By Dr. Ryan Sultan, MD
Double Board-Certified Psychiatrist (Adult & Child/Adolescent)
Columbia University Irving Medical Center | Integrative Psych NYC
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📂 Category: ADHD Across Populations
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ADHD in women is often missed because females present with inattentive symptoms (not hyperactivity), are diagnosed 5-10 years later than males, and face unique hormonal factors affecting symptom severity across menstrual cycles. |
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⚠️ The Hidden Epidemic: ADHD in Women Did you know? Women with ADHD are diagnosed an average of 5-10 years later than men, and many are never diagnosed at all. The reason? ADHD looks different in women—and our diagnostic criteria were developed by studying boys. If you've struggled your whole life with focus, organization, or feeling "scattered," and you've been told "you're just anxious" or "you're too sensitive," this page is for you. |
Here's the uncomfortable truth: ADHD research has historically focused on hyperactive boys. The diagnostic criteria in the DSM were developed primarily from studies of school-age boys who were disruptive in class.
The result? Millions of women and girls with ADHD went undiagnosed because they didn't fit the stereotypical profile.
| Reason | Explanation |
| 1. Different Presentation | Women are more likely to have inattentive ADHD (daydreaming, disorganization) rather than hyperactive symptoms (running around, interrupting). Inattentive symptoms are easier to miss. |
| 2. Better Masking | Due to socialization, women develop compensatory strategies that hide their struggles: over-scheduling, excessive list-making, apologizing constantly, people-pleasing to mask forgetfulness. |
| 3. Internalized Struggles | While boys with ADHD often act out (leading to diagnosis), girls internalize their struggles as anxiety, depression, or low self-esteem—which then become the focus of treatment. |
| 4. Higher Academic Compensation | Intelligent women with ADHD can often achieve academically through brute-force effort until college or career demands exceed their coping capacity—leading to late diagnosis. |
The Statistics:
ADHD doesn't look the same in women as it does in men. Here's how the core symptoms manifest differently:
| Domain | Typical in Men | Typical in Women |
| Hyperactivity | Physical restlessness, can't sit still, pacing, fidgeting visibly | Mental restlessness, racing thoughts, inner tension, excessive talking |
| Impulsivity | Interrupting, blurting out, risk-taking behaviors, reckless driving | Impulsive spending, emotional outbursts, saying "yes" to too many commitments |
| Inattention | Difficulty sustaining attention on tasks, easily distracted by external stimuli | Overwhelmed by details, difficulty prioritizing, losing things constantly, "brain fog" |
| Emotional | Quick anger, frustration, externalizing problems | Emotional sensitivity, rejection sensitivity dysphoria (RSD), internalized shame |
| Social | Trouble following social rules, appearing "odd" or disruptive | People-pleasing to compensate, masking symptoms, social exhaustion |
| Organization | Messy workspace, losing important items | Excessive list-making that doesn't get followed, cluttered purse/car, always running late despite trying hard |
While men with ADHD are split fairly evenly between hyperactive and inattentive types, women are significantly more likely to have the inattentive presentation:
This matters because inattentive ADHD is much harder to spot—especially in a culture that expects women to be organized, detail-oriented, and emotionally regulated.
ADHD symptoms in girls often go unrecognized during childhood because they don't match the "classic" profile of a hyperactive boy disrupting class.
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📚 The "Daydreamer" Described as "spacey," "in her own world," or "not paying attention." Stares out the window during class, misses instructions, but isn't disruptive. Teachers say: "She's so bright, but she doesn't apply herself." |
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💬 The "Chatty Cathy" Talks excessively, interrupts, can't wait her turn in conversation. Hyperfocuses on social relationships. May be seen as "dramatic" or "attention-seeking." Parents say: "She just won't stop talking!" |
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😰 The "Anxious Perfectionist" Works twice as hard as peers to achieve the same results. Homework takes hours. Constant worry about forgetting things or making mistakes. Parents say: "Why is everything such a struggle? She's so smart." |
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🎭 The "Emotional Roller Coaster" Intense emotions, frequent meltdowns over small issues, rejection sensitivity. Labeled as "too sensitive" or "moody." Teachers say: "She needs to develop a thicker skin." |
1. They Don't Disrupt Class
Boys with ADHD get sent to the principal's office. Girls with ADHD get labeled "ditzy" or "unmotivated" but aren't seen as a problem.
2. They Compensate Better
Girls develop workarounds: asking friends for notes, using charm to get extensions, staying up late to finish assignments. This masks the core deficit.
3. They Internalize Failure
Rather than acting out, girls with ADHD develop internalized narratives: "I'm stupid," "I'm lazy," "Something is wrong with me." This leads to anxiety and depression—which then become the focus of treatment.
4. Puberty Changes Everything
Many girls with ADHD "hit a wall" in middle school or high school when:
ADHD has three official presentations. Here's how they show up in women:
70-80% of women with ADHD have this type.
Core symptoms:
How it looks in daily life:
Less than 10% of women with ADHD have purely this type.
Core symptoms:
How it looks in women:
Meets criteria for both inattentive and hyperactive-impulsive presentations. Often the most impairing but also most likely to be diagnosed (symptoms are more visible).
This is HUGE and rarely discussed: Estrogen modulates dopamine activity in the brain. Since ADHD is fundamentally a dopamine disorder, hormonal fluctuations directly affect ADHD symptoms.
| Phase | Estrogen Level | ADHD Impact |
| Follicular Phase (Days 1-14) | Rising estrogen | Better focus and motivation. Medication works well. Many women feel "normal" during this phase. |
| Ovulation (Day 14) | Peak estrogen | Peak performance. Best focus, mood, and executive function of the month. |
| Luteal Phase (Days 15-28) | Dropping estrogen | ADHD symptoms worsen. Medication feels less effective. Brain fog, irritability, emotional dysregulation. |
| Menstruation (Days 1-5) | Lowest estrogen | Worst ADHD symptoms. Difficulty concentrating, emotional sensitivity, fatigue, forgetfulness. |
1. Pregnancy & Postpartum
2. Perimenopause & Menopause
3. Hormonal Birth Control
Some women with ADHD benefit from:
Many women with ADHD are first diagnosed with anxiety or depression. Here's why—and how to tell the difference:
ADHD symptoms create anxiety and depression:
Result: You get treated for anxiety/depression, but the underlying ADHD remains. The treatment helps somewhat, but you still struggle with focus, organization, and follow-through.
| ADHD | Anxiety | Depression |
| Lifelong pattern since childhood | Often starts in teens/adulthood | Episodic; periods of normalcy |
| Difficulty initiating tasks | Avoids tasks due to worry | Lacks motivation to start |
| Responds to structure and deadlines | Structure may increase anxiety | Structure doesn't help mood |
| Inconsistent performance across situations | Consistently anxious | Consistently low mood |
| Forgetful even for enjoyable activities | Remembers worries clearly | Anhedonia (nothing enjoyable) |
| Racing thoughts about many topics | Racing thoughts about worries | Negative rumination |
It's also possible to have ADHD plus anxiety or depression. In fact:
The key question: Were you struggling with focus, organization, and impulsivity before the anxiety or depression started? If yes, ADHD may be the root cause.
If you suspect you have ADHD, here's what the diagnostic process looks like:
Not all mental health providers are knowledgeable about ADHD in women. Look for:
Dr. Ryan Sultan specializes in ADHD evaluation and treatment for women in NYC.
A proper ADHD evaluation includes:
Clinical Interview (60-90 minutes):
Rating Scales:
Optional: Neuropsychological Testing
Your clinician should rule out other conditions that mimic ADHD:
To be diagnosed with ADHD, you must have:
Important: The "before age 12" criterion is controversial for women, as symptoms may have been masked or dismissed in childhood. Many experts argue this threshold is too rigid for women.
The good news: ADHD is highly treatable. Most women see significant improvement with the right approach.
Stimulant Medications (First-Line Treatment)
Methylphenidate-based:
Amphetamine-based:
Considerations for Women:
Non-Stimulant Medications (Second-Line or Add-On)
When non-stimulants are preferred:
See our complete ADHD medication guide for detailed comparisons.
Cognitive Behavioral Therapy (CBT) for ADHD:
ADHD Coaching:
Dialectical Behavior Therapy (DBT):
Sleep Optimization:
Exercise:
Nutrition:
Environmental Setup:
Beyond treatment, here are practical strategies that many women with ADHD find helpful:
Sarah, 34 - "I Thought I Was Just Bad at Life""I was diagnosed at 32, after my second child was born. I'd always struggled with organization and time management, but I thought everyone did. I was constantly losing things, running late, forgetting appointments. My husband would get frustrated: 'Just write it down!' But I'd lose the list. After my son was born, I couldn't cope anymore. The sleep deprivation plus managing two kids, a job, and a household—I had multiple meltdowns. My OB suggested I might have postpartum depression. The antidepressant didn't help. A friend suggested ADHD. I laughed—I wasn't hyperactive! But I took an online screening and scored high. Got evaluated, started Vyvanse, and within two weeks I cried with relief. For the first time in my life, I could finish a task without my brain pulling me in 10 directions. I wasn't lazy or stupid—my brain just needed help." |
Michelle, 28 - "High-Achieving on the Outside, Falling Apart on the Inside""I have a master's degree and a good job. Everyone thinks I'm 'together.' What they don't see: I stayed up until 3am multiple nights a week in grad school because I couldn't start assignments until the panic set in. I've been written up at work for missing deadlines. My apartment is chaos. I was diagnosed with anxiety at 22. The medications helped a little, but I still couldn't get my life organized. At 27, my therapist said, 'I think we're treating the wrong thing.' ADHD evaluation confirmed combined type. The diagnosis was bittersweet. Relief that there's a reason—but grief for all the years I spent thinking I was just incompetent. I'm on Adderall now plus ADHD coaching. I'm learning that needing structure and support doesn't make me weak." |
Dr. Jennifer, 51 - "Diagnosed in Perimenopause""I'm a physician. I diagnosed ADHD in kids all the time. It never occurred to me I had it. At 49, I started having terrible brain fog. I'd walk into exam rooms and forget why I was there. I'd lose my stethoscope three times a day. I thought it was early dementia. My internist checked my thyroid—normal. Then she asked about my menstrual cycle. Perimenopause. But when she sent me to a psychiatrist, he asked about my childhood. Turns out I'd always been disorganized and distractible—I just compensated with intelligence and extreme effort. Now that my estrogen was dropping, I couldn't compensate anymore. Diagnosis: ADHD, unmasked by hormonal changes. Started low-dose Adderall plus estradiol patch. It's like someone turned the lights back on." |
No—ADHD is a neurodevelopmental disorder that begins in childhood. However, symptoms can be masked until adulthood, especially in women who develop compensatory strategies. Many women are diagnosed in their 20s-50s when:
No. Many women fear medication will make them "flat" or "zombie-like." In reality, proper ADHD treatment helps you be MORE yourself—you can finally access your intelligence, creativity, and capabilities without the static of distractibility and disorganization.
If medication makes you feel "off," the dose is wrong or it's the wrong medication. Work with your doctor to adjust.
Pregnancy: Stimulant medications are generally not recommended during pregnancy. Discuss with your OB and psychiatrist—some women discontinue medication, others use non-stimulants, others decide the benefits outweigh the risks.
Breastfeeding: Small amounts of stimulant medication pass into breast milk. Again, this is a personal decision to make with your doctors based on severity of symptoms and other factors.
Yes, ADHD is highly heritable. If you have ADHD:
The silver lining: You'll recognize symptoms early and can get your child help sooner than you received it.
ADHD is lifelong, but symptoms often change with age. Hyperactivity tends to decrease in adulthood (you're not climbing on furniture), but inattention and executive dysfunction often persist. About 60-80% of people with childhood ADHD continue to have impairing symptoms in adulthood.
This confuses many people: "I can focus on things I'm interested in for hours, so how can I have ADHD?"
ADHD is not an inability to focus—it's an inability to regulate attention. Your brain seeks high-stimulation activities. Things that are novel, interesting, urgent, or rewarding capture your attention easily (hyperfocus). Boring, repetitive, or low-stimulation tasks don't produce enough dopamine to maintain attention.
Many psychiatrists and therapists accept insurance. Learn about ADHD treatment options in NYC.
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📞 Schedule an ADHD Evaluation with Dr. Ryan Sultan Dr. Ryan Sultan, MD is a double board-certified psychiatrist (Adult & Child/Adolescent) specializing in ADHD evaluation and treatment for women and girls in New York City. Why Dr. Sultan for ADHD in Women:
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