHD symptoms, hormonal fluctuations during a women's menstrual cycle can affect the severity of symptoms throughout the month. Many girls and women with ADHD have described how their condition seems to worsen during the premenstrual period - the time in their cycle when premenstrual syndrome (PMS) symptoms also peak³.

Patient picks for ADHD

Mental health

Is ADHD in adult women underdiagnosed?

When most people think of ADHD (attention deficit hyperactivity disorder), a very particular image comes to mind. Specifically, a young boy wreaking havoc in the classroom - running around, disrupting his classmates and interrupting the teacher. They don't necessarily think of the young girl daydreaming in the corner, still less an adult woman who has dealt with certain misconceptions her entire life.

by Abi Millar

Mental health

ADHD in adults

Attention deficit hyperactivity disorder (ADHD) causes problems with concentrating (inattention), and being too active and having difficulty staying focused (hyperactivity). The difficulties caused by ADHD vary from mild to severe. Although ADHD starts in childhood, the difficulties often persist into adulthood. Sometimes adults are diagnosed with ADHD for the first time because the problems have not been properly assessed and the diagnosis not made during childhood. Attention deficit disorder (ADD) is a term used for people who have excessive difficulties with concentration without other ADHD symptoms such as excessive impulsiveness or hyperactivity.

by Dr Colin Tidy, MRCGP

Further reading

1. Hinshaw et al: Annual research review: attention-deficit/hyperactivity disorder in girls and women: under-representation, longitudinal processes, and key directions.

2. University of Bergen: Women with ADHD often develop anxiety and depression.

3. CHADD: The complete picture: how estrogen affects women with ADHD.