The Overlooked Reality of ADHD in Women and Girls
If you’ve been struggling with anxiety, depression, or severe PMS, and finding that treatment isn’t getting you where you want to be, it may be time to consider another possibility.
Attention-Deficit/Hyperactivity Disorder (ADHD) is frequently overlooked in girls and women. In part, this is due to ADHD presenting differently in women than it does in men. But I suspect it is also because the medical community often falls back on outdated assumptions—dismissing women as simply “hormonal” or naturally prone to anxiety and depression.
In my practice, I frequently work with girls and women who have been treated for anxiety or depression for years, yet continue to struggle with:
- Motivation and procrastination
- Difficulty getting organized
- Jumping from one task to another
- Social challenges
- Difficulty regulating emotions
Many of these women have a harsh internal dialogue, frequently labeling themselves as “stupid,” “lazy,” or “not enough.” When we sit down together, I listen to the ways they are forcing their lives to work—white-knuckling through challenges and working twice as hard just to get through the day. Often, when I bring up the possibility of ADHD, my clients are surprised. They either believed it was “something boys get” or assumed they would have outgrown it by adulthood.
Moving Past Outdated Stereotypes
For years, ADHD was largely considered a condition that affected hyperactive young boys. Later, it was blamed on poor parenting or dismissed as a way to get prescription medication. Today, however, we know that people of all races, ethnicities, ages, and genders can experience ADHD.
We also know that ADHD isn’t just a problem at school. It affects all aspects of life, including how we view ourselves, our relationships, and our emotional reactivity—in addition to our ability to plan, organize, initiate tasks, and avoid careless mistakes.
The Hormone Connection: Why Masking Falls Apart
It is incredibly common for me to work with women in perimenopause or menopause who are no longer able to “mask” their way through life. They often have no idea they’ve been working harder than the average person and can’t understand why their brain suddenly isn’t working right.
As estrogen begins to decrease, a woman’s ability to mask her neurodivergence also begins to fall apart, leaving her with symptoms she can no longer manage. When we look at the bigger picture and identify all the ways she has been working around her own brain, things finally begin to make sense. Estrogen isn’t the only issue; rather, these women have been masking their ADHD for so long that they simply don’t know any other way.
Research exploring the implications of ADHD for women—and how hormone fluctuations impact symptoms—is still quite limited. However, we are beginning to learn that during times of significant estrogen changes (puberty, pregnancy, postpartum, perimenopause, and menopause), the impacts of ADHD are much greater. Estrogen actively impacts brain structure and the functioning of key neurotransmitters, specifically serotonin and dopamine. Practically speaking, these are the chemicals that govern mood, reward processes, and working memory—our mental “scratchpad” that helps us do math in our heads or remember why we walked into a room.
Because dopamine functions differently in male versus female brains, the hyperactive symptoms often seen in preschool-aged boys are typically much less evident in young girls before puberty.
The High Cost of Undiagnosed ADHD
When I first started conducting ADHD assessments, I focused on adults. This interest grew from years of working with young adults who had incredibly challenging relationships with themselves. Like many professionals, I initially attributed this to anxiety, stress, or past trauma—and it certainly can be all of those things—without considering the possibility of a lifelong neurodevelopmental challenge.
When I first started reading about how ADHD uniquely presents in women, alarm bells went off in my head: Had I been missing a giant red flag?
The more I read, the more convinced I became that undiagnosed ADHD is a massive problem for women. It causes lost time, unrealized potential, strained relationships, and academic or career hurdles (even among highly successful women). Furthermore, women with undiagnosed ADHD have more medical concerns and an increased rate of other mental health comorbidities. All of this culminates in lower self-esteem and a highly critical inner voice.
Next Steps and Assessment
If you have a child who is diagnosed with ADHD or you are experiencing life challenges that feel unnecessarily difficult, ADHD may be part of the picture. Look out for symptoms like:
- Trouble maintaining relationships
- Difficulty starting or finishing projects, underperforming
- Struggling to get and stay organized, over plan and struggle to carry out the plan
- Regularly losing things (keys, glasses, phone)
- “Time blindness” (chronic lateness or underestimating how long tasks take)
- Zoning out or feeling restless
- Shame, negative sense of self, and/or perfectionism
- High emotional sensitivity, frequent irritability, persistent depression/anxiety
A great first step is talking to your physician or counselor. They may point you toward an online screening tool or refer you for formal testing. (I recommend the Adult ADHD Self-Report Scale, or ASRS, which you can easily find online for free).
Assessment for ADHD can take several forms. A provider will usually conduct a psychological interview to better understand your symptoms and uncover the ways you may be overworking to mask them. They may use a semi-structured interview designed specifically for ADHD diagnosis, and they might also administer formal cognitive or executive functioning tests to give you the clarity you deserve.
Dr. Christy Hutton