6 Ways ADHD Affects Men and Women Differently

“Research generally shows more similarity than difference in the core symptoms of ADHD, but there are differences in how ADHD is recognized and experienced [in males and females],” says Dara Babinski, PhD, a clinical psychologist at the Penn State Neuroscience Institute in Hershey, Pennsylvania. These variations can sometimes make ADHD harder to diagnose or understand.

It’s important to clarify that biological sex (the physical elements of being male or female) and gender identity (someone’s sense of their own gender) are different things. Most research on ADHD has been done on the basis of biological sex only. This means transgender people’s experiences with ADHD are less understood, and your experience may not align with the observations below if you’re trans.

Here, experts discuss six key ways ADHD affects men and women differently.

1. ADHD Symptoms Look Different in Men and Women

But Ellen Littman, PhD, a clinical psychologist in Mount Kisco, New York, says both sexes experience inattention and hyperactivity to some degree; they just look different for each. “For girls and women, hyperactivity usually manifests as things like daydreaming, picking your cuticles, or messing with your split ends, as opposed to jumping out of your seat and yelling,” she says.

Dr. Littman explains that women tend to internalize their symptoms, while men externalize theirs.

“With women, there’s a cognitive, emotional, and physical restlessness, but it’s just more controlled,” she says. “Boys may have symptoms that are more obvious and easy to recognize.”

Littman also says that girls and women tend to mask their symptoms. “So they have more subtle symptoms, and on top of that, they attempt to hide their symptoms and [can] come across as if they're fine,” she says.

2. Men Are Diagnosed Earlier and More Often

• About 16 percent of boys ages 3 to 17 have been given a diagnosis of ADHD
• About 8 percent of girls ages 3 to 17 have been given a diagnosis of ADHD

“It’s just a lot harder for girls to get diagnosed unless they have observable symptoms, like jumping around,” says Littman.

Littman says the implications of a delayed diagnosis can be emotionally devastating for females. “So girls spend at least 5 to 10 years [waiting for a diagnosis], and during those years, they have to make sense of why things are difficult for them, and they attribute it to their own character flaws because they don’t have a neurological explanation to help them make sense of it,” she says.

3. Women May Be Misdiagnosed With Another Condition

“In girls and women, clinicians may focus appropriately on anxiety, depression, or other concerns but fail to also consider ADHD,” says Dr. Babinski. “Girls may be missed when their symptoms are less noticeable or disruptive, or when anxiety, depression, or other concerns are prioritized.”

A misdiagnosis can be particularly problematic when women aren’t given the proper treatment they need for ADHD.

“If they’re diagnosed with anxiety and depression, they’re going to be put on SSRIs or other drugs that are not going to be helpful,” says Littman. “So getting them correctly diagnosed is huge.”

4. Hormonal Changes Affect Women More

Hormonal changes appear to play a more significant role in ADHD among women than men.

“In women, reproductive transitions, such as pregnancy, postpartum, and menopause may also affect symptoms,” says Babinski.

“Girls and women’s symptoms do not start until there’s estrogen in their system, so that’s why lots of 7-year-old boys are easy to diagnose, but 7-year-old girls, unless they are unbelievably hyperactive, not many 7-year-old girls will be diagnosed because their symptoms are just [not obvious],” says Littman.

5. Women With ADHD Tend to Be Harder on Themselves

Women with ADHD may be more likely to judge themselves harshly as they struggle with symptoms, stigma, and the frustration that can come with a misdiagnosis. “They are really hard on themselves. To make them feel worthy is really difficult,” says Littman.

“Women [with ADHD] tend to isolate and withdraw. They tend to feel like they are inadequate, relative to their peers, and over time, they can develop a lot of negative ways of hiding and coping, like self-medicating with drugs, food, or alcohol,” says Littman.

6. The Long-Term Outlook Is Different for Men and Women

“This earlier mortality may be a result of being overwhelmed and distracted. Women don’t always follow up with preventive tests like mammograms. They take good care of their kids, but they tend to not take good care of themselves. Or, they might engage in unhealthy behaviors, like smoking or drinking,” says Littman.

Awareness of sex-based differences in ADHD is important. This knowledge means you’re able to better advocate for yourself and get the care you need.