ADHD in Women: Why Can It Take So Long to Be Recognised?
ADHD in women can be overlooked when difficulties are internalised, masked or compensated for. We explore why recognition can take until adulthood and why appearing to cope doesn't necessarily mean things have been easy.
For a long time, the picture many of us had of ADHD was fairly specific.
A young boy.
Lots of energy.
Can't sit still.
Calls out in class.
Probably spends a reasonable amount of time being told to stop swinging on his chair.
And yes, ADHD can absolutely look like that.
But it can also look like the girl sitting quietly in class who has missed half of what the teacher has said because she was somewhere entirely different in her head.
The teenager who leaves every piece of homework until the night before but somehow still gets good grades.
The woman with seventeen lists, three calendars and an impressive ability to look organised while privately feeling as though she's permanently five minutes away from dropping a ball.
The mum who can remember everyone else's appointments, PE days and birthday parties but has been meaning to book her own dentist appointment for approximately eleven months.
Or the woman who has spent much of her life wondering:
Why does everyone else seem to find this easier than I do?
For many women, ADHD isn't recognised until adulthood.
And when it finally is, there can be an enormous mixture of relief, disbelief and sometimes grief.
ADHD isn't a male condition
ADHD occurs across genders, but historically much of what we understood about it was shaped by research and clinical descriptions that disproportionately focused on boys.
That matters.
If the version of ADHD we're looking for is predominantly externalised, disruptive and visibly hyperactive, people whose difficulties are more internalised can be much easier to overlook.
A girl who repeatedly disrupts lessons is likely to attract attention.
A girl who sits quietly while mentally disappearing for large parts of the lesson may not.
She's not causing anybody else a problem.
But that doesn't necessarily mean she isn't struggling.
Sometimes inattentiveness looks like daydreaming
Women diagnosed with ADHD later in life often describe longstanding difficulties with things such as:
Drifting away during conversations.
Reading something several times before taking it in.
Forgetting instructions.
Losing belongings.
Starting tasks and not finishing them.
Leaving work until the last possible moment.
Difficulty estimating how long things will take.
Becoming overwhelmed by multi-step tasks.
Frequently forgetting appointments or commitments.
Having dozens of thoughts competing for attention.
Struggling enormously with boring tasks while becoming completely absorbed in interesting ones.
As a child, some of this may have been described as being:
Dreamy.
Chatty.
Disorganised.
Sensitive.
Bright but not reaching her potential.
Or my personal favourite:
“She just needs to apply herself.”
Because apparently there was a mysterious Apply Yourself button somewhere that nobody thought to show us.
Hyperactivity doesn't always mean running around
This is another reason ADHD can be missed.
Hyperactivity can be very visible.
But it can also be experienced as internal restlessness.
A constantly busy mind.
Needing to be doing something.
Talking quickly or a lot.
Interrupting because the thought feels as though it might disappear if you don't say it immediately.
Fidgeting.
Picking at nails or skin.
Frequently changing position.
Finding genuine rest surprisingly difficult.
Feeling uncomfortable when there isn't enough stimulation.
Some women don't describe themselves as physically hyperactive at all.
But ask whether their brain ever shuts up and you may get a very different answer.
Being bright can hide a lot
Intelligence doesn't protect somebody from ADHD.
But it can make ADHD easier to compensate for.
If you learn quickly, you may be able to miss significant chunks of teaching and still understand enough to do well.
If you can produce good work under pressure, procrastination may not become obvious until the demands become greater.
If you have supportive parents providing structure, reminders and organisation, executive-functioning difficulties may not become fully apparent until you leave home.
This is why someone can do very well at school and still have ADHD.
The question isn't simply:
“Did you achieve?”
It's also:
“What did it take for you to achieve?”
Then there is masking
Many girls learn very early to watch what other people are doing and adjust themselves accordingly.
They may work incredibly hard not to forget things.
Stay quiet because they're worried about getting something wrong.
Become perfectionistic.
Overprepare.
People please.
Check everything repeatedly.
Use anxiety to make sure things get done.
And eventually, these strategies can become so familiar that the person doesn't even recognise them as strategies.
They just think:
This is how I have to function if I don't want everything to fall apart.
From the outside, she looks organised.
From the inside, she may be exhausted.
“But I've always managed”
This is something I hear frequently.
And often, it's true.
You have managed.
But managing doesn't necessarily mean something has been easy.
Sometimes ADHD becomes more apparent when the demands of life increase.
Moving away from home.
University.
Starting a career.
Being promoted.
Having children.
Managing a household.
Trying to organise several people's lives rather than just your own.
Suddenly there are more things to remember, more transitions, more demands and fewer external structures holding everything together.
The strategies that previously worked may no longer be enough.
This can be the point at which women begin seeking help for anxiety, overwhelm, low mood or burnout without initially recognising ADHD as part of the picture.
Motherhood can be a particularly interesting moment
For some women, becoming a parent is when things really start to unravel.
Parenting requires an extraordinary amount of executive functioning.
Remember the appointment.
Pack the bag.
Sign the form.
Buy the present.
Respond to the school email.
Find the missing shoe.
Plan dinner.
Remember that it's apparently Victorian Day tomorrow and your child requires a historically accurate costume despite informing you of this at 8:47pm.
All while somebody is asking you a question.
It is a lot.
For a brain already working hard to manage attention, working memory, organisation and emotional regulation, the additional cognitive load can expose difficulties that were previously just about manageable.
Interestingly, another common route to recognition is through a child's assessment.
A parent starts reading about ADHD because their child has been referred and thinks:
Hang on.
I do that.
And that.
And... actually quite a lot of this.
There can be an emotional cost to going unrecognised
When nobody has given you another explanation, it's very easy to make ADHD difficulties about your character.
I'm lazy.
I'm unreliable.
I'm too much.
I'm not disciplined enough.
Why can't I just get organised?
Why do I keep doing this?
Why can't I cope when everybody else seems to?
Years of those messages can affect self-esteem.
By the time someone reaches assessment in adulthood, we aren't necessarily just exploring ADHD traits.
We're sometimes also unpicking decades of conclusions they have drawn about themselves because they didn't have another framework for understanding their experiences.
Diagnosis doesn't rewrite your history, but it can change how you understand it
This is something I understand personally as well as professionally.
I have ADHD myself.
Understanding that hasn't suddenly made me organised at all times, given me a flawless working memory or prevented me from occasionally searching for an object that is already in my hand.
Unfortunately.
What it has done is give me a much more useful framework for understanding why some things require more effort than others.
It allows the question to move from:
“What's wrong with me?”
towards:
“What does my brain need here?”
And that is a very different starting point.
Of course, relating to this doesn't automatically mean you have ADHD
This is important.
Most people procrastinate sometimes.
Most people forget things.
Most people become distracted.
Most people feel overwhelmed occasionally.
ADHD isn't diagnosed because somebody relates to a Reel or recognises themselves in a list of traits.
A comprehensive assessment considers whether there is a persistent pattern of difficulties beginning during development, occurring across different areas of life and having a meaningful impact on functioning.
It also considers alternative and overlapping explanations.
Anxiety, trauma, autism, sleep difficulties, stress and other psychological or physical factors can sometimes produce experiences that look similar.
For many people, more than one thing may be relevant.
The aim of assessment shouldn't be to squeeze somebody into a diagnosis.
It should be to understand the whole picture.
Perhaps you've always been trying harder than anyone realised
One of the most powerful things about recognising ADHD later in life can simply be understanding that difficulties you interpreted as personal failures may have had another explanation.
You may have developed some extraordinarily effective ways of coping.
You may also be tired of having to work quite so hard.
Both things can be true.
And if you're beginning to wonder whether ADHD might explain some of your experiences, you don't need to have decided that you definitely have it before asking questions.
Curiosity is a perfectly reasonable place to start.
Wondering Whether You Might Have ADHD?
At I.N. Therapy Berkshire, we provide comprehensive and neuroaffirming ADHD and combined autism and ADHD assessments for adults.
Assessment considers your experiences now alongside developmental history, masking, compensatory strategies, strengths and difficulties across different areas of your life.
If you're not sure whether assessment is the right next step, you can also access a standalone Neurodevelopmental Consultation to talk through what you've been experiencing and consider the options available.
Comments