ADHD in women: Why It’s So Often Missed and Misunderstood

When most people picture ADHD, they imagine a hyperactive young boy who can’t sit still in class. But ADHD—Attention-Deficit/Hyperactivity Disorder—doesn’t always look like that. For many women and girls, it shows up in quieter, less visible ways. And because the early research on ADHD focused mostly on boys, countless women go undiagnosed for years, sometimes decades.

In this post, we’ll explore how ADHD presents differently in women, why it’s so often missed, and what it looks like when it goes undetected into adulthood.

ADHD in Women Is Often Internalized

While boys with ADHD are more likely to show externalizing behaviors like hyperactivity and impulsivity, girls tend to internalize their symptoms. That means instead of acting out, they may:

• Struggle with chronic daydreaming or mental “zoning out”

• Seem overly chatty or emotionally reactive

• Have intense feelings of overwhelm or anxiety

• Work very hard to mask their symptoms through perfectionism

• Blame themselves for difficulties in school, work, or relationships

Because these symptoms don’t always disrupt others, they’re often misattributed to

personality traits or mood disorders like anxiety or depression.

The Masking Trap: “She Seems Fine”

Women with ADHD often become experts at masking—hiding their difficulties by overcompensating. They might seem organized on the surface but are spending an enormous amount of energy managing the chaos behind the scenes.

This can look like:

• Staying up all night to meet deadlines they struggled to start

• Writing exhaustive to-do lists but still feeling stuck

• Appearing social but feeling misunderstood or overwhelmed by conversations

• Being perceived as “too sensitive” or “too emotional”

Over time, the mental load of masking can lead to burnout, shame, and a persistent feeling of not being good enough.

The Problem With Late Diagnosis

Because so many women go undiagnosed as children, they often reach adulthood with a long history of unexplained struggles. Some common signs of undiagnosed ADHD in

women include:

• Difficulty managing time or staying focused on tasks

• Trouble with emotional regulation or mood swings

• Disorganization despite great effort to stay on top of things

• Chronic overwhelm, especially around daily responsibilities

• A pattern of underachievement that doesn’t match their intelligence or effort

Many women finally get diagnosed in their 20s, 30s, or even later—often after their child is diagnosed or during a life transition that makes coping harder (e.g., becoming a parent, starting a new job, or returning to school).

Hormones and ADHD: A Complicated Relationship

Hormonal fluctuations can significantly impact ADHD symptoms in women. Estrogen levels influence dopamine, a key neurotransmitter involved in ADHD. This means symptoms can worsen during:

• Menstruation: Many women report a noticeable increase in symptoms before their period.

• Pregnancy: Some feel relief, while others experience more difficulty.

• Perimenopause and menopause: These hormonal shifts often intensify ADHD symptoms, sometimes triggering a diagnosis for the first time.

Understanding this link can help women prepare for and manage these changes more

effectively.

You’re Not Lazy or Broken—You Just Haven’t Been Seen Clearly

One of the most powerful things a woman can hear after an ADHD diagnosis is: "You're not lazy, you're not failing—you’ve been trying to navigate life with an invisible challenge that no one saw."

Diagnosis can bring immense relief and open the door to effective support, whether that’s therapy, coaching, medication, lifestyle changes, or a combination.

What to Do If This Sounds Like You

If you see yourself in this post, you’re not alone. Many women carry the weight of undiagnosed ADHD for years, often in silence. Reaching out to a mental health professional who understands the nuances of ADHD in women is a meaningful first step.

You don’t need to keep struggling to "hold it all together." Support is available—and healing starts with being seen for who you truly are.

Looking for support? I offer a free 15-minute consultation where we can talk about what’s going on and whether therapy might be helpful for you.

Book a time https://harmonyhealingpsychotherapy.janeapp.com

You deserve support that gets it.