ADHD in women: why it goes unnoticed until adulthood

“I was filling in the questionnaire for my son. Halfway through I put the pencil down, because I realised I was answering for myself.”

That is often how it begins. A woman in her thirties or forties who has spent her whole life being seen as a little scattered, a little dreamy, sometimes “too much” — and at the same time as someone who, in the end, always pulls everything together. Who had decent marks at school but studied for every test the night before. Who has a system of sticky notes, reminders and alarms at home, and nobody knows how much it costs her. And who, when her child is diagnosed, when she burns out, or when she stumbles on an article by chance, suddenly sees a pattern she could never name before.

ADHD (attention deficit hyperactivity disorder) is a neurodevelopmental difference — a way the brain regulates attention, drive and emotion. It is not the result of poor upbringing or laziness. A diagnosis is made by a psychiatrist or a clinical psychologist; I do not make diagnoses, and I won’t make one in this post either. What I would like to show is why ADHD in girls and women so often hides behind other names — and what that means for the way a woman sees herself.

Why ADHD was seen as a “boys’ disorder” for so long

The first descriptions of attention problems were based on boys who disrupted lessons: they couldn’t sit still, interrupted, got into fights, ran around the classroom. The criteria by which professionals recognised ADHD for decades were therefore shaped around that picture. Anyone who didn’t fit it slipped through the sieve.

The American diagnostic manual DSM-5 states that the sex ratio in childhood is roughly two boys to every girl, while in adults it narrows to about 1.6 to 1. That narrowing alone tells us something: girls with ADHD didn’t disappear, they were simply recognised later. In clinical samples — that is, among children whom someone actually brings for an assessment — the gap between the sexes is often even wider than in the general population. Who gets assessed depends on who is bothering whom.

As far back as the late 1990s, a meta-analysis by Gaub and Carlson showed that girls with ADHD have, on average, less hyperactivity and fewer behavioural problems than boys, while inattention is similar in both sexes. In other words: the part of ADHD that the people around you notice most easily is often quieter in girls.

The quieter picture: inattention instead of restlessness

A girl with ADHD often doesn’t run around the classroom. She looks out of the window. When the teacher calls on her, she doesn’t know where they are. She forgets her slippers, her homework and her deadlines, but she is kind and she tries. She may be very talkative, interrupt, and blurt out something that then stings her for the rest of the day. In her, hyperactivity often shows up as inner restlessness — a head that never goes quiet — or as constant fidgeting, playing with her hair, doodling in the margins of her exercise book.

Mowlem and colleagues looked at a large group of children with marked ADHD symptoms and compared who went on to be diagnosed. They found that girls needed more additional difficulties — behavioural or emotional — than boys with the same level of symptoms before they were diagnosed. Inattention on its own, then, was not enough for anyone to suspect anything.

Being good as armour

Many girls learn early on that being “good” is safe. When things don’t come to you the way they come to others, you have two options: give up and become “the one who doesn’t care”, or start compensating. A great many choose the second path. They copy out their notes twice. They stay up while others sleep. They check everything three times because they can’t rely on themselves. From the outside this looks like conscientiousness, even perfectionism.

The compensating works — until it doesn’t. It usually holds through primary school, sometimes through secondary school and university. But when life gets more complicated — a job with several projects at once, a household, children, caring for parents — a system built on extreme effort gives way. For many women this is the first moment anyone asks whether it might be something other than “poor organisation”.

If you recognise yourself here, you may also find the post Perfectionism and overthinking: two sides of the same fear helpful. In women with ADHD, perfectionism is often not a personality trait but a safety net someone built so that they would never be caught slipping up.

The wrong door: anxiety, depression, burnout

Women with unrecognised ADHD don’t come to the doctor saying, “I think I have ADHD.” They come because they can’t sleep, because their chest feels tight, because they’re exhausted, because they cry in the car before work. And what they describe is real: anxiety and depression are common among women with ADHD. An international group of experts led by Susan Young wrote in a consensus statement on women with ADHD that they often receive other diagnoses first, while ADHD stays in the background — sometimes for years.

Anxiety is often a perfectly understandable response. If you have spent your whole life forgetting things, missing deadlines and hearing that you don’t try hard enough, you learn to live on alert. You are always checking, always worrying about what has slipped through your fingers again. I wrote about how everything can look fine on the outside while an alarm rings inside in High-functioning anxiety: in control on the outside, an alarm ringing inside.

How to tell where one ends and the other begins is a separate question, and the post ADHD or anxiety? How to tell them apart is devoted to it. Here I’ll just say this: treating anxiety can be entirely appropriate and still not explain everything. If the confusion, forgetfulness and difficulty getting started on tasks don’t ease once the anxiety settles, it is worth mentioning to your doctor.

Hormones: a subject we still know too little about

Many women with ADHD describe their symptoms changing over the month — certain days before a period being noticeably harder, focus even more fragile and emotions even quicker. They describe something similar after giving birth and during perimenopause, when some women who had “somehow coped” for years find their system collapsing at precisely that point.

Researchers suspect that the influence of oestrogen on dopamine transmission in the brain plays a part, but there is still little research on this and most of it is small. So I won’t quote figures here. What does hold true is that what women describe deserves to be taken seriously — and that it makes sense to talk about it with a doctor who knows that ADHD is not only a childhood issue. If the latest chapter of life is what concerns you, also read Depression in perimenopause: when your body changes, and your mood with it.

What is expected of women — and why that is where ADHD hurts most

Most of the organisational work in families is still invisible, and it often falls to women: who has a doctor’s appointment when, when the parents’ evening is, what’s missing from the fridge, whose birthday is next week. This is work that rests almost entirely on executive functions — planning, remembering, switching between tasks. Precisely the things that are most strained with ADHD.

A man with ADHD who forgets the parents’ evening is “a typical man”. A woman who forgets is “a bad mother”. That difference in expectations is no small thing; it changes how a woman judges herself. I wrote about the guilt carried by the most devoted mothers in Mother’s guilt: why the most devoted mothers are the ones who feel they do too little.

Because ADHD is highly heritable, it often happens that a mother recognises herself through her child. This is how such a conversation in therapy might sound (a composite, not a real person):

“When the psychologist was explaining how my son has all his tabs open at once, I started laughing. And then crying.”
“What was in those tears?”
“That I’d always thought I was just bad at it. At everything.”
“And now?”
“Now I don’t know. I’m angry. And also … a bit relieved. Is that normal?”
“Yes. Both at once. Perhaps we could look at what you had to do all these years to keep going.”

Relief and grief often arrive together. Relief, because the thing has a name. Grief for the years when you explained yourself to yourself as lazy, disorganised or incapable. More about what a late explanation gives and takes away is in the post ADHD in adults: signs we have put down to character for decades.

The shame you carry with you

When someone doesn’t know for years why something isn’t working for them, they invent an answer themselves. And that answer is almost always about character: “I’m lazy. Incompetent. Useless.” Out of this grows shame — the feeling that what is wrong is not what you did, but who you are. I wrote about how shame works and why it sits so firmly in Shame: the emotion that whispers “There is something wrong with me”.

Hinshaw and colleagues followed a group of girls with ADHD from childhood into early adulthood. They showed that, as adults, these girls had more difficulties than the comparison group — including higher rates of self-harm and suicide attempts, particularly those in whom both inattention and impulsivity were pronounced. I don’t write this to frighten anyone. I write it because it matters to know that unrecognised distress is not harmless.

If you are having thoughts of hurting yourself, don’t stay alone with them: in Slovenia, call Klic v duševni stiski on 01 520 99 00 (every day from 7 pm to 7 am) or the Samaritans helpline (Zaupni telefon Samarijan) on 116 123 (24 hours a day). If you are in immediate danger, call 112.

Shame doesn’t disappear with a diagnosis. A diagnosis can explain why things were hard for you, but it doesn’t erase the voice that has been telling you for thirty years that you don’t try hard enough. That voice was once external — a teacher’s, a parent’s, a boss’s — and slowly it became your own. This is exactly where therapy has a lot to do.

Exercise: a map of invisible effort

This exercise is not a test, and it won’t tell you whether you have ADHD. What it will do is help you see how much energy goes into things that other people do in passing — and that is a good start, whatever a possible assessment might show.

1. Write down three everyday tasks that take a disproportionate amount of your energy. For example, answering emails, paying bills, tidying up after dinner. Not the ones that are hard for everyone, but the ones that make you wonder why they don’t come easily to you.
2. Next to each, write down what you have devised in order to manage it. An alarm, a note on the fridge, a deadline you brought forward, a friend who calls you. These are your compensations.
3. Rate how much each compensation costs you. From one (almost nothing) to five (it drains me). Don’t correct yourself; write the first number that comes.
4. Look for a trace from childhood. Was there anything similar in primary school? What did teachers write about you in school reports or say at parents’ evenings?
5. Write one sentence about yourself that isn’t a judgement. Instead of “I’m disorganised”, for example: “Organising things takes me more energy than it takes others, and I still get it done.”

If you decide on a professional assessment, this sheet will help. A doctor or psychologist will ask about exactly these things: what isn’t working, since when, and how you deal with it.

Where this explanation doesn’t hold

It wouldn’t be honest if this post sounded as though ADHD were the answer to every bout of tiredness and distraction. It isn’t. Concentration is quickly worn down by lack of sleep, chronic stress, anxiety, depression, traumatic experiences, thyroid problems, anaemia, hormonal changes and some medications. A woman with a baby and a full-time job will be distracted even without ADHD — because she is a human being, not a machine.

What points towards ADHD is above all that the difficulties stretch back to childhood, that they appear in several settings (at home, at school or work, in relationships), and that they don’t go away when life calms down. If you were focused and organised until thirty and then everything fell apart, it is more likely that something else has happened — and that deserves attention too.

I would also be cautious about self-diagnosis from the internet. Videos about ADHD can help, because they give people language for an experience they couldn’t describe before. At the same time, the signs they list are often so general that almost anyone recognises themselves in them. “Do I have ADHD?” is a good question. But the answer has to come from someone who can assess you as a whole.

What therapy can offer

Psychotherapy doesn’t replace a diagnostic assessment, nor does it replace medication when a doctor recommends it. But it can help with what no tablet can: the story you tell about yourself. The anger and grief for the lost years. The perfectionism that helped you survive but now leaves you breathless.

Because I am training in relational family therapy, I am especially interested in how ADHD lives within relationships. What did your family say about you when you were a child? Who was “the scatterbrain” and who was “the reliable one”? How is the work shared in a couple when one partner forgets and the other holds everything together? These roles are often handed down in families, and they can be looked at without blaming anyone. Some of the themes that intertwine with ADHD in adults — such as work that is both a gift and a burden — are explored in ADHD and entrepreneurship: a gift and a burden at once.

And perhaps most importantly: therapy is a place where you don’t have to compensate. Where you can say “I forgot” and nothing happens. For many women with ADHD, that alone is a new experience. If you want to understand how brains differ without a pejorative undertone, the concept of neurodivergence may help. I also work with English-speaking clients, in person in Ljubljana.

What to remember

• In girls, ADHD often shows up more quietly — as inattention, daydreaming and inner restlessness — so it is easier to overlook.
• Many women compensate for years with diligence and perfectionism; when life becomes more demanding, that system can give way.
• Women with unrecognised ADHD often first get help for anxiety, depression or burnout; that may be right, but it doesn’t necessarily explain everything.
• A diagnosis is made by a psychiatrist or a clinical psychologist; online questionnaires can only be a first hint.
• Late recognition often brings relief and grief at the same time — and both deserve room.