ADHD affects people of all genders. But for decades, research and public awareness focused on hyperactive boys. As a result, many women with ADHD grew up without anyone recognising it.
NICE, which sets national guidance for health services in England, tells clinicians to be aware that ADHD is thought to be under-recognised in girls and women. It says they are less likely to be referred for assessment, may be more likely to have undiagnosed ADHD, and may be more likely to receive an incorrect diagnosis of another mental health or neurodevelopmental condition.
How big is the gap?
The NHS England ADHD Taskforce looked at how often ADHD was recorded in health records between 2000 and 2018. In adults, it was recorded in 0.74% of men but only 0.20% of women. The Taskforce links this to missed or mistaken diagnoses, especially in women and girls. Research suggests the real rate of ADHD in adults is higher than either figure.
Why ADHD is missed in women
Inattentive symptoms are less visible
The NHS says ADHD may be recognised less often in women because women with ADHD more commonly have inattentive symptoms, and these can be harder to recognise than hyperactive ones.
A girl who daydreams, loses her things and quietly falls behind is less likely to be noticed than a child who disrupts the class. She may be described as “chatty”, “scatty” or “not reaching her potential” rather than referred for assessment.
Hyperactivity can look different
Where hyperactivity is present, it may show up as talking a lot, emotional intensity, a busy mind, or constantly taking on too much, rather than physical restlessness.
Masking
Masking means hiding or compensating for traits in order to fit in. Acas describes masking as hiding parts of a condition to fit in better, and notes that it can cause mental health problems.
Women with ADHD often describe:
- spending hours preparing to look organised
- checking and rechecking work to avoid mistakes
- copying how others behave in social situations
- holding it together in public, then collapsing at home
- relying on perfectionism, anxiety or people-pleasing to cope
Masking can work for a long time, but it tends to be exhausting. It can also mean that doctors, teachers and family don’t see the struggle.
Other diagnoses come first
Many women are first treated for anxiety or depression, or told their difficulties are down to stress. Sometimes those conditions are present as well as ADHD. Sometimes ADHD is part of what’s driving them. There’s more on this on the page about ADHD and other conditions.
How it can show up
Every person is different, but women diagnosed as adults often describe:
- feeling overwhelmed by running a household, even when coping well at work (or the other way round)
- a sense of being “lazy” or “not trying hard enough”, despite great effort
- struggling with the mental load of family life, like appointments, forms and school admin
- intense emotions and sensitivity to criticism
- difficulties becoming more obvious after having children
- a long history of burnout
See the full list of adult ADHD symptoms.
Hormones and ADHD
Many women say their ADHD symptoms seem to change with their hormones. This is an area of growing interest, but it’s important to be clear about what is and isn’t known.
The menstrual cycle
Some women notice that focus, mood and emotional control are harder in the days before a period. Keeping a simple diary of symptoms alongside your cycle can help you and your clinician see whether there’s a pattern.
It’s also worth knowing about premenstrual syndrome (PMS). The NHS says a small number of women have more severe symptoms, known as premenstrual dysphoric disorder (PMDD). If your mood changes severely before your period, speak to your GP, as PMDD can be treated in its own right.
Pregnancy and after birth
If you take ADHD medicine and are pregnant, trying to get pregnant or breastfeeding, talk to your prescriber. The NHS medicine pages include specific information on pregnancy and breastfeeding. Don’t stop or change your medicine without advice.
Perimenopause and menopause
Some women first seek an ADHD assessment in their 40s or 50s, when difficulties seem to get worse.
The NHS lists problems with memory or concentration, “brain fog”, mood swings, low mood and sleep problems as possible symptoms of menopause and perimenopause. These overlap with ADHD, which can make things hard to untangle. It might be:
- ADHD that was always there but is now harder to manage
- menopause or perimenopause symptoms without ADHD
- both at the same time
- another cause, such as depression, poor sleep or a physical health problem
A good assessment will look at your whole history, including childhood, rather than only recent changes. It’s also worth speaking to your GP about menopause symptoms separately, as treatment for these may help.
Getting assessed as a woman
The assessment process is the same for everyone. A specialist will ask about your symptoms now and in childhood, how they affect your life, and whether anything else could explain them. See what happens in an ADHD assessment.
A few tips can help if you’ve spent years masking:
- Be honest about the effort. Explain what it takes to look like you’re coping, not just the results.
- Give examples from home as well as work. Difficulties are often clearer in private.
- Look for childhood evidence. School reports may mention being chatty, disorganised, dreamy or underachieving.
- Mention past diagnoses. Include anxiety, depression or any other conditions, and any treatments.
- Note hormone patterns. Mention any link with your cycle, pregnancy or perimenopause.
- Bring someone who knows you. A parent, sibling or partner can describe what they’ve seen.
If you’re weighing up how to get assessed, see NHS or private.
After a diagnosis
Many women describe mixed feelings after a late diagnosis. Relief and understanding are common, but so is grief for the years spent struggling without an explanation. It can help to talk this through with people you trust, a peer support group, or a therapist.
Treatment options are the same for women and men, and include medication, psychological support and practical changes. See ADHD treatment.