Why ADHD in women is underdiagnosed

Published March 2024 | 6 min read
Expert contributors Dr Tamara May, clinical psychologist; Vivian Dunstan, founder, ADHD Support Australia
Words by Angela Tufvesson 

ADHD is often associated with gender stereotypes and different presentations, leaving many girls undiagnosed into adulthood. Learn about the signs of ADHD in women.

As a child, Katie Airey had trouble keeping on top of daily tasks, sitting still and paying attention. She found it difficult to think through her actions and maintain relationships, especially as she got older.

"I struggled with all types of relationships and would make the same mistakes over and over on a loop," she says. "I hadn’t held down an intimate relationship past around six months, and friendships came and went within the blink of an eye. People could see that I was different but could never fully put their finger on what it was."

It wasn't until Katie was 30 years old that she was finally diagnosed with attention deficit hyperactivity disorder (ADHD).

"During the big lockdown in Melbourne in 2020, I began noticing that things were not as they should be. Like everyone, I hugely struggled with lockdown, but it was becoming more than just a struggle," she says.

"I was a primary school teacher and was used to a job that was all-consuming and very active. Working from home from a laptop screen was driving me mad, and my pent-up energy and frustrations began to fully overwhelm me."

After an appointment with her GP and a referral to a psychiatrist, Katie says her diagnosis came as an enormous relief. "I have learned how to make and maintain relationships so much better, and I developed self-compassion, which was completely alien to me," she says.

Typically diagnosed in childhood, ADHD was once thought of as a predominantly male disorder, although research suggests that ADHD affects males and females equally. Boys are much more likely to receive a diagnosis, and while the gender disparity reduces in adulthood, many women with ADHD only find out they have the condition later in life – or not at all, which impedes access to treatment and support.

What is ADHD?

ADHD is a neurodevelopmental condition that impacts the brain’s executive functions. Common symptoms include difficulty with paying attention, controlling impulsive behaviours, and planning and organising tasks.

"You have trouble managing your time and you’re often late. You might procrastinate and not want to start a task because you feel overwhelmed," explains ADHD Support Australia founder Vivian Dunstan, who was diagnosed with the condition at the age of 55.

"It's also forgetting where you've put things and feeling restless. People with ADHD sometimes find it really hard to get good sleep, and unfortunately lack of quality sleep exacerbates the symptoms of ADHD."

There are three main types of ADHD, depending on which symptoms appear most:

Inattentive ADHD

• Difficulty concentrating
• Difficulty staying focused
• Trouble organising tasks
• Often losing things
• Poor attention to detail
• Forgetting to perform daily activities like housework or homework

Hyperactive-impulsive ADHD

• Fidgeting and restlessness
• Difficulty sitting for long periods of time
• Difficulty engaging in quiet activities
• Acting or speaking before thinking things through
• Frequently shifting tasks without completing the first task
• Difficulty standing in line or waiting

Combined-type ADHD

• Symptoms of both inattentive and hyperactive-impulsive ADHD

Adult ADHD symptoms may be more internalised and less obvious than those in children with ADHD. Obvious hyperactivity in childhood may become an inner sense of restlessness as you get older. Periods of being organised may alternate with periods of feeling overwhelmed. Severe procrastination and a poor sense of time may persist.

How does ADHD present in women and girls?

It's estimated that one in 20 children in Australia have ADHD, while international studies report that about 3% of adults worldwide have been diagnosed with the condition. However, growing public awareness and acceptance of ADHD has led to a sharp increase in people seeking assessment and support – especially in adulthood – so the true numbers may be higher.

Even though, historically, ADHD has been diagnosed more commonly in boys than girls, experts say this isn’t because girls are less susceptible. Instead, ADHD in women and girls may present a more socially acceptable set of symptoms that mask the true nature of the condition.

"While the symptoms are the same, some symptoms may appear slightly differently due to stereotypes or expectations that differ for girls and boys," says clinical psychologist Dr Tamara May, who works with adults with ADHD.

"A girl's hyperactivity may present as talkativeness and be seen as a positive social trait but not as a symptom of ADHD, despite it impacting on friendships and the girl perhaps being perceived as 'annoying' by peers," says Dr May.

Research shows that girls are more likely to present with inattentive ADHD, while boys are more likely to have ADHD of the hyperactive or combined type.

"Many people will have the inattentive type of ADHD that can go under the radar because the symptoms are more internal – for example, daydreaming, not listening when spoken to and having difficulties concentrating and focusing attention," says Dr May.

"If girls and women haven't fitted the stereotype of ADHD, they are frequently missed or diagnosed with other conditions like anxiety or depression."

A similar pattern of gender bias has emerged in autism diagnoses, with girls under-represented in the data due to different ways in which their autistic characteristics present compared with boys.

Common ADHD symptoms in women

Dr May says the rise of ADHD influencers and high-profile women like Mia Freedman and Em Rusciano sharing their ADHD diagnoses has resulted in more women seeking assessments and getting much-needed support.

Building on this momentum, a 2023 Senate inquiry found Australia needed a government-funded national framework to address ADHD. It recommended an increase in the number of healthcare professionals, particularly GPs and nurses, who can contribute to assessment and support services.

At present, adult ADHD is diagnosed by a team of professionals, including a GP, psychologist and psychiatrist, who examine your physical and mental wellbeing, health history and other records like school reports or family accounts.

Vivian from ADHD Support Australia says that many women diagnosed with ADHD recall struggling with the demands of independent study during secondary school, while others may have had a diagnosis of anxiety or depression.

"ADHD can be mistaken for anxiety because anxiety has similar symptoms," she says. "For example, if you're anxious about something, you also can't focus. You might not be able to sleep, and you might also be forgetting things and losing things and not be able to get on with things."

Dr May says other common signs for women include feeling like you don't fit in, not being at the same stage as your peers in life milestones, struggling to maintain jobs or not progressing in your career, and finding it hard to maintain your life – managing life admin and responding to friends in a timely way.

Emerging evidence also suggests that ADHD symptoms may be affected by the menstrual cycle, but this potential link needs to be studied further. You might notice your attention is better before ovulation and worse after, or that your symptoms have become worse during perimenopause.

Treatment for adult ADHD

A large body of evidence supports the use of medication in the treatment of adult ADHD. The number of Australians being prescribed medication for ADHD more than doubled between 2018 and 2022, according to a 2023 health department briefing published under freedom of information laws.

Best results usually come from using medication in combination with psychological strategies like cognitive behavioural therapy (CBT), which teaches skills to reduce the impact of ADHD.

"I do take medication," says Katie. "I also have regular appointments with my psychologist and psychiatrist to ensure a fully holistic approach to my health and wellbeing. I still am highly anxious, and life still presents its challenges, but I am in the best place I have ever been."

Vivian says coaching in areas like social skills and goal setting can also be helpful. "There’s much more talk about ADHD coaching now," she says. "It lets you implement different strategies and move forward from your diagnosis."

Where to find support

You can access a range of evidence-based online programs based on CBT through This Way Up, a not-for-profit initiative developed by experienced psychiatrists and clinical psychologists, to help you take control of your mental wellbeing today.

The programs are available free of charge when prescribed by a clinician. Alternatively, you can access the programs without a supervising clinician for $59 per program. Or, depending on your extras cover, we'll cover the cost of eligible courses, up to your annual limit^*.

We've also expanded our mental health offering to include a free HCF HealthyMinds Check-in for eligible members^{^}. This gives you faster, easier access to PSYCH2U psychologists and digital support services to help you take control of your mental wellbeing.

GP2U

If you think you might be experiencing symptoms of ADHD or want to talk to a healthcare professional about your concerns, the first step is to speak to your GP. Our partnership with GP2U, an online video GP service, makes it easier for eligible members to access telehealth services. All HCF members with health cover can access a standard GP consultation (up to 10 minutes) for a fee of $50.