ADHD was thought of as a disorder that affects hyperactive boys for generations. This iconic figure of a child who refuses to stay seated and sit in class went by the name of the disruptive child who bounces off the walls and was, of course, almost always male. Women and girls weren’t in the picture, and neither were they sought by clinicians. But they are not sought after frequently enough.
Things are different today, though, with data. The CDC Morbidity and Mortality Weekly Report 2024 found that 61% of girls and women who had ADHD were not diagnosed as children, compared to 40% of boys and men. That’s millions of women who had been all of these years asking themselves why things were more difficult for them than for anyone else. Those anxious, disorganized, emotional, or not putting in enough effort women. Women who created all sorts of coping strategies just to get through demands others appeared to be able to manage.
If you are an adult woman who has had a hunch that you may have ADHD – or have been told that it is impossible that you could – then this article will be of interest.
Why ADHD in Women Looks So Different
ADHD in women is not the same as it was in the past when it was first diagnosed, because the hyperactive and disruptive inability to concentrate and seem to be missing is not the usual symptom. ADHD typically manifests in women as inattention – being more internalized, more quiet – and virtually undetectable to others.
While one boy with ADHD can stand in the middle of the class and talk to the teacher, a girl with ADHD sits at her desk, staring out the window, lost in thought. Both are disabled to the same extent. Just one is referred for assessment.
This isn’t a small mistake in clinical care. It’s a systemic problem that has left generations of women without an accurate diagnosis, with an appropriate treatment, with the basic relief of understanding why they experience the world the way they do.
ADHD Symptoms in Women: What to Actually Look For
ADHD symptoms in women are very real, disruptive and persistent but not necessarily the textbook type of hyperactive boy. These are the most common experiences of an adult woman with ADHD:
Chronic Mental Overwhelm
Often, women with ADHD experience an under-focused mind that bounces from idea to idea but never arrives at anything useful. The thoughts stack up one on top of another. There’s always more to think about, more to remember, more to worry about, and not forget. This is an internal noise, very fatiguing and often confused with anxiety – as it appears on the outside.
Extreme Disorganization Despite Effort
From the home to the inbox to the handbag to the to-do list, chronic disorganization in ADHD is omnipresent and indomitable, regardless of her best efforts to keep systems in place in her adult life. She can buy planners, apps, and organizers, and she can find a period of calm for 2 weeks, and then she gets back into the chaos. It’s not about being lazy. It is a lack of executive functioning and is treatable.
Forgetfulness That Feels Personal
Not showing up, not remembering what was said, forgetting names, losing things over and over again – the memory problems that women have with ADHD are very personal. Since no rationale comes to mind, the inference is typically moral, she is careless, she does not care, she is not trying. All of the above are false.
People-Pleasing and Perfectionism as Coping
An often overlooked symptom of ADHD in women is perfectionism and people pleasing. To over-compensate, many women with ADHD have been known to be very conscientious, working twice as hard to achieve the same outcomes, never missing a social cue, appearing organized and over-worked in public and secretly drowning in their own private world.
This style of payment eventually gets old. The most common one is a big life change – a student begins college, a student gets a lot of work, children are born, a marriage breaks up, and women begin to notice they are entering menopause. As external structures collapse or as coping demands increase, coping strategies fall, and it becomes impossible to ignore the symptoms of ADHD.
Emotional Intensity and Sensitivity
Emotional regulation is a significant symptom in ADHD: Women experience more frustration, criticism or disappointment. If women with ADHD are told that they are too sensitive, too emotional, or overreacting in general, they actually have the message that they are feeling emotions that they are unable to manage, and this is what they suffer from – ADHD.
These include rejection sensitive dysphoria (RSD) – a strong and sometimes overwhelming feeling of being rejected or criticised in a way that can affect the woman’s social and work-life.
Chronic Lateness and Time Blindness
Women with ADHD often have the real, neurological problem of time blindness, which is the inability to see how much time has elapsed or to estimate the time a task will take. This manifests itself as being late for tasks all of the time, consistently underestimating time requirements, and the inability to get things done until the last minute.
Restlessness That Stays Inside
In contrast to the physical hyperactivity seen in male ADHD presentations, women with ADHD are more likely to have internal restlessness – a buzzing, restless quality of mind that can include an inability to relax, not being able to sit still with thought-bubbles going all the time, or a need to be constantly doing something. In her outward behavior, she might seem peaceful. On the inside, she’s never not.
Why ADHD Is Missed and Misdiagnosed in Women
Underdiagnoses of ADHD in women is no coincidence. It’s the inevitable outcome of a diagnostic system that has largely been based on the study of hyperactive boys and the pathological way that women’s emotional experiences are investigated and not their neurological ones.
Diagnostic criteria have been designed for male presentations. The diagnostic criteria for ADHD were developed from studies that mainly focused on boys. Symptoms typical of women, which are quieter and internal, emotionally more focused were not well captured.
Women mask better and longer. Socialization socializes girls from an early age to deal with emotions, follow the rules, and not interfere. Girls with ADHD learn to act neurotypical – to sit still, to look like they are paying attention, to mask confusion. This masking is very expensive in terms of energy and gives rise to a very convincing surface appearance, which hides a lot of internal damage.
The symptoms land other diagnoses first. If a woman complains of problems with concentration, emotional instability, anxiety, chronic stress and exhaustion, she is much more likely to be diagnosed with generalized anxiety disorder, major depression, or even bipolar disorder than to be diagnosed with ADHD. For many women, the diagnosis of ADHD is the diagnosis that helps them understand why they have not been diagnosed with anything before.
Hormonal fluctuations make symptoms inconsistent. Estrogen has a significant interaction with dopamine – the neurotransmitter most implicated in ADHD. Estrogen is known to fluctuate throughout the menstrual cycle, during pregnancy, and in the years leading up to and after menopause, so ADHD symptoms are unpredictable during these periods of changes. One week a woman feels fine and then the next she feels like she can’t keep her head above water and her doctors say it’s the way she is feeling.
ADHD and Hormones: A Critical Connection
Perhaps one of the most significant and overlooked conditions related to ADHD in an adult female is the relationship between hormones and symptom severity. During the days just before menstruation, postpartum, and during perimenopause, when estrogen is low, ADHD symptoms can intensify significantly, as estrogen increases dopamine transmission.
For many women the week before their period is their worst week with ADHD. Others have reported that the fog following their birth never lifted or that the onset of perimenopause resulted in a sudden and bewildering drop in cognitive functioning that wasn’t attributed to ADHD.
A hormonal element comes into play, so that women with ADHD should always be assessed in the context of their menstrual cycle and hormones. A psychiatrist who specializes in treating ADHD in females will ask about these patterns, and take them into account when determining medication management.
The Emotional Cost of a Late ADHD Diagnosis in Women
Most women who are diagnosed with ADHD have been developing their private story of failure for decades. They know that they are smart. They are aware of their own capabilities. They do not know why they can’t do what others appear to do without thinking.
The shame (and the guilt) that they carry within themselves is significant. Undiagnosed ADHD is more likely to cause depression, anxiety, low self-esteem, disordered eating and relationship problems in women. They are not just additional conditions that are unrelated to ADHD – in many cases they are the sum of years of untreated neurodevelopmental problems in a world that isn’t designed for their brain’s way of functioning.
It is truly life changing to have a correct diagnosis as an adult, even late in life. For many women it’s the first time that a pattern, a feeling of personal failure is explained in a scientific way. So this is the magic of the reframe, just that one.
How an ADHD Psychiatrist Diagnoses ADHD in Women
Adult ADHD in women is a diagnosis that requires a clinician who can recognize and appreciate the subtle presentation of ADHD in women that is unlike the textbook hyperactive male presentation.
Dr. John Shershow’s practice evaluates their case the following way:
In-depth clinical interviews where current symptoms are explored across all life domains (work, relationships, home management, emotional functioning, self-esteem) and developmental history is explored in great detail to determine if there are developmental patterns present since childhood, but never previously recognized.
Validated rating scales such as CAARS and Brown ADD Rating Scales that have been sensitive to the inattentive presentation which is more prevalent among women.
Differential diagnosis that thoroughly considers the overlaps between sleep disturbances, trauma, anxiety, and depression with ADHD – and that does not rule these conditions out of the picture.
A collaborative treatment discussion that leads to a personalized treatment plan – not a scripted, cookie-cutter approach, but a more thoughtful, patient-specific approach that might involve medication management, therapeutic referrals, and psychoeducation.
Dr. Shershow provides confidential telehealth appointments for adult women throughout NYC and NJ. No waiting room, no barriers between you and a true answer and no commute.
ADHD Treatment for Women: What Actually Helps
ADHD in adult women is very treatable once it is correctly diagnosed. Effective approaches include:
Medication management – Stimulant medications remain a first-line, evidence-based treatment and as effective in women. Doses might change throughout the cycle. If stimulants aren’t tolerated or if a woman wants to use another alternative, they can use non-stimulant options.
CBT for ADHD – Cognitive behavioral therapy for ADHD focuses on the avoidance, perfectionism, emotional issues and negative thinking that build up over years of untreated ADHD symptoms.
Psychoeducation – For women who have been self-blame for decades, understanding that ADHD is a neurological disorder is a key component of treatment.
ADHD coaching – Real-life executive function coaching for managing time, organizing, and routines.
Hormonal awareness – Knowing the symptoms throughout the menstrual cycle and letting your psychiatrist know enables you to manage your medications more accurately and effectively.
Frequently Asked Questions – ADHD in Women
Q1: What are the most common ADHD symptoms in women that are different from men?
Women are more likely to be inattentive, characterized by internal restlessness, chronic disorganization, forgetfulness, inability to complete tasks, emotional sensitivity, and mental overload than they are to be physically hyperactive like men. In women, symptoms of ADHD are more internal, more likely to be misattributed to anxiety or depression, and more likely to be hidden by perfectionism/people-pleasing behavior.
Q2: Why are so many women with ADHD diagnosed late?
Late diagnosis ADHD in women is the result of several factors: diagnostic criteria were developed around a male presentation, girls are more likely to conceal difficulties, symptoms are often misdiagnosed as anxiety or depression and the hormonal fluctuations add to the ambiguity for patients and clinician. 61% of girls with ADHD are diagnosed in adulthood, confirming this trend in the 2024 CDC data.
Q3: Can you have ADHD and anxiety at the same time?
Yes – it is very prevalent. More than 51% of adults with ADHD also suffer from anxiety disorder. In women, the two conditions are highly overlapping as the chronic stress and over-activity that happens with unmanaged ADHD reliably triggers anxiety symptoms. If a doctor believes your child may be experiencing anxiety, they may want to have a psychiatric evaluation to find out if your child has ADHD or if anxiety is simply a symptom of ADHD or if anxiety and ADHD are a combination of the two.
Q4: Does ADHD get worse during perimenopause?
Yes. Estrogen is known to also have a strong influence on dopamine regulation, and as estrogen levels drop during perimenopause, many females experience a sudden increase in their symptoms of ADHD – from problems with memory, concentrating, emotional imbalances and fatigue, which can be significantly worse than years before. This is a time when women may first seek psychiatric treatment as they have tried to handle their symptoms without diagnosis or treatment.
Q5: Is telehealth ADHD diagnosis accurate for women?
Yes. Just as in children, for the majority of adults a thorough telehealth assessment by a trained ADHD psychiatrist is the same as an in-person evaluation. Dr. Shershow has made telehealth appointments for ADHD evaluations available to women in NYC and NJ, so it’s easier to get the expert psychiatric care you need without having to travel or schedule an evaluation.
Q6: I’ve been in therapy for years for anxiety and depression. Could it actually be ADHD?
It is one of the most frequent experiences of women adults seeking ADHD assessment. Anxiety and depression are very real and frequently coexist with ADHD – if these disorders have been treated for several years, without the usual sense of relief, you might want to consider the possibility that ADHD is involved. You will not be denied mental health care because of an evaluation. It provides a complete clinical picture.
Q7: What should I look for in an ADHD psychiatrist for women in NYC or NJ?
Find a psychiatrist who has a Board Certification in Psychiatry and specific experience in treating adult women with ADHD who takes a comprehensive history, has experience with the hormonal nature of ADHD in women, uses accurate diagnostic tools and provides personalised treatment and not a prescription. Dr. John Shershow’s New York and NJ practice specializes in this type of comprehensive psychiatric examination that takes into consideration the entire person and their specific issues.
You Have Always Been Capable. Now Get the Right Answer.
Dr. Shershow’s female patients who come to the practice after years of an inaccurate diagnosis are intact and not damaged. In nearly all cases, they are highly capable individuals who have been working far harder than they need to – for no particular reason, unassisted.
Correct diagnosis doesn’t make you different. It details who you always have been – and shows you how to create a life that will work with your neurology, not against it.
Dr. John C. Shershow, M.D. is accepting new telehealth patients across New York City and New Jersey.