Many women spend decades believing they are simply anxious, forgetful, or "not good enough" before discovering they have ADHD. Experts now say outdated diagnostic models, social conditioning, and gender bias have kept millions of women invisible.

For decades, Attention Deficit Hyperactivity Disorder (ADHD) has largely been viewed through the lens of hyperactive young boys who struggle to sit still in classrooms. But that narrow understanding has left countless girls and women undiagnosed, often until adulthood—after years of silently battling anxiety, self-doubt, exhaustion, and feelings of failure.

New discussions among psychologists and researchers are challenging these long-held stereotypes, arguing that ADHD in women frequently presents differently, making it easier to overlook. Rather than being disruptive or visibly hyperactive, many women learn to suppress, or "mask," their struggles from an early age, delaying diagnosis by years.

Research suggests women receive an ADHD diagnosis, on average, five years later than men. Before receiving the correct diagnosis, many are instead treated for anxiety, depression, or other mental health conditions, while the underlying neurodevelopmental condition remains unnoticed.

Speaking on Medical News Today's "In Conversation" podcast, Professor Davida Hartman, Chartered Educational and Child Psychologist and Clinical Director at The Adult Autism and ADHD Practice in Ireland, explained that the biggest challenge lies not in women hiding ADHD intentionally, but in society's limited understanding of how the condition truly presents.

"Historically, diagnostic criteria were developed based largely on studies involving young boys," Hartman said. "As a result, many women simply didn't fit the expected picture of ADHD."

The hidden burden of masking

One of the most significant reasons women remain undiagnosed is a coping mechanism known as masking.

From childhood, many girls quickly learn which behaviours are socially acceptable. They suppress impulsive thoughts, force themselves to appear attentive in classrooms, hide restlessness, and work tirelessly to avoid criticism. While this helps them blend in socially, it often comes at a significant emotional cost.

According to Hartman, masking requires constant mental effort, eventually leading to stress, burnout, shame, and chronic anxiety.

Many women become experts at "performing focus," appearing organized and attentive even while internally struggling to concentrate. Because they perform well academically or professionally, teachers, parents, and even healthcare professionals often fail to recognize the warning signs.

Why women are often misdiagnosed

Experts believe another major obstacle is the tendency to attribute women's symptoms to anxiety, depression, hormonal changes, or stress rather than considering ADHD.

Hartman noted that many healthcare professionals still associate ADHD primarily with hyperactivity and disruptive behaviour, overlooking individuals who experience the condition internally.

She also highlighted broader gender biases within healthcare, where women's experiences have historically been dismissed or explained away as emotional or hormonal issues.

The result is that many women spend years receiving treatment for mental health conditions without anyone investigating whether ADHD could be the underlying cause.

Perimenopause can expose long-hidden ADHD

For many women, the first major turning point comes during their late 30s or 40s, particularly during perimenopause.

Emerging research suggests hormonal changes may make ADHD-related difficulties, particularly forgetfulness, emotional regulation, and executive functioning, more noticeable. While the core traits of ADHD may not necessarily worsen, women often find it harder to continue masking them as life's responsibilities increase.

Balancing careers, raising children, caring for ageing parents, and managing households can overwhelm coping strategies that previously kept symptoms under control.

"It becomes harder to keep everything together," Hartman explained, adding that emotional resilience often declines during this phase, making long-standing ADHD traits much more apparent.

ADHD is more than a deficit of attention

Hartman believes society needs to rethink how it understands ADHD altogether.

Rather than describing it as a deficit of attention, she argues it should be viewed as a different style of attention.

People with ADHD often struggle with tasks that fail to capture their interest but can display extraordinary levels of focus when engaged in something meaningful—a phenomenon commonly known as hyperfocus.

This different way of processing information also contributes to creativity, innovation, rapid problem-solving, and the ability to manage multiple streams of information simultaneously.

According to Hartman, these strengths are frequently overlooked because educational systems and workplaces continue to reward only one style of attention.

Medication is not the only answer

Although stimulant medications can significantly improve symptoms for many people, Hartman emphasized that treatment should never follow a one-size-fits-all approach.

Some individuals benefit greatly from medication, while others achieve better outcomes through lifestyle changes, psychological support, coaching, workplace adjustments, or a combination of approaches.

She cautioned against unrealistic expectations that medication alone will solve every challenge associated with ADHD.

"The most important thing is finding what works for each individual," she said.

Understanding brings relief

Receiving an ADHD diagnosis later in life can be an emotional experience for many women. Rather than changing who they are, it often provides an explanation for years of feeling different, misunderstood, or overwhelmed.

Hartman believes one of the greatest benefits of diagnosis is self-understanding.

"When people understand why they experience the world differently, it allows them to replace shame with self-compassion," she said.

Changing the conversation around ADHD

Experts believe greater awareness among healthcare professionals, educators, and families is essential to reducing delayed diagnoses in women.

Routine screening for ADHD in mental health services, improved education about how the condition presents across genders, and moving beyond outdated stereotypes could help thousands receive earlier support.

Most importantly, Hartman argues, society needs to stop viewing ADHD solely through the lens of deficits.

"We need different kinds of brains," she said. "Neurodiversity is part of human diversity. Every type of brain brings its own strengths and challenges."

As conversations around women's mental health continue to evolve, experts hope that future generations of girls will no longer have to wait decades to understand why their minds work differently—and that recognition will come with acceptance rather than stigma.