Why ADHD is Missed in Women and Girls
This is a six-part deep dive look into female ADHD to help you better advocate for yourself and your children.
ADHD (attention deficit hyperactive disorder) was recognized in literature at the turn of the 20th century. In 1902, it was described by British pediatrician Sir George Frederic Still as “an abnormal defect of moral control in children.”
However, the DSM didn’t recognize the disorder until 1968 (under a different name. It wasn’t until 1980 that ADD was coined. That name stuck until 1987, when the word “hyperactivity” was added to the name (Anderson, 2025), and ADHD was recognized as we know it today.
What is ADHD?
ADHD is the most common neurodevelopmental disorder, persisting into adulthood, and affects around 192 million people (3% of adults worldwide) (Zhu et al., 2017). ADHD is known to seriously affect most all aspects of a persons life, from academic and professional achievements, interpersonal relationships, overall health, and daily functioning.
Symptoms of ADHD include:
inattention (not being able to keep focus),
hyperactivity (excess movement that is not fitting to the setting) and
impulsivity (hasty acts that occur in the moment without thought).
ADHD can lead to poor self-esteem and social function in children when not appropriately treated (Harpin et al., 2016). Adults with ADHD may experience poor self-worth, sensitivity towards criticism, and increased self-criticism possibly stemming from higher levels of criticism throughout life (Beaton, et al., 2022).
It is critical you find a support network that understands, validates, and supports your experience. Navigating a world built for neurotypical minds creates endless friction. You can find community in the Asterisk Women’s Health Telegram group as a starting poing.
Why ADHD was Thought of as a MALE Disorder
“Attention-deficit/hyperactivity disorder (ADHD) was once thought to be a male only disorder, leaving women and girls to suffer in silence (Attoe et al, 2023).”
“Girls are more often diagnosed with ADHD-Inattentive (ADHD-I), exhibiting symptoms such as distraction, disorganization, and forgetfulness (Nussbaum, 2012).”
“Boys more frequently present with ADHD-Hyperactivity/Impulsivity (ADHD-HI), exhibiting greater levels of hyperactivity, impulsivity, and aggression (Waite, 2010).”
Since psychologists thought of ADHD as inherently male, the questionnaire and diagnostic guidelines primarily look for ADHD-HI symptoms. “Findings suggest that the current diagnostic criteria and/or clinical practice is biased toward the male presentation of ADHD (Mowlem et al., 2018).”
Of the 10 diagnostic tests available currently, only THREE include female specific norms (Young, et al, 2020).
This is why your friends, sisters, and colleagues are getting diagnosed so late in life. Their symptoms aren’t recognized as “classic ADHD” symptoms in youth, and our culture primes parents to scrutinize their boys, not their girls.
“One potential reason for this differential rate of diagnosis is that physicians may lack knowledge of gender differences in ADHD, leading to overlooked or missed diagnoses for women and girls (Quinn, 2008). Many women seeking treatment for mood and emotional problems may have unrecognized ADHD (Quinn, 2008).”
This is why we always say ask your doctor for the female symptoms or dosages. Doctors often don’t realize their training left themselves biased, and they need to look in the literature for female-specific identifiers.
ADHD and its Impact on Women
Due to women with ADHD having higher rates of comorbities, it can make diagnosing the ADHD that much harder, leading to lack of or misdiagnosis. However, when ADHD received treatment, the other comorbidities often resolve or improve.
“There are several key characteristics specific to the expression of ADHD in women as compared to men. These characteristics include differences in symptom presentation, decreased self-esteem, more difficulty in peer relationships, increased likelihood of anxiety and other affective disorders, the development of coping strategies that mask symptoms of ADHD, and gender based societal expectations (Quinn & Madhoo, 2014).”
“Women are often diagnosed with, and treated for, a comorbid condition before being recognized as having ADHD. Quinn (2005) found that 14% of girls with ADHD were prescribed antidepressants before being treated for ADHD compared to only 5% of boys.”
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ADHD and Women’s Self Esteem
“Robison et al. (2008) looked at gender differences in ADHD symptoms, psychological functioning, physical symptoms, and treatment response. They found that women were rated as more impaired on every measure of ADHD symptoms. Women were also found to score higher on rating scales for anxiety and depression as well as experienced greater emotional dysregulation compared to men.”
When Fuller-Thomson et al. (2016)compared women aged 20 to 39 years with ADHD to women without ADHD, they found that:
“Women with ADHD had twice the prevalence of
substance abuse,
current smoking,
depressive disorders,
severe poverty, and
childhood physical abuse…
As well as triple the prevalence of
insomnia,
chronic pain,
suicidal ideation,
childhood sexual abuse, and
generalized anxiety disorder.”
Biederman et al. (2006) compared girls with ADHD to girls without ADHD over a 5-year period.
“ADHD was associated with a significantly increased lifetime risk of major depression, multiple anxiety disorders, bipolar disorder, oppositional-defiant disorder, conduct disorder, Tourette’s/tic disorders, enuresis, language disorder, nicotine dependence and drug dependence.
Results from this study show that at a mean age of 16 years, girls with ADHD are at a very high risk for antisocial, mood, anxiety, and addictive disorders.”
“Biederman et al. (2006) stress the importance of early intervention and prevention strategies for girls with ADHD considering the high morbidity associated with ADHD in females found in their study.”
Women with ADHD often reference difficult childhoods, a sence of self-loathing, and a sense of alienation from community. When undiagnosed, there is no escape from the confusion, only blame.
Key Takeaway: It wasn’t your fault. It’s not your fault. You weren’t supported and you deserve that, now.
Why Getting Diagnosed (even in adulthood) Matters
“A higher sense of control has been found to predict lower levels of psychological distress, depression, and anxiety (Keeton et al., 2008). Many women with ADHD may lack this sense of control, which may leave them more vulnerable to psychological distress and lower life satisfaction.”
When you don’t understand why your brain works differently (and how), it is very likely you’ll feel out of control. Not to mention, “(Women) often attributed successes to external causes (i.e., luck, powerful others etc.) and failures to internal flaws (i.e., lack of intelligence, laziness etc.” Social grooming pressures women to internalize problems, accelerating feelings of self loathing when something goes wrong.
“Undiagnosed ADHD may have an impact on women’s ability to form and sustain close and meaningful relationships. Diagnosis can provide an explanation, relieve feelings of shame and guilt, and allow for increased self-acceptance. These feelings were shared by many women across several articles."
“These women often blamed themselves for difficulties they faced growing up and a diagnosis validated their struggles, reduced feelings of self-blame, and provided them with access to various treatment interventions.”
“Women also described a change in their behavior upon discovering they had ADHD, reflected in their relationships with their children, romantic partners, and with themselves.
“Findings indicate that prior to diagnosis many women felt that they were bad people; consequently, a diagnosis made it possible for women to reconceptualize some of the feelings of guilt and shame as an external cause.”
⚠️ There’s something you need to know about getting diagnosed as an adult.
“If ADHD was not diagnosed in childhood or adolescence, primary care physicians did not consider making an ADHD diagnosis in adults. These findings may indicate a gap in knowledge of ADHD in adults and females for healthcare providers and teachers which may impede access to appropriate diagnoses and treatment options.”
What to do Next
It is clear that life without a diagnosis generates greater stress and a sense of being out of control of oneself and one’s life. Unfortunately, the majority of physicians don’t know to
look for ADHD in adults, and
look for ADHD in females.
This is where you come in. Asterisk aims to help women become their best advocate, by empowering them with their own data. Learn how to communicate more directly and efficiently with your providers today. You deserve support.
Citations
Anderson, Dave. “What Is the Difference between ADD and ADHD?” Child Mind Institute. Child Mind Institute, 20 Feb. 2025. Web. 23 June 2025.
“What Is ADHD?” Psychiatry.org - What is ADHD?. American Psychiatric Association, June 2022. Web. 23 June 2025.
Attoe, Darby E, and Emma A Climie. “Miss. Diagnosis: A Systematic Review of ADHD in Adult Women.” Journal of attention disorders vol. 27,7 (2023): 645-657. doi:10.1177/10870547231161533
Harpin VA. (2005). The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Arch Dis Child. 90 Suppl 1(Suppl 1):i2-7.
Beaton, D. M., Sirois, F., & Milne, E. (2022). Experiences of criticism in adults with ADHD: A qualitative study. PloS one, e0263366.
Harpin, V et al. “Long-Term Outcomes of ADHD: A Systematic Review of Self-Esteem and Social Function.” Journal of attention disorders vol. 20,4 (2016): 295-305. doi:10.1177/1087054713486516
Young, Susan et al. “Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women.” BMC psychiatry vol. 20,1 404. 12 Aug. 2020, doi:10.1186/s12888-020-02707-9