Attention Deficit Hyperactivity Disorder, more commonly known as ADHD, is historically known as a neurodevelopmental disorder that interferes with daily function and development through inattention, hyperactivity, and impulsivity. However, this definition is largely based on how ADHD has been studied and recognized in men rather than in women. Today, in schools, homes, and medical settings, researchers and clinicians are paying closer attention to how ADHD presents differently in women and girls because so many have gone undiagnosed for years. Women often experience ADHD symptoms that are more masked, internalized, and frequently misdiagnosed (Littman & Wagenberg, 2023; Platania et al., 2025; Stibbe et al., 2020). Especially when undiagnosed, ADHD can cause several disruptive and antisocial behaviors over the lifespan of patients, ranging from substance abuse and work absenteeism to criminality, further contributing to the socioeconomic burden of the disease (Stibbe et al., 2020). Misdiagnosis can change the trajectory of one’s life, and it changed mine.
I grew up in an immigrant home where struggling academically was not a choice. As an adolescent, I often did badly when I was left to complete tasks without my mother’s supervision. My mother would get upset, indicating that I needed to “grow up.” Fast forward to high school: I got diagnosed with anxiety and depression because of experiences that I had been going through, even though I still became my class’s salutatorian. Therapy was not resolving my overbearing amount of anxiety and depression. I would always ponder when I would stop feeling so awful. I got to college, where life became centered around self-accountability and doing well, and I genuinely could not function because I could not concentrate on anything. This past year, I got diagnosed with ADHD after years of appearing high-functioning, meaning I would work under high stress while my mental health suffered as a result. It all finally made sense to me.
I went undetected for 20 years of my life as a woman due to the stigma and diagnostic gap between how ADHD presents in men and in women. I struggled so much as a woman being held up to high expectations while not understanding why my brain would not function the way I wanted it to. You must be wondering, how could this even happen? One major reason is that, in classrooms, clinics, and even at home, ADHD in women often does not look like the version people expect. Mental health conditions can be misdiagnosed quite frequently, even though they are often the main expressive behaviors in women’s ADHD symptoms. Men are more likely to experience externalizing disorders, such as substance or alcohol abuse, antisocial personality disorder, and conduct disorder, while internalizing disorders, such as anxiety, depression, somatic symptoms, and bulimia, are more common in women (Littman & Wagenberg, 2023; Martin et al., 2018; Platania et al., 2025).
Symptom masking has become quite common among women with ADHD (Marschall, 2026; Platania et al., 2025). Women, including myself, often have a greater tendency to internalize their struggles, as we are often told that it is our “hormones” or something that can be left to be resolved by ourselves. Since men exhibit more defining features of ADHD that have been researched based on adolescent and male populations, they are more likely to get symptom relief through medication at a younger age than women (Littman & Wagenberg, 2023; Platania et al., 2025).
As mentioned earlier, hormones play a completely different role in gender symptom manifestations, yet this is often overlooked. Across different stages of life and in healthcare settings, this can make women’s ADHD even harder to recognize. A premenstrual girl with ADHD presenting to a clinician as insecure, anxious, and despondent can appear confident, effective, and hopeful a week later, after menstruation commences (Littman & Wagenberg, 2023; Quinn & Madhoo, 2014). Several women around me who have been diagnosed with ADHD have discussed the major highs and lows they have and how they feel like they are “going insane.” However, often they get directed to the idea of having PMDD or other menstrual-hormone associated disorders compared to ADHD. Women with ADHD exhibit high rates of premenstrual syndrome, premenstrual dysphoric disorder, severe postpartum depression, and climacteric symptoms when compared with their neurotypical peers (Quinn & Madhoo, 2014).
Today, researchers believe there is a need to develop a new edition of the DIVA-5 designed to better capture ADHD manifestations in women and girls, and examining gender differences in populations with and without ADHD could deepen our understanding of how ADHD manifests across genders (Platania et al., 2025). If clinicians had been better equipped to recognize these signs earlier, I may have understood myself sooner and spent less of my life believing I simply was not enough as an individual. Closing the symptom gap for women with ADHD is not just about improving diagnosis; it is about ensuring that more girls and women are understood, supported, and treated before being detrimentally impacted long-term.
References:
Davies, W. (2014). Sex differences in attention deficit hyperactivity disorder: Candidate genetic and endocrine mechanisms. Frontiers in Neuroendocrinology, 35(3), 331–346. https://doi.org/10.1016/j.yfrne.2014.03.003
Littman, E. B., & Wagenberg, B. (2023, July 26). Gender differences in ADHD and their clinical implications. Psychiatric Times, 40(7). https://www.psychiatrictimes.com/view/gender-differences-in-adhd-and-their-clinical-implications
Marschall, A. (2026, March 31). ADHD masking harms neurodivergent women at work. ADDitude. https://www.additudemag.com/neurodivergent-women-in-workplace-adhd-masking/
Martin, J., Walters, R. K., Demontis, D., Mattheisen, M., Lee, S. H., Robinson, E., Als, T. D., Brikell, I., Ghirardi, L., Larsson, H., Sullivan, P. F., Thapar, A., Neale, B. M., & Andreassen, O. A. (2018). Sex-specific manifestation of genetic risk for attention deficit hyperactivity disorder in the general population. Journal of Child Psychology and Psychiatry, 59(8), 908–916. https://doi.org/10.1111/jcpp.12874
Platania, N. M., Starreveld, D. E. J., Wynchank, D., Beekman, A. T. F., & Kooij, J. J. S. (2025). Bias by gender: Exploring gender-based differences in the endorsement of ADHD symptoms and impairment among adult patients. Frontiers in Global Women’s Health, 6, Article 1549028. https://doi.org/10.3389/fgwh.2025.1549028
Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: Uncovering this hidden diagnosis. The Primary Care Companion for CNS Disorders, 16(3), Article PCC.13r01596. https://doi.org/10.4088/PCC.13r01596
Ramtekkar, U. P., Reiersen, A. M., Todorov, A. A., & Todd, R. D. (2010). Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: Implications for DSM-V and ICD-11. Journal of the American Academy of Child & Adolescent Psychiatry, 49(3), 217–228.e3. https://doi.org/10.1016/j.jaac.2009.11.011
Stibbe, T., Huang, J., Paucke, M., Ulke, C., & Strauss, M. (2020). Gender differences in adult ADHD: Cognitive function assessed by the test of attentional performance. PLOS ONE, 15(10), e0240810. https://doi.org/10.1371/journal.pone.0240810
