Why ADHD Hits Women Harder: The Overlooked Struggle
Main, points no filter:
✅ ADHD in women is historically missed and misunderstood. ADHD was long defined by how it showed up in boys—loud, hyper, and disruptive. Girls didn’t fit that mold, so they were ignored, misdiagnosed, or labeled with anxiety, depression, or just “too sensitive.” The system was never built to see them.
✅ Research is decades behind—and biased. Most studies excluded females because of hormones or pregnancy risks, meaning the DSM criteria and most diagnostic tools are skewed toward how ADHD shows up in boys. This leaves girls and women falling through the cracks, often blaming themselves for symptoms they were never taught to recognize.
✅ Hormones make everything harder. ADHD symptoms in women aren’t stable—they shift with hormonal changes during menstrual cycles, pregnancy, and menopause. That means their executive dysfunction, brain fog, and emotional dysregulation can vary wildly, making treatment harder and life more exhausting.
✅ The mental load is real—and gendered. Executive dysfunction hits differently when you’re expected to do it all. Society grooms women to manage households, multitask, and remember everything—things ADHD makes brutally difficult. Meanwhile, men are often given a pass for the same struggles.
✅ The cost of being undiagnosed is devastating. ADHD is more than being “scatterbrained.” When untreated, it shortens lifespans and increases the risk of physical and mental health issues. But perhaps the heaviest toll is internal: the shame, the missed opportunities, the decades of thinking “something’s wrong with me.”
Read enough, want to talk through this? Schedule a consult. Want to read more? Take a deep dive below:
I was in elementary school in the early 90’s and graduated high school in the early 2000s. I remember the stigma of the “Ritalin kid” and the kids who went to the nurse’s office in the middle of the day to take medicine. I remember these were the children that the teachers were always correcting or sending to the principal’s office. From what I remember, the boys were getting scolded. I don’t remember the girls getting in trouble for jumping off their desks. Fast
Fast forward twenty-five plus years since high school graduation. Add a family of four, one global pandemic, and one late ADHD diagnosis. It is clear why ADHD in women is often missed, misdiagnosed, or misunderstood.
ADHD was defined as a childhood disorder manifested in little boys that couldn’t sit still and were always getting corrected by the teachers. Because little girls with ADHD don’t often match these criteria, they are overlooked by teachers, parents, and pediatricians.
Furthermore, if girls do display this behavior the cultural expectations often lead them to mask their behaviors, internalizing them. This often leads to other mental health diagnoses or challenges. It is important to understand that ADHD in women often presents differently due to biological, cultural, and systemic factors that uniquely impact them.
The Research Gap: most research does not include female specific symptoms
Historically, ADHD research mostly involves boys and young men. Here are some reasons why:
Boys with ADHD tend to have more visible, disruptive behaviors than girls, making the symptoms, and the boys, more noticeable.
Historically, studies didn’t include females because they could be or get pregnant during the trials.
The hormonal influence on efficacy of treatment is too difficult to control for in a study.
Girls and women with ADHD are misunderstood because the research is decades behind.
Since there is less data about females with ADHD and how symptoms present, the criteria listed in the DSM (a book used to diagnose mental health disorders) tends to capture a skewed view. The assessments, especially the ones more readily available, do not capture the nuances of symptoms as they are presented in girls.
As the misdiagnosed or undiagnosed girls grow up, their symptoms leave them feeling less than or different than their peers. The symptoms are also exacerbated by hormone fluctuations. You can listen to the podcast ADHD for Smartass Women to get a more in-depth explanation about the biases. I have it saved in a playlist on my YouTube channel, be sure to give it a listen.
Hormones and Dopamine: A Complex Chemical Relationship
Here are some facts:
ADHD is rooted in dopamine dysregulation.
Estrogen plays a key role in how dopamine functions in the brain—fluctuations in hormone levels (monthly cycle, pregnancy, perimenopause) = fluctuations in ADHD symptoms.
Women with ADHD often experience heightened emotional dysregulation, brain fog, and executive dysfunction during hormonal shifts.
This makes symptom management more unpredictable and harder to treat consistently.
A women’s estrogen levels peaks and falls twice during a typical menstrual cycle.
The patterns are more irregular when a female first starts menstruating and then again when nearing menopause.
This means that behaviors and struggles and can ebb and flow within a 28-day cycle and across a lifespan. What a woman in her twenties may be able to navigate easily will be more difficult after childbirth or during perimenopause when the levels of hormones change dramatically.
Executive Function is Gendered Work
What are executive functions?
Executive functions refer to the processes in our brains that help us to execute tasks. Think of them as the executive suite of a corporation. Executive functions develop in a particular order as you grow and are “fully” developed in your mid-twenties, a little later (and less “fully”) if you have ADHD.
Executive function is judged by the strength of these seven skills:
1. Self-awareness:
2. Inhibition:
3. Non-Verbal Working Memory:
4. Verbal Working Memory:
5. Emotional Self-Regulation:
6. Self-motivation:
7. Planning and Problem Solving:
Read more about these functions in an article by Dr. Russel Barkley.
What is gendered work?
Cultural expectations place the burden of invisible labor—planning, remembering, multitasking—on women. Women are groomed for this from childhood with the games and toys that they are expected to play with.
Think of the first time you changed a diaper. If you are a woman, it was probably at a much younger age than a male. Girls babysit and watch their younger family members while boys are groomed for other tasks. This is by no means a global statement and the world is slowly shifting, but it is also important that we don’t ignore the water we are swimming in.
The intersection of executive functions and gendered work.
Generally, in personal and professional roles, men often have support in doing gendered tasks. They have assistants in the office that remind them of deadlines and due dates. If they are in a hetero relationship, the female partner is expected to organize the household.
Men are also more readily excused for missteps and forgetfulness with a “boys will be boys” explanation. Forgetting tasks or being disorganized is endearing in a male and inexcusable in a woman.
The struggle for a woman with ADHD is two-fold. They struggle to keep up with life and because they are expected to do this flawlessly, they experience shame and guilt when they fall short.
There was chatter during the height of COVID that ADHD was being over diagnosed and people were being overmedicated. I see these numbers as proof that women simply couldn’t hold their shit together anymore. The structure and routine in their professional life was taken away while simultaneously adding the responsibility of virtual learning.
Note: I am not a man hater, I am speaking in general terms. I want to take a moment to acknowledge the men who go above and beyond for their families and pull women up with them as they grow personally and professionally.
The Cost of Being Missed or Misunderstood
We have discussed the reasons why ADHD is missed in girls and women. But why is this important?
Think of ADHD like diabetes. If a person is diagnosed with diabetes, they can make changes to their lifestyle to minimize the impact on their body. If left untreated, diabetes will eventually impact their entire body and lead to heart disease, kidney disease, eye damage (potentially leading to blindness), nerve damage (neuropathy), and increased risk of infections and slow healing.
People with untreated ADHD have a lifespan on average seven years shorter than their neurotypical peers. Additionally, there is a higher risk of other physical health conditions plus increased rates of suicide, anxiety, and depression.
Let’s not forget the emotional toll that isn’t technically a “diagnosis” like: self-doubt, imposter syndrome, low self-worth.
Late diagnosis often means years of internalized shame and missed opportunities.
Moving Forward: Validation and Advocacy
So what can you do?
You can have conversations about ADHD in women. Even if you aren’t a woman or you don’t have ADHD. Statistically speaking, you know someone with ADHD. Talking openly about the symptoms without the shame, guilt, and judgment will help normalize the conversation.
Support organizations that advocate for research that includes hormonal and gender-specific experiences. This isn’t just for ADHD, this is for any research.
Remove the stigma around ADHD and encourage women to seek evaluation, support, and community—especially those who “never fit the mold” but always felt something was off.
If you’re a woman who’s struggled silently with focus, overwhelm, and burnout—know that it might not be you. It might be undiagnosed ADHD, and you’re not alone. Set up a consult, let’s chat.
📚 Further Reading on ADHD in Women
Want to dig deeper into why ADHD often hits women harder? These resources break down the science, the lived experience, and what we’re still getting wrong.
“A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls”A comprehensive overview of how ADHD manifests differently in females—emphasizing inattentive presentations, diagnostic challenges, and the impact of hormonal changes.👉 Read it on PubMed
“The Unique Challenges Faced by Women With ADHD”(Psychology Today)Explores how hormonal cycles (menstrual, pregnancy, menopause) affect ADHD symptoms, and discusses coping hurdles unique to women.👉 Read the article
“Why ADHD Is Missed in Women” (Psychology Today)Highlights diagnostic bias—women often internalize symptoms and experience mood shifts during hormonal changes, leading to misdiagnoses.👉 Read it here psychologytoday.com
“ADHD and Menopausal Madness”** (Psychology Today)Discusses how the drop in estrogen during menopause can mimic or worsen ADHD-like symptoms by affecting dopamine.👉 Read the article
“Females with ADHD: An Expert Consensus Statement” (Young et al., 2020)A research panel review emphasizing the need for gender-specific ADHD assessment and treatment over the lifespan.👉 Read the abstract
"A Review of ADHD in Women and Girls" – A helpful overview of how ADHD shows up differently in females and why it's often missed. Read it here
How ADHD Manifests Differently in Women
(Psychology Today) – Explains how your cycle, pregnancy, or menopause can make ADHD symptoms worse. Read it here
"ADHD: What Everyone Needs to Know" by Stephen Hinshaw and Katherine Ellison – A great book that covers the science and stigma of ADHD, with a section on women’s unique struggles. Find it on Bookshop.org