The Hidden Challenge of ADHD in Girls and Women
For decades, ADHD has been understood and diagnosed primarily through a male-centric lens. This systemic bias has led to a crisis of underdiagnosis, missed and misdiagnoses among girls and women, leaving many without the support they need. Despite the potential of experiencing greater longer-term levels of impairment than males, females with ADHD are often overlooked, leading to profound lifelong consequences.
Clinicians play a pivotal role in closing this gap. By recognising the unique presentations of ADHD in females and adapting assessment practices accordingly, we can ensure timely and accurate diagnoses, ultimately improving patient outcomes.
Why Are Women So Often Missed?
Studies suggest that 50-75% of women with ADHD remain undiagnosed. The reasons for this are multifaceted:
- Internalised Traits – ADHD often presents differently in females, making it harder to detect. While males typically externalise their ADHD traits, females typically internalise theirs with inattentiveness being more prominent than hyperactivity/impulsivity.
- Referral and Diagnostic Bias – The external nature of ADHD traits in males makes them more likely to be flagged early for assessment, with fewer referrals for girls due to their less obvious traits. The male-centric diagnostic assessment criteria also fail to account for these differences, contributing to systemic under-recognition of ADHD in women and girls.
- Compensation and Masking – Females with ADHD often develop coping mechanisms like perfectionism and social mimicry, masking their struggles, leading to underestimation of their challenges and delayed support.
- Missed and Misdiagnosis – Females with ADHD are often diagnosed with anxiety, depression, or other mental health conditions due to overlapping traits that obscure their ADHD.
- Sociocultural Factors – Females behaviours such as daydreaming, emotional sensitivity, excessive talkativeness or giggling are often dismissed as personality quirks serving to misattribute or minimise ADHD traits.
- Stigma - ADHD is stigmatised due to its complex, poorly understood nature, with ADHD females facing even greater stigma, deterring them from seeking assessment.
ADHD in Women Across the Lifespan
ADHD presents differently in females throughout different stages of life. Understanding these variations is crucial for accurate diagnosis and effective treatment.
- Childhood: While boys with ADHD typically externalise their traits, girls predominantly internalise theirs, making them subtler and therefore more easily overlooked.
- Adolescence: Puberty and cyclical hormonal fluctuations play a critical role in influencing ADHD traits in females. While males with ADHD often enter adolescence with already elevated traits, females typically experience an escalation of traits during this period, leading to greater levels of impairment.
- Adulthood: ADHD continues to present differently in males and females throughout adulthood. Males with ADHD are more likely to experience challenges in spatial memory and complex attention. In contrast, females often report greater challenges with arousal regulation and processing speed.
- Pregnancy: For pregnant women with ADHD, inattentive traits predict significant impairment in professional life, daily functioning, and relationships, while impulsivity specifically influences professional and relationship challenges.
- Parenthood: Female ADHD parents report more severe ADHD traits than male ADHD parents, suggesting a greater cumulative burden of executive dysfunction, emotional dysregulation, and societal expectations.
- Perimenopause and Menopause: The hormonal fluctuations during perimenopause and menopause can further influence ADHD traits in females, often leading to severe climacteric mood challenges and cognitive decline.
A Clinical Approach: Identifying ADHD in Women
Recognising ADHD in women requires integrating female-sensitivity into ADHD diagnostic assessments that considers internalised traits, masking behaviours, and hormonal influences. We have developed a checklist to support clinicians which includes:
✔ Prioritising Trauma-Informed Care
✔ Avoiding Male-Centric Bias
✔ Recognising Female-Specific ADHD traits
✔ Evaluating ADHD Across The Female Lifespan
✔ Considering Differential Diagnoses and Comorbidities
✔ Fostering a Supportive and Empowering Process
The full checklist is available for download [here].
Download the White Paper
For a deeper dive into the crisis of underdiagnosis, ADHD across the female lifespan and the impact of late diagnosis, access our full white paper [here].
How ThinkDivergent Supports Clinicians
ThinkDivergent is committed to promoting equity in neurodevelopmental care by offering a streamlined, inclusive assessment platform that empowers patients and clinicians. Unlike traditional tools, our platform integrates:
🔹 A neuro-inclusive app replacing outdated, neurodivergent-unfriendly forms
🔹 A structured workflow guiding clinicians through critical decisions
🔹 Automated, personalised, strengths-based reports
🔹 Built-in governance ensuring safe, accountable care
This holistic approach boosts productivity, minimises administrative burden, and enhances clinical efficiency, while reducing diagnostic bias and supporting evidence-based decisions for clinicians.
By enabling neuro-affirmative care, ThinkDivergent also helps clinicians deliver high-quality, patient-centered support, including female-sensitive assessments that recognise unique ADHD traits in women.
Want to learn more about how ThinkDivergent can support your practice? Get in touch today to find out how our technology can help:
- Improve assessment quality and patient outcomes.
- Improve patient and clinician experience.
- Save hours per patient by generating comprehensive and personalised reports.
