Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often presents during childhood. People with the disorder might find it difficult to focus on tasks, objectives, and activities and control impulsive behaviors.

Folks often receive a diagnosis of ADHD during childhood, but its effects can continue throughout adult life. ADHD is diagnosed more often in boys, but many girls and women are underdiagnosed.

Do boys get diagnosed with ADHD more than girls?

In an era of growing awareness about wage gaps and social inequities, researchers are devoting more energy to health disparities like this one. Boys still receive ADHD diagnoses much more often than girls, according to the Centers for Disease Control and Prevention (CDC) — 12.9 percent compared with 5.6 percent.

Is it just that boys have ADHD more often than girls do? Or does the culture around research, diagnosis, and treatment of the disorder heavily skew toward boys? Researchers are realizing it’s more complex than that.

Many girls with undiagnosed ADHD grow up hearing themselves mislabeled as “spacey,” “way too talkative,” and “disorganized.”

As teenagers, they may fall behind academically, even though their frustrated parents and teachers know these young women are intelligent and capable. And in adulthood, many still have trouble with increased responsibilities and different roles.

The difference in diagnosis rates and resulting access to treatment can have a considerable impact on women with ADHD. It affects the ways they navigate their lives, develop their self-esteem, and build relationships.

The reasons boys with ADHD are more likely to receive a diagnosis than girls are varied and complex. Here are just a few of the main factors:

  • Until recently, most studies have focused on boys, so more is known about how boys experience ADHD and how the disorder shapes their lives.
  • ADHD presents differently in different people. Sex and hormones may influence which symptoms are dominant.
  • Sex norms may force girls to mask and hide symptoms of ADHD. Stereotypes around neatness, organization, cooperation, compliance, and social behaviors may encourage girls and women to deny or compensate for ADHD symptoms in classrooms and family structures.
  • A 2019 study found that sex differences in symptoms may also keep teachers from recognizing symptoms of ADHD in girls. Because symptoms can be more subtle in girls, healthcare practitioners may be less likely to diagnose girls with ADHD unless they also show symptoms of emotional disorders.
  • According to a 2014 research review, medical professionals may be more likely to treat anxiety and depression in girls without recognizing coexisting ADHD.

To receive an ADHD diagnosis, an individual must have at least six of nine major symptoms listed in the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)” for a specific type of ADHD.

These symptoms must be present and disruptive to everyday life for at least 6 months and in more than just one setting — at home and at school, for example.

ADHD is a mental health condition that affects the ability to do some or all of these tasks:

  • paying attention, focusing, or concentrating for prolonged periods
  • noticing some details
  • breaking activities and goals into steps or stages
  • staying organized
  • managing schedules
  • remembering things
  • sitting still
  • managing impulses

Types

People with ADHD typically have symptoms that fall into one of three categories.

Inattentive

The following are signs of inattentive ADHD:

  • difficulty concentrating
  • being easily distracted
  • regularly making careless mistakes
  • often losing necessary items

Hyperactive-impulsive

Hyperactivity-impulsivity presents in the following ways:

  • restlessness
  • difficulty remaining seated
  • excessive talking
  • frequent interruptions during conversation

Combined

A combination of both inattentive and hyperactive-impulsive symptoms characterize combined ADHD.

Holding up the pocket mirror: Is this you?

ADHD looks different from person to person.

Take a look at this list of practical symptoms from the National Institute of Mental Health (NIMH). If you recognize many of them, it might be a good idea to talk with a healthcare professional about what you’re experiencing.

  • I have a persistent feeling that my life is completely out of control.
  • I don’t invite people into my house because it’s usually a mess.
  • At school and at work, I try to hide the fact that I’m feeling hopelessly lost and behind.
  • I forget appointments — and even when I remember them, I am often late.
  • I read the same sentence over and over. It takes me forever to read something, even if it’s important to me.
  • I feel restless and fidgety in long meetings. Meetings are almost always too long for me.
  • I wish I could stop interrupting people so much. Ditto for blurting.
  • I spend a lot of time looking for stuff I’ve lost or misplaced.
  • I’ve had more than my fair share of car accidents.
  • I have heaps of paper in my life — and in the heaps are bills I haven’t remembered to pay and important stuff I need to do, like renewing my driver’s license.
  • People sometimes tell me it looks like I am not listening to them.
  • When I have a big project to do, I freeze or procrastinate because I have absolutely no idea where to start.
  • When things feel too out of control, I do something impulsive to escape or forget. I might buy things, overeat, or drink too much.
  • I can become hyperfocused on one thing, leaving everything else undone.
  • I’m really good at setting goals, but I usually lose interest or get distracted before I complete them.
  • I’ve lost jobs because I have trouble staying organized and following through.
  • I’ve had relationship conflicts for the same reasons.
  • All of this leaves me feeling anxious and depressed.

A 2019 study suggests that girls may be underdiagnosed because they often have more symptoms of inattentive ADHD than of hyperactive-impulsive ADHD.

Because the symptoms of hyperactive-impulsive ADHD can be louder and more disruptive, the comparatively quiet distractibility of inattentive ADHD doesn’t capture the attention of parents, teachers, and healthcare professionals as readily.

ADHD symptoms vary from person to person. Generalizations based on sex or gender aren’t always helpful in making sure each individual gets the right care.

Here’s what recent research has revealed about gender differences in ADHD symptoms.

ADHD and hormones

In both sexes, changes in hormone levels can influence ADHD symptoms. Regardless of their sex assigned at birth, individuals may experience a shift in symptoms around puberty when sex hormones influence physical symptoms and behavior. Fluctuating hormones can affect symptoms in other ways:

  • Experts in a 2020 statement agreed that hormone levels in pregnancy and menopause can also increase symptoms.
  • A small 2017 study found that inattention can increase after the ovulation phase of your menstrual cycle.
  • Changes in estrogen levels across your cycle can increase ADHD symptoms, especially for women with ADHD who may experience more impulsivity.

Psychological and emotional effects of ADHD on women

  • A 2014 research review of girls with ADHD showed that their self-esteem is often lower than boys with ADHD — even well into adulthood.
  • Research from 2016 comparing girls who have ADHD with girls who do not have ADHD suggests that those with ADHD often have more conflict in their social relationships than those without ADHD.
  • A 2017 study of women and girls suggests that women diagnosed with ADHD have a higher risk of experiencing symptoms of depression, anxiety, and eating disorders. Additionally, borderline personality disorder is more likely to be reported among women previously or concurrently diagnosed with the hyperactive-impulsive type of ADHD.

There’s no full cure for ADHD. But several measures are available to help reduce ADHD’s impact on people who live with it.

1. Medication

When children and teens have diagnosed ADHD, doctors often prescribe stimulant or nonstimulant medications to manage symptoms and improve functioning.

2. Psychotherapy

A 2020 statement from health experts recommended that girls and women talk with therapists about extra risks they could face as a result of ADHD.

The experts added that girls and women with ADHD are more likely to develop substance use problems, behaviors that increase the likelihood of negative outcomes, disordered eating, and self-harming.

3. Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) can help folks with ADHD identify patterns of behavior and thinking that make symptoms worse or disrupt executive function. The treatment helps people develop coping skills and make adjustments to how they feel and behave.

Over time, this can help reduce the impact of ADHD on daily living.

A 2021 study examined the possibility of conducting CBT through an app-based chatbot. This could improve accessibility and help people with ADHD get around time or cost barriers to receiving the care they need.

4. Social skills training

ADHD can negatively affect a person’s relationships and social interactions. Women who don’t yet have a diagnosis, or received one later in life, might find adjusting difficult.

For this reason, training people with ADHD in social skills can help them find smoother integration and nurture relationships.

However, it’s not always effective in a clinical setting.

A 2017 review found that educating people with ADHD about skills in genuine interactions might be more valuable for their progress. The review also suggests that educating peers and family members about the way ADHD works and affects social integration might help them accommodate the individual’s needs.

5. Education about ADHD

Educating girls and women about ADHD may help them avoid:

  • feeling shame and blaming themselves
  • seeking stimulation that can negatively affect them
  • coping skills that can do more harm than good

Women write about ADHD

How sex and gender can affect ADHD treatment

A 2020 research review showed that doctors routinely prescribe medication less often to treat girls with ADHD than they do boys.

This difference in prescription rates is sometimes surprising. The same study found that both stimulant and nonstimulant medications improve most symptoms in girls as much as they do in boys — or even more so.

Again, it’s possible to attribute these differences to behavioral differences between girls and boys that may cause boys to receive treatment more often than girls.

In adults, prescription rates are more equal. Women still receive less medication than men, but the difference is not as dramatic.

More research needs to take place that explores the differences in how different bodies process ADHD medications and how rising and falling hormones alter the effectiveness of medication.

For example, a 2007 study showed that stimulant medications “wear off” earlier in the day for girls. Understanding these differences may help doctors tailor treatment to what each woman needs.

When a clear diagnosis and effective treatments are delayed, people can experience worse outcomes over the course of a lifetime. These include:

Girls and women are often underdiagnosed or misdiagnosed when it comes to ADHD.

It could be because they’ve become good at compensating for or masking their symptoms. Or it might be that parents, teachers, and health professionals don’t recognize symptoms of inattention as readily as they do more boisterous and disruptive symptoms.

Women are also more likely to:

  • experience changes in symptoms because of fluctuating hormones
  • develop anxiety disorders and depression because of ADHD
  • have lower self-esteem and higher conflict in relationships because of ADHD

As more research focuses on the lived experiences of women with ADHD, women can look forward to treatments that work more effectively for them as individuals.

For now, here’s something to consider.

If you have ADHD, you’re not lazy. You’re not scatterbrained. Like 4.4 percent of adults reported by NIMH in the United States, you have a mental health condition that makes paying attention, resisting impulses, preparing, organizing, and completing tasks challenging or sometimes impossible.

Getting the right kind of treatment can be like flipping a tapestry art-side up. The tangle of knots and threads can begin to make beautiful, colorful sense.