Why are Women with ADHD Under-Diagnosed?

Attention Deficit Hyperactivity Disorder (ADHD) is a brain disorder characterized by increased inattention, hyperactivity and impulsivity (5).  ADHD has been diagnosed in young boys who show symptoms of rule breaking, fidgeting, and various other kinds of external and overt behaviors.

Typically, these young boys are referred to outside clinicians who can properly diagnose them with ADHD after receiving recognition from their teachers due to their conduct. (3)  Luckily, the treatment of ADHD, which consists of medication, therapy and self-help techniques, can greatly reduce the symptoms of this disorder, especially when treated during childhood (5, 6).  But what about the young girls in the class— why are they being referred to clinicians at alarmingly lower rates than their male peers for symptoms of ADHD-?

ADHD remains under diagnosed in females due to the distinct presentation of their symptoms. Women display less obvious symptoms than males which is why they are often not diagnosed or do not receive treatment until they are in adulthood(1). The symptoms more commonly seen in women, such as forgetfulness, disorganization and lower self esteem, are not always attributed to ADHD. Also, while males with ADHD typically display hyperactivity, disruptive behavior and increased motor activity, females manifest the disorder by being hyper-talkative or displaying emotional reactivity(1).

A teacher is likely to refer a boy to a clinician for acting out while girls, who are likely to become socially withdrawn or display inattentiveness, will not be reported and continue to suffer as they get older (3). In regards to this theme of internalizing their symptoms, young girls are more likely than boys to compensate for their ADHD symptoms and mask their challenges, making it difficult for parents and teachers to notice.

This leaves females increasingly vulnerable to suffer from their ADHD symptoms and become overwhelmed, anxious, depressed and develop lower self esteem (4). In general, ADHD is highly co morbid with other mental health disorders for both men and women. Women with ADHD have higher rates of co existing anxiety and depression, and while their ADHD may go undetected, their secondary disorders can be misdiagnosed as primary.

For example, clinicians can misinterpret certain symptoms females experience, such as inattention and being socially withdrawn, as symptoms of depression or anxiety rather than ADHD (1,4). Women can become depressed over their trouble with organization and inattention but their treatment becomes focused on alleviating the wrong disorder. Due to this stereotypical assumption of the presentation of ADHD, women face the possibility of their procrastination and inattentiveness to be overlooked and not receive the appropriate treatment.

While both boys and girls are affected by ADHD, due to gender biases’ behind diagnoses, girls are not receiving the opportunity for adequate treatment. While teachers in elementary school focus on the little boys who cannot sit still and who speak out of turn, there are girls in that classroom too who will grow up without the same access to treatment. Intelligent women who succeed academically and professionally can still be suffering from ADHD while spending extra time on their work and suffering emotionally (1).

On a more optimistic note, now that the problem has been identified, steps can be taken to find a solution. Since ADHD has been proven to be highly treatable, there is no reason women should have to suffer with these symptoms through out their life. Clinicians and teachers can become educated on the different presentations of ADHD and look out for females who may be struggling internally but not exhibiting disruptive behaviors like their male peers.

Work Cited
1.Quinn, P. O. (2005). Treating adolescent girls and women with ADHD: Gender‐Specific issues. Journal of clinical psychology, 61(5), 579-587.
2.Owens, E. B., & Hinshaw, S. P. (2016). Childhood conduct problems and young adult outcomes among women with childhood attention-deficit/hyperactivity disorder (ADHD). Journal of abnormal psychology, 125(2), 220.
3. Sciutto, M. J., Nolfi, C. J., & Bluhm, C. (2004). Effects of child gender and symptom type on referrals for ADHD by elementary school teachers. Journal of Emotional and Behavioral Disorders, 12(4), 247-253.
4. Waite, R. (2010). Women with ADHD: It is an explanation, not the excuse du jour. Perspectives in Psychiatric Care, 46(3), 182-196.
5. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
6. https://www.nytimes.com/ref/health/healthguide/esn-adhd-know.html