ADHD in women and girls: why diagnosis often comes late

Historic research and diagnostic descriptions were built mostly around boys with hyperactive, disruptive behaviour. Girls are more likely to present with inattention, internal restlessness, emotional intensity or difficulty with organisation. They may be seen as shy, dreamy, chatty or anxious. Teachers and parents may not link these to ADHD. Girls often work harder to compensate, so difficulties may only surface when demands increase, for example at secondary school, university or parenthood.

Masking means suppressing or hiding difficulties to meet expectations. Examples include rehearsing conversations, over-preparing, keeping lists and pushing to appear organised. It can allow academic success but leads to exhaustion, anxiety and a sense of being an impostor. Women often describe a long gap between how they look to others and how it feels inside.

• Being treated for anxiety or depression with limited benefit.

• Difficulty managing household tasks, paperwork and time.

• Emotional sensitivity and rejection sensitivity.

• Sleep problems and a mind that does not switch off.

• Burnout at work or after having children.

• Recognising traits in a child who is diagnosed and then in themselves.

Oestrogen influences dopamine pathways, and many women notice symptoms vary across the menstrual cycle, worsen premenstrually, change in pregnancy and the postnatal period and become more difficult in perimenopause, when concentration and memory complaints are common. Distinguishing ADHD, hormonal change, depression and sleep disruption takes skill. Some women are diagnosed for the first time at menopause. Discuss both with a clinician if you are in midlife.

Be explicit with your GP that you wish to be assessed for ADHD, and describe how difficulties have affected your life over time rather than listing isolated symptoms. Ask the assessor about experience with women and with co-occurring conditions. Include examples from school and from early adulthood. Women often feel dismissed, so it can help to take written notes.

Treatment may include medication, psychological support such as cognitive behavioural approaches adapted for ADHD, coaching, workplace adjustments and treatment of any co-occurring conditions. Many women report relief at having an explanation and describe a need to process earlier experiences. Peer support groups and charities can help.

Women often rehearse what they will say and still find themselves minimising difficulties in the room. A written summary can help, with examples from school, work, relationships and home life, and a note of anything you do to cope, such as extra lists, alarms or avoiding certain tasks. Mention how symptoms change across your cycle if they do. If a clinician suggests that you are simply stressed or anxious, it is reasonable to ask what would make them consider ADHD and to request referral for a specialist opinion.