How To Get Diagnosed With ADHD As A Woman: Navigating The Differences

Attention-deficit/hyperactivity disorder (ADHD) can be a common neurological condition affecting roughly 129 million kids and adolescents and 366 million adults worldwide. 

It may impact people of every gender, age, race, background, and culture, but studies suggest that boys are about twice as likely as girls to receive an ADHD diagnosis. 

The potential reasons for this discrepancy can vary, but research indicates that females with ADHD may present symptoms differently than their male counterparts, possibly leading to a lack of symptom recognition. In addition, women tend to be more frequently misdiagnosed. Undiagnosed ADHD can have a negative impact on an individual’s daily life, sense of self, and overall mental health. Seeking a diagnosis may involve sharing your personal history, assessing your symptoms, undergoing medical evaluations, and going through psychological and functional assessments. Whether or not you’re diagnosed with ADHD, seeking help from a licensed mental health professional can be beneficial to manage symptoms.

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Receiving an ADHD diagnosis as a woman

Adult women and men typically undergo the same diagnostic process for ADHD. However, there are many other factors that healthcare professionals may need to consider when diagnosing ADHD in women specifically. 

The diagnostic process often consists of multiple steps, and a qualified mental health professional typically uses several tests and assessments to determine whether one has ADHD and to rule out other conditions that may have similar symptoms. It can be critical to note that this process often differs between individuals and healthcare providers. 

Personal history and ADHD risk factors

The first step of the diagnostic process is typically an interview and assessment of your personal history to determine whether you displayed ADHD symptoms during childhood. For example, the healthcare provider may ask questions about your school performance, as well as whether you got in trouble with teachers, had difficulty establishing relationships with peers, or struggled with organization and time management. 

The professional may also request to speak with a parent, caregiver, family member, or anyone else who can provide more information about your childhood. Not only can this give them a fuller perspective of your childhood experience, but questions about your family history may also reveal risk factors for ADHD. 

An exact cause for ADHD has yet to be identified. However, experts believe there are several potential links:

• Genetics: Family and twin studies reveal that ADHD may have a heritability rate of up to 80%, indicating a significant genetic component. 
• Traumatic brain injury (TBI): While the data is somewhat inconclusive, there is evidence to suggest that individuals with childhood TBI may be more likely to develop ADHD in adulthood. 
• Environmental conditions: Some older research connects prenatal alcohol and nicotine use, as well as early exposure to neurotoxins, with a higher risk of ADHD.
• Low birth weight: Babies with a low birth weight may also be more likely to develop ADHD. 

Symptom assessment

During this initial assessment, a physician or mental healthcare professional will typically ask about your current challenges and uncover symptoms you may be experiencing. To understand how ADHD symptoms shape individual experience, it can be helpful to understand that there are generally three types of ADHD classified by their most dominant symptoms.

ADHD predominantly inattentive presentation (formerly known as ADD)

People with this type of ADHD often struggle with attention and concentration. They may: 

• Have difficulty organizing and focusing on tasks
• Be easily distracted
• Appear preoccupied or detached
• Have a hard time following directions
• Have trouble performing tasks that require sustained mental effort
• Make careless mistakes, miss details, and/or lose items when engaging in tasks

Predominantly hyperactive/impulsive presentation 

This type of ADHD is largely characterized by hyperactive and impulsive behaviors, such as the following:

• Impulsive or impatient behaviors
• Risky or hasty decision-making
• Restlessness and fidgeting
• Trouble taking turns or waiting in line
• Difficulty engaging in quiet activities
• Excessive talking/interrupting others
• Impulsive exclamations or inappropriate comments

Combined inattentive/hyperactive presentation

People with this type of ADHD often display a combination of both inattentive and hyperactive/impulsive symptoms. For example, they might have challenges with hyperactivity and impulsive behavior while remaining distracted and unfocused.

It may be prudent to mention that executive dysfunction, typically involving difficulty with organization, time management skills, and emotional dysregulation, can present with every type of ADHD. 

Symptomatic expressions in women

Women and girls can have any type of ADHD, and the frequency and severity of symptoms may vary between all individuals, regardless of gender. 

According to Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD), women and girls with combination or hyperactive/impulsive presentation sometimes report experiencing “internalized” hyperactivity, presenting symptoms such as the following:

• Difficulty sustaining healthy long-term relationships
• Fear of rejection, leading to “clinginess” in relationships
• Difficulty leaving unhealthy relationships
• “Overworking” to compensate for challenges in work or school
• Extreme, unhealthy self-discipline
• Trouble concentrating on one topic
• Frequent “daydreaming”
• Excessive/impulsive speech
• Impulsive behaviors
• Fidgeting and difficulty sitting still
• Self-harming activities

Medical evaluation

Your doctor may review your medical history, conduct a physical exam, and order lab work if necessary to identify or rule out underlying medical conditions that may mimic or contribute to ADHD symptoms, such as a seizure disorder or thyroid condition. They may also ask about your family’s medical history. 

Psychological testing and functional assessments

During the evaluation process, psychological testing may be recommended by the healthcare provider to assess cognitive function, emotional dysfunction, and other relevant psychological factors. This may also rule out any other mental health conditions, like personality or mood disorders, that may mimic symptoms of ADHD. 

Functional assessments can also measure cognitive function within the context of executive dysfunction. This generally refers to the difficulties you might face in everyday life that impact your ability to meet your responsibilities and goals, such as problems with working memory, organization, planning, problem-solving, time management, and emotion regulation. 

Functional assessments often have an interpersonal component, measuring one’s ability to sustain relationships, interpret social cues, and maintain awareness of one’s own behavior and its impact on others.

ADHD diagnostic criteria 

Although there is some debate as to whether it should be reevaluated, the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR) to diagnose ADHD states that children up to age 16 must display six or more symptoms for at least six months to receive a diagnosis. Adults 17 and over must present five or more symptoms. In addition:

• Symptoms must be severe enough to disrupt the quality of work, school, or social function.
• Symptoms must be present in two or more settings, such as work, school, home, with friends and relatives, in social interactions, and other activities.
• Several symptoms must be present before 12 years old.
• The symptoms aren’t the result of another condition, such as a mood disorder, personality disorder, anxiety disorder, or dissociative disorder. 
• The symptoms do not occur solely during the course of schizophrenia or another psychotic disorder.  

The impacts of misdiagnosis on women’s health

Women and minorities tend to be among the most misdiagnosed and underdiagnosed groups in healthcare, which can contribute to a significant disparity in treatment and successful outcomes. When left untreated, ADHD can cause problems affecting both genders: 

• Poor performance at work or school
• Difficulty forming and maintaining healthy relationships
• Executive dysfunction in organization and time management
• Impaired working memory
• Difficulty managing thoughts, emotions, and behaviors

However, mis- or undiagnosed ADHD in women may carry additional consequences. For example, without a diagnosis, there is often no explanation for perceived “flaws” other than personal shortcomings. When an individual resorts to self-blame for social, emotional, academic, and work struggles, it can lead to low self-esteem and self-efficacy.

These types of troubles can begin in childhood, potentially causing alienation, peer rejection, and bullying. Studies also suggest that women may use self-harming behaviors to cope with these painful experiences, such as misusing substances, alcohol, and sex to self-medicate. 

There can be potential physiological consequences to an ADHD misdiagnosis as well. For example, a misdiagnosis of anxiety or depression might cause professionals to overlook a severe physiological condition with symptoms similar to ADHD because they didn’t believe a physical examination was warranted. 

Serious conditions, such as inflammatory diseases and immune dysregulation associated with ADHD and comorbid stress, may be overlooked when ADHD isn’t considered as a diagnosis. 

How to seek treatment for ADHD

Psychoeducation can empower women to take charge of their mental health, speak confidently to healthcare professionals, and advocate for appropriate diagnosis and ADHD treatment. Receiving a diagnosis can be a huge relief for some women who have potentially internalized symptoms throughout their lives as “faults” or “character flaws.” Education can often provide explanations for their experiences, helping them make sense of the past and gain confidence in their abilities to cope with struggles in the future. 

While early intervention can be preferable for favorable outcomes, treatment at any time can make a significant difference in one’s quality of life and well-being. With therapy and/or coaching, women with ADHD can improve executive function, learn techniques to enhance cognitive flexibility, manage emotional regulation, and regain self-confidence. 

Could you be living with ADHD?

Talk about it with a therapist online

The rise in online therapy through platforms like BetterHelp may provide unique advantages for people with ADHD. For example, because it eliminates geographical barriers, virtual therapy typically offers access to a broader pool of therapists with experience diagnosing and treating women with ADHD. In addition, therapy from home may be better suited for people with organization and time management challenges due to its flexibility in scheduling.

BetterHelp therapy is frequently more affordable than conventional treatment options without insurance, and a growing body of research also suggests that virtual therapy can be just as effective as traditional therapy for treating ADHD and common comorbidities like anxiety and depression.