ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental condition that often goes unrecognized in girls and women.
While traditionally associated with hyperactive boys, ADHD manifests differently in females, presenting unique challenges that can persist into adulthood.
Girls and women with ADHD may struggle with inattention, organization, and emotional regulation, often leading to difficulties in academic, professional, and social settings.
The subtle signs of ADHD in females can include daydreaming, anxiety, perfectionism, and people-pleasing behaviors.
Recognizing these less obvious symptoms is crucial for proper diagnosis and support, as ADHD can significantly impact a woman’s daily life, self-esteem, and overall well-being.
This article explores the often-overlooked signs of ADHD in girls and women, aiming to increase awareness and understanding of how this condition uniquely affects the female population.
To ensure clarity, it is important to note that in this article, the terms ‘girls,’ ‘women,’ and ‘females’ will specifically refer to individuals who identify as cisgender.
This is due to limitations in the research on ADHD, which often do not specify whether gender non-conforming individuals or transgender women are included.
Signs of ADHD in Girls And Women
Girls and females with ADHD can experience similar signs related to the disorder such as inattention, difficulty with organization, motivation issues, and hyperactivity.
However, there can be differences in how ADHD presents in females compared to males, often with more subtle symptoms that can be easily overlooked.
Here are the key signs to watch for in girls and women:
Inattention and Difficulty Focusing
Girls and women with ADHD often struggle with maintaining focus and attention, but this may manifest in less obvious ways:
- Daydreaming or appearing “spacey”
- Difficulty following conversations or instructions
- Trouble completing tasks from start to finish
- Needing more time to process information
Dr. Jacque Bogdanov, a Licensed Child Psychologist, notes:
“Girls are more likely to have problems with distractibility, but not always distractibility with things going on around them. Instead, they can easily be distracted by what’s going on internally, like their thoughts. And this can be hard to notice.”
Internalizing Signs
Girls and women with ADHD are more likely to experience internalizing problems compared to boys.
This means they tend to direct feelings and behaviors inward rather than outward, making their symptoms less visible and often harder to recognize.
Key manifestations, signs, and consequences include:
- Anxiety, excessive worry, and rumination
- Depression or persistent low mood
- Social withdrawal and difficulty maintaining relationships
- Difficulty expressing emotions
- Increased risk of mood disorders
- Academic or professional underachievement despite high potential
- Chronic stress and burnout from trying to meet expectations
As one woman with ADHD described:
“You have so many thoughts in your head that, in the end, it just becomes stressful.” (Öster et al., 2019)
Emotional Sensitivity and Regulation
Females with ADHD often experience intense emotions and struggle with regulation:
- Mood swings and irritability
- Difficulty calming down when upset
- Emotional outbursts that seem disproportionate
- Tendency towards anxiety and depression
As one woman with ADHD described:
“I remember having temper tantrums that would scare me, because I realized that I couldn’t control them, and I didn’t even know why I was so upset.”
Compensatory Behaviors and Perfectionism
To mask their struggles, many girls and women with ADHD develop coping mechanisms:
- Becoming perfectionists or overachievers
- Obsessively over-preparing for tasks
- Creating rigid routines to manage disorganization
- Working excessively long hours to keep up
Dr. Muffazal Rawala, a Consultant Adult Psychiatrist and ADHD expert, explains:
“…were they actually coming in earlier, staying up late to manage their workload when the distractions of an office environment were not there? So what were the compensatory mechanisms which this individual has put in their lives in order to perhaps mask some of these symptoms of having attention dysregulation or time management poor organizational abilities.”
Social Difficulties and People-Pleasing
The social world for girls with ADHD may be more complicated than that of boys and men.
Girls may feel more pressure to pay close attention to their friend’s feelings, or they may have to pick up on subtle social cues, which can prove hard for someone with ADHD.
If they find difficulty in paying attention to their friends and can be impulsive in conversations (e.g., interrupting), this can cause a rift and fallout.
Verity is a 10-year old girl with ADHD. She struggles to maintain friendships and often feels left out at school. Verity tries to join groups at recess but has a hard time listening to her friends talk about their interests. She frequently interrupts them or changes the subject to talk about something she finds more exciting. This frustrates her peers and leads to arguments.
Verity's ADHD symptoms like poor listening skills, impulsivity, and trouble staying focused impact her ability to maintain positive social connections.
ADHD can significantly impact social interactions for females:
- Struggling to maintain friendships
- Difficulty picking up on subtle social cues
- Interrupting or dominating conversations
- Tendency towards people-pleasing behaviors
A female student with ADHD shared:
“I think because of the self-esteem issues, it has affected me socially because I’ve become a people pleaser. And so, a lot of the time, rather than just being myself and sticking to my values, a lot of the time I’m trying to meet the values of others around me.”
Overwhelm and Executive Function Challenges
Girls and women with ADHD often feel overwhelmed by daily responsibilities:
- Difficulty managing multiple tasks
- Chronic disorganization and messiness
- Poor time management
- Forgetfulness with important dates or assignments
Dr Muffazal Rawala, Consultant Adult Psychiatrist and ADHD expert explains how life can feel chaotic:
“As soon as responsibilities increase with increasing… demands on their personal lives, maybe they’ve entered into a relationship or parenthood. So think of it as the more balls you have to juggle in the air at some point in the life, things start falling apart.”
One woman described her experience:
“When I become so stressed that I can’t do anything, then I lie down and stop caring and I feel like I’m a failure.”
Imposter Syndrome and Low Self-Esteem
Imposter syndrome is common in girls and women with ADHD who are high achievers.
Even when they accomplish great things, they often feel like a fraud who does not deserve their success.
Jess, who has ADHD, earns straight As in school through tremendous extra studying, coping strategies, and help from tutors. Her classmates simply see a smart student who gets top grades. Because they don't witness her struggles, Jess feels like an imposter who sneaked into the "top student" role rather than deserving it. She doubts her abilities and wonders if she could keep up the performance without all the compensation techniques. This erosion of self-confidence worsens the imposter syndrome.
The constant struggle to keep up can lead to:
- Feeling like a fraud despite achievements
- Chronic self-doubt and negative self-talk
- Attributing successes to luck rather than ability
- Internalizing criticisms and failures
A woman with ADHD explained:
“You really internalize that criticism of not meeting the mark, of not being capable enough where other people seem to manage effortlessly.”
“One study we looked at suggests that ADHD in females – especially when it involves hyperactive/ impulsive symptoms – can increase the risk of self-harm when there is also emotion dysregulation.” (from Rosenthal, 2021)
Hormonal Fluctuations and ADHD Symptoms
Recent research suggests that hormonal fluctuations during the menstrual cycle can significantly impact ADHD symptoms and medication effectiveness in women.
During the luteal phase, when estrogen levels drop, women with ADHD may experience worsening of symptoms and decreased response to stimulant medications.
This can lead to increased inattention, emotional dysregulation, and mood disturbances in the premenstrual period.
Some clinicians have found success in adjusting stimulant medication dosages during the premenstrual phase to compensate for these hormonal changes.
This approach may help maintain consistent symptom management throughout the menstrual cycle. However, it’s crucial to note that such adjustments should only be made under medical supervision.
Understanding the interplay between hormones and ADHD symptoms can lead to more personalized and effective treatment strategies for women.
It highlights the importance of tracking menstrual cycles and symptoms to identify patterns and optimize treatment.
This emerging area of research underscores the need for gender-specific approaches in ADHD management.
Why ADHD is Often Missed in Females
ADHD in girls and women is frequently overlooked due to:
- Less obvious hyperactivity compared to boys
- Compensatory behaviors masking symptoms
- Internalizing problems rather than externalizing
- Societal expectations for girls to be well-behaved
As Rosenthal (2021) noted:
“Compared to boys and men, girls and women with ADHD may have symptoms that are less noticeable to others. This is because they often have an inattentive presentation of ADHD, with symptoms such as difficulties with organization, focus and attention to detail.”
Recognizing these subtle signs is crucial for proper diagnosis and support, as ADHD can significantly impact a woman’s daily life, self-esteem, and overall well-being.
Early identification and intervention can lead to better outcomes and improved quality of life for girls and women with ADHD.
Managing ADHD in Girls and Women
While ADHD presents challenges, evidence-based strategies can help girls and women effectively manage symptoms.
- Academic accommodations like additional time for assignments allow girls to excel despite focus issues.
- Cognitive-behavioral therapy helps build coping skills for organization, emotional control, and social skills.
- Coaching provides personalized strategies for managing distractions, transitions, and overwhelm.
- Medication can alleviate ADHD symptoms but should be carefully evaluated by doctors, as girls may be more sensitive to side effects.
- Support groups connect women with ADHD to share ups and downs without judgment.
- Mentoring programs can help to build self-esteem and guidance.
- Daily movement (e.g., cardio exercises) and mindfulness help channel excess energy and emotions.
- Most importantly, compassion and patience from others, as well as themselves, allow girls and women with ADHD to navigate challenges while valuing their unique skills and talents.
- Self-help strategies that you can implement yourself, e.g., creating an ADHD-friendly environment, identifying your strengths, and letting go of perfectionism.
FAQs
Can girls and women with ADHD experience difficulties in relationships?
Yes, girls and women with ADHD can experience difficulties in relationships.
ADHD symptoms, such as impulsivity, forgetfulness, and inattentiveness, can impact their ability to effectively communicate, listen, and maintain focus within relationships.
This may lead to misunderstandings, conflict, and challenges in meeting relationship expectations.
However, with awareness and support, individuals with ADHD can develop strategies to manage their symptoms and enhance their relationship skills, fostering healthier and more fulfilling connections with others.
Can ADHD symptoms change during different life stages for females?
Yes, ADHD symptoms can change during different life stages for females.
Hormonal fluctuations during puberty, menstruation, pregnancy, and menopause may exacerbate ADHD symptoms in women. This can lead to changing symptom presentation over the lifespan (Antoniou et al. 2021).
‘We’re recognizing that… often their symptoms get worse before their periods and also after menopause when estrogen drops.’
Professor Amanda Kirby
What are some common misconceptions about ADHD in girls and women?
Before realizing they have ADHD, girls and women may be attributed negative labels such as:
“Lazy” or “unmotivated” due to difficulties with focus and productivity.
“Airheaded” or “scatterbrained” because of forgetfulness and disorganization.
“Spacey” or “daydreamer” as a result of inattentiveness and zoning out.
“Emotional” or “moody” due to challenges in regulating emotions and impulsivity.
“Underachiever” because of inconsistencies in academic or professional performance.
“Unreliable” or “flaky” because of difficulty with time management and meeting commitments.
These labels often overlook the underlying neurobiological factors of ADHD, leading to misunderstanding and frustration for the individuals involved.
Further Reading
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References
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