For women, gender disparities in ADHD diagnoses can be deadly

It was long assumed that boys were more likely to have attention-deficit/hyperactivity disorder (ADHD). But recent research suggests girls have been widely underdiagnosed—with sometimes devastating consequences.

Now, many women who have long suffered from mental health conditions and everyday challenges are identifying ADHD as the underlying cause.

“Women are much more likely to have what’s called ‘inattentive ADHD,’ versus ‘hyperactive ADHD,’” says Dr. Sarah Greenberg, a licensed psychotherapist and the vice president of expertise and strategic design for neurodivergence nonprofit Understood.org. “The hyperactivity is really visible to others in the room, whereas for inattentive ADHD that hyperactivity is internal. It might look like daydreaming or staring into space. But I can assure you, there’s a lot happening in the brain.”

Dr. Greenberg says that undiagnosed ADHD can create challenges in childhood, from social to academic, leading to lots of self-doubt. Coupled with the over-thinking tendencies of those with inattentive ADHD, many are instead diagnosed with anxiety or depression. That misdiagnosis can have serious consequences, as untreated ADHD has been associated with everything from higher rates of substance abuse to divorce, car accidents, even suicide attempts.

Women with ADHD are Often Misdiagnosed

According to a study conducted by Understood.org, 72% of women with ADHD have at least two other mental health conditions, like anxiety or depression, and 44% were diagnosed with anxiety, depression or another mental health condition first. 

Furthermore, 89% say they originally attributed ADHD symptoms—like disorganization, overthinking and chronic lateness—to personal character flaws.

“’Hysteria’ was a label given to women for a range of things, from insomnia to anxiety, and the theory rested on uterine imbalance,” explains Dr. Greenberg. “We don’t use that label anymore, but what has persisted is women are more likely to get diagnosed with an emotional disorder rather than ADHD, which is a brain difference.”

According to a 2022 study conducted by the American Centers for Disease Control, boys are twice as likely to be diagnosed with ADHD. However, a 2022 study by medical research provider Epic Research found that women aged 23 to 49 were diagnosed twice as frequently as men that year compared to 2020. Males were also diagnosed with ADHD at 28% higher rates than females in 2022, down from 133% in 2010. 

In the Canadian province of Ontario, prescriptions for stimulant medications—often used to treat ADHD—were more prevalent among adult women aged 18 to 64 than men in 2023. 

“We’re getting closer to gender parity in adulthood, so that is very much a silver lining,” says Dr. Greenberg. “We’re also getting closer to gender parity in childhood. Whereas we used to see three boys diagnosed for every girl, we’re now seeing two, so that ratio is getting better.”

Women with ADHD are Often Treating the Wrong Condition

Misdiagnosis is common among women with ADHD, both because of longstanding misconceptions and because many of the diagnostic tools that test for ADHD are based on the hyperactive presentation more common in boys.

As a result, women tend to suffer with ADHD well into adulthood before understanding the cause of some of their neurological differences, and the likely culprit behind other lifelong challenges.

“It’s really important to get that ADHD diagnosis right, because while anxiety and depression are treatable and can be short term, ADHD is a lifelong difference,” says Dr. Greenberg. “Sometimes depression or anxiety speaks more to symptoms one has experienced, but it’s much more efficient to address ADHD as the primary condition.”  

There is yet to be a formal study into the relative effectiveness of anxiety and depression treatment on those with undiagnosed ADHD. However, a 2024 study of healthcare records in Wales found that women are more likely to be prescribed antidepressant medication prior to being diagnosed with ADHD, and are more likely to stop using the medication afterwards.

“Anecdotally, it’s what we hear from patients all the time,” says Dr. Julia Schechter, a clinical psychologist at the Duke University School of Medicine and co-director of the Duke Center for Girls and Women with ADHD. “We hear that story so often.”

“’For years, I was told I was anxious. For years, I was on medication that was not effective. Then I found out I had ADHD, and getting on ADHD medication really reduced the symptoms’.”

The Dangers of Living with Untreated ADHD

Research shows that those with untreated ADHD are more likely to struggle in school and to maintain employment, have financial challenges, get divorced, get into car accidents and struggle with substance abuse at higher rates. 

In women, untreated ADHD has also been linked to higher rates of unplanned pregnancy,eating disorders and suicide attempts. 

According to the Understood.org study, 23.5% of women diagnosed with ADHD report a history of suicide attempts, compared with 8.5% of men with ADHD.

“We know that untreated ADHD is linked to so many negative outcomes for everyone,” says Dr. Schechter. “But for women and girls in particular, not treating this condition really can be a matter of life and death.”

Awareness and Diagnoses Have Been Skyrocketing Since COVID

Longstanding assumptions about ADHD primarily affecting young boys started to change during the pandemic, for many reasons. 

For one, those with undiagnosed ADHD often learn to cope with the disorder over time, such as by using timers, to-do lists and reminders, sticking to routines and by optimizing their workspace—much of which was disrupted by the pandemic. As a result, adults with undiagnosed ADHD felt the symptoms more acutely.

“It was also becoming part of the conversation, and a big part of that was social media,” says Dr. Schechter. “People were turning to social media for medical questions and there was a lot of information out there around ADHD, especially ADHD in females.”

Mothers Often Identify Symptoms in Their Children

Many parents were also overseeing their children’s remote education, exposing some to signs and symptoms they might have otherwise missed.

“They saw more of the challenges they had and started to look for reasons,” says Dr. Emma Climie, an associate professor at the school of applied psychology and director of The Strengths in ADHD Lab at the University of Calgary. “Parents were saying, ‘I’ve had similar challenges, what kind of support is there for my kids, and would that help me as an adult as well?”

Dr. Climie explains that ADHD has “a strong hereditary component,” and during the pandemic, parents were more attuned to their children’s learning challenges, prompting more to seek diagnoses for their kids.

As they learned more about the disorder, many parents—and especially mothers —identified similar symptoms in themselves. “ADHD apples don’t fall far from ADHD trees,” she says.

As a result, the pandemic could go down as a turning point in our cultural perception of ADHD in women and girls, raising awareness of some of the common symptoms and helping those who have long suffered because of the disorder without understanding why. 

“There’s always been a smaller, vocal group saying, ‘what about women and girls with ADHD?’

but I don’t think they had really found their voice,” Dr. Climie says. 

“In the last few years, there’s been more people joining that conversation. We’re starting to develop new tools and assessments. And we’re starting to identify that ADHD looks a little bit different in girls and women.”

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