ADHD was long considered a male-only disorder. Photo / 123rf
From hyperactivity to impulsivity, the symptoms in females can be very different from male ones – making the condition harder to diagnose.
Cases of attention deficit hyperactivity disorder (ADHD) seem to be rocketing – so much so that there is talk among medical professionals that it’s “the label of moment”.
For decades, it has been seen as a “male only disorder”, but that is also changing fast.
The growing number of high-profile women who have gone public about their ADHD – the former Spice Girl Mel B, TV presenter Sue Perkins and the actress Sheridan Smith to name a few – coupled with a plethora of ADHD content across social media platforms, especially TikTok, have all prompted more women and girls to see it in themselves and seek help.
Women are now being diagnosed at unprecedented rates. So what does ADHD look like in women – and why are we only recognising it now?
“ADHD for both men and women is a developmental disorder with three groups of symptoms,” says Dr Sally Cubbin, a consultant psychiatrist and lead doctor for women with ADHD at UK Adult ADHD Network (UKAAN).
These symptoms are:
“There is some suggestion that women are less likely to struggle with hyperactivity – although they certainly can – and more likely to have the inattentive symptoms,” says Cubbin.
“At school, the stereotype would be the dreamy girl looking out the window.
“As an adult, it might be really struggling with the daily admin of life.
“That’s getting somewhere on time, running a household, driving the car without being distracted, paying bills, putting the bins out, getting the children to school in the morning and in bed before it’s late.”
“Firstly, it’s a lot less likely to be diagnosed by adulthood, because it’s picked up in far more boys than girls,” says Cubbin.
“An inattentive girl slips easily under the radar in class, compared to a disruptive boy who can’t sit still.”
Clinical referrals in boys typically exceed those for girls, with ratios ranging from 3-1 to 16-1, but the sex ratio in adult clinics is much less pronounced – some research has found it to be equal.
“For women and girls struggling with any of the ADHD symptoms, there’s a tendency to compensate, to try and overcome the difficulties, mask the symptoms in order to please others and fit in,” says Cubbin.
“Research suggests that they force themselves to cope through putting in long hours or hard work or overwhelming effort.
“They might appear to be managing, but at great personal cost.
“It’s exhausting, stressful and often comes hand in hand with a lot of self-blame, anxiety and low self-esteem. ‘Why is this so difficult for me?’ ‘Why can’t I do better?’ ‘What’s wrong with me?’.”
In women:
In girls:
“It’s hard to know because, for so many years, women were neglected in the research. ADHD was considered a childhood condition associated with boys,” says Ellie Dommett, a professor of neuroscience at King’s College London’s ADHD Research Lab.
“Around 3 per cent of adults worldwide have ADHD and while it’s more likely to be diagnosed in boys than girls, by the time we get to adults, it’s pretty equal.”
“It’s really important to recognise that the impact on daily life is super diverse and context-dependent,” says Dommett.
“If you’re a self-employed creative, for example, who can keep your own hours and are rewarded for thinking outside the box, daily life might be much easier than if you have an office job in a formal setting which is very rule-bound.”
Whatever your position though, there’s no avoiding the daily admin of adult life – and for someone with ADHD, this can be very challenging.
“Running a home is tedious stuff,” says Cubbin.
“Putting out the bins, buying the milk, putting a wash on, paying the bills. It can be hard to stay on top of all that.
“Even going on holiday – packing, keeping hold of the passports, not missing the plane – can be extremely stressful.”
The result of holding it all together can take a severe mental toll, and lead to depression, feelings of self-blame and also sheer exhaustion.
“People think of ADHD as having loads of energy but actually fatigue is also common,” says Cubbin.
“You often don’t sleep well because your mind is whirring so you don’t wake up refreshed. Then you have to work harder than anyone else to manage on a daily basis.”
“It’s a generalisation, but women and girls are more likely to compensate by making every effort to overcome their difficulties,” says Cubbin.
“They’ll manage to get something done even if it takes a lot of stress, effort and panic and their teacher or employer might not have noticed how much they struggled.”
Research suggests that ADHD is more likely to be picked up in school when it presents with learning problems – and girls with ADHD are less likely to have learning difficulties than boys.
Externalising problems – rule-breaking, aggression and criminality – are also more common in boys and men with ADHD (although they are elevated in both sexes) so more likely to receive attention.
Girls and women with ADHD are more likely to suffer internalising disorders – emotional problems, anxiety, depression – which may not be linked to ADHD.
“A lot of doctors won’t look for ADHD in women, especially if they’re not hyperactive,” says Cubbin.
“If a woman presents with anxiety or low mood, and tells her GP, ‘I’m not coping, I’m swamped, I’m overwhelmed,’ ADHD often wouldn’t occur to them.”
This depends on many factors, including ADHD symptoms, job, family life and the people around you.
“Untreated problems around impulse control might lead to unplanned pregnancies, higher rates of STDs as you don’t think about contraception,” says Cubbin.
“You’re also more likely to lose control with drugs and alcohol – partly because you’re self-medicating difficult feelings – which can also lead to more risky sexual behaviour.”
Women with ADHD are more likely to become smokers, and develop alcohol and drug use disorders. Obesity is also more likely, as well as bulimia and binge eating.
“Again, if you’re not good with impulse control, and you need constant stimulation, that can come from constant snacking. That has a knock-on effect on health and puts you at higher risk of high blood pressure, strokes, heart attacks.”
Work and relationships are also likely to suffer.
“You might have a quick turnover of jobs as you get bored easily, or maybe struggle to stay in a job. There’s a higher instance of relationship breakdown and divorce, perhaps because of mood instability and arguments – as ADHD is difficult to live with – or impulsivity might cause infidelity.”
Some research has shown that ADHD can reduce life expectancy by as much as 13 years.
“There are lots of explanations,” says Cubbin.
“Car accidents – any accidents – are more common. You’re less likely to look after your health – and if you have a chronic condition that needs managing, like diabetes or epilepsy which is more common in people with ADHD, that’s hard to do with a chaotic lifestyle.”
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