When most people think of ADHD, the image that comes to mind is that of a young boy who is impulsive, hyperactive, and constantly on the move. While this depiction captures one expression of ADHD, it reflects a narrow and often misleading view of a condition that affects people of all genders. This stereotype has long shaped both public understanding and clinical practice, contributing to the widespread underdiagnosis and misunderstanding of ADHD in girls and women.
An important expert consensus article published in BMC Psychiatry in 2020 challenges this male centric model of ADHD. Drawing on extensive research and clinical expertise, the authors call for a complete rethinking of how we conceptualise ADHD in females. They argue that ADHD must be understood as a lifespan condition that presents differently at various stages of life and that these differences are particularly shaped by biological, psychological, and sociocultural factors, including the profound effects of hormonal fluctuations.
Historically, the ADHD diagnostic criteria has been predominantly based on how symptoms present in young boys, especially those with the hyperactive/impulsive subtype. These boys tend to show externalising symptoms that are disruptive and easy to observe in classroom settings. In contrast, girls are more likely to exhibit internalising symptoms such as daydreaming, disorganisation, low self-esteem, and heightened emotional sensitivity. These behaviours are less likely to be seen as problematic and often get misinterpreted by teachers as shyness or laziness, or by parents as personality traits. Because clinicians have traditionally relied on criteria designed around male presentations, historically many girls have fallen through the cracks.
The diagnostic gap often widens during adolescence, a period of immense developmental and hormonal change. As estrogen levels increase, some girls with ADHD experience a worsening of symptoms, particularly in areas like emotional regulation, attention, and mood stability. These changes, paired with rising academic and social pressures often reveal difficulties that were either hidden or well masked previously. Unfortunately, at this developmental phase, many of these girls are misdiagnosed with depression, anxiety, or other mood disorders instead of ADHD. In their attempts to cope, some may turn to perfectionism, disordered eating, or self-harm which are strategies that temporarily soothe their distress but ultimately continue to mask the underlying neurodevelopmental condition.
The influence of hormones on ADHD symptoms continues into adulthood, particularly across the menstrual cycle, during pregnancy, and in perimenopause. Estrogen and progesterone influence the dopamine system, which plays a key role in ADHD. For instance, high levels of estrogen during the first half of the menstrual cycle increases dopamine release and receptor sensitivity, potentially improving attention and cognitive function. Furthermore, many women report noticeable changes in attention, mood, and energy levels in the luteal phase of their menstrual cycle, when estrogen drops, and progesterone rises. This is because progesterone has an inhibitory effect, reducing dopamine activity and worsening symptoms like distractibility and emotional instability. During pregnancy, some women experience a temporary reduction in symptoms due to elevated estrogen levels, only to see a sharp increase postpartum when hormone levels plummet. In perimenopause and menopause, declining estrogen can again intensify symptoms like forgetfulness, mental fatigue, and emotional reactivity.
These hormonal dynamics are critical to understanding the lived experience of ADHD in women, yet they are rarely considered in diagnostic or treatment discussions. As a result, many women go through major life transitions without appropriate support. Some may feel like they are “falling apart” in midlife, not realising that the worsening of symptoms is tied to hormonal shifts that interact with their ADHD. Understanding this interaction is crucial for tailoring ADHD treatment to women at different life stages.
Contrary to outdated beliefs, ADHD does not fade with age – it morphs. In adulthood, women may no longer be bouncing off the walls, but they often report chronic disorganisation, time blindness, emotional exhaustion and a persistent sense of overwhelm. They may appear “high functioning” to others while privately struggling to meet demands of work, relationships, parenting, and daily life. Common difficulties include impulsive spending, trouble initiating or completing tasks, forgetfulness, and intense emotional reactions. Many women only begin to suspect they have ADHD after one of their children has been diagnosed, prompting a retrospective realisation about their own lifelong patterns.
Diagnosing ADHD in women is further complicated by high rates of comorbid and misdiagnosed conditions. ADHD in females is frequently misunderstood as depression, anxiety, bipolar disorder, borderline personality disorder, or eating disorders. These conditions may exist alongside ADHD, but they can also obscure it. When the core issue of ADHD remains undetected, women may receive ineffective or conflicting treatments. A more integrated, gender informed diagnostic approach is essential. One that considers ADHD as a potential root cause when executive dysfunction, impulsivity, and emotional instability are present.
To address these difficulties, the article makes several critical recommendations. These include:
- Diagnostic criteria must be revised to reflect how ADHD manifests in girls and women across the lifespan, including the impact of hormonal changes.
- Clinicians should conduct a thorough assessment including gathering evidence from multiple sources, incorporating insights from family members, educators and close partners.
- Support must be ongoing and flexible, adapting to different life stages. From school to motherhood to menopause.
- Healthcare providers and educators must receive better training to recognise and respond to ADHD in females, especially in ways that consider both biological and contextual factors.
To summarise, ADHD in girls and women is real, prevalent and too often missed. Left unrecognised, it can lead to years of unnecessary suffering, misdiagnosis, and self-blame. But with awareness, accurate diagnosis, and tailored support (including a focus on hormonal influences), these individuals can not only manage their symptoms but can learn to thrive. This is not merely a matter of personal health; it is a systemic issue that demands a more inclusive and informed approach to mental health care. It is time to change the story and make space for the full, complex reality of ADHD in women.
At Headway Psychology, we offer ADHD assessments that align with the latest research and expert recommendations, including those outlined in the BMC Psychiatry consensus article. Our assessment approach makes sure to consider the distinct ways ADHD shows up in girls and women at different life stages, with careful attention to gender specific patterns and developmental changes over time. We use multiple assessment measures and gather input from multiple sources to ensure a more accurate and comprehensive understanding of symptoms in different contexts.
If you have related to this article and are wondering if you have ADHD, it is recommended that you reach out to Headway Psychology for a diagnostic assessment or for one-on-one counselling to support management of mood symptoms and/or executive dysfunction.
For those interested in diving deeper into this topic, you can read the full article here: Females with ADHD: An Expert Consensus Statement
