In the past, ADHD has been considered to occur more commonly in males than in females. Results from the US National Health Interview Survey show that in children, 13.2% of males are at some point diagnosed with ADHD, compared to 7% of females. However, recent studies have identified that the ratio of males to females affected by ADHD is closer to 1:1 in adults.
Because of the historical notion that ADHD occurred less in females, they have been continually under-represented in studies and literature about ADHD. Thus, it has not until recently become clear that ADHD may affect females differently than males. In this post, we’ll explore a couple of ways the condition may present differently in females, and what that might mean for those with ADHD.
Hyperactive/impulsive symptoms are less outwardly obvious
Outwardly obvious symptoms of hyperactivity/impulsivity may include difficulty sitting still, and interrupting or intruding. Historically, it has been common for males to be diagnosed with this subtype, and as such it has become how most people expect those who have ADHD to present.
Females may experience hyperactive/impulsive symptoms more inwardly than outwardly – this might look or feel like racing thoughts, feeling restless, and talking fast or excessively.
They may also present with more inattentive symptoms, which may be less obvious to others, although they are still linked to functional impairment. Some inattentive symptoms may include poor attention to detail, difficulty maintaining attention and focus, and difficulty organizing tasks and activities.
These symptoms are less obvious and disruptive, which may contribute one explanation for the proportion of females who are misdiagnosed or late diagnosed.
Unique effects on emotional and mental health
Compared to males with the condition, females with ADHD have reported more overall stress, anxiety and depression. ADHD symptoms such as disorganization and inattention may be mistakenly attributed to these conditions, which can also affect likelihood of timely diagnosis.
Living without a diagnosis of ADHD, and subsequently, without access to necessary accomodations and resources, may also have flow-on effects which could contribute to the increased incidence of mental health conditions in females with ADHD.
Females with ADHD also have lower self-esteem than males, and may blame themselves for their difficulties. Combined with the societal expectations placed on females, those with ADHD may have a more negative self-perception which may lead to feelings of guilt, failure, and inadequacy.
They may also experience more difficulty with emotional regulation compared to males with ADHD, and when coupled with the above effects stemming from reduced self-esteem, this may lead to uncontrollable emotional outbursts.
Reduced treatment rates
A recent investigation identified that teachers may consider the level of functional impairment most significant when deciding whether to refer a child with ADHD for treatment. Supporting this, a 2009 study identified that females who were referred for treatment were more likely to present with increased symptom severity.
Since females are less likely to appear outwardly hyperactive/impulsive, and their symptoms may be overlooked due to signs of other mental health conditions, they may be less likely to be referred for assessment and treatment for their ADHD than their male counterparts.
Compared to females without ADHD, those with the condition were found to have fewer friends and stable friendships, and their friendships featured more negative interactions, including conflicts. They may also experience judgement or rejection from peers based on their functional difficulties.
Another study also identified that for children with ADHD who exhibited difficulties with social conduct as a result of their condition, peer relationships were more affected for females than for males.
Other research has suggested that females with ADHD may have increased difficulties in social settings overall, including in marital and work-related relationships, compared with males.
Females with ADHD may experience heightened emotional reactivity compared to males with ADHD, and as such may see the effects of this in their relationships. Conflicts may arise more frequently, or they may react more severely than would typically be expected.
The impact of hormonal fluctuations on ADHD symptoms
Hormonal changes during the reproductive cycle may impact the severity of ADHD symptoms. A 2021 study found that compared to the general population, a higher proportion of females with ADHD experienced pre-menstrual dysphoric disorder (PMDD) and postpartum depressive symptoms. One review has suggested that females with ADHD may experience decreased symptom severity in the two weeks prior to the menstrual period, in comparison to the two weeks after.
Variation in sex hormone levels throughout the reproductive cycle may also affect the levels of hormones in the brain, including dopamine, a hormone considered to contribute to the symptoms of ADHD. However, further research is required to fully understand the interplay between ADHD and sex hormones.
TikTok user @mindovermatterwithemma posted this video sharing a bit about how their menstrual cycle affects their ADHD symptoms:
We hope this post helped you learn more about how ADHD might affect females differently. If you know someone who might benefit from this post, please share it with them! We’d love for our resources to reach those who need them.