ADHD in Women: Signs, Symptoms, Treatments and Why Its Often Missed

Understanding ADHD in Women

For decades, Attention-Deficit/Hyperactivity Disorder (ADHD) has been mischaracterised as a condition that mostly affects hyperactive young boys who can’t sit still in class. The image is familiar: a disruptive child bouncing off walls, constantly interrupting, visibly struggling to pay attention.

But for many girls and women living with ADHD, that picture couldn't be further from the truth.

ADHD in women is quieter—less visible, but no less real. It shows up as: Internal chaos masked by external composure. Missed deadlines despite the best intentions. Conversations interrupted by racing thoughts. A calendar full of reminders, yet another appointment missed. A body that never quite settles. Emotions that feel sharp, fast, sometimes overwhelming

It can also look like perfectionism, people-pleasing, and a lifetime of wondering why everything seems just a little harder than it should be. It’s working twice as hard to hold it all together—and blaming yourself when it falls apart.

At Kantoko, we aim to provide an accessible and clinically grounded understanding of adult ADHD— to offer clarity, reduce stigma and support better outcomes. If you're a woman with ADHD—or you think it might be part of your story—this guide is here to help make sense of it all.

In This Guide, We Explore:

Why Women Are So Often Missed
Symptom Evolution from Childhood to Adulthood
Common Co-occurring Conditions
Treatment and Support Strategies
The Path Forward After Diagnosis

Why ADHD in Women Is Often Missed

Despite affecting an estimated 5-7% of youth and 2-6% of adults globally, ADHD has historically been identified far more frequently in males with clinical referral ratios between 3:1 and 16:1. By adulthood, this gender gap narrows significantly as previously missed females are diagnosed.

In Australia, Pharmaceutical Benefits Scheme (PBS) data shows a striking shift:

Between 2014–15 and 2022–23, the number of women receiving ADHD medications increased from 3,569 to 40,911—a rise of over 1,000%.
Since 2020, more women than men have been treated for ADHD under the PBS.
In 2022–23, 40,911 women were being treated, compared to 28,446 men.

These striking numbers tell a story not of a sudden surge in ADHD among women, but of decades of missed diagnoses finally being recognised.

The question isn’t “why are so many women being diagnosed now?”—it’s “why were they missed for so long?”

The answer lies in a perfect storm of structural and clinical bias:

Research Bias

ADHD was originally researched through a narrow lens—hyperactive boys. A review of 70 studies from the DSM-III-R to DSM-IV era found that 81% of participants were male. This male-centric evidence base shaped clinical training, research, and diagnostic criteria—prioritising externalising behaviours like impulsivity and disruption, while overlooking how ADHD shows up in girls.

Referral Bias

Even when symptoms are identical, girls are less likely to be referred for ADHD assessment. In a landmark study, parents and teachers reviewed identical case descriptions that only varied by gender. When the child was described as a girl, parents and teachers were significantly less likely to recommend an ADHD evaluation.

This initial barrier has lasting consequences—referral is often the gateway to diagnosis and support.

Symptom Expression

ADHD does not present the same way in all individuals.

Boys are more likely to exhibit externalising symptoms: hyperactivity, impulsivity, and defiance.
Girls often display internalising symptoms: inattention, daydreaming, emotional sensitivity, and social withdrawal.

Because these symptoms are less disruptive, they are more easily misinterpreted as personality traits—such as being "moody," "lazy," or "not applying herself"—rather than recognised as signs of a neurodevelopmental condition.

Masking

Many girls and women with ADHD develop complex strategies to mask their difficulties.

They may appear organised, attentive, and high-achieving, while privately struggling with overwhelm, inattention, or emotional dysregulation. Socially, they often learn to mimic peers and conform to expected behaviours.

This "masking" can be so effective that even family members and clinicians fail to notice the extent of the effort it takes to function. In many cases, women are only recognised when those coping mechanisms begin to collapse—often under increased life demands.

The Cost of being Missed

The cumulative impact of being overlooked is profound.

Without a diagnosis, many women internalise long-standing narratives of personal failure—believing they are lazy, unreliable, or emotionally unstable. This can erode self-esteem, delay access to support, and lead to chronic mental health challenges.

Often, women are only identified after a significant life transition—such as starting university, navigating parenthood, or facing burnout in the workplace—when their ability to maintain control begins to falter. For others, ADHD is recognised during treatment for anxiety or depression, when underlying symptoms are finally understood in context.

This delayed recognition often means that women endure years of unnecessary struggle before accessing appropriate understanding, support, or care.

ADHD in Women: How Symptoms Evolve from Childhood to Adulthood

ADHD isn't static—it changes over time, shaped by both developmental milestones and hormonal fluctuations. For women, these shifts can significantly alter how symptoms present and the challenges they create. Understanding these patterns is crucial for recognising ADHD at any age.

Childhood: The Quiet Struggle

In childhood, girls with ADHD often go unrecognised precisely because they don't fit the stereotype. Unlike boys who might be visibly hyperactive or disruptive in class, girls typically present with:

Quiet inattentiveness that's easily mistaken for daydreaming
Disorganisation that's attributed to carelessness rather than executive dysfunction
Social withdrawal or difficulties that may be labelled as shyness
Strong emotional reactions that get labelled as sensitivity

These girls often struggle with self-esteem from an early age—sensing they're different but not understanding why. Research confirms they experience more peer relationship problems and are frequently targets of social exclusion or bullying because their social cues and behaviours may seem "off" in subtle ways their peers detect.

While boys typically externalise their frustration through disruptive behaviour, girls tend to internalise it—developing anxiety, perfectionism, or withdrawing socially. This internalisation makes their ADHD less visible but no less damaging. Many adult women recall being called "lazy," or "chatty" as children, with no one considering that a neurodevelopmental condition might be at play.

Early identification matters—unaddressed ADHD in girls can lead to academic underachievement, chronic low self-confidence, and vulnerability to mental health issues as they mature.

Adolescence: When Challenges Intensify

The teenage years often bring ADHD into sharper focus as academic demands increase and social dynamics grow more complex:

High school's heavier workload and need for independent organisation can overwhelm coping strategies that worked in earlier years
The intense social pressure of adolescence makes ADHD-related social difficulties more painful
Hormonal changes during puberty often exacerbate symptoms—many girls report their attention difficulties and emotional regulation worsen significantly after beginning mensuration.
Impulsivity combined with a desire for acceptance creates vulnerability to risk-taking behaviours

Research shows concerning patterns: teens with ADHD start engaging in high-risk activities earlier than peers, including sexual activity. Studies have found that approximately 15% of young women with ADHD experienced teen pregnancy, compared to just 3% of those without ADHD—highlighting how impulsivity and social vulnerability can have significant consequences.

This developmental stage also brings increased risk for co-occurring conditions like eating disorders, self-harm, and substance use. Without proper support, some adolescents discover that these maladaptive behaviours temporarily quiet their racing thoughts or provide relief from emotional intensity.

Paradoxically, adolescence is sometimes when diagnosis finally occurs—as academic demands increase, or emotional struggles become more apparent, attentive educators or healthcare providers might finally recognise the underlying ADHD that was missed in childhood.

Adulthood: When the Scaffolding Falls Away

Many women reach adulthood without having their ADHD identified. Some have succeeded academically through exhaustive effort and elaborate compensatory strategies. Others may have struggled but had their difficulties attributed to anxiety, or poor motivation.

Early adulthood often becomes a breaking point as:

University or work environments demand self-management without the external structure that previously helped contain ADHD symptoms
Independent living requires consistent organisation, time management, and follow-through
Relationships become more complex, with ADHD-related emotional intensity or inattention creating interpersonal challenges
Career advancement depends on executive functions that may be compromised by ADHD

At this stage, many women seek help—not for ADHD itself, but for the emotional toll of constantly falling behind despite trying their best. Chronic procrastination, missed deadlines, relationship difficulties, and emotional dysregulation often drive them to therapy, and it is here that ADHD is sometimes finally recognised.

Interestingly, many women are diagnosed after their children receive an ADHD diagnosis—recognising their own lifelong struggles in their child's symptoms and evaluation.

In adulthood, ADHD in women often manifests as:

Persistent disorganisation despite repeated efforts to "get it together"
Time blindness and difficulty estimating how long tasks will take
Struggles with attention, particularly on unstimulating tasks
Emotional reactivity that feels disproportionate or unpredictable
Impulsive choices in relationships, spending, or career moves
A pervasive sense of overwhelm in managing daily life

For women who understand their ADHD and develop effective management strategies, adulthood can also bring strengths to the forefront—creativity, high energy, innovative thinking, and empathy born from their own struggles all become assets in the right environments.

Common ADHD Co-morbidities in Women: Anxiety, Depression, Autism and More

ADHD rarely travels alone. For women with ADHD, additional mental health conditions frequently complicate the clinical picture. Understanding these common "comorbidities" is essential for effective diagnosis and treatment.

The Complex Clinical Picture

While men with ADHD also experience co-occurring conditions, women show significantly higher rates of certain comorbidities. These additional conditions can:

Mask underlying ADHD, delaying diagnosis
Be mistaken for ADHD, leading to misdiagnosis
Develop as a consequence of untreated ADHD

ADHD, Anxiety and Depression in Women

Anxiety and mood disorders appear at strikingly high rates in women with ADHD. Research confirms that girls with ADHD are 5.4 times more likely to be diagnosed with major depression and three times more likely to be treated for depression before their ADHD diagnosis. Results from a large cohort study found that over 50% of women with ADHD had an anxiety disorder and approximately 37% had a mood disorder—roughly double the rates seen in men with ADHD.

This relationship often follows predictable patterns:

Secondary development: Years of struggling with undiagnosed ADHD creates chronic stress, underachievement, and self-criticism that gradually erodes mood and increases anxiety
Symptom overlap: Difficulty concentrating can be a symptom of both ADHD and depression, creating diagnostic confusion
Treatment imbalance: When both conditions co-exist, clinicians often focus solely on treating the mood disorder, missing the underlying ADHD
Incomplete improvement: Treating anxiety or depression alone typically yields limited results when ADHD remains unaddressed

This creates a common scenario: a woman seeks help for anxiety or depression, receives appropriate treatment, but continues to struggle with attention, organisation, and executive function. Only when the underlying ADHD is finally recognised and treated does complete improvement occur.

ADHD and Eating Disorders in Women

Research has identified a strong association between ADHD and eating disorders (EDs), particularly in females. The relationship is striking when comparing prevalence rates:

In the general female population, eating disorders occur at relatively low rates:

Anorexia Nervosa: ~0.9%
Bulimia Nervosa: ~1.5%
Binge Eating Disorder: ~3.5%

However, among women with ADHD, these rates rise dramatically, with studies estimating that 11-16% develop some form of eating disorder. Conversely, ADHD is overrepresented in eating disorder populations:

10-17% of individuals with Anorexia Nervosa (purging type) have ADHD
8.3% of those with Binge Eating Disorder have comorbid ADHD

Several neurobiological and psychological mechanisms connect these conditions:

Impulse regulation difficulties: The impulsivity central to ADHD can extend to eating behaviours, making it difficult to resist urges to binge or purge
Emotional dysregulation: Many women use food to regulate emotions or self-soothe when feeling overwhelmed
Executive function impairments: Difficulty with planning and time management can lead to irregular eating patterns, meal skipping, and subsequent overeating
Compensatory hyperfocus: Some women with ADHD develop intense focus on food, calories, or weight as a way to create a sense of control in contrast to other areas of life that feel chaotic

Importantly, treating the underlying ADHD often leads to improvements in eating disorder symptoms. ADHD medication can help regulate impulsive eating patterns, while cognitive-behavioural approaches addressing both conditions simultaneously typically yield the best outcomes.

ADHD and Autism Spectrum Disorder (ASD): AuDHD in Women

ADHD and Autism Spectrum Disorder (ASD) frequently co-occur. Studies show that 40–70% of individuals with ASD also experience ADHD symptoms, while 20–50% of those with ADHD meet diagnostic criteria for ASD. Until the publication of the DSM-5 in 2013, clinicians were unable to diagnose both conditions in the same individual, which limited research, clinical awareness, and formal recognition of this overlap.

This comorbidity creates unique diagnostic challenges for women, as both conditions are frequently under-diagnosed in females. Women with co-occurring ADHD and ASD (sometimes called "AuDHD") often present with a distinct profile that can appear paradoxical:

Camouflaged/masked social difficulties: Unlike the more obvious social challenges often seen in males, women may develop sophisticated masking strategies that hide their social communication challenges. This often involves meticulously studying and mimicking neurotypical peers—copying conversational patterns, facial expressions, and social behaviours—to create the appearance of intuitive social understanding.
Sensory processing issues: Heightened sensory sensitivities that affect attention and concentration. This often manifests as intensified reactions to sensory input—becoming overwhelmed by certain sounds, textures, lights, or smells that others barely notice.
Executive dysfunction and routine conflicts: Women might simultaneously crave routine and predictability (autism) yet struggle to maintain consistent systems due to executive dysfunction (ADHD). This internal battle between the desire for structure and the inability to implement it leads to a cycle of perfectionism, frustration, and feelings of failure.

Because these patterns differ from traditional male presentations—and are often masked by intelligence and coping strategies during brief clinical assessments—clinicians may overlook the full picture, especially if they are only attuned to one condition.

As awareness and understanding of neurodivergence in women grows, more clinicians are beginning to screen for both ADHD and ASD when symptoms like social exhaustion, sensory sensitivities, or rigid thinking appear alongside inattention or executive challenges.

Recognising this dual profile is critical. Without it, support can become fragmented—targeting one diagnosis while missing the broader context of a woman’s lived experience.

Additional Mental Health Conditions

Trauma History: Women with ADHD are more likely to have experienced childhood trauma, creating a complex interaction between ADHD symptoms and post-traumatic stress. This relationship appears bidirectional:

ADHD symptoms like impulsivity can increase exposure to traumatic situations
Growing up with undiagnosed ADHD in non-supportive environments can create chronic stress and psychological trauma
Trauma can exacerbate executive function difficulties and emotional dysregulation
Both conditions affect similar neurobiological systems involving attention, arousal, and stress response

Studies indicate that women with ADHD report higher rates of adverse childhood experiences (ACEs) and are at increased risk for interpersonal victimisation throughout life. This trauma history often complicates diagnostic assessment, as post-traumatic symptoms can mimic or exacerbate ADHD presentations.

Trauma-informed approaches to ADHD treatment are especially important for women with this complex presentation, integrating strategies that address both neurodevelopmental and post-traumatic aspects of their experience.

Rejection Sensitive Dysphoria: While not yet formally recognised as a distinct diagnosis in the DSM-5, Rejection Sensitive Dysphoria (RSD) is increasingly acknowledged as a common and debilitating feature of ADHD, particularly in women. It manifests as an extreme emotional sensitivity and pain, and can often appear as:

Intense, overwhelming emotional reactions to perceived rejection that feel disproportionate and beyond voluntary control
Anticipatory anxiety about potential criticism leading to avoidance behaviours
People-pleasing tendencies and conflict avoidance
Setting extremely high standards to prevent any possibility of criticism
shutting down or withdrawing when rejection is perceived
Relationship difficulties due to misinterpreting neutral cues as negative

This extreme emotional sensitivity is thought to stem from both neurobiological factors (dysregulation of emotion processing in ADHD) and accumulated experiences of actual criticism or rejection related to undiagnosed ADHD symptoms throughout life. RSD is frequently misdiagnosed as social anxiety, depression, or borderline personality disorder, further complicating the clinical picture for women with ADHD.

Substance Use Disorders: Young women with ADHD have approximately twice the prevalence of substance abuse and smoking compared to peers without ADHD. This elevated risk stems from several factors:

Impulsivity affecting decision-making around substance use
Self-medication attempts to regulate attention, emotions, or sleep
Use of substances to cope with co-occurring anxiety or depression
Social vulnerability and peer influence
Delayed development of executive functions that help regulate behaviour

Many women report unknowingly using substances to manage ADHD symptoms before diagnosis—using nicotine for its stimulant effects on concentration, alcohol to quiet racing thoughts, or cannabis to help with sleep disruption. Research indicates that early treatment of ADHD can reduce the risk of developing substance use disorders, highlighting the importance of timely diagnosis and intervention.

The Diagnostic Journey: Why It's Different for Women

For many women, the path to an ADHD diagnosis is long, winding, and often marked by misdiagnosis and dismissal. This journey typically looks quite different from the more straightforward route many males experience.

Misdiagnosis First: Before receiving an ADHD diagnosis, women are frequently diagnosed with and treated for other conditions:

Anxiety: The racing thoughts and overwhelm of ADHD are often misinterpreted as generalised anxiety
Depression: The chronic stress and self-criticism that can result from untreated ADHD may present as depression
Bipolar Disorder: Emotional intensity and mood fluctuations can be mistaken for mood disorders
Borderline Personality Disorder: Impulsivity and emotional reactivity might be misattributed to personality disorders

One study found that 14% of girls with ADHD had been prescribed antidepressants before their ADHD was diagnosed, compared to only 5% of boys. This pattern continues into adulthood, with many women cycling through multiple diagnoses and treatments that never quite address the root cause.

The Late-Diagnosis Experience:

While boys are typically diagnosed in childhood, women are diagnosed approximately four years later than men on average (23.5 years versus 19.6 years). Many women aren't diagnosed until their 30s, 40s, or even later—often after:

A child or family member receives an ADHD diagnosis, prompting recognition of similar traits
Life transitions (career advancement, parenthood) overwhelm existing coping mechanisms
Menopause reduces oestrogen levels that previously helped modulate symptoms
Self-education through books, social media, or friends' experiences creates awareness

Late diagnosis brings mixed emotions—relief and validation, but also grief for years spent struggling without understanding why. Many women describe a process of reframing their life history through this new lens, recognising that what they perceived as personal failings were actually untreated ADHD.

ADHD Treatment and Management for Women: Medication, Therapy, and Lifestyle

Effective ADHD management typically involves a personalised, multimodal approach tailored to a woman's specific symptom profile, life circumstances, and hormonal patterns.

Medication Considerations:

While the same medications are used for all genders, women may experience unique considerations:

Hormonal Interactions: Fluctuating hormones throughout the menstrual cycle can affect medication efficacy. Many women report their medication seems less effective during the luteal phase (week before menstruation) when oestrogen levels drop.
Dosing Flexibility: Some women benefit from adjustable dosing approaches—for example, slightly higher doses during premenstrual phases when symptoms typically worsen.
Pregnancy and Breastfeeding: Treatment decisions during pregnancy require careful risk-benefit analysis. While stimulant medications were historically discontinued during pregnancy, recent research suggests some medications may have acceptable safety profiles. These decisions should be made individually with knowledgeable healthcare providers.
Menopause: Declining oestrogen during perimenopause and menopause can significantly impact ADHD symptoms and medication response. Treatment plans may need adjustment during this transition.

Psychological Approaches:

Several therapeutic modalities can be particularly beneficial for women with ADHD:

Cognitive-Behavioural Therapy (CBT) for ADHD: Addresses the thought patterns and behaviours that have developed from years of untreated ADHD. CBT can help women develop organisational strategies, challenge negative self-perception, and build self-compassion.
Dialectical Behaviour Therapy (DBT) Skills: Particularly helpful for emotional regulation challenges. DBT provides concrete techniques for managing intense emotions, improving interpersonal effectiveness, and developing mindfulness.
Acceptance and Commitment Therapy (ACT): Helps women clarify their values and take committed action despite the challenges of ADHD, while also practicing acceptance of neurodiversity.
Group Therapy: Provides validation and reduces isolation. Many women find enormous relief in connecting with others who share similar experiences.

Lifestyle Foundations:

These approaches enhance overall functioning and can improve response to other treatments:

Exercise: Regular physical activity has been shown to improve attention and boost mood—particularly important for women who may be more susceptible to co-occurring depression and anxiety.
Sleep Hygiene: ADHD often impacts sleep quality, creating a vicious cycle as sleep deprivation worsens ADHD symptoms. Establishing consistent sleep routines is crucial.
Stress Management: Regular stress-reduction practices (mindfulness, yoga, time in nature) can help regulate the nervous system and improve executive function.
Nutrition: While no specific diet "cures" ADHD, stable blood sugar helps prevent energy crashes that worsen attention. Some women find that protein-rich meals provide more sustained focus.
Hormonal Support: For some women, hormonal treatments (such as hormone replacement therapy during menopause) may help stabilise ADHD symptoms that fluctuate with hormonal changes.

The Importance of Individualised Care

Effective ADHD treatment is not one-size-fits-all. Women’s needs often shift across life stages, influenced by hormonal changes, evolving responsibilities, and co-occurring conditions. Treatment should be collaborative, flexible, responsive, and regularly reviewed to ensure they remain aligned with each individual’s experiences and goals

Diagnosis as a Turning Point: Finding Language, Relief, and Self-Compassion

For many women, receiving an ADHD diagnosis in adulthood is more than a label—it marks a turning point. Longstanding struggles begin to make sense, and what once felt like personal failings are reframed as symptoms of a neurodevelopmental condition. But while diagnosis brings clarity, it can also introduce a complex emotional landscape that takes time to process.

The emotional Journey of Late Diagnosis

Relief and Recognition
The initial response is often one of profound relief—finally having a framework to explain years of frustration, confusion, and self-doubt. Many women describe the experience as validating and even transformative: for the first time, they feel truly seen.

Grief and Reflection
Relief is frequently followed by grief—grief for missed opportunities, strained relationships, and the years spent internalising blame. This phase can be painful but is also an essential part of healing, as women begin to re-evaluate their past through a new lens.

Integrating Identity
Gradually, the diagnosis becomes part of a broader self-understanding. ADHD is no longer seen as a flaw, but as one dimension of a complex neurological profile—bringing both challenges and strengths. This shift allows space for self-acceptance and redefinition.

Compassion and Reframing
Perhaps most powerful is the development of self-compassion. Where once there was blame, there is now understanding: the recognition that past difficulties were not the result of personal inadequacy, but of an unsupported brain trying to navigate an unsupportive world.

Reclaiming the Future

For women with ADHD —diagnosis doesn’t erase the past, but it can help make sense of it. It offers language for experiences that once felt isolating, and a clearer path forward. With the right support, many Women with ADHD begin not only to manage their symptoms, but to develop agency and a renewed sense of trust in themselves and their capabilities.

They can start building a life that reflects their values, goals, and strengths—designed by them, for them—with greater clarity, self-awareness, and kindness.

At Kantoko, we emphasise treating the whole person, not just a collection of symptoms. Our goal is supporting women and adults in creating lives that reflect their authentic selves, while providing meaningful care and support for navigating a world not always designed for them.

Whether you're navigating a new diagnosis, exploring whether ADHD might be part of your story, or supporting someone you care about, we’re here to walk with you—offering clarity, guidance and care that honours both the challenges and strengths that come with ADHD. Ready to take the first step? Get started with us today.

This article is for general informational purposes only and does not constitute a diagnosis or individual medical advice. While Kantoko offers ADHD assessment and support services, this content is not a substitute for a consultation with a qualified healthcare professional. If you’re concerned about ADHD, we encourage you to speak with your GP or connect with one of our clinicians.