Understanding ADHD symptoms in women: A comprehensive guide

What Are the Types of ADHD?

The four main symptoms of ADHD are inattentiveness, hyperactivity, impulsivity, and disorganization. People with ADHD may present all of these symptoms to some degree, but ADHD has three distinct presentations:

• Predominantly inattentive: trouble with listening, following directions, staying on task, losing/misplacing belongings or materials, forgetfulness, organization
• Predominantly hyperactive-impulsive: inability to stay still or to wait, fidgeting, overactivity, and frequent intrusions or interruptions into other people’s activities
• Combined inattentive and hyperactive: exhibits both inattentive and hyperactive traits sustained over a long period of time

For those with ADHD, these traits are seen at levels that are excessive or inconsistent with someone’s age and developmental level. These symptoms are commonly carried into adulthood. 

Symptoms of ADHD can also be categorized by severity:

• Mild: Fewer symptoms, minimal interference with functioning and daily life
• Moderate: Number of symptoms and intensity lies between mild and severe
• Severe: Significant impact on daily functioning, with many symptoms present and some especially intense

ADHD may also cause problems with executive function, which is the mental process that allows us to control focus and attention, plan, remember, and multi-task. This often means that people with ADHD are forgetful, struggle to plan, or have trouble focusing for extended periods.

Diagnosing ADHD in 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. 

Diagnostic criteria for ADHD are split by the types of ADHD. 

For inattentive ADHD, someone must meet the above criteria and experience fewer than five symptoms of impulsivity or hyperactivity and five or more of the following symptoms: 

• Difficulty focusing
• Trouble listening
• Not very attentive to detail, makes simple mistakes
• Disorganized
• Trouble completing tasks
• Frequently loses important belongings
• Easily distracted
• Forgetful
• Avoids tasks that require more mental energy or prolonged focus

For impulsive/hyperactive ADHD, symptoms must have existed before the age of 12 and for more than six months, and one must experience fewer than five symptoms of inattention and five or more of the following symptoms:

• Leaving their seat when expected to remain seated
• Blurting out answers, completing other’s sentences
• Interrupting others or intruding on their activities
• Difficulty staying quiet during activities
• Fidgeting and tapping hands or feet
• Difficulty sitting still
• Trouble waiting their turn
• Talking excessively
• Restlessness

Finally, there is the combined presentation. Like the previous types, symptoms must be present before the age of 12 and for more than six months. Someone will be diagnosed with a combined type if they experience five or more symptoms of inattention and five or more symptoms of hyperactivity/impulsivity.

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.

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.

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

Though the same diagnostic criteria is used to diagnose ADHD in women and men, due to societal influences, social norms, and expectations for women, there can frequently be a difference in how symptoms are managed and expressed. 

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 emotional regulation and expression levels than men. 

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 have learned 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 as a result of their ADHD and masking strategies. 

This becomes a problem where diagnoses are considered. Despite newer research claiming otherwise, a large majority of people still believe that ADHD is more common in boys than girls, and that it usually presents itself as rowdiness, disruption, or any number of other obvious hyperactive indicators. 

This means that many girls and women with ADHD never get diagnosed since their symptoms and presentation are so different from that of men, thereby being less noticeable and often seen as “sub-threshold.”

What Are the Signs of ADHD in Girls?

There are many examples of what ADHD looks like in girls. 

Girls who have a more inattentive presentation often have trouble focusing and staying on task. They likely aren’t very disruptive in class, but you may catch them staring off into space or not listening to directions. They can often be unorganized, forgetting events or tasks or losing their belongings. Because focusing is hard, they may also avoid tasks that require more mental energy or prolonged focus, procrastinating on them or leaving them incomplete. This can also impact their attention to detail, leading them to make simple mistakes.

Girls who are predominantly hyperactive/impulsive may come across as very social while actually being internally hyperactive. Their thoughts can move very quickly, so they may come across as talkative and impulsive, not always thinking extensively before acting or speaking. They can also be very fidgety and have a hard time staying still, both physically and in their life—they might have a tendency to stay busy and active due to their restless nature.

Then, there are girls who fit more into a combined type presentation. That means their symptoms can include both inattentive and hyperactive/impulsive behaviors, such as disorganization, fidgeting, trouble focusing, and more.

Other signs of ADHD that can occur in girls as a result of their symptoms are:

• Feeling regularly overwhelmed
• Issues with time and money management
• Poor performance in school
• A history of anxiety and depression

Other signs that a girl might have ADHD are her emotional concerns or worries. Girls who have more trouble with executive function (i.e. trouble focusing or procrastination) often face higher levels of rejection from peers, which can seriously affect their self-esteem. 

What Are the Signs of ADHD in Women? How Do You Tell If You Have ADHD as a Woman?

It is even easier for women’s ADHD symptoms to go unnoticed than it is for girls’, since most women with ADHD have been masking their symptoms and developing coping skills to deal with them since childhood. 

However, a very common sign of ADHD that is more prevalent in women than both men and non-ADHD girls is low self-esteem. Women 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.

There are also those who may not be as adept at coping with their ADHD as others. Your ADHD may sometimes make your daily struggles worse. Tasks like cooking meals, doing chores, or keeping up at work might keep you on your heels and make you feel like you’re constantly behind. This can cause overwhelming stress or exhaustion. Another common sign, especially in undiagnosed cases, is difficulty regulating emotions and emotional responses, as ADHD is a sensory processing disorder.

Waiting for diagnoses can have its own effects on women, and these effects can be signs of ADHD in and of themselves. Years of internalizing their symptoms and emotions and developing unhealthy coping mechanisms to manage symptoms can also lead to anxiety in women with ADHD. Women with ADHD are more likely to have anxiety disorders than men with ADHD. 

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

Common Symptoms of ADHD in Women

Women who have ADHD are diagnosed using the same diagnostic criteria used for men. That being said, women tend to exhibit most of the following symptoms: 

• Inattention
• Difficulty focusing
• Difficulty concentrating
• Difficulty completing tasks
• Forgetfulness
• Difficulty with short-term memory
• Restlessness
• Procrastination

Another common symptom is tangential conversational and thought patterns, showing itself by frequently changing topics mid-conversation, sometimes making it difficult to have congruent thought patterns or conversations with others. Again, it’s important to understand that each ADHD symptom is individualized and specific to each person, so they will likely present themselves slightly differently in each person.

What Does Untreated ADHD Look Like in Women?

Untreated ADHD in women is highly individualized in its symptom presentation. That said, untreated ADHD in women can cause common ADHD symptoms like difficulty staying organized, forgetfulness, and difficulty completing tasks. 

However, the negative effects of struggling to manage ADHD on one’s own can also cause impairments in view of self, self-perception, and self-esteem as well as high levels of anxiety/anxious rumination. 

Untreated ADHD can also lend itself to inconsistent behavior patterns and difficulties with timeliness, which can potentially cause issues in social relationships. 

What Does ADHD Masking Look Like in Women?

The term “masking” refers to ways in which people compensate for or try to hide symptoms they find hindering or not socially acceptable by behaving differently in an effort to “hide” or “mask” it. 

For many women, being “over-productive” or constantly busy and overscheduled can serve as a masking behavior, as being busy can put distance between them and their distressing emotions and behavior. This state of being can also be an effort to compensate for the idea that they have felt or been called “lazy” due to their ADHD symptoms inhibiting their focus and timeliness.

Another common form of ADHD masking that can occur in women is to over-apologize due to an internalized fear that they are inconveniencing others by their actions. 

Many women who get diagnosed as adults have many 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.

What Can ADHD Be Mistaken for in Women?

Some of the most prominent conditions ADHD can be mistaken for in women are anxiety disorders, autism, and depression. Because they so often occur alongside ADHD in women, women’s ADHD symptoms can be attributed to their anxiety or depression, thus complicating the process of getting an ADHD diagnosis. ADHD in women can elicit the same type of internal responses as anxiety. 

For example, the freeze response or difficulty remembering things and completing tasks can increase the likelihood of negative automatic thoughts about oneself and anxious rumination regarding how they are perceived by others due to your “inaction.” In other instances, the rigidity and hyperfixations caused by ADHD can also be misinterpreted as or confused with the hyperfixations found in autism.

There are a number of co-occurring conditions, also known as comorbidities, that commonly occur alongside ADHD. These comorbidities can cause women with ADHD to go undiagnosed or misdiagnosed due to their similar symptomatic patterns and the masking of ADHD symptoms.  

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. 

Other common co-occurring conditions are:

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

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.

Managing ADHD Symptoms

One of the best and most effective ways to manage ADHD symptoms is to seek assistance from a mental health professional. Through professional supportive services, you can find coping and emotional regulation strategies that are effective for you and your specific symptoms. 

CBT is a great therapeutic tool for ADHD that combines behavioral and cognitive strategies. CBT can help you make behavioral and environmental adjustments in your life that support your ability to complete tasks and achieve goals. These changes can also help “automate” your day and give you a clear routine, which is a great supplement to using cognitive tools such as challenging and reframing to ease your symptoms. 

What Does ADHD Treatment Look Like for Women?

The first step in getting treatment for your ADHD is getting diagnosed. Though we’ve explained why that can be difficult for girls and women, there are ways to get unbiased answers. It can be beneficial to go to a medical professional who specializes in diagnosing women and girls.

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 treatment referrals and underdiagnosis than it is to effectiveness. Medications will not cure ADHD, but they can help make symptoms more manageable so they have less of an impact on daily functioning. 

Common medications used for ADHD are called psychostimulants, 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 the brain chemicals 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 also be a combination of them that works best for you.   

The main objective is to learn healthy and effective coping strategies and life-management skills, which would help regulate symptoms and perhaps 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. It can be helpful to know that others feel overwhelmed and face feelings of rejection as often as you, and help normalize symptomatic traits that you may have learned to dislike or think badly of over time. 

Can ADHD Medication Be Taken During Pregnancy?

No medications for ADHD have been proven to be safe to take while pregnant. Though they have not conclusively been proven harmful, it can be risky and is not often recommended without severe ADHD symptoms.

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 improve 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 to find out if you (or they) might be struggling with ADHD.