ADHD in Men vs. Women: Why Gender Matters in Diagnosis and Treatment
Overview of ADHD Symptoms in Men vs. Women
Over the years, our understanding of ADHD has evolved significantly. It has taken on various forms, including different diagnostic criteria, but one constant remains: women are frequently underdiagnosed or misdiagnosed. Although ADHD’s core symptoms—inattention, hyperactivity, and impulsivity—are shared between genders, distinct differences in biology, societal roles, and coping mechanisms result in unique experiences for men and women. Grasping these nuances can help bridge the gap in ADHD diagnosis and treatment, which historically favors men over women.
Women’s symptoms are often underdiagnosed due to their different presentation, which tends to be more inattentive than hyperactive. Further complicating matters, women's symptoms are frequently mistaken for anxiety or depression. Both men and women typically experience core ADHD symptoms like difficulty with executive functioning, distractibility, poor impulse control, and emotional dysregulation. However, men often present more prominently with hyperactive and impulsive behaviors, whereas women might exhibit internalized struggles.
Understanding ADHD Symptoms in Men and Women
For many years, ADHD was widely considered a condition predominantly affecting boys and men. Diagnostic tools such as self-report measures often skew toward male symptoms. These assessments include questions like "Do you feel the need to climb on things?"—a behavior more commonly observed in boys. This misconception is reinforced by the fact that hyperactive and impulsive symptoms are easier to notice, bringing men and boys to clinical attention more frequently, whether through school disruptions or referrals for psychological assessments. Symptoms in men might include physical restlessness, impulsive decisions, and interrupting others.
In contrast, women typically exhibit the inattentive subtype of ADHD, which manifests as forgetfulness, trouble focusing, and being easily distracted. Unfortunately, these behaviors are often dismissed as personality traits like daydreaming or disorganization, rather than recognized as neurological symptoms. Moreover, women's executive functioning challenges are frequently linked to anxiety or mood disorders, delaying accurate diagnosis and treatment. Many women remain undiagnosed until adulthood, facing the compounded effects of untreated ADHD.
Hormonal Differences and Their Impact
One critical factor that sets ADHD in women apart is the impact of hormonal fluctuations. Women undergo significant hormonal changes throughout their lives, particularly during puberty, menstrual cycles, pregnancy, and menopause1. These hormonal shifts, coupled with increased responsibilities such as caregiving and career demands, can exacerbate ADHD symptoms. Estrogen levels, in particular, influence dopamine—a neurotransmitter central to ADHD. For example, rising estrogen levels may enhance focus, whereas a drop in estrogen, such as during menstruation or menopause, can intensify symptoms like forgetfulness, distractibility, and mental fog2.
In men, who do not experience the same cyclical hormonal fluctuations, ADHD symptoms tend to be more consistent. However, testosterone levels may play a role in externalizing behaviors such as hyperactivity and impulsivity3. This likely contributes to why boys are more frequently diagnosed, as their behaviors tend to disrupt others, making them more visible. Understanding these hormonal influences is vital in diagnosing ADHD earlier in girls and tailoring treatment plans for women.
The Gender Gap in Diagnosis
Research shows that boys are diagnosed with ADHD at significantly higher rates than girls, particularly during childhood6. ADHD diagnoses hinge on behaviors observed before age 12 according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The discrepancy in diagnoses stems from the fact that boys are more likely to exhibit outward signs of hyperactivity. On the other hand, girls frequently internalize their symptoms, masking them to fit societal expectations. This internalization can lead to girls being mislabeled as “lazy” or “disorganized,” rather than recognized as struggling with ADHD.
Girls, often socialized to meet higher standards of focus and organization, might work harder to mask their struggles. As a result, many girls remain undiagnosed until adulthood when the demands of life become overwhelming. The pressure to keep up can lead to low self-esteem, chronic stress, and worse outcomes compared to boys who often receive support earlier.
In contrast, boys' more disruptive behaviors—like fidgeting, acting impulsively, and taking risks—draw attention to their struggles, leading to earlier diagnosis and intervention. These earlier interventions help manage symptoms but can also contribute to boys feeling "different" or "broken" compared to their peers.
Coping Mechanisms and Societal Expectations
Societal expectations and gender roles significantly impact how men and women manage their ADHD symptoms. Women are often expected to handle multiple responsibilities, including organization, multitasking, and family caregiving—tasks that can be particularly taxing for someone with ADHD. To manage these expectations, many women engage in “masking,” where they overcompensate to conceal their challenges. However, masking often leads to burnout, exhaustion, and even resentment in personal relationships. The invisible nature of these struggles may lead women to internalize narratives of inadequacy, increasing stress and exacerbating ADHD symptoms.
On the other hand, men—especially boys—are generally given more freedom to express hyperactive or impulsive behavior. The phrase “boys will be boys” reflects how society normalizes their externalized behaviors. However, the same behaviors in girls are often not afforded the same acceptance. Girls are expected to play quietly and remain focused, leading to greater internal pressure for those struggling with ADHD.
The Impact on Work and Relationships
ADHD is a lifelong condition, and its impact is felt well beyond childhood. Studies indicate that ADHD persists into adulthood for 50-86%5 of those diagnosed in childhood, affecting work performance, relationships, and overall life satisfaction. In the workplace, women with ADHD may struggle with time management, organization, and multitasking—skills that are often required in professional environments. Men may face these challenges too. Or they can face different challenges, as impulsivity and restlessness can hinder their ability to remain focused on tasks, leading to difficulties in a structured 9-to-5 job setting.
In personal relationships, both men and women with ADHD can encounter difficulties with communication, emotional regulation, and managing responsibilities. ADHD also doubles the likelihood of divorce6, as individuals with ADHD are more prone to stress and conflict in romantic relationships. This burden can be particularly overwhelming for women, who often bear a larger share of household and caregiving duties, leading to additional stress and burnout.
Gender-Specific Treatment Strategies
Considering these gender differences, treatment strategies should be personalized to address the unique needs of men and women. For women, treatment plans may need to account for hormonal fluctuations that impact ADHD symptoms, along with the societal pressures they face. Early intervention is crucial for girls and women to prevent long-term emotional and psychological harm, particularly internalized feelings of inadequacy. Therapy should focus on stress management, self-compassion, and counteracting negative self-narratives.
For men, treatment may emphasize managing hyperactivity and impulsivity through behavioral therapy. Men can also benefit from therapy aimed at understanding and mitigating the negative self-talk that can arise from their ADHD challenges. In both cases, early intervention can help prevent the long-term impact of untreated ADHD on career performance, relationships, and mental health.
The Role of Stereotypes
Lastly, it is essential to address the role that gender stereotypes play in the under-recognition and misdiagnosis of ADHD. While this article highlights many gender-specific trends, it is critical to note that not all boys have hyperactive ADHD, and not all girls experience inattentive ADHD. And that the article has a bias use of a binary gender perspective. The use of stereotypes in this article is hoping to move individuals and providers one step closer to treating the whole person as an individual by seeing the nuanced way that ADHD can present itself in different genders.
Conclusion
Understanding the gender-specific nuances of ADHD is crucial to improving diagnosis and treatment outcomes for women and men alike. While both men and women share common ADHD symptoms, their presentation, life experiences, and societal pressures result in distinct challenges that require tailored interventions. By increasing awareness of these differences, we can help ensure that both men and women with ADHD receive the support they need to thrive.
Are you wondering if you have ADHD? Let's talk. If you're looking for support, Dr. Rebecca Branda, Psy.D. is here to help. Book an appointment online or over the phone today.
Resources
1. The Complete Picture: How Estrogen Affects Women with ADHD. (n.d.). CHADD. https://chadd.org/adhd-weekly/the-complete-picture-how-estrogen-affects-women-with-adhd/
2. Hormonal Changes & ADHD: A Lifelong Tug-of-War. (2023, May 1). ADDitude. https://www.additudemag.com/hormonal-changes-adhd-puberty-postpartum-menopause-andropause/
3. Agrawal, J., Ludwig, B., Roy, B., & Dwivedi, Y. (2019). Chronic Testosterone Increases Impulsivity and Influences the Transcriptional Activity of the Alpha-2A Adrenergic Receptor Signaling Pathway in Rat Brain. Molecular Neurobiology, 56(6), 4061–4071. https://doi.org/10.1007/s12035-018-1350-z4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6401208/#:~:text=The%20ratio%20of%20boys%20to,clinical%20compared%20to%20population%20samples.
5. Grow Out of ADHD? Not Likely. (n.d.). CHADD. https://chadd.org/adhd-weekly/grow-out-of-adhd-not-likely/#:~:text=And%20while%20some%20children%20may
6. Board, A. E. (n.d.). ADHD Marriage: Statistics, Trends, and Personal Stories. https://www.additudemag.com/adhd-marriage-statistics-personal-stories/