ADHD in women: What are differences in symptoms and diagnoses between men and women?

What Are the 4 Symptoms 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 listening and staying on task, losing belongings/materials
• Predominantly hyperactive-impulsive: inability to stay still or to wait, fidgeting, overactivity, and frequent intrusions 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. 

People with ADHD also have problems with executive function, which are the mental processes that allow us to control focus and attention, plan, remember, and multitask. This might mean that they are forgetful, bad planners, or have trouble focusing for extended periods.

Why Do People Develop ADHD?

The specific reason or cause for ADHD is unknown. Though the exact cause isn’t fully understood, it can be a product of both environment and genetics. Parents with ADHD can pass the trait to their kids, so if you are a parent of a child with ADHD, chances are higher that either you or your spouse also have ADHD.

However, the presence of ADHD is not solely reliant on genetics. Environmental factors play a role in ADHD development as well. ADHD can sometimes be attributed to a person’s brain function and structure. Conditions like epilepsy, brain injury, or premature birth can also put children at risk of developing ADHD.

How Does ADHD Look Different in Females?

The symptoms and presentation types are generally the same for both women and men with ADHD. However, while men and boys usually tend toward the predominantly hyperactive-impulsive presentation, women and girls tend toward being predominantly inattentive.

This means that ADHD symptoms in women and girls are often much more covert than in men and boys. While poor classroom performance is a symptom seen in both boys and girls, boys with ADHD also typically exhibit behavioral problems like acting out, being rowdy or causing disruptions, getting in fights, or interrupting during class. 

ADHD symptoms in girls, even those that fit under the umbrella of hyperactive/impulsive, don’t usually present themselves boldly. 

Most of the time, young girls with ADHD have trouble focusing for extended periods or are easily distracted. They are also less likely to be overtly or physically aggressive, and when they do behave aggressively, they are more likely to be relationally aggressive, which involves hurting someone else through relationships or social status.

For women, the symptoms still apply, but the impact of their ADHD is slightly different than they are for men. For instance, women experience more emotional and psychological distress than men do as a result of their ADHD.

These differences occur for multiple reasons. First, as previously stated, most girls have inattentive ADHD, which means that they may seem a bit spacey or find it hard to focus, but their symptoms would present completely differently than the large majority of ADHD boys’.

The other reason is that girls usually develop better coping strategies, allowing them to internalize their symptoms and present themselves as normal, if slightly inattentive, students. Even if a girl is predominantly hyperactive/impulsive, she has likely learned to mask her symptoms so that they occur internally rather than externally most of the time.

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, fidgeting, disruption, or any number of other obvious indicators.

Clinicians also tend to look specifically for more disruptive symptoms because many of the studies performed on children and adults with ADHD primarily included boys and men. 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 “subthreshold.” 

What Are the Signs of ADHD in Girls?

In terms of symptoms, there are many examples of what ADHD looks like in girls. 

Girls that have a more inattentive presentation often have these traits:

• Difficulty paying attention, trouble listening
• Not very attentive to detail, makes simple mistakes
• Disorganized
• Trouble following instructions or completing tasks
• Frequently loses belongings
• Very easily distracted, forgetful
• Sees tasks that require more mental energy or prolonged focus as hard, dislikes them

Girls that are predominantly hyperactive/impulsive may come across as very social, though they are actually internally hyperactive. Girls with this presentation might be:

• Extremely talkative
• Impulsive, doesn’t think extensively before acting or speaking
• Fidgety
• Quick to make friends but find it hard to maintain friendships
• Fearful of rejection by friends or peers, causing them to remain in toxic relationships with people
• Spacey or daydreamy, though their thoughts are actually moving very quickly and are hard to keep in one place
• Working much harder than their peers, compensating in order to achieve the same amount of success

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

• Disorganization
• Feeling regularly overwhelmed
• Issue 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 problems or worries. Girls that have more trouble with executive function (i.e. trouble with focusing or procrastination) often face higher levels of rejection from peers, which can seriously affect their self-esteem. 

It’s also common for ADHD in girls to be accompanied by depression and/or anxiety. These are some of many co-occurring conditions that are frequently seen. 

Another is a behavioral disorder called conduct disorder in which a child behaves anti-socially and irresponsibly, often disregarding standards or rules. They can also have oppositional defiant disorder, which includes traits like regular and incessant anger, fighting, defiance, irritability, or cruelty. This occurs more commonly in both boys and girls with predominantly hyperactive ADHD. 

However, both of these disorders occur more frequently in girls with ADHD than in girls without it, and can cause issues with their ability to maintain good relationships, especially with their mothers. 

What Are the Signs of ADHD in Women?

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 that 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. 

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 can also lead to anxiety in women with ADHD. Women with ADHD are more likely to have anxiety disorders like specific phobias and generalized anxiety disorder (GAD) 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.

What Can ADHD Be Mistaken for in Women?

There are a number of co-occurring conditions, also known as comorbidities, that can cause women with ADHD to go undiagnosed or misdiagnosed.  

Two of the most prominent are anxiety and depression. Because they so often occur alongside ADHD in women, women’s ADHD symptoms frequently get attributed to their anxiety or depression, thus complicating the process of getting an ADHD diagnosis. This is why it can be beneficial to stabilize one’s anxiety symptoms before treating ADHD, as ADHD medications work best when severe anxiety or depression is not present. 

Other common co-occurring conditions are conduct disorder, oppositional defiant disorder, learning disabilities, bipolar disorder, and 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.  

Because of these co-occurring conditions coupled with less prominent symptoms, women tend to be older than men when they are diagnosed with ADHD.

What Does ADHD Treatment Look Like for Females?

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.

For a diagnosis, symptoms must have existed before the age of 12, occurring for months or years, and cannot be attributed to situational circumstances like quarantining or working from home.

The two main strategies for treating ADHD are medication and counseling. For children and adults with ADHD, medication is usually the first route taken for treatment, sometimes 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 you of your ADHD, but they can help make your symptoms more manageable. 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 do not prescribe stimulants to treat ADHD, as there are many risks to taking them. Use of stimulants carries a significant risk of abuse, as well as numerous side effects that can occur when used not as prescribed, such as high blood-pressure, strokes, and seizures.

Counseling

There are multiple counseling approaches that can be effective in treating ADHD as well as co-occurring anxiety or depression, and it may be a combination of them that works best for you. Talk therapy is a common treatment technique, but other ADHD-focused coaching is helpful depending on your personal circumstances and symptoms.  

The main objective is to learn good coping strategies and life-management skills, which would help regulate your symptoms and perhaps boost self-esteem. 

The support and understanding found in talk therapy or support groups can be massively beneficial for women with ADHD specifically, 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 might. 

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 males and females. A larger understanding of ADHD’s presentation in both 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.