By: Johanna Badenhorst
(And Why So Many Are Still Being Missed)
As a kid, I wasn’t quiet.
I was talkative, expressive, energetic — often told I was “too much,” “too emotional,” or needed to “try harder to focus.” I wasn’t floating under the radar. I was right there: loud, misunderstood, and still completely missed.
And here’s the kicker — I went on to become a psychologist.
Even with professional training, it wasn’t until my 30s that I realised I was living with undiagnosed ADHD.
I knew what ADHD looked like on paper. But I didn’t know what it looked like in me — because I didn’t match the boyish, hyperactive stereotype we’re all taught to spot.
This post (and the ADHD Her Way podcast episode that inspired it) explores what ADHD really looks like in women and girls — and why we’re still being misdiagnosed, mislabelled, or overlooked entirely.
What Does ADHD Actually Look Like in Women?
In my podcast episode, I shared some of the traits that come up again and again in my community. These are the kinds of patterns women often start recognising in themselves long before anyone mentions ADHD:
- Talkative or expressive, often interrupting
- Emotionally intense or “sensitive” to others’ tone or words (Shaw et al., 2014; Barkley & Murphy, 2006)
- Overwhelmed in noisy, busy environments (Camara et al., 2021)
- Trouble following instructions or juggling competing demands (Quinn & Madhoo, 2014)
- Appears disorganised or “scattered” (Young et al., 2020)
- Known as a perfectionist or people pleaser (often linked to masking) (Russell et al., 2011)
- Cycles of burnout from overcompensating (ADHD Foundation, 2021)
- Strong sense of shame around being “lazy” or “not reaching their potential” (Gershon, 2002)
- Difficulty maintaining routines despite having clear goals (Nadeau et al., 2015)
- Deep fear of disappointing others or being perceived as unreliable (often tied to RSD)
These characteristics align with what many ADHD researchers now understand: that women often internalise their symptoms and develop complex coping mechanisms that hide the underlying neurodevelopmental difficulties — especially during adolescence and early adulthood.
These are not uncommon. They’re just under-acknowledged.
Why ADHD in Women Is Missed or Misdiagnosed
Girls with ADHD — especially those who are expressive, emotional, or perfectionistic — often don’t match the classic “hyperactive boy” profile (Gershon, 2002). Instead, they’re labelled as:
- Overly sensitive
- Dramatic
- Anxious
- Messy
- Defiant
- Disorganised — or “just hormonal”
By adolescence, many girls have developed advanced coping mechanisms to hide their challenges. This is often referred to as masking, and while it can keep things looking “together” on the surface, it usually leads to:
- Chronic emotional exhaustion
- Low self-worth
- Missed diagnoses or late-life burnout (Young et al., 2020)
And because girls are less likely to be referred for ADHD assessment (Russell et al., 2011), many go undiagnosed until adulthood — often after they’ve already experienced anxiety, depression, or professional burnout.
The Hormone Factor: Estrogen and Executive Functioning
For women, ADHD symptoms often worsen during hormonal shifts — like puberty, postpartum, and perimenopause. This is due to estrogen’s role in regulating dopamine (a key neurotransmitter involved in attention and impulse control).
Research highlights:
- Camara et al. (2021): Estrogen fluctuations affect attention, mood, and executive function
- Osianlis et al. (2024): Hormonal phases like the luteal period, postpartum, and menopause are associated with increased cognitive symptoms in ADHD
- Nadeau, Littman & Quinn (2015): Many women aren’t diagnosed until perimenopause, when existing strategies stop working
Personally, learning to track my cycle and adjust expectations accordingly helped me avoid spirals and burnout. I began to plan for the weeks I’d feel dysregulated instead of pushing through with guilt.
RSD and Emotional Intensity
Many women with ADHD describe living in a near-constant state of emotional hyper-awareness — especially when it comes to rejection or criticism. This is often referred to as Rejection Sensitivity Dysphoria (RSD).
While not formally included in diagnostic criteria, research on emotional dysregulation in ADHD supports it (Shaw et al., 2014; Barkley & Murphy, 2006).
RSD might look like:
- Intense distress after receiving feedback
- Avoiding tasks due to fear of failing or being judged
- Overthinking social interactions and perceived rejection for days
- Sudden mood shifts that feel “too much” even to the person experiencing them
Women often internalise these reactions, thinking they’re “too emotional” or “not resilient enough,” when in fact they’re part of a neurobiological cycle linked to ADHD.
Questions That Might Help You Reflect
At the end of my episode, I shared these reflection questions. They’re not diagnostic — and they’re definitely not part of a clinical assessment. But they are powerful prompts for self-awareness, and often lead women to explore their experience more deeply.
You might ask yourself:
- Do I feel like I’m pretending to be “normal,” but deep down feel like I’m barely holding it together?
- Do I start the day with good intentions but end up emotionally drained or overwhelmed by noon?
- Am I easily distracted by background noise, conversations, or clutter — even when I’m trying to focus?
- Do I panic or shut down when given multi-step instructions — worried I’ll forget something or get it wrong?
- Have I been called forgetful, messy, or lazy — even though I’m always trying to keep up?
- Do I crash after social situations and replay conversations for days?
- Do I feel like others with similar education or skills are “getting ahead,” while I’m still stuck in the chaos?
If some of these resonate, it doesn’t mean you have ADHD — but they may point to patterns worth exploring.
Final Thoughts: You’re Not Broken. You’re Likely Just Undersupported.
Many women with ADHD have spent decades blaming themselves for things that were never their fault. But we now know that ADHD in women is:
- Underdiagnosed
- Undervalued
- Underresearched
- Often misunderstood — even by professionals
And yet, support is possible. Self-awareness is important and a supportive community changes everything.
For me, finally understanding my ADHD wasn’t just informative, it helped me stop fighting my brain and start working with it.
That’s what I want for you, too.
Want to Go Deeper?
- Listen to the podcast: What Does ADHD Look Like in Women and Girls?
- Download the Mini Crisis Survival Kit or Routines & Rhythms guide
- Or come join us in the ADHD Her Way Hub — a space for connection, clarity, and real talk about life with an ADHD brain
Disclaimer
This post is for general educational purposes and is not intended as psychological assessment, diagnosis, or treatment. If you believe you or someone you care about may have ADHD, speak with a qualified health professional such as a psychologist, psychiatrist, or paediatrician.
References
- Barkley, R. A., & Murphy, K. R. (2006). Attention-Deficit Hyperactivity Disorder: A Clinical Workbook.
- Camara, E., Ekhtiari, H., & Lawrence, N. S. (2021). The impact of sex hormones on cognitive functioning in women with ADHD: A systematic review. Archives of Women’s Mental Health, 24(3), 405–419.
- Danielson, M. L., et al. (2018). Prevalence of diagnosed ADHD among US adults. Journal of Clinical Child & Adolescent Psychology.
- Gershon, J. (2002). A meta-analytic review of gender differences in ADHD. Clinical Psychology Review, 22(4), 349–363.
- Nadeau, K. G., Littman, E. B., & Quinn, P. O. (2015). Understanding Girls with ADHD.
- Osianlis, E., Thomas, E. H. X., Dwyer, D. B., Adikari, A., & Gurvich, C. (2024). ADHD and sex hormones in females: A systematic review. Journal of Attention Disorders. https://doi.org/10.1177/10870547251332319
- Quinn, P. O., & Madhoo, M. (2014). A review of ADHD in women and girls. Primary Care Companion for CNS Disorders, 16(3).
- Ramtekkar, U. P., Reiersen, A. M., Todorov, A. A., & Todd, R. D. (2010). Sex and age differences in ADHD symptoms and diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 49(3), 217–228.
- Russell, G., Steer, C., & Golding, J. (2011). Social and demographic factors that influence the diagnosis of ADHD. Social Psychiatry and Psychiatric Epidemiology, 46(8), 723–732.
- Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in ADHD. American Journal of Psychiatry, 171(3), 276–293.
- Young, S., Adamo, N., Ásgeirsdóttir, B. B., et al. (2020). Females with ADHD: An expert consensus statement. BMC Psychiatry, 20, 404.
