As discussed in a previous article, ADHD diagnoses in women ages 23-29 and 30-49 nearly doubled from 2020 to 2022. This means that many women went undiagnosed for a significant portion of their lives.
Lack of diagnosis can have severe repercussions for women with ADHD. Once you know you have the disorder, you can overcome the challenges. So, what should women who have ADHD or who are exploring a potential ADHD diagnosis know?
First, let's go over what ADHD is and the distinct ways it can present. Then, we'll talk about what ADHD looks like in women, including the impact of masking, lack of diagnosis, and potential comorbidities, and how to manage the condition.
What is ADHD?
ADHD is a neurodevelopmental disorder, meaning that it affects the growth and development of the brain. Characterized by ongoing patterns of inattention, hyperactivity and impulsivity, or both, ADHD can impact all areas of your life, from your mental and physical health to interpersonal relationships, work, and school.
There are three subtypes or presentations of ADHD:
ADHD Hyperactive/Impulsive Type
Primarily hyperactive/impulsive ADHD is diagnosed when someone experiences six or more symptoms of hyperactivity or impulsivity, as defined by the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). People with primarily hyperactive/impulsive ADHD may have an intense need to move around or fidget, acting as though they're "always on the go" or are "driven by a motor." They may interrupt others unintentionally and frequently or engage in impulsive actions.
ADHD Inattentive/Distractible Type
Primarily inattentive ADHD is diagnosed when someone experiences six or more symptoms of inattention for at least six months, as defined by the DSM-5. In those with primarily inattentive ADHD, we generally notice that they are distracted easily. People with this type of ADHD may be forgetful, lose or misplace necessary items (like your car keys or phone) frequently, have trouble following through with tasks, and zone out or daydream often. One might be late to turn in work assignments or show up to events, even if they try their best not to. Primarily inattentive ADHD is the most prevalent type of ADHD in women.
ADHD Combined Type
The combined presentation of ADHD is exactly what it sounds like. According to the DSM-5, when someone has six or more inattentive ADHD symptoms and six or more hyperactive/impulsive ADHD symptoms instead of one or the other for the past six months, they have combined presentation ADHD.
ADHD Symptoms in Women: A Checklist
Since women with ADHD often learn to hide their symptoms early in life, what ADHD looks like in women can differ from those seen in men and boys. Additionally, research shows that women very literally experience ADHD differently, even with gender bias and masking removed from the equation.
Specifically, women and girls show a predominance of inattention and are more likely to internalize their symptoms. Boys and men display more significant levels of hyperactive/impulsive symptoms and are more likely to show symptoms externally.
ADHD symptoms in women can include but aren't limited to the following:
- Excessive talking.
- Fidgeting or needing to move and walk around often.
- Feeling as though your thoughts go "a mile a minute."
- Impulsive actions (e.g., impulse spending) or talking without thinking.
- Frequent daydreaming, which might affect daily life activities and productivity.
- Avoidance of or dislike for tasks that require sustained mental effort (e.g., homework, paperwork, or work projects).
- Trouble staying focused on one topic. For example, you may jump from one topic to another during a conversation, even if it doesn't make sense to others.
- Fear of rejection, which can lead to staying in unhealthy romantic relationships or not standing up for yourself in social circles.
- Perfectionism, self-harm, or placing extreme pressure and responsibility on yourself.
- Adopting compensatory strategies, such as masking, relying on perfectionism and anxiety to get things done, or working longer than everyone else to keep up with work, school, or daily life tasks.
- Difficulty keeping your room, home, or another personal space clean despite your best efforts.
- Trouble sustaining friendships, even if you make friends easily.
If you resonate with or checked a significant portion of the symptoms above, it may be worthwhile to look into an ADHD diagnosis. Even for those aware that they have ADHD, it can be validating to look at a list of symptoms and remember, "This is why I feel the way I do." In turn, you can reduce shame and get the support you need.
What Does ADHD Look Like in Women?
Marked symptom differences are often seen in women with ADHD, which may contribute to misdiagnosis or lack of diagnosis, alongside stereotypes and sexism.
Women With ADHD Are Often Undiagnosed or Diagnosed Later in Life
Extensive evidence suggests that ADHD is and continues to be under-recognized and under-treated in adults, especially in adult women. When it comes to ADHD in older women, some may never get a diagnosis. Unfortunately, late-diagnosed and undiagnosed ADHD in women can come with consequences.
- Poor self-esteem from years of living without diagnosis and treatment.
- Feeling misunderstood.
- Guilt and shame for ADHD symptoms (e.g., "Why can't I just clean the house like everyone else?")
- Negative or hurtful comments from others (e.g., "You just aren't trying hard enough").
- Challenges in friendships or interpersonal relationships.
- Financial issues or problems at work.
An ADHD diagnosis can have a positive impact on adult women with ADHD because it means that you can better find ways to manage your symptoms and improve your quality of life and functioning.
Mental Health and Co-Occurring Conditions in Women With ADHD
A study on women with ADHD vs. women without ADHD found that women with ADHD were twice as likely to experience depressive disorders, substance use disorders, current smoking behaviors, poverty, and other challenges. The same study found that women with ADHD were three times as likely to experience generalized anxiety disorder (GAD), chronic pain, insomnia, and suicidal ideation.
If you're like a lot of women with ADHD, especially those who are undiagnosed or who were diagnosed late, you may have gotten several (applicable or inapplicable) mental health diagnoses before ADHD. In turn, you may have received treatments and suggestions that were not what you needed.
Rejection sensitivity and emotional dysregulation, both of which already come with ADHD, can make coping with the symptoms more difficult. People may not understand how intensely you feel or why your brain works the way it does - until you meet other women with ADHD.
Higher Prevalence of ADHD Masking Behavior in Women
Masking is when a person with a condition like ADHD or Autism attempts to act in a way that makes them seem as though they don't have the disorder to others. Because of the way women and girls are socialized, many women with ADHD adopt masking behavior to fit in with and succeed in a neurotypical society.
Here are some examples of masking behaviors a woman with ADHD might use:
- Smiling and nodding during a conversation to look like you're paying attention even if you haven't been.
- Staying quiet around others so that you don't talk too much or misspeak.
- Holding hyperactive tendencies, like fidgeting, in.
This can and often does play a role in late diagnosis. Masking is a protective behavior, but it doesn't come without repercussions.
Many people face worsened symptoms of other mental health conditions as a result of masking. For example, if anxiety co-occurs with primarily inattentive ADHD in women, a woman may remember to do things she otherwise wouldn't due to people-pleasing (e.g., "I NEED to get this done, or my boss will hate me").
Masking and reliance on things like excessive worry or people-pleasing can come with severe stress that affects your physical body and health just as much as your mind. Burnout, chronic pain, and mental health concerns are all more common in women with ADHD compared to the general population, which may speak to the strain masking can cause.
Women and High-Functioning ADHD
Whether due to masking or differences in presentation, many women with ADHD are high-functioning from childhood onward. “High functioning” usually refers to someone who can mask well and can live and present in a way that is seen as socially acceptable and successful in society.
High-functioning ADHD in women might mean that you have a thriving career, lasting friendships and relationships, or a family. In other words, you might appear to "have it all together" from the outside. You might hear things like, "You can't have ADHD - you're a great employee!"
Although high-functioning ADHD can appear as though it's "not a problem" on the outside, it doesn't mean that symptoms don't affect you or your life seriously.
Treatment and Management Strategies for Women with ADHD
Since women with ADHD often present differently, it only makes sense that different treatment and management strategies work for women with ADHD. In many cases, a combination of lifestyle improvements, medication, therapy, tools or skills, and reducing shame can be powerful.
Take Advantage of Accessible Diagnosis, Treatment, and Education
For women with ADHD who went undiagnosed for most of their lives, looking for a professional who can provide a diagnosis and treatment can be daunting. You might not know who to go to for a diagnosis, or you might worry about getting brushed off. Keep the following in mind as you work to get your ADHD diagnosis or manage your symptoms.
1. Consider telehealth services
Telemedicine has improved access to diagnosis and treatment. Online appointments make diagnostic services, medication management, and finding a neurodivergence-affirming therapist much more doable. Note that you'll need to find a provider licensed in your state and, in some cases, may need to come in for drug testing for medication.
2. Get informed on how you may respond to treatments differently
Hormone differences can affect the way ADHD medications work for women. For example, the changes in estrogen and progesterone levels that occur at puberty can cause ADHD medications to be less effective. Another consideration regarding medication treatment for ADHD in women is that prescriptions may curb your symptoms less during some parts of your menstrual cycle.
It's also essential to consider co-occurring mental health conditions and how they might impact ADHD treatments when relevant. ADHD medication is a game-changer for many people, and despite misconceptions, it can actually reduce the risk of substance abuse in those with ADHD rather than raise it. Still, not everyone will respond to it the same way. Some fare best with non-medication approaches or combine low doses of medication with other practices, like body doubling and supportive routines.
With all of this in mind, it can take time to find the right approach to treatment for ADHD in women. Discuss different medications or dosages with your doctor, consider adding alternative treatments or practices to aid symptom management, and use trial and error to discover which strategies, habits, and tools work best for your brain.
3. Be proactive, and don't give up
If you're confident that you have ADHD but have been brushed off, it's okay to get a second or third opinion. Finding a professional who has worked with ADHD in adult women can be advantageous for both your diagnosis and treatment. Paying close attention to how you are responding to various treatment strategies is essential. Since it can take time to find what works, be sure to practice self-compassion!
Flow Club and Supportive Body Doubling for ADHD Women
Many women are emotionally intelligent and consider themselves highly sociable. In turn, practices like body doubling tend to work well for and appeal to women with ADHD.
Popularized by the ADHD community, body doubling is when you complete a task alongside another person. They don't necessarily need to engage in the same task, but they should also be working on something themselves. Their presence alone helps you "lock into" an activity and get things done.
With Flow Club, you can body double anytime, from anywhere, without needing to coordinate with your friends or family. Flow Club lets you schedule or jump straight into virtual body doubling sessions with a supportive ADHD community. All you have to do is show up, decide what you’re going to do, do it, and we will celebrate your progress or give you the encouragement you need to keep going.
Flow Club provides 100% shame-free accountability while boosting your productivity naturally. You will meet other women with ADHD who will share your experiences.
ADHD Women-Friendly Online Spaces
Outside of Flow Club, online spaces where you can read about and interact with other women with ADHD can help you feel less alone.
When it comes to nearly any health concern, women so frequently aren't taken seriously or go without a proper diagnosis. Thankfully, communities like the ADHDwomen Reddit can provide peer support while suggesting tips and tricks to improve your daily life.
Women with ADHD often have to fight for diagnosis and treatment due to differences in presentation or stereotypes surrounding ADHD that have been debunked but remain rampant. Body doubling communities like Flow Club can be incredibly helpful for women with ADHD, as can having a supportive community and finding resources that aid in the diagnosis and treatment of ADHD.
Don't give up on finding what works for you. Click here to try body doubling with Flow Club for free.