Between 1-9% of school-age children in the UK have ADHD. However, the signs commonly go unnoticed in girls.
This often means many women go undiagnosed for decades. Actor Sheridan Smith and singer Lily Allen are among those diagnosed later in life.
With that in mind, Dr Elena Touroni, a consultant psychologist and co-founder of The Chelsea Psychology Clinic, has explained the most common signs of ADHD that go overlooked in girls and women.
She has also shared insight into why it is harder to spot ADHD in women rather than men, as well as the impact a late diagnosis can have on girls’ careers and mental health.
What are the most common signs of ADHD that go overlooked in girls?
Individuals with ADD and ADHD often struggle with attention, hyperactivity, and impulsivity. These challenges typically begin in childhood, but some may not receive a diagnosis until adulthood.
ADHD in girls can look like this:
- daydreaming quietly in class
- feeling anxious or sad
- exhibiting silliness or apparent ditziness
- acting shy or inattentive
- trouble maintaining friendships
- picking at cuticles or skin
- being a perfectionist
ADHD in women can look like this:
- failing to give close attention to details or making careless mistakes in activities
- trouble holding attention on tasks
- not following through on instructions and failing to finish duties (such as: losing focus, getting side-tracked)
- trouble organising tasks and activities
- getting easily distracted
- forgetfulness in daily activities
- internalising symptoms, including mood and anxiety
In general, ADHD symptoms can include:
- Struggling with attention to details
- Difficulties completing school or work tasks
- Disorganisation
- Being fidgety, restless or hyperactive
- Talking excessively
- Impatience
- Impulsivity
This condition can cause problems with:
- Impulse control
- Emotional regulation
- Anger management
- Substance misuse
- Eating problems
- Sleep disorders
ADD/ADHD can also impact a person’s education, work, daily activities, relationships and quality of life. ADHD or ADD is thought to be present in about 4-5% of the adult population and is generally under-recognised in women.
You have a greater probability of having ADHD if:
- A close family member has being diagnosed with ADHD
- You have epilepsy
- You have a neurodevelopmental disorder e.g. autism, tic disorder, a learning disability/difficulties
- You have another mental health condition
- You have a history of substance misuse or eating disorders
If you find that you’re having trouble with staying focused, now might be a good time to reach out for help. If you haven’t been diagnosed yet, you’ll need to see a specialist to confirm if you have ADHD.
Why it is harder to spot ADHD in girls and women rather than men?
Dr Touroni says: “Research has shown that it is much more likely for boys to be diagnosed with ADHD than girls. When there is a very hyperactive child or a child with behavioural problems, there is a bias in spotting ADHD in boys compared to girls.
“ADHD isn’t harder to spot in women than men — it’s much more about the assumptions that we make about women and how we understand female behaviour.
“With girls, there might be a different interpretation of their particular symptoms, such as inattentiveness and hyperactivity, because it tends to be seen as part of their personality and might not necessarily be associated with ADHD. It is very much about perception.
“We have seen this across a full range of psychiatric diagnoses where something might be more commonly diagnosed in men than women. This is not because the symptoms each gender displays is different but because of a social bias of how we understand the behaviour of the different genders.”
The health expert says it can come down to parents, as well as teachers and educational settings, being more prone to missing it in girls, or it needing to be much more severe in presentation for it to be identified in young girls.
She added: “Young girls might also be better at masking it, and developing coping strategies and workarounds, so they can be better at conforming to social norms and more able to compensate for their inattentiveness. This can then mean that ADHD is more likely to be missed.
“The threshold for diagnosing ADHD seems to be much higher in women than men because of the different social assumptions that we make about male and female behaviour.”
What impact can a late diagnosis have on future careers and mental health?
The impact of missing a diagnosis is quite significant, Dr Touroni says. She explains that this is because it’s likely to have a lot of implications for education if someone is underperforming due to either inattention or hyperactivity or both.
“It also contributes to developing low self-esteem if you perceive that your inability is something that is intrinsic and characteristic of your personality rather than a biological condition,” she said.
“There are a lot of educational and mental health consequences of not receiving a diagnosis. ADHD in women is associated with higher levels of depression and anxiety as well as self-harm.
“There are also consequences in terms of career because educational performance will shape someone’s ability to believe in themselves and can have a lot of implications for career progression.
“One caveat is that some people with ADHD can experience it almost like a superpower because they are able to be very busy and active and juggle multiple responsibilities in a way that is almost very difficult for people who are neurotypical.
“So some women, if they have managed to find a career that is a good fit for ADHD characteristics, can really thrive because the way their brain works is actually a huge asset.”
Dr Touroni ends by saying ADHD is not all about deficits – it can come with tremendous strengths. But being aware of it on a diagnostic level can be tremendously helpful because you understand how your mind works and how to use those strengths and abilities and find a career that is a good fit.