Monica Racoviță

How is ADHD perceived in girls and women?

5 December 2022

woman holding up piece of paper to show young girl opposite

Definitions of ADHD and neurodivergence have expanded to include the multitude of ways in which people experience their surroundings. But does this go far enough for girls and women, or is there still a gender bias?

Some people process information differently from the accepted norms. Experts previously considered this to be due to various developmental disorders or mental health conditions, including autism spectrum disorder, Tourette’s syndrome and attention deficit hyperactivity disorder (ADHD). Increasingly, people with these different ways of processing information and their advocates would like to shift the focus away from brain dysfunction and towards neurodiversity as a spectrum. This would validate the different ways in which people interact with the world around them.

On this spectrum, ADHD can be puzzling at first glance. On the one hand, it can be challenging to live with ADHD, which generally causes two types of issues: problems maintaining attention, and hyperactivity and impulsiveness. Problems affecting attention include: difficulty listening to or carrying out instructions, difficulty starting or finishing tasks (especially those that are dull or time consuming) and being easily distracted, forgetful or prone to making mistakes. Hyperactivity and impulsiveness can manifest as difficulty staying still, being interruptive, talking excessively and difficulty assessing danger.

On the other hand, new research has started to emphasise the strengths and benefits that may come with ADHD, which some people refer to as ‘superpowers’. Examples include:

hyperfocus – the ability to focus on an enjoyable task for long periods with great efficiency, and produce high-quality outcomes
resilience – this can come from needing to work harder to overcome challenges
creativity – using new perspectives to help solve a problem
high levels of courage, energy and social intelligence, which refers to conversation skills, sense of humour and empathy.

Girls with ADHD can grow up unaware of their condition, with those around them potentially blaming any academic and social difficulties they may be experiencing on character flaws.

ADHD in girls and women can be marked by gender stereotypes

For decades, it was believed that ADHD mainly affected young boys. This was aided by the fact that hyperactive manifestations of ADHD seemed more prevalent in boys, whereas girls more commonly experienced issues with inattention. Revamped diagnostic criteria, however, de-emphasised hyperactivity and included more symptoms related to inattention. This reduced prevalence ratios of diagnosed cases among boys vs. girls from 25:1 (before the 1980s) to 3:1 (currently). In addition, girls are typically more likely to hide and internalise any difficulties they might experience. So unless they are being highly disruptive in class, their inattention will more likely be associated with anxiety or depression.

Girls with ADHD can grow up unaware of their condition, with those around them potentially blaming any academic and social difficulties they may be experiencing on character flaws. Years of demoralisation and internalised stigma can lead to mental health problems in adulthood, such as anxiety, depression and even self-harm or suicide. Self-harm, in particular, is more likely to affect women with ADHD than men.

There seems to be a growing tension between the medical model for ADHD and the neurodiversity approach. Both approaches offer evidence-based solutions for people with ADHD – in particular, girls and women.

Lack of awareness and outdated attitudes can affect the identification of ADHD

Identifying ADHD is not without its challenges. Primary care practitioners, often the first point of contact, may lack awareness of existing ADHD guidelines. In addition, short visits to the doctor do not leave enough time for systematic assessments, which need to include developmental history, medical examinations and tests. The combination of hyperactivity being a very visible sign and many healthcare professionals still associating ADHD with boys can lead to overdiagnosis in boys and underdiagnosis in girls. It is also important to consider the hormonal changes during a woman’s life, particularly during puberty, pregnancy and menopause, as evidence suggests that these affect ADHD characteristics.

Disorder or difference?

There seems to be a growing tension between the medical model for ADHD and the neurodiversity approach, as mentioned at the beginning. In the humble opinion of this author, both approaches offer evidence-based solutions for people with ADHD – in particular, girls and women.

The medical model can help identify the condition more precisely, and, in severe cases, which are characterised by dysfunction in the dopamine pathway and a high risk of self-harm, medication and therapy can significantly improve a person’s quality of life. On the other hand, the neurodiversity approach can increase the acceptance and awareness of behaviours associated with ADHD and draw attention to its potential associated strengths. It can also lessen the stigma of expected gender behaviours and increase awareness of the different ways in which boys and girls typically cope.

How is ADHD perceived in girls and women?

Definitions of ADHD and neurodivergence have expanded to include the multitude of ways in which people experience their surroundings. But does this go far enough for girls and women, or is there still a gender bias?

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ADHD in girls and women can be marked by gender stereotypes

Lack of awareness and outdated attitudes can affect the identification of ADHD

Disorder or difference?

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.