For many women, the journey towards an ADHD diagnosis begins with a question they may have been asking themselves for years: why do some things seem so much harder for me than they seem to be for other people?
It might be managing everyday tasks, remembering appointments, starting something that needs to be done, staying focused at work or keeping on top of competing demands. Often, these difficulties have been explained in other ways. A woman may have been told she is stressed, anxious, disorganised, forgetful or simply trying to do too much.
For some women, an ADHD diagnosis eventually provides an explanation for a pattern that has been there for much of their lives. For others, that explanation comes much later, if at all.
ADHD has historically been associated with the image of a disruptive, hyperactive boy. That has contributed to girls and women being overlooked, particularly when their symptoms are less obvious to the people around them.
ADHD doesn’t always look like ADHD
ADHD is a neurodevelopmental condition that can affect attention, impulse control and executive functioning. It does not look the same in everyone.
Girls and women are more likely to experience predominantly inattentive symptoms, which can be less noticeable than obvious hyperactivity. Difficulties may include:
• Forgetting appointments, conversations or important details
• Struggling to start or finish tasks
• Procrastinating, even when something is important
• Losing track of time
• Difficulty prioritising competing demands
• Becoming easily distracted
• Feeling overwhelmed by ordinary responsibilities
• Struggling with working memory and organisation
• Experiencing racing thoughts or an internal sense of restlessness
None of these symptoms is unique to ADHD, which is why assessment needs to look at the wider picture.
A woman experiencing these difficulties may instead be described as stressed, anxious, emotional, disorganised or someone who needs to manage her time better.
She may even describe herself that way.
The woman who appears to be coping
One of the misconceptions I see is that someone who is successful, organised or high-achieving cannot have ADHD.
In reality, achievement can sometimes conceal significant difficulties.
Some women compensate by working longer hours, creating detailed routines, making extensive lists, checking their work repeatedly or becoming highly perfectionistic. These strategies can be effective, but they can also be exhausting to maintain.
From the outside, someone may appear extremely organised. Internally, they may be putting a great deal of effort into staying on top of things.
This is why I think it is useful to ask not only, “Are you managing?” but also, “How much effort does it take you to manage?”
Two people can achieve the same outcome, while one has had to use considerably more mental and emotional energy to get there.
Masking can hide the problem
Masking is essentially the process of hiding or compensating for difficulties so that they are less visible to other people.
For a woman with ADHD, this might mean arriving everywhere very early because she knows that without careful planning she is likely to be late. It might mean checking emails repeatedly, relying heavily on reminders, copying organisational systems used by colleagues or working late because concentration has been difficult during the day.
Over time, these strategies can become so familiar that neither the woman herself nor the people around her recognise what is happening.
Sometimes, being very organised can actually make ADHD harder to identify. The lists, routines and constant checking may be the things that are allowing someone to function, rather than evidence that they have no difficulties with organisation.
Why women are sometimes diagnosed with anxiety, depression or burnout instead
ADHD and mental health difficulties can overlap considerably.
A woman who has spent years struggling to organise her life, meet deadlines, remember commitments or complete tasks may understandably become anxious, exhausted or lose confidence.
She may seek help because she feels overwhelmed or burnt out without realising that longstanding ADHD could be contributing.
That does not mean anxiety, depression or burnout are not genuine problems. ADHD can coexist with these conditions, and one can exacerbate the other. This is why an ADHD assessment should not focus only on what is happening now. Looking at a person’s developmental history can help identify whether there has been a longstanding pattern of difficulties.
Hormones can add another layer
Hormonal changes may also influence how manageable ADHD symptoms feel at different stages of a woman’s life.
During perimenopause, for example, fluctuations and eventual decline in oestrogen may exacerbate difficulties with concentration, memory, motivation, emotional regulation and organisation.
For a woman who has spent years compensating for ADHD, this can sometimes be when those strategies stop working as well.
She may find herself struggling at work, becoming more forgetful, feeling overwhelmed by everyday tasks or wondering why things that once felt manageable suddenly seem much harder.
For some women, this is when the possibility of ADHD is first considered.
It is important not to assume that every new difficulty during perimenopause is ADHD. Sleep disruption, stress, mood changes, hormonal fluctuations and other factors can all affect concentration and wellbeing. A proper clinical assessment is important.
The cost of being missed
There is an important difference between being undiagnosed, misdiagnosed and diagnosed late.
An undiagnosed woman may have ADHD but never receive an explanation or appropriate support.
A misdiagnosed woman may have her difficulties attributed to something else, such as anxiety or depression, without ADHD being recognised as part of the clinical picture.
A delayed diagnosis means ADHD is eventually identified, but much later than it might reasonably have been.
For some women, this can mean years of unnecessary struggle and self-blame.
Repeatedly trying hard but finding that performance is inconsistent can be particularly difficult. A woman may know she is capable because there are times when she performs exceptionally well, yet struggle to reproduce that performance consistently.
Over time, she may start to think of herself as lazy, unreliable, disorganised or someone who never quite reaches her potential.
That can affect confidence, relationships, education, careers and mental health.
A diagnosis can change the narrative
One of the most important things a diagnosis can provide is an explanation.
It can connect experiences that previously seemed unrelated: procrastination, forgetfulness, difficulty with time, feeling overwhelmed or struggling to organise everyday life.
For some women, there is a sense of relief in finally having an explanation for difficulties that have been present for years.
There can also be more complicated emotions. Some women feel sadness or anger about the fact that their ADHD was not recognised earlier, particularly when they think about how much effort they spent trying to compensate. Both reactions are understandable.
A diagnosis does not explain every difficulty in someone’s life, nor should it be seen as an excuse. But it can provide a more accurate framework for understanding why certain things have been difficult and what might help.
Diagnosis should be the beginning, not the end
An ADHD diagnosis in itself is not treatment. What happens afterwards is important.
Depending on the individual, support may include:
• ADHD medication where clinically appropriate
• Psychological support
• Practical strategies for managing executive-function difficulties
• Workplace or educational adjustments
• Support for coexisting anxiety or depression
• Calendars, reminders and visual prompts
• Breaking larger tasks into smaller, manageable steps
• Clear written instructions and priorities
• Reducing unnecessary interruptions or distractions
The aim is not to lower expectations. It is to make it easier for someone to use their abilities without having to spend so much energy compensating for their difficulties.
Support also needs to recognise strengths. People with ADHD can be creative, energetic, intuitive and good at generating ideas or responding quickly to changing situations. A good assessment should consider the whole person rather than focusing only on what they find difficult.
Looking at ADHD differently
I think we are becoming better at recognising that ADHD does not have one particular appearance.
A woman does not have to have been a disruptive child, struggle academically or appear obviously hyperactive to have ADHD. She may have done well at school, built a successful career and developed a sophisticated set of strategies to manage difficulties that other people never saw.
Sometimes it is only when circumstances change that those strategies become harder to maintain. A new job, having children, increasing responsibilities or changes around perimenopause can all place additional demands on attention, organisation and emotional regulation.
That does not mean that every woman who feels overwhelmed has ADHD. Forgetfulness, anxiety, exhaustion and difficulty concentrating can have many causes.
But if a woman has experienced these difficulties throughout her life, particularly if they have affected different areas of her life over time, it can be worth considering whether there is a broader explanation.
For women who do have ADHD, being properly assessed can be an important step towards understanding their experiences and finding support that is appropriate for them.
The aim should not simply be to identify ADHD, but to understand the individual woman sitting in front of you, including her difficulties, strengths, circumstances and what she needs to function well.
Read the article on Living360’s campaign to highlight the gaps in women’s ADHD diagnosis:
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