As adult ADHD specialists, we address attention-deficit/hyperactivity disorder in men and women. While members of either sex can have the full range of ADHD traits, they often experience them differently due to cultural and biological factors. For women, these differences can delay identification and complicate treatment. They can also lead to more severe outcomes when left untreated.
In her recent webcast, Ellen Littman, PhD, describes some of the gender-specific factors that affect the experience of ADHD in adult women. Littman has studied attentional disorders for more than 30 years. She does an excellent job of bringing attention to the latest research in this field and advocating for women with ADHD.
Below, we highlight five sex- and gender-specific factors from Littman’s presentation that help explain why women sometimes appear to exhibit different ADHD symptoms than clinicians expect. If you’re a woman with ADHD, learning about these differences can help you identify and treat your ADHD more effectively:
1. Hormonal Differences
In Littman’s presentation, she speaks at length on the influence of women’s hormones on ADHD symptoms. She reminds us that hormones don’t just interact with a person’s sex organs; they interact with nearly every organ in the body, including the brain. New research shows some hormones measurably influence the expression of a woman’s ADHD.
One particularly impactful hormone is estrogen, which changes most dramatically during puberty, adolescence, and perimenopause/menopause. It also fluctuates monthly during a woman’s menstrual cycle, dropping significantly between ovulation and menstruation. Subtle changes to estrogen levels can even be detected within a single day. Estrogen modulates various brain functions, including attention, memory, motivation, and sleep.
Low estrogen and high progesterone levels have been shown to significantly increase ADHD symptoms in adult women. Women with impulsive tendencies are particularly sensitive to this effect.
This connection between female hormones and women’s ADHD symptoms helps to explain why stimulant medications sometimes work well and other times seem to lose effectiveness. The estrogen factor is also thought to be a major contributor to the misdiagnosis of ADHD in women since ADHD symptoms do not always show up during times of high estrogen.
2. Gender Roles and Expectations
Littman says women who are able to conform to gender expectations generally do. They exert tremendous effort to embody deference, empathy, cooperation, efficiency, organization, and other culturally female traits. When neurodivergent people exert enormous efforts to fit into neurotypical expectations, we call this “masking”.
Women are generally encouraged to put others’ needs first. They are expected to manage jobs and households while simultaneously making time for exercise and other forms of self-care. “That’s a lot of expectations,” Littman says, and “women who thrive with that are unicorns.”
Women who fail to fully conform to these roles don’t typically blame their failure on unrealistic cultural expectations. They blame it on themselves, leading to shame, imposter syndrome, and low self-worth. Since women with ADHD have a particularly difficult time juggling cultural expectations, they are more likely to experience these feelings, contributing to anxiety, depression, and other mood problems.
3. Social Difficulties
Women with ADHD are susceptible to social difficulties. They find it more difficult to initiate new friendships and maintain old ones. “Friends easily fall off their overcrowded radar screens,” Littman says.
Those who have yet to be diagnosed and treated often feel misunderstood, with loved ones mistakenly labeling them as lazy, uncaring, or overreactive. Women with undiagnosed ADHD rarely feel truly known, and social interactions can overwhelm them.
Many women cope by isolating themselves, which hinders social skills development and leads to further social problems. Past relationships have often been hurtful and disappointing, so many are reluctant to develop deep connections. For this reason (likely coupled with impulsivity), women with ADHD are much more likely to engage in risky sexual behaviors such as casual and unprotected sex.
Both men and women with ADHD tend to have hypersensitivities in the central nervous system. In other words, their brains tend to amplify the input from the body’s sensory organs. There are a variety of hypersensitivity types.
According to Littman, women with ADHD are more likely than men to experience the following hypersensitivity types: tactile defensiveness (to things like tight or scratchy clothing, etc.); somatic complaints (headaches, stomach aches, nausea); sensory overload (a tendency to shut down or lash out in response to distressing sounds, smells, etc.); sleep difficulties; and pain reactivity.
Hypersensitivities exacerbate many of the issues women with ADHD experience. For example, a woman who is already struggling with impulsivity may be more likely to act on her impulses if she is simultaneously experiencing tactile discomfort or sensory overload. Hypersensitivity can also cause a woman’s anxiety to worsen.
5. Co-occurring Issues
Many people who have ADHD also have other, co-occurring mental health issues. In some cases, these issues are inborn; in others, they develop due to unhealthy coping mechanisms.
Littman reminds us that women are much more likely to be diagnosed with an anxiety disorder than men. Women are also far more likely to experience depression and emotional dysregulation. Dysregulated eating and personality disorders (such as borderline personality disorder) are more common.
Compared to women without ADHD, women with ADHD are more likely to experience externalizing disorders, including oppositional defiant disorder and conduct disorder. These issues can increase ADHD’s impact and lead to misdiagnosis.
Estrogen appears to play a role in co-occurring issues. Estrogen and other female hormones interact with impulsive, addictive, and other tendencies commonly experienced by women with ADHD, significantly complicating their symptom profiles. “The centrality of the hormone involvement is just amazing,” Littman says.
The gender-specific factors Littman covers in her presentation—including hormonal differences, gender roles, social difficulties, hypersensitivities, and comorbid conditions—all affect women’s experiences of ADHD. In some cases, these factors cause women’s observable ADHD symptoms to worsen. In others, the suffering these factors cause is mostly internalized. Even when they are clinically invisible, these factors have a real emotional impact on the women experiencing them.
Access Supportive Therapy for Women with ADHD
If you’re a woman with ADHD struggling with ADHD, you don’t have to struggle in isolation. Working with a neurodiversity-affirming ADHD specialist can provide you with the understanding and support needed to begin feeling confident and in control. As clinical psychologists, we can also address the co-occurring anxiety and depression that you may feel.