ADHD Looks Different in Girls and Women, Posing Unique Health Risks

School used to be pretty easy for Kate Jarvis when she was a little girl, back in the 1980s. She was a straight-A student, creative, and so organized that she’d even prep her toothbrush with toothpaste each night before school. She says her mother used to call her “bright-eyed and bushy tailed.”

Then puberty hit, and everything started to fall apart. She found it harder to focus in school, and her grades slipped. “It really hit my self-esteem badly. I felt pretty awful about myself,” she says.

In high school, she was diagnosed with anxiety and depression. She struggled to fit in. She says it stung when teachers would write comments like, “Kate has so much potential, if only she’d apply herself.”

“So it felt like character flaws rather than what it really was, which was undiagnosed ADHD,” says Jarvis, who didn’t get a diagnosis until her late 30s.

Researchers say Jarvis’ story is pretty common. For decades, ADHD, or attention deficit hyperactivity disorder, was considered a childhood disease that mostly affected boys – and boys were the focus of most research, says Julia Schechter, a clinical psychologist and co-director of the Duke Center for Girls and Women with ADHD. But ADHD often manifests differently in girls.

“They’re more likely to appear distracted, disorganized, kind of have their head in the clouds rather than show that overt, hyperactive or impulsive behavior that can disrupt a classroom,” Schechter says.

She says those symptoms in girls are easier to miss. That’s one reason why girls tend to get diagnosed years later than boys, often not until adulthood. Instead, women will spend years wondering what’s wrong with them, being treated for anxiety or depression without addressing the underlying cause.

“Sometimes those conditions are truly present,” Schechter says. “Other times they’re secondary to years of undiagnosed and untreated ADHD.”

The heavy health cost of missed treatment

There is a cost to those years of missed treatment. ADHD is a neurodevelopmental condition that influences many aspects of a person’s life and can bring challenges with social relationships, impulse control and low self-esteem.

“For women, the risks are even more striking,” Schechter says. “So compared to girls and women without ADHD, those with ADHD have more problems with friendships. They’re more likely to experience abuse by romantic partners, more likely to have a teen pregnancy compared to boys and men with ADHD.” They’re also more likely to have feelings of worthlessness and self-harm or attempt suicide.

And there are other health risks for women, including a higher incidence of obesity, eating disorders, type 2 diabetes and cardiovascular disease than their peers without the condition, says Dr. Patricia Quinn, a developmental pediatrician who has specialized in ADHD in women and girls for decades. She says several factors linked to ADHD can contribute to these risks. They include impulsivity, trouble sleeping, an inability to maintain healthy routines, the chronic stress of living with unmanaged symptoms and poor food choices driven by the need to seek dopamine.

Last year, a large study from the UK found women with ADHD die on average nearly nine years earlier than their peers without the disorder – and two years earlier than men with ADHD. Yet many people don’t realize just how serious ADHD can be.

“It’s not just an excuse for ‘why I’m always late for work,'” Quinn says. “It’s a significant problem in their lives.”

In recent years, growing recognition of gender differences in ADHD has helped lead to a surge in diagnoses among adult women – nearly 7 million women in the U.S. had the diagnosis as of 2023, according to federal data analyzed by the nonprofit Children and Adults with Attention-Deficit/Hyperactivity Disorder, or CHADD. While boys are still diagnosed at roughly 2 to 3 times the rate of girls, those disparities even out in adulthood.

A breaking point in midlife

Often, women can spend years masking their symptoms, says Ellen Littman, a clinical psychologist who specializes in women with ADHD. But when life gets more complex, their compensation systems can crumble.

“And it just reaches a critical mass point of, ‘I can’t manage all of this,'” Littman says.

For Amy Reyer, that breaking point came at age 48. She was caring for two teens and aging parents, and had a demanding job that had her constantly on call.

“I was holding it together, as I’d learned to do, but a lot was breaking down,” Reyer says.

Reyer says her whole life, she’d struggled with focus and anxiety. She felt like she always had to work three times as hard as her peers to get things done.

“I spent most of my life trying to prove that I wasn’t defective,” she says.

“I just assumed that everything I was going to do was going to be really, really difficult – and more difficult for me. But I didn’t know why at that time until I was diagnosed.”

Still, she’d managed to earn a doctorate and had a successful career in media. Then perimenopause hit, and it all became too much. “I was pretty overwhelmed and I wasn’t sleeping,” Reyer says.

Emerging evidence suggests fluctuations in estrogen levels can exacerbate symptoms of ADHD, and perimenopause might be a particularly vulnerable time. Research suggests women with ADHD enter perimenopause years earlier than those without the disorder and experience more severe symptoms during this menopausal transition.

One survey of more than 3,000 women with ADHD found the vast majority had been diagnosed for the first time during the menopausal years. “The big, big shift was brain fog and executive functioning problems during the menopausal years,” says Jeanette Wasserstein, a neuropsychologist who conducted the survey. She specializes in ADHD and is on the faculty at the Icahn School of Medicine at Mount Sinai.

Reyer says she’d first suspected she had ADHD after her son was diagnosed, because the disorder is highly genetic. She says when she was diagnosed in her late 40s, it changed her life because it led to treatment. Once she found an ADHD medication that worked for her, it was like a lightbulb came on.

“I remember just saying to myself, ‘Oh my God, this must be what normal feels like,'” she says.

Treatment beyond medication

Medication is just one part of treatment. Dr. Patricia Quinn, who recently released a guide for clinicians to treat ADHD in women, says for women in perimenopause, hormone replacement therapy can also be helpful. And because so many women have dealt with a lifetime of demoralization and shame, she says therapy – especially cognitive behavioral therapy – is also key, “because you need to rewrite all those scripts that are going on in your head.”

Psychologist Ellen Littman says in her practice, the focus is on helping women reframe their understanding of themselves “from ‘I’m a broken loser and I’m useless’ to helping them see themselves through the lens of this neurological information. And it changes their self-esteem and their ability to be effective in their lives and more confident as a parent and a partner.”

Lifestyle changes like exercise, meditation and a healthy diet can also help, says Kathleen Nadeau, a clinical psychologist in Maryland who’s been working with women and girls with ADHD for more than four decades. She says she encourages patients to find environments that play to their strengths – which can sometimes mean career changes.

“The metaphor I use is to plant yourself in the right garden, where the things that you’re good at can be nourished and expanded,” Nadeau says. “And the things that you struggle with are not what is emphasized in terms of what you’re supposed to do every day.”

Learning to thrive 

Ruth Danoff says getting an ADHD diagnosis at age 50 led to a process of understanding her life – her inability to focus and do well in school as a child despite being told she was bright, the years of struggling with “big emotions” and feeling overwhelmed.

It also ultimately led to a new professional path. After spending her whole career in administrative support jobs where she says she was consistently “dinged for not paying enough attention to detail,” now, at age 65, she’s become an entrepreneur and advocate for other women with ADHD. She serves on the community advisory council at the Duke Center for Girls and Women with ADHD .

“My mission in life is that I don’t want any woman to go through what I went through,” Danoff says. “And if I can help just one woman, that’s the best feeling in the world.”

Kate Jarvis says seeking a diagnosis, no matter your age, is worth it. After feeling like she didn’t quite measure up for so long, getting diagnosed with ADHD as an adult led her to medication and therapy, and ultimately, self-acceptance.

“There is so much joy waiting on the other side,” she says. “There’s so much joy.”