How Does ADHD Differ in Men and Women?

Attention deficit hyperactivity disorder (ADHD) is a neurological condition that affects the way a person thinks and behaves. The three main symptoms of ADHD are inattentiveness (difficulty concentrating), hyperactivity (excessive movement) and impulsivity (acting on impulse).

Boys are more than twice as likely to be diagnosed with ADHD than girls; however, research suggests that ADHD occurs just as often in girls as it does in boys. 

The problem is that the diagnostic criteria for ADHD were originally developed based on the behaviour of boys. Behavioural symptoms are generally obvious and easy to identify.

However, girls tend to internalise their ADHD – they experience their symptoms on the inside without necessarily expressing them in their behaviour. As a result, girls with ADHD are often left undiagnosed for many years.

Are ADHD symptoms different for women?

Research suggests that the symptoms men and women with ADHD experience tend to be very similar. For the most part, men and women with ADHD have the same type, number and severity of symptoms and respond best to the same medications. 

However, the lived experiences of men and women with ADHD are often very different. Men tend to externalise their symptoms, which means they often display their symptoms outwardly through aggression and hyperactivity. 

In contrast, women usually internalise their ADHD symptoms, which means they often develop severe anxiety, sadness and loneliness. This internalisation means that self-doubt and self-harm are both more common in women with ADHD than in men.

Women with ADHD face the additional challenges of female gender role expectations and fluctuating hormone levels, which can make the burden of ADHD even greater. In fact, research shows that women with ADHD tend to experience higher levels of anxiety and depression than men.

Researchers continue to investigate whether there are genetic differences in how ADHD affects the brains of men and women, or whether the differences they experience are due to other biological and environmental factors.

Why is it harder to spot ADHD in girls?

ADHD was first defined based on the behavioural symptoms of hyperactive boys. Boys are 2-3 times more likely to display hyperactivity than girls. As a result, boys’ ADHD symptoms can be more obvious and easier to spot. 

At school, boys with ADHD may be disruptive in the classroom; whereas, although girls with ADHD may struggle in school, their problems tend to be less noticeable.

Boys with ADHD often experience symptoms of hyperactivity, such as struggling to sit still, fidgeting constantly or being unable to wait their turn. 

Girls with ADHD often experience symptoms of inattentiveness, such as struggling to concentrate and follow instructions, or frequently losing and forgetting things. 

ADHD symptoms in women are often overlooked because they are seen as “character traits” rather than symptoms. Sometimes, girls with ADHD are labelled as daydreamers, “spacey” or forgetful.

Potential signs of ADHD in women

Women with ADHD often believe that the challenges they experience make them “wrong”. As a result, it can be hard to detect ADHD in women because they try to conceal their struggles out of shame.

Most women with ADHD experience inattentiveness (difficulty concentrating and paying attention), which may manifest, for example, in them avoiding tasks like reading. 

However, there are many other symptoms of ADHD in women, including:

  • Chronic anxiety
  • Hypersensitivity to sensory stimuli, such as touch, sounds or smells
  • Extreme emotional responses, including episodes of rage or tears
  • High levels of shame
  • Low self-esteem
  • Severe premenstrual symptoms, including mood swings and sleep problems
  • Inconsistent eating habits
  • Excessive substance use
  • Perfectionistic behaviour

ADHD in adult women can often look like anxiety or a mood disorder, which means women with ADHD often get misdiagnosed. 

Potential symptoms of ADHD in men

It is typically easier to spot ADHD in men since the diagnostic criteria for ADHD were developed based on the behaviour of boys. Typically, males with ADHD show signs of hyperactivity and impulsiveness.

Common signs of ADHD in boys and men include:

  • Restlessness 
  • Always being on the go
  • Fidgeting
  • Frequent mood swings
  • Lack of patience
  • Being very talkative
  • Disruptive behaviour, including outbursts of noise
  • Impulsive behaviour, such as grabbing things without asking

How do gender roles affect women’s experiences of ADHD?

Traditional female gender roles idealise women who are calm, organised, and helpful. As a result, women with ADHD often feel inadequate and ashamed for having frequent mood swings, being late or losing things. 

Women with ADHD may struggle to feel like they are doing a good job and often feel embarrassed for experiencing chaos and disorder in their everyday lives. 

The problem is that women with ADHD are often misdiagnosed as having anxiety because they hide their symptoms and don’t talk to others about what they are experiencing internally. 

Why does ADHD in women lead to low self-esteem?

ADHD in adult women can lead to low self-esteem. Women with ADHD commonly feel “inadequate” and blame themselves for their lack of ability to fulfil the calm and organised gender role expectations.

Women with ADHD often feel shame about being distracted, disorganised and impulsive. However, females with ADHD tend to be better at keeping their impulsiveness hidden than males, especially in social situations.

While it is common for males with ADHD to express their impulsivity in outbursts such as aggression, females tend to suppress their emotions until they get home. As a result, outbursts in women with ADHD tend to be directed at their partners or children, instead of the person or situation that initially triggered the emotion.

Sadly, women often feel immense guilt for their outbursts and believe losing control means they are a “bad person”. If they don’t yet have an ADHD diagnosis, women can get caught up in a shame spiral, which pulls down their self-esteem.

Getting an ADHD diagnosis can help lift a huge weight off women’s shoulders as they realise they are not “flawed” or “wrong”, they simply have a biological condition that affects the way they think and behave. 

Being diagnosed with ADHD can help a woman start to build her self-esteem once more and embrace her uniqueness without judgment.

At the Blue Tree Clinic, we offer private ADHD assessments in London. We are here to help give you the diagnosis and support you need to start living your life free of shame and self-doubt. Fill out our contact form here to find out more.

How do hormones influence ADHD symptoms?

Hormones directly affect the frequency and intensity of ADHD symptoms. Since females experience much more dramatic monthly hormonal fluctuations than males, ADHD symptoms in women tend to get worse at certain stages during the menstrual cycle.

High levels of estrogen and progesterone improve brain functioning. However, just before a woman’s period each month, these two hormone levels drop. 

As a result, women with ADHD often experience heightened irritability, sleep problems and concentration difficulties in the days just before their period starts. Often, these symptoms are misdiagnosed as a severe form of premenstrual syndrome (PMS) and the underlying ADHD is overlooked. 

As well as dropping monthly with each menstrual cycle, women’s estrogen levels also drop permanently during menopause. This means menopause can be a particularly challenging time for women with ADHD, especially if it is undiagnosed. 

Menopausal low estrogen levels can cause women with ADHD to experience confusion, memory problems, difficulty concentrating and sleep struggles.

Perfectionism in women with ADHD

Perfectionist behaviours are common in women with ADHD. Women with ADHD often feel shame for not being as “perfect” as they want to be. 

When a woman has ADHD, she is more likely to experience problems focusing, paying attention, remembering details, staying motivated and keeping organised. Therefore, it can be particularly difficult for women with ADHD to meet the standards they set for themselves.

As a result, girls with ADHD may spend hours making sure a school project is “just right”. As adults, they may stay up all night preparing for work presentations and meetings, take an excessive amount of time to craft the wording of an email, or even procrastinate on work tasks altogether out of fear of messing up.

Their differences can feel especially challenging when they notice other women around them seem to find tasks much easier than they do. 

Women with ADHD may feel embarrassed and hide the fact that they have to put in a lot more time and effort to get the same results as their colleagues or friends. They often keep their struggles a secret because they feel like they “should” find tasks easier and more effortless than they do. 

As a result, women with ADHD often delay getting help and instead struggle alone for years trying to present a facade of perfection.

What other conditions do women with ADHD experience?

Adult women with ADHD often struggle with multiple other mental and physical health conditions, especially if their ADHD is left undiagnosed.

Women with ADHD frequently experience anxiety, which can lead to symptoms such as headaches, nausea, nail-biting and inconsistent eating patterns.

Other conditions women with ADHD commonly experience include:

  • A high BMI
  • Personality disorders, such as borderline personality disorder
  • Addictive behaviours, such as gambling, compulsive shopping or substance abuse

What happens if ADHD in adult women is left undiagnosed?

Undiagnosed ADHD in women can lead to increasingly severe psychological struggles.

Sometimes, women with ADHD are too distracted to remember to practice self-care. Sleep problems, a common symptom of ADHD, can further add to these struggles. As a result, women with undiagnosed ADHD can become burnt out and experience a downward spiral in their self-esteem. 

Low self-esteem can mean that women with ADHD are more likely to tolerate abusive relationships because they believe they are unworthy of healthy love. This sense of hopelessness, combined with the fact that women with ADHD often struggle with impulsivity, means women with ADHD are more likely to self-harm than men with ADHD and may also experience suicidal thoughts.

It is common for women with undiagnosed ADHD to experience chronic stress. As a result, they often end up using substances to help them cope. This may include taking anxiety, sleep, or pain medication, or using alcohol or other drugs.

As women get older, they often learn to hide their symptoms more easily. However, this doesn’t mean they aren’t struggling just as much under the surface. Women with ADHD often attempt to keep their struggles a secret by distancing themselves from their friends or partner. 

Undiagnosed ADHD can lead to serious mental health problems, including suicidal thoughts, social isolation and substance abuse. This is why getting an ADHD diagnosis is so important. 

If you believe you might have ADHD, the Blue Tree Clinic is here to support you. We offer private ADHD therapy in London, designed to help you manage your symptoms, improve your mood and feel encouraged in your life.

Recap: The challenges of ADHD in women

Despite experiencing largely the same symptoms, women with ADHD often face more challenges than men with the same condition. 

Women are more likely to hide their symptoms, and, combined with hormonal fluctuations and the pressures of gender role expectations, this can lead to increased stress for women with ADHD compared to men.

As a result, women with ADHD are more likely to struggle with low self-esteem and shame. They often blame themselves for their struggles rather than realising they are symptoms of a neurological condition.

Why is getting an ADHD diagnosis so important?

Getting a diagnosis is the first step to freedom for people with ADHD. 

A diagnosis provides you with a scientific reason for the symptoms you have been experiencing. It gives you validation and helps explain your struggles and the way you have been feeling. 

Once diagnosed, you can start to see that your traits aren’t flaws, they are simply different ways of thinking. 

Although people with ADHD cannot rewire their brains to run differently, they can learn to embrace their differences and seek support for their challenges.

At our private London psychology clinic, our goal is to help you remove the shame from your struggles and support you through finding new self-acceptance. Through the therapy and medication options we offer, we can help you manage your symptoms so that you can thrive. 

To book an ADHD assessment or therapy session, get in touch with us using our contact form here.