adhd in females: outdated criteria leading to missed diagnoses

unfortunately, i am not alone. this is a common experience among females with adhd. the underlying issue is that adhd diagnostic criteria are male-oriented, but  females do not necessarily present with the same symptoms . this is similar to how commonly known  heart attack symptoms  are predominantly representative of the typical male presentation.

as a result of  outdated criteria , females with this condition often go either undiagnosed or misdiagnosed, a significant barrier to proper treatment or accommodations.

difficulties with social interaction  are common amongst individuals with adhd. for example, there have been many instances where i was particularly passionate about a topic of conversation and spoke loudly and frequently to ensure others understood the point i wanted to make. this sort of assertive behaviour has often led to confrontation, which for many would be uncomfortable but is especially difficult for me to navigate since the way my brain interprets things makes me extremely sensitive.

like many females with adhd, my life experience has been further complicated by the  discrepancy in the prevalence of diagnoses between sexes . for most of my life, i was part of the disproportionate number of women with no explanation for our difficulties with social interaction. these experiences can be especially damaging if they cause people to question whether they will ever “fit in,” since this can in turn lead to additional mental health concerns, including issues with  self-esteem .

adhd is also commonly associated with poor academic outcomes, although a  2014 study  points out that “satisfactory academic achievement should not rule out an adhd diagnosis.” thus, academic performance is not necessarily a reliable predictor of adhd, adding an additional layer of complexity to the diagnostic process. according to a  2021 article , this is especially problematic for females because they are more likely to put in the extra effort required to maintain good grades; a reality that is perfectly encapsulated by my personal experience. throughout every step of my education, i have had to study two or three times as much as my colleagues just to earn an average grade, while they were able to get an a with considerably less study time. but despite needing to give all this extra effort, i have still succeeded at many educational levels, which likely contributed to my delayed adhd diagnosis.

receiving an initial misdiagnosis of this sort is quite common since  both anxiety and depression  are commonly comorbid with adhd in females. in fact,  depression  is the most common prior diagnosis for females with adhd. there is also a need to increase awareness regarding  other comorbidities  such as sleep disorders, anxiety disorders (e.g., obsessive-compulsive disorder), eating disorders (e.g., anorexia), and substance use disorders (e.g., alcohol addiction), all of which share similar symptoms to those of adhd. in addition, according to a  2020 study , females are more likely than males to have “subtle and internalized presentations’’ of adhd, which in combination with the commonly perceived notion that adhd is a  male disorder , further increases the likelihood of a misdiagnosis.

it is also crucial to better understand the different presentations of adhd and start establishing  female-specific signs and symptoms  in order to provide accurate and timely diagnoses for women and girls. this will not only improve their quality of life, but it can also be lifesaving. considering that  previous research  has identified gender as a contributing factor to adhd stigmatization, expanding the body of research on adhd in females will also likely help destigmatize this condition.