ADHD in women: why it’s often missed

Why ADHD in women is often missed

The national guideline on ADHD in England and Wales asks healthcare professionals to be aware that ADHD is thought to be under-recognised in girls and women, and that they:^[1]

• are less likely to be referred for assessment for ADHD
• may be more likely to have undiagnosed ADHD
• may be more likely to receive an incorrect diagnosis of another mental health or neurodevelopmental condition.

The NHS suggests one reason: women with ADHD more commonly have inattentive symptoms, which can be harder to recognise than hyperactive ones.^[2] The Royal College of Psychiatrists notes that ADHD is more commonly diagnosed in boys than girls in childhood, but that in adults diagnosis is more equal between men and women — perhaps because boys are more likely to show the hyperactive and impulsive symptoms that get noticed.^[3]

How it can show up

The core signs of ADHD are the same for everyone (see ADHD in adults: signs and symptoms). But the experience can be quieter. Women describe things like:

• daydreaming, drifting off in conversations or losing the thread of thoughts
• a busy, restless mind rather than a restless body
• working far harder than others appear to, just to stay on top of things
• strong emotional reactions, or feeling overwhelmed quickly
• a long history of being called “dreamy”, “chatty”, “disorganised” or “not living up to potential”

These are common human experiences too. On their own, they do not mean someone has ADHD — what matters is persistence, pervasiveness and impact.

Coping, masking and the hidden cost

Many people with ADHD develop ways to hide or compensate for their difficulties: over-preparing, perfectionism, lists everywhere, staying up late to catch up, or rehearsing conversations. The Royal College of Psychiatrists notes that people with ADHD often develop ways to hide their symptoms, and that doing so can be very exhausting and negatively affect mental health.^[3]

“I’m 38 — it’s been missed throughout my entire life. I could never vocalise how I felt until now.”Rachael, quoted by the Royal College of Psychiatrists

Masking can work for years — until demands outgrow the coping strategies. A new job, a promotion without structure, a baby or a house move can be the tipping point. The Royal College of Psychiatrists describes how rising demand and stress can leave people with ADHD overwhelmed, and that appropriate support helps.^[3]

When another diagnosis comes first

Because NICE highlights a higher chance of incorrect diagnosis in women and girls,^[1] some women are first treated for anxiety or depression. These conditions are real and common alongside ADHD — the Royal College of Psychiatrists notes that some people receive a mental health diagnosis that only explains part of their difficulties, and that underlying ADHD can then be missed.^[3] If treatment for another condition has helped only partly, and attention or organisation problems go back to childhood, it is reasonable to ask your GP whether ADHD has been considered.

Life stages and hormones

Some women say their symptoms feel different around periods, pregnancy or the perimenopause. This is an area of growing interest, but the research is still developing and the evidence is not yet clear. If you notice patterns, a simple diary — dates, sleep, mood and how manageable everyday tasks felt — gives your GP or specialist something concrete to discuss.

Questions you might ask your GP

Going in with a few questions can make a short appointment feel less rushed:

• “Could my difficulties with attention and organisation be ADHD, and could I be referred for a specialist assessment?”
• “If my anxiety or low mood treatment has only partly helped, could something else be going on as well?”
• “How long is the local waiting list — and in England, could I use Right to Choose?”^[2]
• “Is there any support I can access while I wait, at work or through local services?”

Bring short notes about childhood (school reports can help), how things affect you now, and any patterns you have noticed. It is fine to say you find appointments hard and to read from your notes.

Starting the conversation

You don’t need to be certain to ask. Book a GP appointment, bring examples from childhood and from now, and explain how they affect your life. Our guide to getting an ADHD assessment in the UK walks through referrals and Right to Choose in England. The NHS lists charities including ADHD UK and ADHD Adult UK for information and peer support.^[2]

Common questions