ADHD in women

ADHD in women is common, and frequently missed

For much of the history of ADHD, the condition was studied and described mainly in young boys. The picture that became familiar (the restless, disruptive child who cannot sit still) was drawn largely from how ADHD tends to look in boys. The diagnostic criteria, the screening tools and the public image of ADHD all grew out of that narrower view. One consequence is that generations of girls and women were never recognised, because their experience of ADHD did not match the stereotype.

That is now changing. ADHD is understood to affect women and men, and awareness of how it presents in women has grown considerably. A large number of women are being assessed for the first time in their thirties, forties and fifties, often after years of sensing that something did not add up, and after being told that what they were describing was simply stress, anxiety or not coping. ADHD is a recognised neurodevelopmental condition, not a personality flaw or a lifestyle problem, and it does not disappear in adulthood.

Why ADHD is so often overlooked in women

A narrow idea of what ADHD looks like

ADHD has three recognised presentations: predominantly inattentive, predominantly hyperactive-impulsive, and combined. Women are more likely to have a predominantly inattentive presentation: difficulty sustaining attention, disorganisation, forgetfulness, losing track of tasks and a mind that is hard to settle. These difficulties are quieter than overt hyperactivity, less likely to disrupt a classroom or an office, and therefore far less likely to prompt anyone to suggest an assessment. In Dr Crocker’s experience, women are also often far better at masking these features, so that their outward presentation under-reflects the severity of their internal struggle. A girl who is daydreaming and struggling silently rarely gets referred; a boy who is climbing the furniture usually does.

Masking and compensation

Many girls and women develop strategies that hide their difficulties from the people around them. This is often called masking. It can take the form of intense effort, perfectionism, over-preparation, elaborate list-making and reminders, people-pleasing, or simply working far harder than peers to reach the same result. Masking can be effective enough that ADHD goes unnoticed by teachers, employers, partners and clinicians for decades. But it comes at a cost: it is exhausting to maintain, and it tends to break down at points of increased demand, such as starting university, beginning a demanding job, becoming a parent, or reaching perimenopause. Dr Crocker has always described masking with the swan analogy: a woman may look placid and relaxed above the waterline, but underneath only she knows how hard she is having to kick.

Symptoms mistaken for something else

Because the inattentive and internalised features of ADHD overlap with other conditions, women are frequently diagnosed with anxiety or depression first, and the underlying ADHD is not considered. Difficulty regulating emotion, low self-esteem and chronic overwhelm can be read as features of mood or personality rather than as part of an attention difficulty. Anxiety and depression genuinely do co-occur with ADHD, but persistent, untreated ADHD is very good at causing both. When they are treated in isolation, and the ADHD beneath them is missed, the response to treatment is often incomplete.

How ADHD can present differently in women

There is no single way that ADHD presents, and every person is different. That said, the following features come up often when women describe their experience:

• Inattention, disorganisation and difficulty with planning, prioritising and finishing tasks
• An internal sense of restlessness or a busy, racing mind, rather than visible physical hyperactivity
• Emotional sensitivity, and a strong reaction to perceived criticism or rejection
• Feeling persistently overwhelmed by the combined load of work, home, relationships and caring responsibilities
• Low self-esteem built up over years of feeling that one has to try harder than everyone else to keep up
• Co-occurring anxiety, low mood, or difficulties with sleep

Hormones and ADHD across a woman’s life

Why diagnosis often comes later in life

It is very common for women to be assessed for ADHD only in mid-life. There are a few recurring reasons. One is that a child is assessed and diagnosed, and in learning about ADHD a parent recognises a great deal of their own experience. Another is reaching a point where the usual coping strategies are no longer enough: a new and more demanding role, the arrival of children, or the hormonal changes of perimenopause can all tip a previously manageable situation into burnout. For many women, a diagnosis later in life brings a sense of relief and a kinder explanation for difficulties they had spent years attributing to personal failure.

What a thorough assessment involves

ADHD cannot be diagnosed from a single questionnaire. A screening tool can be a useful starting point and can help decide whether a full assessment is worthwhile, but it is not a diagnosis. You can try the validated questionnaires the practice uses on the screening questionnaires page.

A proper assessment, carried out in line with NICE guidance and Royal College of Psychiatrists standards, looks at the whole picture. Caledonian Psychiatry works to the AQAS standards, a recognised quality framework that helps guard against both the overdiagnosis and the underdiagnosis of ADHD. Because ADHD is a neurodevelopmental condition, the assessment looks for evidence that some traits were present in childhood, even where they were never recognised at the time. It considers current symptoms across different areas of life, the impact those symptoms have, and other explanations that need to be excluded or accounted for, including anxiety, depression and autism. Where possible, information from someone who has known the person a long time can be helpful, and it matters that the assessor understands how ADHD presents in women, so that an inattentive, well-masked presentation is not dismissed.

Many people worry about the requirement for evidence of childhood symptoms, yet childhood is often the hardest period to reconstruct in hindsight. So try not to worry: school reports are helpful, and a relative who noticed these features in childhood is better still, but the absence of either should not put anyone off having an assessment.

Getting an assessment with Caledonian Psychiatry

Caledonian Psychiatry is a private psychiatric practice regulated by Healthcare Improvement Scotland (reg. no. 03427), providing assessments remotely to adults across Scotland. Assessments are carried out by our psychiatrists (MRCPsych), each experienced in adult ADHD and autism assessment.

No GP referral is needed: you can refer yourself directly using the contact form below, or by emailing or calling the practice. The practice does ask for a copy of your GP summary records (usually available from your GP) and, ideally, a brief GP letter, as this makes everything easier. Not involving your GP will not preclude an appointment or a diagnosis, but it may restrict the practice’s ability to prescribe, particularly controlled medications, where applicable.

A private ADHD assessment is £800, covering two 60-minute consultations and a detailed written report for you. With your consent, the report is also shared with your GP to support a conversation about treatment and, where appropriate, shared care. See the fees page for the full schedule, or read more about the ADHD assessment itself.