Understanding ADHD symptoms in women: A comprehensive guide

What Are the Types of ADHD?

There are three distinct presentations of ADHD, each characterized by a certain set of symptoms. They include:

• Predominantly inattentive: Primary symptoms include trouble listening, following directions, or staying on task; losing/misplacing belongings or materials; forgetfulness; disorganization.
• Predominantly hyperactive-impulsive: Primary symptoms include an inability to stay still or to wait, fidgeting, overactivity, and frequent intrusions or interruptions into other people’s activities.
• Combined inattentive and hyperactive: People with this presentation exhibit both inattentive and hyperactive traits sustained over a long period of time.

Symptoms of ADHD can also be categorized by severity: mild, moderate, and severe. 

It’s common for young children to display some of these traits, however those with ADHD exhibit these symptoms to an excessive degree or in a way that is inconsistent with their age and developmental level. 

Ideally, ADHD is diagnosed in childhood, but the condition doesn’t go away so symptoms will persist into adulthood. This is why it’s important to get diagnosed as young as possible—so that children get access to tools and systems that help them manage their symptoms. 

Why ADHD Symptoms in Women Are Often Overlooked

When people think of ADHD, many imagine hyperactive traits, like the image of a little boy being rowdy or disruptive in class. This is a common issue when spotting ADHD in children for two central reasons: 

1. This doesn’t account for inattentive ADHD, which can be less noticeable in classroom settings. Inattentive ADHD is more commonly seen in girls, while hyperactivity is more common in boys.
2. Despite being more frequently diagnosed in boys, ADHD is just as common in girls and women. 

This common misconception results in many young girls being overlooked or misdiagnosed—sometimes until they’re well into adulthood. 

ADHD in Women vs. Men: Is There a Difference?

Though women and girls tend to present as inattentive and men and boys are more often hyperactive, there is no difference in symptom sets between girls and boys with ADHD. Girls can also be hyperactive or present a combination of symptoms, just as boys can have an inattentive or combined presentation. This means that, when looking at diagnostic criteria, there is no difference between ADHD in girls versus boys.

That said, there is often a big difference in how boys and girls, and likewise men and women, manage and express their symptoms thanks to societal influences, social norms, and expectations for women.

In American culture, women often experience pressure to perform and complete a higher amount of tasks—especially domestically and emotionally—and have higher expectations placed on their ability to regulate their emotions, i.e. keep their emotions and expressions calm and neutral, than men do. 

Because of this, women tend to exhibit more inattentive symptoms and criteria of the ADHD spectrum—not because they don’t experience hyperactivity, but because they face societal pressures that transform these symptoms. This means ADHD symptoms in women and girls are often much more covert than in men and boys. 

Even if a girl or woman has predominantly hyperactive/impulsive symptoms, she may learn to mask her symptoms so that they occur internally rather than externally most of the time. In this case, “masking” refers to when someone with a neurodivergence presents themselves in a way that isn’t true to their natural behavior and presentation and is done for the benefit of others. This masking can cause women to experience more emotional and psychological distress than men do.

Inattentive presentations in women and girls become a problem where diagnoses are considered. Until recently, studies on ADHD predominantly focused on boys, so much of the research around symptom presentation, diagnosis, and the effectiveness of medication and treatment was not tested on girls. 

As a result, many girls and women with ADHD never get diagnosed: Since their symptoms and presentation are so different from men, they’re less noticeable and often seen as “sub-threshold.”

Common Signs of ADHD in Women

The four main symptoms of ADHD are inattentiveness, hyperactivity, impulsivity, and disorganization. Women who have ADHD are diagnosed using the same diagnostic criteria as men. However, women tend to exhibit the following symptoms more often (with consideration to the cultural and societal factors above): 

• Inattention
• Difficulty focusing
• Difficulty concentrating
• Difficulty completing tasks
• Forgetfulness
• Difficulty with short-term memory
• Restlessness
• Procrastination
• Non-linear thought or conversation (changing topics mid-conversation, difficulty staying on-topic)

Another common sign, especially in undiagnosed cases, is difficulty regulating emotions and emotional responses, as ADHD affects sensory processing.

There are common sets of symptoms, but it’s important to understand that each ADHD symptom is individualized, so they’ll present slightly differently for everyone. For example, just because women and girls tend toward inattentiveness doesn’t mean they can’t be hyperactive. The individuality of symptoms reinforces that it’s crucial to consider the whole picture when diagnosing or seeking a diagnosis for ADHD.

Diagnosing ADHD in Women

For anyone—men and women—diagnosing ADHD is a process that takes time and considers multiple factors and areas of your life, including both interpersonal and intrapersonal functioning. For a diagnosis, symptoms must have existed before the age of 12, occur for more than six months, significantly impair functioning in multiple areas of life (e.g., work, school, and/or social life), and cannot be attributed to situational circumstances, like quarantining or working from home, or other mental health conditions, like anxiety or autism. 

In order to diagnose you, a qualified mental health professional like a psychologist will ask you a variety of questions about your symptoms, experiences, and behavioral patterns in multiple settings, such as school, work, or home. Some may also speak with people who knew you as a child, such as family members, teachers, or friends, to get a better understanding of you and your symptoms. The process of diagnosis, as well as the criteria for being diagnosed, are exactly the same for men and women. 

For more information, click here to see a full breakdown of the diagnostic criteria for ADHD. 

Seeking professional psychotherapy services is a great way to begin to understand your symptoms and explore a potential ADHD diagnosis. A therapist can help you better understand your specific ADHD symptoms and how they manifest.

What Does ADHD Look Like in Girls?

Due to each person’s unique experience of ADHD, there are many examples of what ADHD might look like in girls. However, many girls still display common threads.

Girls who have a more inattentive presentation often:

• Have trouble focusing and staying on task
• Aren’t very disruptive in class, but you may catch them staring off into space or not listening to directions
• Can be disorganized, forgetting events or tasks or losing their belongings
• Avoid tasks that require more mental energy or prolonged focus, procrastinating on them or leaving them incomplete (because focusing is hard)
• Struggle with attention to detail, leading them to skim over their work for the sake of getting it done more quickly and, consequently, make simple mistakes

Girls who are predominantly hyperactive/impulsive:

• May come across as very social while actually being internally hyperactive
• May seem talkative and impulsive, not always pausing to think before acting or speaking (because their thoughts move quickly)
• Can be very fidgety and have a hard time staying still, both physically and in their life—they might have a tendency to keep their schedule busy and active

Girls may also show a combined presentation of inattentive and hyperactive/impulsive behaviors, such as disorganization, fidgeting, trouble focusing, and more.

It’s important to note that ADHD can result in other issues developing, some of which may be easier for teachers and parents to spot than the symptoms listed above. Examples of these behaviors or traits include:

• Feeling regularly overwhelmed
• Issues with time and money management
• Poor performance in school
• A history of anxiety and depression
• Emotional concerns or worries (Girls who have more trouble with executive function, like focusing, often face higher levels of rejection from peers, which can affect their self-esteem.)

What Does ADHD Masking Look Like?

The term “masking” refers to ways in which people change their behavior to compensate or try to hide symptoms they find hindering or not socially acceptable. One example of a masking behavior is being “over-productive.” Overscheduling or constantly being busy can be an attempt to distance themselves from distressing emotions and behavior. It can also serve as a way to compensate for feeling or being called “lazy” due to their ADHD symptoms, which inhibit their focus and timeliness.

Many women diagnosed with ADHD as adults have various masking tendencies, some of which they may not even realize are occurring. Without a diagnosis, it’s often assumed that their ADHD symptoms are simply character traits, which can insinuate that they have control over things like their inability to focus, timeliness, forgetfulness, talkativeness, and other symptoms that are actually a result of their brain function. 

Societally, these traits are often viewed as bad or disrespectful, causing people with undiagnosed ADHD to feel like they need to work to hide these traits in order to be accepted by others. Long term, though, this can have many negative consequences on one’s self-esteem and overall mental health. 

In fact, research shows that self-esteem issues are more prevalent in women with ADHD than in both men and women without ADHD. The science makes sense: Trying to manage ADHD on your own is hard, which can result in developing negative self-perception and poor self-esteem. 

The Mental Health Impact of Undiagnosed ADHD

Once girls with ADHD grow up, it is even easier for their ADHD symptoms to go unnoticed. Most women with ADHD, especially those who were not diagnosed, have been masking their symptoms and developing coping skills to deal with them since childhood, creating their own systems for working and moving through the world to fit into society’s mold for how people should function.

One common result of ADHD is high levels of internalized shame. Shame cycles can be a very common experience with ADHD. Many symptoms, such as being disorganized, having trouble with timeliness, or being unable to focus, can cause someone with ADHD to feel down on themselves and ashamed of their perceived lack of skill in these areas. 

When someone is formally diagnosed with ADHD, it’s much easier to recognize this spiral for what it is and redirect before it gets insurmountable. But when someone doesn’t know they have it, traits like being undermotivated, late, disorganized, or too chatty become personal flaws, not symptoms of a disorder. 

Shame can create a vicious cycle: It drains mental and emotional energy, so as someone gets more ashamed, it becomes harder and harder to stay motivated to complete tasks or get things done. This leads to putting things off, which can make one feel worse about themselves and their low productivity. Together, lack of motivation and shame build on themselves in a continuous loop, making it incredibly difficult to find the energy to do even simple tasks.

Sometimes this shame can be used as a negative coping mechanism, using negative self-talk (“You’re so lazy” or “This is so easy for everyone else, why can’t you just do it?”) to try and fuel motivation and get things done. Due to the negative impact of shame, this form of motivation isn’t sustainable long-term. 

Instead, radical acceptance and encouragement, such as providing breaks, taking care of your needs, and being OK with whatever you get done, is much more effective and beneficial for your mental health.

Can ADHD Occur with Other Mental Health Issues?

According to research, women with ADHD are more likely to develop co-occurring conditions like depression and anxiety than men with ADHD. Women with ADHD can also feel a pervasive and near-constant sense of being overwhelmed, which is often a result of internalizing their symptoms for months or years. 

This predisposition for anxiety can even make them vulnerable to bouts of self-harm or suicide, in severe cases. Treatments like medication, therapy, and support groups are very helpful in curbing these symptoms.

What Can ADHD Be Mistaken for in Women?

There are a number of disorders that have similar symptoms to ADHD, many of which commonly occur alongside the disorder. Co-occurring conditions, also known as comorbidities, can complicate the diagnosis process and cause women with ADHD to go undiagnosed or misdiagnosed well into adulthood.  

Some of the most prominent conditions ADHD can be mistaken for in women are anxiety disorders, autism, and depression. 

Other common co-occurring conditions are:

• Conduct disorder
• Oppositional defiant disorder
• Learning disabilities
• Bipolar disorder
• Substance use disorder

All of these can end up masking symptoms of ADHD in women, or even cause them to be misdiagnosed, due to their symptomatic similarities and biased ADHD methodology.

When two or more conditions are present at the same time, it can be beneficial to stabilize symptoms of other conditions, either through therapy or medication, before treating ADHD—ADHD medications work best when severe anxiety or depression symptoms are not present. 

What Does ADHD Treatment Look Like for Women?

The two main strategies for treating ADHD are medication and psychotherapy. For children and adults with ADHD, medication is usually the first route taken for treatment, often accompanied by therapy. 

Medication

Medication use is lower in girls and women with ADHD than it is in boys and men, but that is due much more to bias in underdiagnosis and treatment referrals than it is to effectiveness. Medications will not cure ADHD, but they can help make symptoms much more manageable. 

Psychostimulants are some of the most common medications used for ADHD, the two most common being amphetamines (such as Adderall and Vyvanse) and methylphenidate (such as Concerta, Focalin, Focalin XR, Daytrana, and Metadate). Psychostimulants target and attempt to regulate brain chemicals like dopamine that affect behavior and attention.

There are also non-stimulant medication options such as Strattera, guanfacine, and clonidine. Thriveworks clinicians and nurse practitioners can prescribe stimulants to treat ADHD, though their use is strictly monitored in order to protect the health and well-being of the client, as there are some risks to taking them. Use of stimulants carries a risk of abuse, as well as side effects that can occur when used not as prescribed, such as high blood pressure, strokes, and seizures.

Therapy

There are multiple counseling approaches that can be effective in treating ADHD as well as any co-occurring conditions. It may be a combination of them that works best for you.   

The main objective in therapy for ADHD is to learn healthy and effective coping strategies and life-management skills, which will help regulate symptoms and boost self-esteem. 

The support and understanding found in talk therapy or support groups can be massively beneficial, specifically for women with ADHD, since anxiety and depression so often accompany their ADHD. Therapists will, among other things, help normalize symptoms and traits that you may have learned to dislike or think badly of over time. It can be helpful to know that other people feel as overwhelmed as you and face similar feelings of rejection or feeling different, and that your symptoms are not personal failings. 

The Bottom Line

As more women and girls seek diagnosis and treatment for their ADHD, more research is necessary to more thoroughly examine the effects and symptoms of ADHD in both men and women. A larger understanding of ADHD’s presentation in all genders is required to develop better symptom profiles and increase the number of accurate diagnoses of ADHD in both women and girls. 

If you believe that the symptoms above sound like you or your child, speak with a doctor or mental health professional about whether they could be a result of ADHD.