How Is ADHD Different In Women Than Men?

The symptoms of ADHD are sometimes different in women than they are in men. Gender matters when it comes to ADHD, and also anxiety, depression, and other conditions that often coexist with ADHD. How is ADHD different in women than men? Let’s review some key differences in this article. 

  • Prevalence of ADHD in men vs women. While ADHD affects both men and women, it is well known that males are more likely to be affected early in life. Based on recent data, the male :female ratio is 2.28:1.  By the time they reach adulthood, however, women and men receive the diagnosis of  ADHD in almost  equal proportions. Some researchers argue that the ADHD cases in women may go underdiagnosed because they display symptoms differently. Therefore, women may  instead be diagnosed with premenstrual syndrome (PMS),eating disorders,  anxiety or depression. Some women who receive the diagnosis in their 30s or 40s, after one of  their children is diagnosed with ADHD. Women who found later in life they have ADHD are more likely to blame themselves, have financial problems, employment issues, divorce and less likely to get higher education. 
  • ADHD types and symptoms are based on gender. In many cases, men and women share the same symptoms characteristic to ADHD. However, there are differences in some cases. For example, girls/women are more likely to have inattentive ADHD compared with boys/men with ADHD, who are more frequently diagnosed with hyperactive/impulsive or combined ADHD. 

In terms of ADHD-related symptoms, adolescent girls appear to have lower self-efficacy and fewer coping strategies compared with boys with ADHD. Girls and young women tend to internalize the symptoms, daydream, have intellectual impairments, and become withdrawn. Women are more likely to be more verbally aggressive rather than display physical aggression. In boys, ADHD symptoms are more likely to present as an inability to sit still and listen, excessive running, being more physically aggressive, not listening, and often interrupting others.

  • Sex hormones and ADHD. Sex hormones estrogen, progesterone  and testosterone may play an important role in how people with ADHD experience symptoms. Fluctuating estrogen and progesterone levels can have an impact on the intensity of the symptoms. When the sex hormones are high, they support healthy cognition and overall brain function. However, when the hormone levels drop before menses, women tend to experience worsening of the ADHD symptoms, along with PMS. Low levels of estrogen leads to increased irritability, mood changes, with negative impact on sleep and focus. Estrogen levels also decrease throughout the menopause, when ADHD symptoms also become more intense. Estrogen works closely with the neurotransmitter serotonin, and when estrogen is low, serotonin levels also drop. Men have higher levels of testosterone than women, and this hormone works closely with the neurotransmitter dopamine. High testosterone levels are linked with more aggressive, impulsive behavior , which is seen more often in men with ADHD. 
  • Coexisting  conditions. ADHD is often associated with other conditions, which also have specific symptoms, affecting  men differently than women. Depression and anxiety are more often seen in girls and women with ADHD  compared with boys/men. However, physical aggression and aggressive behavior is seen more often in men compared with women with ADHD. But do we have the right understanding of depression? Mental health experts call for a broader definition of depression, observing the difference of how this condition manifests in women compared with men. They point out that aggression, self-destructive behavior, risk taking, hyperactivity, irritability, and substance abuse are signs of depression, and are more likely experienced by men with depression. Women with depression experience significantly higher rates of sexual and partner violence compared with men, which can further contribute to mental health problems. Except for social anxiety, all other forms of anxiety are more common in women compared with men. Women are also more likely to experience eating disorders like bulimia, while men are more likely to turn to  alcohol abuse.

Finally, let’s consider the  ADHD treatment efficacy for women versus men.  Based on research studies, ADHD treatments are equally effective in both men and women. The standard treatment includes prescription medication and psychotherapy. However, women are less likely to be referred for and receive treatment for ADHD compared with men. For women, a multimodal approach that includes not only ADHD drugs and psychotherapy, but also stress management, and ADHD coaching may offer more improvement in the symptoms. 

Cognitive-behavioral therapy (CBT), which is a special form of psychotherapy, is a great option in case ADHD is associated with stress, anxiety, and depression. Group therapy is another great option, especially for those who feel alone, have low self-esteem, have relationship problems and try to hide their symptoms and emotions. Women who experience a significant aggravation of symptoms related to menses may benefit from hormone therapy. Anger management therapy is particularly helpful for those who experience anger and aggressive behavior. This therapy helps people recognize early frustration and manage them in a way the needs are expressed, yet stay calm, in control.