ADHD in Women: the surprising differences

ADHD has historically been more commonly associated with boys and men than women and girls. ADHD tends to present differently in males, in a way that makes it more “noticeable”- for example, hyperactivity, inability to concentrate, and being “boisterous”. ADHD in women is more likely to present as shyness, or seeming withdrawn. Many women with ADHD say they were initially described as “flaky” or “spacey”, and it’s common for women to be misdiagnosed as depressed, anxious, or even bipolar, rather than ADHD. Misdiagnosis in women is likely to be largely due to the fact that there are differences in how ADHD presents in males and females, and some of those differences can be surprising. Here, we’re going to take a look at how ADHD commonly presents differently in women.

Types of ADHD in women

Firstly, it’s important to note that there are actually different types of ADHD- this applies to both men and women. The first type of ADHD is the Hyperactive/Impulsive Type. This is probably the type of ADHD that most people think of when they typically think of “ADHD”. Symptoms include often feeling restless and fidgety. A person with this type of ADHD may also be talkative, or always in motion, or someone who likes to be constantly busy. Boys are more likely to be diagnosed as having hyperactive/impulsive type ADHD. The second type of ADHD is the Inattentive Type. This type of ADHD presents as persistent forgetfulness, lack of attention to detail, inability to complete tasks, and being easily sidetracked. Girls and women are more likely to be diagnosed with Inattentive type ADHD than boys. Thirdly, there is the Combined Type. This type of ADHD can include a mixture of both inattentive and hyperactive/impulsive traits and behaviours. Because females are more likely to present with the symptoms of the Inattentive type, ADHD can be harder to spot, and easier to misdiagnose as another condition.

So, how do the symptoms of ADHD differ in women?

When it comes to diagnosing ADHD, a specialist ADHD clinician will look for symptoms that not only persist for long periods of time but are severely disruptive at work or at home. For example, for a woman with ADHD, this might present as significant disorganisation that severely impacts day-to-day life, for example, constantly losing keys, forgetting passwords, missing meetings, not being able to complete a supermarket shop, or not being able to complete tasks at work (such as writing an email). Women with ADHD often tend to keep things to themselves, placing a greater burden on fitting in than on taking pride in standing out, some experts say. Many women with ADHD become experts at “masking”- presenting themselves as “normal” whilst struggling internally with the pressure of trying to act the way that they feel is demanded of them by society. Women with ADHD may struggle to maintain friendships, remember important dates, and may find the daily routines of family life testing, especially if disorganisation is one of their symptoms. For women specifically, ADHD can lead to the internalising of emotions and experiences which causes anxiety, and in severe cases can lead to self-harm and even suicide.

How female hormones can impact ADHD

We now understand that female hormones make the experience of ADHD distinctve from that of males, and also play a role in complicating ADHD diagnosis. Hormones at certain stages such as puberty, childbirth, postpartum, and during perimenopause and menopause, and can make ADHD feel like a rollercoaster for women. This is because female hormone fluctuations seem to intensify the symptoms of ADHD in women. Menopause especially can exacerbate ADHD symptoms in women. Menopause is primarily triggered by the decrease in oestrogen levels. Oestrogen plays a crucial role in regulating mood, attention, and impulse control. It also plays a vital role in the parts of the brain that relate to memory and word retrieval. Some women with ADHD  find their cognitive function affected so drastically that they think they may be developing earlier dementia. Women with ADHD who are also experiencing the menopause can find that their work life, home life, relationships, and sleep patterns are severely affected.

How Lack of ADHD Diagnosis Affects Women

When a diagnosis is missed, it can have a negative impact on a woman’s entire life. Women with ADHD tend to find themselves in relationship, financial, or career trouble. Women and girls tend to internalise ADHD symptoms, whereas men and boys tend to externalise - showing traits such as hyperactivity, fidgeting, frustration, or inattentiveness. Internalising leads to anxiety, and even depression.

Diagnosing ADHD in women

Achieving an accurate ADHD diagnosis is the first step to women with ADHD living a happier life. With the right support, women and girls with ADHD can manage symptoms, and this is where Beyond can help. We understand how ADHD affects women, and we know how female hormones can affect ADHD. Our specialist ADHD psychiatrists work to help women feel more in control and lead happier, healthier lives.