ADHD has historically been understood through a very narrow lens — one that mostly reflects how ADHD shows up in boys.
But in clinical practice, I often see something quite different.
Many of the women I assess for ADHD were not diagnosed as children. Instead, they spent years struggling with anxiety, burnout, low self-esteem, or relationship difficulties before anyone considered ADHD as a possibility.
In this article, I want to talk about why ADHD in women is often missed, how symptoms can change across a woman’s life, and what I’ve learned from working with women who receive an ADHD diagnosis later in life.
Much of what I share here comes from a webinar I delivered on ADHD in women for the New Zealand College of Clinical Psychology in October 2023, as well as from clinical experience working with clients across the lifespan.
What Is ADHD?
ADHD stands for Attention Deficit Hyperactivity Disorder, a neurodevelopmental condition that affects executive functioning and self-regulation.
It can involve difficulties with:
Attention and focus
Organisation and planning
Impulsivity
Emotional regulation
ADHD is not simply about “being distracted”. It reflects differences in how the brain regulates attention, motivation, and behaviour.
Research suggests ADHD is highly heritable, with genetic factors accounting for around 70–90% of cases.
The Three Types of ADHD
Clinically, ADHD is typically described in three presentations:
Predominantly Inattentive
Common signs include:
Forgetfulness
Losing things frequently
Difficulty finishing tasks
Easily distracted
Struggling to follow conversations
Predominantly Hyperactive / Impulsive
This may include:
Restlessness or fidgeting
Talking excessively
Interrupting others
Acting before thinking
Combined Type
This includes features of both inattentive and hyperactive-impulsive symptoms.
Why ADHD in Women Is Often Missed
Research consistently shows that boys are diagnosed with ADHD more often than girls.
Some estimates suggest ratios as high as 3:1 to 16:1 in favour of boys.
But this doesn’t necessarily mean boys truly have ADHD more often.
Instead, ADHD in girls is often less visible.
There are several reasons for this.
1. Girls Often Present With Inattentive Symptoms
Boys with ADHD are more likely to show:
hyperactivity
disruptive behaviour
impulsivity in the classroom
These behaviours are highly noticeable to teachers.
Girls, on the other hand, often show inattentive symptoms, such as:
daydreaming
quiet distraction
struggling to follow instructions
appearing disengaged
Because they are not disruptive, their difficulties can easily be overlooked.
2. Many Women Are First Treated for Anxiety or Depression
By adolescence or adulthood, many women with ADHD present with:
anxiety
depression
eating disorders
chronic overwhelm
In these situations, ADHD may remain hidden underneath other mental health difficulties.
Often the underlying ADHD is only recognised much later.
3. Masking and Compensation
Many girls develop strategies to mask their ADHD symptoms.
For example, they might:
rely heavily on friends to remind them about assignments
over-prepare or overwork to compensate
appear organised externally while feeling chaotic internally
These coping strategies can help them get through school — but often at the cost of exhaustion and self-criticism.
4. Gender Expectations
Social expectations can also play a role.
Girls are often expected to be:
organised
responsible
emotionally attuned
socially skilled
When girls struggle with organisation, impulsivity, or emotional regulation, they may feel a strong sense of shame or failure.
Many women I work with describe a long-standing feeling of:
“Why does everything seem harder for me than for everyone else?”
ADHD and Hormones Across the Lifespan
Another important factor — particularly for women — is hormonal changes.
Emerging research suggests that fluctuations in oestrogen may influence ADHD symptoms.
Oestrogen interacts with neurotransmitters such as dopamine, which plays a key role in attention and motivation.
This means ADHD symptoms may shift across different life stages.
Puberty
During puberty:
oestrogen and progesterone levels increase
emotional and cognitive changes occur
Some girls report increased difficulties with:
focus
mood regulation
impulsivity
Pregnancy and Postpartum
Pregnancy can temporarily improve ADHD symptoms for some women due to increased oestrogen.
However, after birth:
oestrogen levels drop sharply
sleep deprivation and parenting demands increase
This can lead to worsening ADHD symptoms.
Perimenopause and Menopause
During perimenopause and menopause, oestrogen levels decline.
Many women report increased:
brain fog
forgetfulness
difficulty concentrating
For some women, this is the first time ADHD becomes clearly noticeable.
What an ADHD Assessment Involves
Diagnosing ADHD in adults requires a comprehensive assessment.
Typically this includes:
Clinical interview
Developmental history
Questionnaires (such as the Conners or ASRS)
Information from family members
School reports where available
ADHD symptoms must:
be present from childhood
cause impairment in multiple areas of life (such as school, work, or relationships).
What an ADHD Diagnosis Can Change
For many women, receiving an ADHD diagnosis can be deeply validating.
It can help make sense of lifelong patterns such as:
difficulty with organisation
overwhelm from everyday tasks
struggles with time management
emotional sensitivity
relationship challenges
Instead of asking:
“What’s wrong with me?”
Women often begin to ask:
“How can I work with my brain rather than against it?”
Practical Strategies That Can Help
Some strategies that many women find helpful include:
1. Understanding Your Patterns
Learning how ADHD affects your thinking, energy, and focus.
2. Using Technology
Reminders, calendar systems, automation and AI when used appropriately can reduce mental load.
3. Simplifying Tasks
Reducing unnecessary complexity in daily routines.
4. Self-Compassion
Letting go of unrealistic expectations and perfectionism.
ADHD Assessments at Empowerment Psychology
At Empowerment Psychology, we provide comprehensive ADHD assessments for adults, adolescents, and children.
Our assessments aim to:
provide clarity and understanding
explore strengths as well as challenges
offer practical recommendations for support
If you are wondering whether ADHD may be affecting you, you can do a screening questionnaire via ADHD New Zealand.
If you are ready to learn more about ADHD assessment for yourself, find out more about the process at Empowerment Psychology.
ADHD Assessments in New Zealand
If this article resonates with you, please remember:
Many women spend years feeling like they are “failing” at life — when in reality their brain simply works differently.
Understanding ADHD can be the first step toward working with your brain rather than constantly fighting against it.
