ADHD in Women

We Demand Attention on Sex Differences in ADHD

How and why do ADHD symptoms manifest differently and more intensely in women vs. men? Do ADHD symptoms differ so significantly by sex that men and women require their own distinct diagnostic criteria? How can we better recognize all symptoms of ADHD in girls and young women to prevent misdiagnosis and inadequate treatment?

By Anni Layne Rodgers, ADDitude Editors Verified Updated on May 9, 2024
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An image of a quote from Dr. Kathleen Nadeau that reads: "There is such a gap between DSM symptoms and daily life challenges for women with ADHD."

What We Know

Research tells us that women experience distinct and distinctly impairing symptoms of ADHD, which they are more likely to mask and hide due to shame.

Though clinical and research bias has historically overemphasized young male presentations of ADHD, Patricia O. Quinn, M.D., and Manisha Madhoo, M.D., emphasize in a 2014 review that, “several characteristics are unique to the expression of ADHD in women and girls.”1 A review of 41 articles and studies led Quinn and Madhoo to conclude that women are more likely than men to have inattentive ADHD and…

  • to experience internalizing symptoms
  • to suffer coexisting anxiety and affective disorders
  • to develop eating disorders and engage in self-harm
  • to develop coping strategies that mask symptoms
  • and to report low self-esteem and relationship problems.

These findings were echoed in a 2021 report by Stephen Hinshaw, Ph.D., director of the Berkeley Girls and ADHD Longitudinal Study (BGALS) — the only longitudinal study on females with ADHD conducted to date.2 That report concluded that “Females with ADHD experience, on average, serious impairments, with a particularly heightened risk for problems in close relationships and engagement in self-harm.” He notes that clinicians may overlook symptoms and impairments in females because of less overt — but nonetheless impairing — symptom manifestations that girls and women frequently mask.


Several experts posit that gender norms and expectations may explain why girls and women with ADHD mask their symptoms. “There’s no room for ADHD when society expects girls and women to be perfect — nurturing, competitive, and sexualized — a pernicious triple bind accentuated during adolescence,” reads an ADDitude article co-authored by Hinshaw.

What We Don’t Know

We don’t definitively know all the distinct ways ADHD manifests in women or how to better recognize female-specific symptoms and impairments across the lifespan.

The BGALS study of 140 girls, beginning around age 9, demonstrates how ADHD manifestations and outcomes change during childhood, adolescence, and early adulthood. However, we’re lacking any longitudinal studies that show how symptoms and challenges manifest and change across a woman’s lifetime. We have no definitive comparison of symptoms in women vs. men from childhood through adulthood. We suspect that symptom severity and distress are higher in women than in men, but we don’t know this with certainty because we lack severity rating scales based on gender. (Current diagnostic tools also favor male presentations of ADHD.) We also don’t know when, exactly, women face the greatest risk for adverse health outcomes due to undiagnosed or untreated ADHD.

“There is such a gap between DSM ‘symptoms’ and ‘daily life challenges’ for women,” says Kathleen Nadeau, Ph.D., co-author of Understanding Girls with ADHD among other books. “I support conducting a large-scale survey of high school girls, female college students, and adult women identified with ADHD to tell us what their areas of biggest struggle are so that, at the very least, we can have the next DSM list accompanying features for females.”

DSM stands for Diagnostic and Statistical Manual of Mental Disorders, a guidebook used by health care professionals to diagnose ADHD, among other mental health conditions.

The accurate diagnosis of ADHD in girls and women hinges on researchers’ ability to establish a history of ADHD symptoms and behaviors commonly seen in females — inattention, emotional reactivity, decreased self-esteem, academic difficulties, and risky behavior. Quinn and Madhoo urge clinicians to identify behaviors suggestive of comorbid anxiety and depression, and to consider not just functioning but distress at home, with peers, in school, and in the workplace.

Why It Matters

A better understanding of sex differences in ADHD — a condition linked to devastating health outcomes when untreated — will improve diagnostic and treatment outcomes for women.

With greater understanding of female symptom profiles and relative symptom severity, we may do the following:

  • determine if the female symptom profile is unique enough to merit a distinct set of ADHD diagnostic criteria
  • understand whether the current DSM criteria should be adjusted to allow for an ADHD diagnosis with fewer or different symptoms
  • decrease the likelihood of misdiagnosis with internalizing disorders or personality disorders, which often delay proper diagnosis and appropriate treatment
  • know why and when ADHD symptoms cause the most impairment to women, and how to adjust treatments and supports to improve health outcomes and quality of life.

“What are the transition points — psychologically, family or school-related, community-wide — that predict impairment vs. resilience for girls with ADHD as they transition through adolescence to adulthood?” asks Hinshaw, architect of the pivotal BGALS study, in response to ADDitude’s call for research priorities.

What ADDitude Readers Tell Us

ADDitude survey results suggests a chasm between ADHD symptoms in men vs. women that grows with age.

In a 2023 survey of adults with ADHD, 78% of women and 75% of men said their ADHD symptoms manifested as procrastination and time-management problems in puberty. While 61% of men cited academic performance issues in puberty, only 49% of women said the same. Women were more likely to recall feelings of sadness or depression, feelings of overwhelm, and rejection sensitive dysphoria as their hallmark symptoms of ADHD in adolescence.

The chasm between ADHD symptoms in men vs. women grew with age, according to the ADDitude survey. In their 40s and 50s…

  • 83% of women with ADHD reported debilitating feelings of overwhelm, but only 59% of men said the same.
  • working memory problems impacted 80% of women but only 65% of men.
  • heightened emotional dysregulation, including anger or hostile behavior, impacted 59% of women but only 44% of men.

The disparities in symptom prevalence and severity between the sexes certainly seem worthy of further investigation.

“The most valuable research, in my opinion, would identify the different presentation of ADHD compared to the typical stereotype,” says an ADDitude reader with ADHD, anxiety, and a learning difference. “Most women are diagnosed too late because biased medical research is geared toward men. Identifying ADHD earlier in women would make the biggest difference. Second, I would like to see research into how women with ADHD receive more negative feedback regarding the exact same symptoms that men exhibit, and how that affects us. For example, if a man with ADHD talks too much or has excessive energy, he’s just an energetic guy, but if a woman acts exactly the same she is domineering and is self-centered.”

What ADHD Experts Say

“The greatest disparities in research on ADHD in women vs. men that I see raise the following questions,” says Maggie Sibley, Ph.D., Associate Professor of Psychiatry & Behavioral Sciences at the University of Washington School of Medicine and a researcher and psychologist at Seattle Children’s Hospital.

  • “What role do hormones play in the expression of ADHD in biological females across the lifespan and across the menstrual cycle?”
  • “What are the core symptoms of ADHD in girls and women across the lifespan (in terms of both sensitivity and specificity)?”
  • “What is the typical trajectory of onset for ADHD in girls and women?”
  • “What are the key points of intervention for women with ADHD (in terms of times of their life and domains of impairment)?”

Next Steps

Consider joining a research study on women with ADHD.

ADHD in Women: Related Reading

We Demand Attention: A Call for Greater Research on ADHD in Women

Intro: Top 10 Research Priorities

  1. Sex Difference in ADHD
  2. The Health Consequences of Delayed ADHD Diagnoses on Women
  3. How Hormonal Changes Impact ADHD Symptoms in Women
  4. How Perimenopause and Menopause Impact ADHD Symptoms, and Vice Versa
  5. The Elevated Risk for PMDD and PPD Among Women with ADHD
  6. The Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing
  7. How ADHD Medication Adjustments During the Monthly Menstrual Cycle Could Improve Outcomes for Women
  8. The Long-Term and Short-Term Implications of Hormonal Birth Control and Hormone-Replacement Therapy Use Among Women with ADHD
  9. How and Why Comorbid Conditions Like Anxiety, Depression, and Eating Disorders Uniquely Impact Women with ADHD
  10. Early Indicators of Self-Harm, Partner Violence, and Substance Abuse Among Girls and Women with ADHD

View Article Sources

1 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), PCC.13r01596. https://doi.org/10.4088/PCC.13r01596

2 Hinshaw, S. P., Nguyen, P. T., O’Grady, S. M., & Rosenthal, E. A. (2022). Annual Research Review: Attention-deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions. Journal of child psychology and psychiatry, and allied disciplines, 63(4), 484–496. https://doi.org/10.1111/jcpp.13480

Fraticelli, S., Caratelli, G., De Berardis, D., Ducci, G., Pettorruso, M., Martinotti, G., Di Cesare, G., & di Giannantonio, M. (2022). Gender differences in attention deficit hyperactivity disorder: an update of the current evidence. Rivista di psichiatria, 57(4), 159–164. https://doi.org/10.1708/3855.38380