Why are women with ADHD underdiagnosed?

We spoke with medical doctor and psychiatry resident Dr Kieran Kennedy and adult psychiatrist Dr Peter Hoey to find out why women with ADHD are often underdiagnosed.

Here what's they had to say.

As girls are less likely to be diagnosed than boys, the prevalence of ADHD in women is largely under-recognised.

"Gendered notions of illness and diagnosis is something that’s followed medicine throughout its history - but when it comes to mental health, this has all too often been blown far beyond what the science really shows," said Dr Kennedy.

"Whether it’s that men don’t struggle with depression or that girls don’t become hyperactive or suffer from ADHD, there are conditions we’ve come to wrongly label in the past as affecting one sex or the other," he said.

"Another factor at play is that medicine and mental health aren’t blankets of the same struggles or symptoms - a mixture of genetics, biology, gender pressure and culture can all impact how men and women present when it comes to certain illnesses."

A 2018 study aimed to pinpoint what differentiated both boys and girls who met the diagnostic criteria for ADHD. It was found that parents seemed to underrate girls' hyperactive and impulsive symptoms, while overrating those of boys.

It was also found that girls who met the criteria displayed more emotional or behavioural problems than girls who didn’t. This was not the case for boys. 

"It’s now thought that a significant part as to the difference in diagnosis rates (which have traditionally shown these to be conditions that primarily affect boys and men) come down to the fact that these conditions don’t present exactly the same in men and women, alongside stereotypes having sidetracked medicine from picking these up in girls early on," Dr Kennedy said.

"In general, women tend to be better socialised and more compliant than men; they are groomed more to fit in than stand out. It’s more common then for women to 'fly under the radar' and simply not be noticed as having problems early on and later on," adds Dr Hoey.

"More is expected from women in the realms of domestic and general life organisation. It’s common for women to simply feel that they are failures in these domains. They can be labelled and self-labelled as being 'spacey' or 'ditzy' without further looking in to what might be the cause of this.

"ADHD symptoms can also vary markedly through the menstrual cycle, generally with pre-menstrual worsening. They might then not be recognised as such, but simply rolled into the experience of premenstrual symptoms."

Meaning? Many girls end up falling through the cracks - and it can impact their entire lives. 

For those whose symptoms are missed as children, many of these women grew up trying to manage (or hide) this condition on their own - unaware why they don't think and act like their peers.

In 2022, these disorders are being diagnosed in women in higher-than-ever rates.

According to a study in The Journal of Clinical Psychiatry, ADHD has been diagnosed with increasing frequency over the past several years, increasing 55 per cent for girls between 2003 and 2011. Among women ages 26 to 34, ADHD prescriptions shot up 85 per cent between 2008 and 2012 alone.

According to Dr Kennedy, understanding that the problem exists in the first place and creating greater awareness around the symptoms of ADHD in women is the key to ensuring these conditions do not go undiagnosed and overlooked.

"All of the above comes together as a bit of a perfect storm for girls and young women suffering these conditions - a mixture of biology, different symptom profiles, stereotypes and culture means that many young women receive a diagnosis much later than their male counterparts. 

He adds, "Thankfully, new research, greater awareness and a push to correct unequal outcomes when it comes to gender means this trend is changing!"

Want to read more about other women's experiences with ADHD? Check out some of the articles on Mamamia:

• 'I hope to no longer be my harshest critic': What it's like being diagnosed with ADHD at 38. 
• It's hard for women to get diagnosed with ADHD. Just ask Abbie Chatfield.
• 'I'm 26 and I just started taking medication for ADHD. Life is finally starting to make sense to me.' 
• 'I was diagnosed with ADHD at 37. It gave me a complete identity crisis.' 
• It took my psychiatrist 10 years to find out I had ADHD. Here's why I'm not angry at them.' 

We are going to be answering some questions and sharing regular content about ADHD in a free weekly newsletter which you can sign up for here.