Diagnosis of ADHD & Autism in Women
11/5/25 | By: Carissa Hannum
Girls and women have significantly been underdiagnosed in the areas of Attention/Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). The underdiagnosis is mostly due to gaps in diagnostic research that has focused on white boys and males’ presentation of both ADHD and ASD rather than women’s presentations. Although the symptoms of ADHD and ASD can be the same in both women and males, their expression can look very different within the female population leading to underdiagnosis. In addition, women are known to mask their symptoms of ADHD and ASD, leading to underdiagnosis. In recent years, there has been a push to change diagnostic criteria of both disorders to consider gender differences in expression of these disorders. This blog hopes to shed light on women’s presentation of ADHD and ASD.
Women’s Experience of ADHD
Frequently one of the gaps in research as well as a frequent stereotype of ADHD focuses on the idea that most individuals that struggle with ADHD symptoms are hyperactive males. Parents and the school system frequently miss the possibility of ADHD in women/girls due to this stereotype. There are three main subtypes of ADHD: predominantly inattentive, predominantly hyperactive-impulsive, and combined subtype of both presentations meaning the individual struggles with symptoms from both presentations.
Women can have any of these presentations, however most research has shown that women are more likely to struggle with an inattentive subtype of ADHD. These symptoms can be easily missed. For instance, some women can appear highly perfectionistic in school. On the surface, they get wonderful grades, show up on time, but at home they are highly disorganized, struggle with getting started with projects, frequently procrastinate, and may be experiencing high levels of depression and anxiety related to some of these struggles. Because of this, many women do not receive diagnosis until their 20s, 30s, and sometimes 40s, silently struggling with these symptoms for years.
An inattentive presentation in women can look like:
Making careless mistakes or difficulty following instructions
Can have difficulty with listening or sustaining attention for long periods of time
Organizational difficulties
Losing interest in things
Struggles completing tasks that may be “boring” or not of interest or something they dislike
Forgetful or easily distracted
As you can see, these symptoms can be easily missed within a school system as they may not be as disruptive to the classroom or cause a close eye for concern. In addition, unfortunately, although women can also struggle with hyperactive and impulsive behaviors, many of these
symptoms and how they can present in women are considered culturally acceptable in women, leading to underdiagnosis. For instance, within our society, women are usually seen as more social than men. These “social” behaviors may actually be hyperactive and impulsive subtype symptoms.
These Hyperactive/Impulsive Symptoms can be expressed as the following in women:
Acting/speaking before thinking.
Feeling as though she is internally being driven by a motor. Although she may be seen as outwardly in her thoughts, thoughts can feel they are going very fast and difficult to keep thoughts on one topic.
Talking more frequently than peers, often just seen as a social behavior in women
Can easily make friends but may not be able to maintain these friendship.
Highly controlled activities or engaging in many activities that require a rigid schedule and sense of self control.
Highly sensitive to rejection, which can lead to unhealthy relationships as a means to make friends.
Can be seen as working harder than others, often developing strategies to appear as successful as others.
Fidgeting or the need to move around frequently. Some women will put this energy into sports.
When exploring diagnosis of ADHD in women stereotypes and stigma bias should be considered, and a holistic picture of women’s experiences, symptoms, and presentation need to be explored.
Women’s Experience of ASD
Much like ADHD, women tend to be diagnosed less or misdiagnosed with ASD. The CDC estimates that “ girls are 4 times less likely to be diagnosed with autism than boys. On average, they also receive a diagnosis almost a year later than boys—at age 5.6 for girls versus 4.8 for boys” (Link to Research). Symptoms in women with ASD are less distinguishable than males. Women tend to have less learning difficulties and language struggles, which can lead to misdiagnosis or a delay in diagnosis until later in life.
Again, stereotypes associated with women as well as how our society tends to view certain traits as socially acceptable for women can impact diagnosis. For instance, women, even those diagnosed with ASD are more likely than men to use masking behaviors to make their own difficulties hidden in certain contexts or situations (more on this below). In addition, women are more likely to have less struggles with social skills than men. Women may be more able to share interests with others, struggle with conversation skills less, and are more prospective at understanding verbal and nonverbal communication. In addition, women have less obvious repetitive behaviors, sometimes only utilizing these repetitive behaviors, like pacing, when alone. Their special interests may also be considered more socially acceptable and easily discussed with peers such as celebrities, animals, Broadway, etc.
As you can see, with more subtle symptoms, these symptoms can easily be missed due to women and girls seeming more neurotypical or socially acceptable. Just because women may not struggle as much in a certain area, does not mean that they may not struggle with other aspects of ASD in their life or are masking these symptoms. A careful diagnostic assessment that considers individual and gender differences should be conducted to explore if ASD is present.
Masking in Women
So, what exactly is masking? Masking is the ability to hide symptoms, experiences, and difficulties associated with ADHD and ASD to appear "normal" in a certain context. Masking can feel like a helpful trait as a means to protect oneself from difficulties of their diagnosis, especially when they could be stigmatized or judged. Frequently women may mask at work, school, or other settings to feel safer in the moment. Because of the amount of energy it can take to mask, hold back certain behaviors, or engage in behaviors that normally would be uncomfortable, masking has several emotional complications. After masking, women can feel highly overwhelmed leading to emotional shut down. Women can also experience depression and anxiety as a result. Examples of masking can be forcing eye contact, creating a conversation list to rely on in social situations, staying in a room with bright lights longer than would be comfortable, hiding stimming behaviors, or even creating an organizational desk at work even if the home environment is less organized.
You deserve Support
If for any reason you feel like you are a woman who may be experiencing symptoms of ADHD or ASD, reach out! You deserve help and support exploring your unique strengths, difficulties, and discovering how you have learned to cope with your symptoms. A specialized treatment provider will be able to help you find a name and answers to your symptoms.
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