Tag: adhd

TCOM Student Article

By Cassandra Miller, OMS-II

This article was originally published in the July/August 2026 issue of  Tarrant County Physician.

Are you prone to losing things? Are you frequently absentminded or easily distracted? These tendencies may seem like the byproducts of a busy lifestyle or personality traits. However, they may also reflect an underlying condition such as an undiagnosed neurodevelopmental disorder like Attention-Deficit/Hyperactivity Disorder (ADHD). Historically, ADHD has been regarded as a predominantly male disorder, leading to gender-based bias in diagnostic criteria and clinical recognition.^1,2 As a result, many female patients remain undiagnosed during childhood. Recent literature suggests that the increasing rate of ADHD diagnoses in women later in life may be linked to differences in symptom presentation, the development of compensatory masking behaviors that obscure clinical detection, and symptom overlap between various psychiatric conditions.^3,4 Addressing diagnostic gaps is of paramount importance to improving early identification of ADHD in female patients and optimizing long-term treatment outcomes.

Despite increasing awareness of ADHD’s prevalence, it remains underrecognized in younger females. Original ADHD diagnostic criteria were derived from studies of hyperactive boys and placed emphasis on behaviors such as impulsivity.¹ As a result, patients with primarily inattentive symptoms are less likely to be diagnosed in childhood. This disparity in diagnosis contributes to the pattern of women being diagnosed in adulthood, as they tend to exhibit primarily inattentive symptoms such as difficulties with time management, overall task completion, and frequent mistakes during routine activities.³

Another contributor to the delayed diagnosis of ADHD in women is the phenomenon of masking. Masking is defined as “a key component of social camouflaging and refers to the concealment of neurodivergent traits and the adoption of alternate social personas.”^5,6 Although more heavily studied in the context of Autism Spectrum Disorder, masking can have positive social effects in overcoming societal stigma associated with ADHD.6 However, this method of meeting external expectations can prove challenging for clinicians as key symptoms may be obscured. Additionally, masking can be exhausting for patients and, over time, lead to poor self-esteem and burnout.^5,6 This, coupled with a disproportionate rate of psychiatric comorbidity in women, represents another factor in ADHD misdiagnosis.

Moreover, women with ADHD are more likely to be diagnosed with a mood or anxiety disorder prior to receiving an ADHD diagnosis.⁷ The overlap in symptoms across these psychiatric conditions can lead clinicians to attribute symptoms such as impaired concentration, restlessness, and emotional dysregulation to mood disorders rather than a neurodevelopmental disorder.7 As a result of delayed diagnosis, ineffective and potentially unnecessary treatments may ensue.

Delayed diagnosis has also been attributed to sociocultural and hormonal factors.³ Regardless, the consequences of delayed diagnosis are substantial. Women with a late ADHD diagnosis report higher levels of academic underachievement, interpersonal difficulties, and feelings of shame.⁶ Clinical education to reduce diagnostic bias and refinement of screening tools is vital to bridging this gender-based gap and reducing the long-term burden of untreated ADHD in young women.

References:

1. Stephen P. Hinshaw, Phuc T. Nguyen, Sinclaire M. O’Grady, and Emily A. Rosenthal, “Annual Research Review: Attention-Deficit/Hyperactivity Disorder in Girls and Women: Underrepresentation, Longitudinal Processes, and Key Directions,” Journal of Child Psychology and Psychiatry 63, no. 4 (2022): 484–496, https://doi.org/10.1111/jcpp.13480.
2. Patricia O. Quinn and Manisha Madhoo, “ADHD in Women and Girls: Uncovering This Hidden Diagnosis,” Primary Care Companion for CNS Disorders 16, no. 3 (2014), https://pubmed.ncbi.nlm.nih.gov/25317366/.
3. Susan Young et al., “Females with ADHD: An Expert Consensus Statement Taking a Lifespan Approach Providing Guidance for the Identification and Treatment of Attention-Deficit/Hyperactivity Disorder in Girls and Women,” BMC Psychiatry 20, no. 1 (2020): 404, https://pubmed.ncbi.nlm.nih.gov/32787804/.
4. Joanna C. Agnew-Blais, “Hidden in Plain Sight: Delayed ADHD Diagnosis in Girls and Women,” Journal of Child Psychology and Psychiatry 65, no. 9 (2024): 1018–1020, https://pubmed.ncbi.nlm.nih.gov/38798101/.
5. Patricia Wurth et al., “Masking in Adults with Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A Systematic Review,” Frontiers in Psychiatry 16 (2025), https://doi.org/10.3389/fpsyt.2025.1668780.
6. Emily Holden and Helen Kobayashi-Wood, “The Adverse Life Experiences of Women with Undiagnosed Attention-Deficit/Hyperactivity Disorder: A Qualitative Study,” Scientific Reports 15 (2025), https://doi.org/10.1038/s41598-025-04782-y.
7. Darby E. Attoe and Emma A. Climie, “Miss. Diagnosis: A Systematic Review of ADHD in Adult Women,” Journal of Attention Disorders 27, no. 7 (2023): 645–657, https://doi.org/10.1177/10870547231161533.