Understanding the Gender Gap: Why ADHD in Women Often Goes Undiagnosed

ADHD is a neurodevelopmental disorder that affects both children and adults, male and female, impacting their ability to focus, control impulses, and regulate hyperactivity. There have been many stereotypes built up over the years, particularly around inattentiveness, a big factor in why ADHD in women is still so misunderstood. 

There have been great improvements in ADHD awareness in recent years, but improvements still need to be made on how the biology, neurology, and gender constructs impact ADHD in women. Let’s take a more in-depth look into how and why women have been and still are both undiagnosed and misdiagnosed today. 

Historical Perspectives of ADHD 

ADHD used to be thought of as a childhood, male condition, with the main symptoms being hyperactivity and impulsivity, the naughty boy at the back of the class that can’t keep still or be quiet is the image we were brought up with. Even though this stereotype has been dispelled, there are many outdated stereotypes that persist, hampering the study, detection, and treatment of ADHD in women. 

Men and boys seem to display the more noticeable symptoms of ADHD, hyperactivity, and impulsivity and these were the ones that were often referred to clinics, which in turn, helped shape the diagnostic criteria and ADHD assessment scales to which all patients are measured, and which are still in use today. Due to these criteria, it was almost impossible to diagnose women and girls with ADHD and remains a problem when it comes to ADHD assessment and diagnosis. 

Symptoms of ADHD in Women and How They Differ to Men

Inattentiveness is the primary symptom in women, but it’s not the only symptom they can possess, and recent research suggests a strong correlation with comorbidities, hormones and other mental and physical conditions that can skew a woman's ADHD assessment and lead to misdiagnosis. Some symptoms women with ADHD may display: 

• Difficulty holding attention to tasks. 

• Easily distracted. 

• Forgetfulness in daily activities. 

• Difficulty organising tasks and activities. 

• Making careless mistakes in activities and difficulty paying attention to detail. · Failing to finish tasks and not following through on instructions. 

• Internalising symptoms such as mood and anxiety. 

As you can tell, the list above contains symptoms that wouldn’t automatically suggest a woman is suffering, compared to the hyperactive and impulsive symptoms a man displays. Again, there is no one size fits all when it comes to ADHD, both men and women can display all 3 symptoms of ADHD, the criteria to which they are measured however, is out of date.

Complications Women Can Face in Obtaining an ADHD Assessment

Instead of fidgeting and running around, girls might daydream, stare into space, or engage in quiet activities as a way to help manage their internal restlessness. This fundamental difference in presentation contributes to the misconception that ADHD primarily affects males. There are many complications that can muddy the waters when it comes to diagnosing women and girls with ADHD. 

Masking, Societal Expectations and Gender Bias. 

Women with ADHD may develop coping mechanisms that enable them to mask their symptoms more effectively. They might work tirelessly to appear organised and attentive, camouflaging their inner struggles. Consequently, their achievements can sometimes overshadow their challenges, making it easy for healthcare professionals, educators, and even family members to overlook the possibility of ADHD. 

Societal expectations and gender bias play a significant role in the underdiagnosis of ADHD in women. Historically, ADHD has been stereotyped as a disorder predominantly affecting hyperactive boys. As a result, clinicians and educators often have a biased perspective, causing them to miss the signs of ADHD in girls and women. 

Society’s long list of expectations for women such as managing the home, the family and themselves, does not bode well for a woman that is struggling with their executive function. However, to seek social acceptance, women would mask their symptoms and engage in a spiral of shame and self-blame. It is difficult for clinicians to understand the extent to which women measure their self-worth and self-esteem according to their success in conforming to gender expectations. 

Girls are often socialised to be more focused on social interactions, communication, and appearance. As a result, symptoms like daydreaming, forgetfulness, or chattiness may be dismissed as typical “feminine” behaviour. Similarly, the impulsivity that characterises ADHD might be attributed to girls' emotional sensitivity rather than an underlying neurological condition. 

The difficulty with Comorbid Conditions and Women with ADHD. 

Another reason ADHD in women goes undiagnosed is the potential for misdiagnosis. ADHD symptoms can overlap with those of other mental health conditions, such as anxiety, depression, and even eating disorders. These coexisting conditions can obscure the core ADHD symptoms, leading to a focus on treating the secondary issues rather than addressing the underlying ADHD. 

ADHD Assessment and Hormonal Challenges

Oestrogen levels in women fluctuate both across the month and lifespan. Oestrogen protects the brain by enhancing neurotransmitter activity, which can impact executive functioning, attention, motivation, verbal memory, sleep, and concentration. Oestrogen levels drop after ovulation, in the middle of the menstrual cycle, and even further near the start of menstruation. This combination of low oestrogen combined with high progesterone exacerbates ADHD symptoms. Another time of life oestrogen drops is around menopause, which can impact mood regulation, attention, and impulse control. 

Around the time of puberty, oestrogen kicks in, which can mean that girls often express anxiety and emotional volatility, which could lead to misdiagnosis of anxiety or a mood disorder and lead to improper treatment. 

Treatment Considerations and Raising Awareness

Raising awareness about the unique ways ADHD manifests in women is crucial to improving diagnosis rates. Education for healthcare professionals, educators, parents, and the broader society can help dispel misconceptions and biases, leading to more accurate identification and intervention. 

Treatment for ADHD can be through therapy, medication, and lifestyle changes and accommodations. Women who suspect they have ADHD should seek help from mental health professionals who are knowledgeable about ADHD in women and girls. It's important for individuals to advocate for themselves, and speaking with a knowledgeable therapist who can help validate your experience and question the societal expectations on your outlook can help you enormously. 

It is also important to ensure your doctor understands the impact of hormones and ADHD and their interplay with medication. Hormone replacement therapy (HRT) can greatly improve symptoms in premenopausal women by increasing available oestrogen and progesterone levels. Stimulants may be less effective in the second half of the menstrual cycle and SSRIs which are commonly diagnosed for mood disorders and anxiety, can impact the effectiveness of the ADHD medication. 

Focusing in on You: A Private ADHD Clinic in Manchester

At Beyond, we are a private ADHD clinic in Warrington, founded by a team of people who have ADHD in response to the challenge of achieving an ADHD assessment and diagnosis from the NHS and within the private sector, we’re empowered to provide an accessible and genuinely supportive experience. 

We are an ADHD clinic here to help women, girls, families, and men and boys, navigate the ADHD assessment, diagnosis, and treatment journey together. If you would like to speak to one of Beyond’s friendly and personal team about obtaining an ADHD assessment for you or your child, you can get in touch here.