Guest Blog: ADHD in Women
Historically, Attention-Deficit/Hyperactivity Disorder (ADHD) has been widely misunderstood as a condition that primarily affects young boys. This misconception has led to widespread underdiagnosis and misdiagnosis in women, many of whom struggle with the disorder well into adulthood without understanding the root cause of their challenges.
Unlike the hyperactive and impulsive symptoms commonly associated with ADHD in boys, women with ADHD often exhibit inattentiveness, emotional dysregulation, and difficulties with organization and executive functioning. However, these symptoms are frequently mistaken for anxiety, depression, or personality traits rather than being recognized as part of ADHD.
As a result, many women do not receive an accurate diagnosis until much later in life - if at all. This blog delves into the unique ways ADHD manifests in women, the impact of late diagnosis, and strategies for managing the condition effectively.
Why ADHD in Women Is Often Overlooked
a) Gender Bias in Diagnosis
For decades, ADHD research focused almost exclusively on young boys, shaping diagnostic criteria that reflect their symptoms. Boys with ADHD tend to display externalized behaviors such as hyperactivity, impulsivity, and disruptive classroom behavior. These symptoms are more visible, leading to earlier and more frequent diagnoses.
In contrast, women and girls often exhibit internalized symptoms such as:
● Daydreaming and forgetfulness
● Struggling with focus and sustained attention
● Chronic disorganization
● Procrastination
● Emotional dysregulation
Since these symptoms do not conform to the traditional ADHD profile, women are often dismissed as being daydreamers, lazy, irresponsible, or anxious rather than recognizing the possibility of an ADHD symptom presentation.
b) Masking and Social Conditioning
From an early age, girls are socially conditioned to be well-behaved, polite, and organized. Many learn to mask their struggles by developing compensatory coping mechanisms, such as:
● Over-preparing and overcompensating to avoid being perceived as forgetful.
● Mimicking peers to blend in socially.
● Relying on structure and routines to manage challenges.
While masking helps women navigate daily life, it can come at a cost - chronic exhaustion, self-doubt, and eventual burnout. Feeling different without knowing why, can create feelings of shame, isolation and fatigue.
The Unique Challenges Women Face With ADHD
Women with ADHD often face a ripple effect of challenges across various aspects of their lives, from school and career to relationships and mental health.
a) Academic and Career Struggles
Many women with ADHD work twice as hard as their peers to meet deadlines, stay organized, and manage their responsibilities. Yet, they often:
● Miss deadlines due to difficulty with time management.
● Struggle with procrastination and perfectionism, leading to last-minute stress.
● Experience job instability because they feel overwhelmed by workplace demands.
Despite their intelligence and abilities, they may feel like impostors, constantly afraid of being "found out" as someone who cannot keep up. Core beliefs of being less-than can take deep root and negatively impact self-esteem.
b) Relationships and Social Interactions
ADHD can impact friendships, family dynamics, and romantic relationships in several ways:
● Forgetfulness: Missing birthdays, important dates, or commitments.
● Emotional dysregulation: Intense emotional responses and difficulty managing frustration.
● Impulsivity: Speaking out of turn and blurting out thoughts without filtering, leading to misunderstandings.
Women with ADHD may struggle to maintain friendships or long-term relationships because they often feel misunderstood or "too much" for others to handle.
c) The Link Between ADHD and Mental Health Difficulties
Since ADHD symptoms overlap with anxiety and depression, many women are misdiagnosed and given antidepressants or anti-anxiety medication instead of appropriate ADHD treatment.
Common co-occurring conditions include:
● Generalized Anxiety Disorder (GAD)
● Depression and mood disorders
● Eating disorders, such as binge eating or restrictive eating patterns
● Substance use disorders
Without proper treatment, these women may struggle with low self-esteem, guilt, and frustration, wondering why they can’t function as easily as those around them.
How Hormones Affect ADHD in Women
One major factor that differentiates ADHD in women from ADHD in men is the role of hormones. Estrogen is a key regulator of dopamine, the neurotransmitter that ADHD medication targets to improve focus and impulse control. As estrogen levels fluctuate, so do ADHD symptoms.
Hormonal Phases That Impact ADHD Symptoms
● Puberty: Estrogen fluctuations can make ADHD symptoms more pronounced.
● Menstrual cycle: Many women experience worsened ADHD symptoms in the days leading up to their period due to lower estrogen levels.
● Pregnancy: Some women report a temporary improvement in symptoms during pregnancy due to high estrogen levels, while others experience extreme executive dysfunction.
● Menopause: The decline in estrogen can worsen ADHD symptoms, leading to increased forgetfulness, brain fog, and emotional instability.
Despite these hormonal influences, ADHD treatment is rarely adjusted for women, leaving many to struggle with inconsistent medication effectiveness.
Advocating for an ADHD Diagnosis: A Guide for Women
For many women, getting an ADHD diagnosis is a long and frustrating process. They may:
● Seek help for anxiety or depression and have ADHD overlooked.
● Be told they "can’t have ADHD" because they did well in school.
● Struggle to find healthcare professionals who understand how ADHD manifests in women.
Many only realize they have ADHD after a child or friend is diagnosed, prompting them to recognize their own symptoms.
If you suspect you have ADHD, here’s how to advocate for a diagnosis:
Educate Yourself – Learn about ADHD in women and how it differs from traditional male presentations.
Keep a Symptom Journal – Track your struggles with focus, organization, and emotional regulation.
Find a Mental Health Professional trained in ADHD Assessment – Work with a Psychologist or Psychiatrist to assess for an accurate diagnosis.
Challenge Misdiagnoses – If you’ve been diagnosed with anxiety or depression but feel like something is missing, push for a second opinion.
Coping Strategies for ADHD in Women
Managing ADHD as a woman often requires a multifaceted approach, combining therapeutic techniques, mindfulness practices, and medication. These strategies aim to address symptoms like inattention, impulsivity, and emotional dysregulation while providing women with tools to thrive in their personal and professional lives. Below are some key approaches to coping with ADHD:
1. Cognitive Behavioral Therapy (CBT)
CBT is a highly effective therapeutic approach for women with ADHD, offering both emotional and practical tools for managing symptoms. CBT is best practiced with a therapist. Here’s some information on what CBT practices look like:
● Addressing Negative Thought Patterns:
Many women with ADHD struggle with feelings of inadequacy or self-criticism, often due to societal expectations or years of undiagnosed challenges. CBT helps women recognize these negative thought patterns and replace them with healthier, more constructive beliefs. For example, instead of thinking, "I'm lazy because I can't stay organized," CBT reframes this as, "I can develop systems that work for me."
● Practical Problem-Solving:
CBT focuses on building tangible skills to handle common ADHD challenges. Women learn how to break down overwhelming tasks into smaller, manageable steps, create routines that reduce decision fatigue, and use tools to stay organized. These strategies help minimize procrastination and create a sense of accomplishment.
● Emotional Regulation:
Women with ADHD may experience intense emotions, such as frustration, guilt, or overwhelm, which can interfere with daily life. CBT teaches techniques for recognizing and managing these emotions. This emotional regulation can lead to improved relationships and greater overall well-being.
2. Mindfulness Practices
Mindfulness is another powerful tool for managing ADHD.
● Improving Attention and Focus:
Women with ADHD often feel pulled in many directions, making it hard to concentrate. Mindfulness practices like meditation, grounding and breathing exercises encourage women to focus on the present moment. Over time, this helps build mental "muscle" for staying attentive and resisting distractions.
● Reducing Impulsivity:
Mindfulness creates a pause between thought and action, allowing people to respond thoughtfully instead of impulsively. This leads to better outcomes in both personal and professional situations.
● Building Self-Compassion:
ADHD symptoms can lead to feelings of inadequacy or shame. Mindfulness fosters self-compassion by teaching people to approach their challenges without judgment. This mindset shift helps them embrace ADHD symptoms as part of who they are while focusing on their strengths and capabilities.
3. Medication
Medication can form a foundational part of ADHD management, providing chemical support to address symptoms of inattention, hyperactivity, and impulsivity.
● Stimulant Medications:
Stimulants, such as those containing methylphenidate or amphetamines, are commonly prescribed for ADHD. They work by increasing the availability of neurotransmitters in the brain, improving focus, attention, and self-control.
● Non-Stimulant Medications:
For women who may not respond well to stimulants or prefer alternatives, non-stimulant medications offer another option. These medications target different pathways in the brain but can still help with symptom management, especially for those with coexisting conditions like anxiety.
● Complementing Other Strategies:
While medication can reduce ADHD symptoms, it works best when combined with therapy and lifestyle changes. Medication can provide foundational stability to fully engage in practices like CBT and mindfulness, enhancing their overall effectiveness.
Final Thoughts
For many women, receiving an ADHD diagnosis in adulthood is a transformative experience - it provides clarity, validation, and access to treatment that can significantly improve self-esteem, relationships, and overall well-being. A combination of strategies such as medication, therapy, and lifestyle adjustments can help women manage ADHD effectively. Many women find relief once they receive the right diagnosis and treatment, finally understanding that their struggles were never due to a lack of effort or intelligence.
References
https://my.clevelandclinic.org/health/diseases/24741-adhd-in-women
https://www.additudemag.com/adhd-in-women-misunderstood-symptoms-treatment/
https://www.webmd.com/add-adhd/adhd-in-women
https://add.org/adhd-in-women/
About the Guest Author: Dr. Amber Cohen is a registered Clinical Psychologist and owner of The Cohen Clinic. The Cohen Clinic is a holistic wellness therapy practice focusing on the mind-body connection. The clinic offers virtual ADHD Assessments to adults 18 years and older within Ontario. https://thecohenclinic.com/