Why ADHD in women and girls is missed and why so many are diagnosed later in life

For most of my life, I knew that something was wrong, but I had no clear language for what that something was. I struggled in ways that never seemed to have an obvious explanation, and over time I came to believe that these difficulties were simply a reflection of who I was as a person rather than something deeper going on beneath the surface.

I was diagnosed with anxiety and depression, and like many women, I was prescribed medication for anxiety that never really made a meaningful difference. I accessed therapy, including cognitive behavioural therapy, but it was very much rooted in a traditional neurotypical medical model. It focused on changing thoughts and behaviours without ever questioning why my brain seemed to work differently in the first place. Despite engaging fully and trying hard to apply what I was taught, it never addressed the core issues I was living with.

I spent years feeling as though I did not quite fit in anywhere, always working harder than others just to keep up, and constantly questioning myself. At one point, I even wondered whether I might be bipolar, simply because I could not make sense of the emotional intensity, the overwhelm, or the exhaustion that followed me through different stages of my life. What I did know was that whatever this was, it felt pervasive, lifelong, and deeply personal, and I carried a huge amount of shame believing it was a fundamental character flaw.

Realising that ADHD was the underlying thread running through all of this was genuinely life changing. It allowed me to make sense of my past with compassion rather than judgement, and it completely shifted how I advocated for myself. For the first time, I was able to seek the right kind of support, support that worked with my brain rather than against it, and that understanding alone made an enormous difference.

As I now see every day in my work, my story is far from unique. It is echoed in the experiences of countless women and girls whose ADHD was missed, misunderstood, or mislabelled for decades. The reasons for this are systemic, deeply rooted, and long standing.

ADHD research was built around boys

Historically, ADHD research focused almost entirely on boys, particularly those who displayed high levels of hyperactivity and impulsivity that were disruptive in classroom settings. These were the children who stood out, drew attention, and were referred for assessment, which meant that ADHD quickly became associated with a very specific and narrow presentation.

As a result, diagnostic criteria and assessment tools were developed around externalised behaviour, rather than internal experience. This legacy is still reflected in frameworks such as the DSM-5, which has shaped how clinicians understand and identify ADHD.

Girls who did not fit this outwardly hyperactive profile were far less likely to be recognised, even when they were struggling significantly.

How ADHD often presents differently in girls

Many girls with ADHD experience difficulties that are less visible to others but no less impactful. They may appear dreamy, distracted, emotionally sensitive, or quietly overwhelmed rather than overtly hyperactive. In school, they are often described as chatty, disorganised, or anxious rather than disruptive.

From an early age, girls are more likely to internalise their struggles. Instead of acting out, they may develop perfectionism, people pleasing behaviours, or high levels of self criticism in an attempt to cope. These strategies can mask ADHD traits extremely well, particularly in environments that value compliance and academic performance.

Because they are often trying so hard to meet expectations, these girls may be praised for coping, while privately feeling exhausted and inadequate.

Masking and social expectations

Social and cultural expectations play a significant role in how ADHD is recognised. Girls are often expected to be emotionally aware, organised, and socially attuned, and when they struggle with these demands, they tend to blame themselves rather than question whether their brain works differently.

Over time, many become highly skilled at masking, carefully managing how they present to the world, over preparing, copying others, and pushing themselves well beyond their limits. While this may help them function on the surface, it often leads to chronic anxiety, burnout, and a growing sense that life feels harder than it should.

By adulthood, ADHD is frequently hidden beneath secondary diagnoses such as anxiety or depression, which are treated in isolation while the underlying neurodevelopmental difference remains unrecognised.

The role of hormones across the lifespan

Hormones add another crucial layer to this picture. Oestrogen plays an important role in supporting dopamine, a neurotransmitter that is already dysregulated in ADHD. Across the menstrual cycle, during pregnancy, after childbirth, and particularly during perimenopause, changes in oestrogen levels can significantly exacerbate ADHD symptoms.

For many women, it is during perimenopause that long standing coping strategies begin to fall apart. Memory difficulties, emotional dysregulation, poor concentration, and profound fatigue may suddenly become unmanageable, prompting them to seek help and to recognise ADHD traits that have been present since childhood.

Historically, this hormonal context has been largely absent from ADHD research and clinical training, contributing to delayed or missed diagnoses in women.

ADHD assessments rely heavily on childhood history

ADHD assessments still place significant emphasis on childhood behaviour, often asking whether someone was disruptive at school or constantly in trouble. For many women, these questions simply do not reflect their experience.

Girls who were academically able, well behaved, or highly anxious are frequently told they cannot have ADHD, despite clear lifelong patterns of executive function difficulties, emotional intensity, and overwhelm. This can be deeply invalidating and is one of the reasons many women continue to doubt themselves even after recognising ADHD traits.

The cost of being overlooked

The long term impact of missed ADHD in women and girls can be profound. Many grow up believing they are lazy, unreliable, or failing at things that seem effortless for others. Careers may be disrupted by burnout, relationships can be affected by rejection sensitivity and emotional dysregulation, and mental health difficulties are common.

By the time ADHD is finally recognised, many women are already exhausted from years of trying to survive in systems that were never designed for their brains.

Why awareness is finally increasing

Awareness is improving, driven by women sharing their stories, growing public understanding of neurodiversity, and the work of organisations such as ADHD UK. Updated guidance from bodies like NICE is also helping to shift practice, although change remains slow.

Many women also recognise ADHD in themselves after supporting their own children through assessment, finally connecting lifelong patterns that previously felt inexplicable.

Moving towards a more inclusive understanding of ADHD

Recognising ADHD in women and girls requires a broader, more nuanced understanding that goes beyond stereotypes. It means valuing internal experience as much as external behaviour, and recognising that success, compliance, or intelligence do not rule out ADHD.

When women are finally able to understand themselves through this lens, the impact can be transformative, not because ADHD suddenly appears, but because it is finally seen and understood for what it has always been.