Understanding Why Women are Much Less Likely to Be Diagnosed with ADHD

Current statistics consistently show that the misdiagnosis of ADHD in women is pervasive. Women and girls are often diagnosed years, even decades, later than men, primarily due to their symptoms being misattributed to anxiety, depression, or other mood disorders. Here are the key findings on the rates of misdiagnosis for women and girls:

Overall Misdiagnosis Rate: Up to 75% of adult women with ADHD are estimated to have been misdiagnosed, often with anxiety, depression, or borderline personality disorder, before finally receiving an accurate ADHD diagnosis.
Later Diagnosis: Females are diagnosed an average of five years later than males, underscoring the chronic delay in identification.
Prior Diagnoses in Inattentive Type: Individuals who are finally diagnosed with Inattentive ADHD are much more likely to have received a prior diagnosis of Anxiety or depression. (between 15-25%).

The high rate of misdiagnosis is rooted in three primary factors related to how ADHD presents in females compared to males:

Symptom Overlap (The “Mask”): The most common reason for misdiagnosis is the significant overlap in symptoms between ADHD and anxiety or depression. Issues like poor concentration, fatigue, irritability, and restlessness can all be symptoms of Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), or Inattentive ADHD. Clinicians often misattribute these symptoms and overlook the underlying ADHD.
Internalized vs. Externalized Symptoms: The classic image of ADHD is a hyperactive boy who acts out (externalizing). Girls are more likely to exhibit internalizing symptoms like quiet inattentiveness, daydreaming, disorganization, and internal restlessness. These internal struggles are not disruptive to the classroom or workplace and therefore do not flag the attention of teachers or doctors.
Secondary Anxiety: For many women, the anxiety and depression are actually consequences of undiagnosed ADHD. Constantly struggling to meet expectations, feeling overwhelmed by simple tasks, chronic procrastination, and continuous self-blame leads to severe emotional distress and high anxiety. A person may be diagnosed with anxiety, but the root cause is the untreated executive dysfunction and emotional reactivity of ADHD.

About the Author: Monique Thompson, PsyD

Monique Thompson (PSY 25685) is a licensed clinical psychologist and partner at the San Francisco Bay Area Center for Cognitive Therapy. She is an Assistant Professor in the Clinical Sciences Program at the University of California, Berkeley. She is a certified cognitive therapist and a Diplomate of the Academy of Cognitive Therapy. She has extensive training in Acceptance and Commitment Therapy (ACT) and Cognitive Behavior Therapy for Insomnia (CBT-I). She treats depression, anxiety, sleep disorders, Adult ADHD, and challenging life transitions. Dr. Thompson has practiced in a variety of settings, including Kaiser Permanente, UC Berkeley and private practice. She was a staff psychologist at Golden Bear Mood and Sleep Research Center at UC Berkeley working on clinical trials to explore and enhance cognitive therapy techniques and treatments for teen insomnia. She has published research on interventions to improve CBT treatments for depression and teen insomnia. She co-authored the Teen Sleep Workbook with Dr. Michael Tompkins (New Harbinger, 2019). Her second book, CBT for Depression, Strategies for Managing Negative Thinking and Living Your Life (Rockridge, 2020) was released on November 3, 2020. Dr. Thompson received a master’s degree from the University of Pennsylvania and a doctoral degree in clinical psychology from the California School of Professional Psychology. To schedule an appointment, call 510.652.4455 ext. 1. To learn more about Dr. Thompson, visit her profile here.