The Silent Struggle: How ADHD Often Goes Undiagnosed in Women and What Can BeDone

// The Invisible Challenge

For many women, life can feel like a never-ending juggling act managing work, relationships, and family expectations while trying to maintain composure. Occasional forgetfulness or mental exhaustion is often dismissed as stress or poor time management. Yet, for some, these struggles point to something deeper and more persistent: Attention-Deficit/Hyperactivity Disorder (ADHD) a neurodevelopmental condition that continues to be under recognized in women.

Despite significant advances in awareness, many women live for decades unaware that their difficulties with focus, organization, and emotional regulation stem from a neurobiological difference, not personal failure.

// The Science Behind ADHD

ADHD is not about laziness or lack of willpower; it is a brain-based condition involving differences in how neural networks regulate attention, motivation, and emotional control. Neuroimaging studies show that individuals with ADHD often have variations in prefrontal cortex activity, a region involved in executive functions such as planning, inhibition, and working memory.

In addition, irregular transmission of dopamine and norepinephrine key neurotransmitters that facilitate reward processing and sustained attention — contributes to fluctuating motivation and focus.

ADHD symptoms typically emerge in early childhood and are classified into three main presentations: inattentive, hyperactive-impulsive, or combined type. While some children’s symptoms reduce with maturity, research suggests that around 60% continue to experience symptoms into adulthood, though often in less visible forms.

// From Childhood to Adulthood: The Overlooked Continuum

In girls, ADHD may look very different from how it appears in boys. Instead of running around or interrupting others, girls are more likely to be quietly distracted, emotionally sensitive, or socially overextended. Their behavior may be perceived as daydreaming or being “too talkative,” rather than symptomatic of a neuro developmental difference.

Because these signs are subtle, teachers and parents may overlook them, assuming the child is simply anxious, shy, or disorganized. Without early recognition, these girls grow into women who struggle to meet adult responsibilities. Many describe living in a constant state of “mental clutter” expending enormous effort to appear organized, yet feeling chronically behind.

“Many of the women I meet have spent years battling self-doubt before realizing their challenges were linked to ADHD,” says Ms. Gayatri Gajjam, “They were often misdiagnosed with anxiety or depression, but those conditions were secondary to the underlying attention difficulties.”

As life’s demands increase balancing professional roles, care giving, and household responsibilities their coping mechanisms often fail. The result is exhaustion, emotional burnout, and an increased risk of coexisting mental health issues.

// Why ADHD Often Goes Undiagnosed in Women

Historically, ADHD research was based largely on male-centered clinical samples, leading to diagnostic criteria that emphasized overt hyperactivity rather than internalized symptoms. This gender bias has led to decades of under diagnosis among women.

Moreover, societal expectations encourage women to be organized, nurturing, and emotionally balanced. To meet these expectations, many women unconsciously develop masking behaviors pushing themselves to over perform or hide their disorganization. This constant compensation can create intense shame and perfectionism.

Hormonal influences also play a significant role. Fluctuations in estrogen and progesterone during puberty, the menstrual cycle, pregnancy, postpartum, and menopause can amplify ADHD symptoms by affecting neurotransmitter balance. These biological shifts often lead women to seek help for mood instability or fatigue, while the core attentional difficulties remain unidentified.

// The Emotional and Functional Impact

Living with unrecognized ADHD can have deep psychological consequences. Persistent forgetfulness or inconsistency in daily functioning can erode self-esteem and foster chronic guilt. Over time, women may internalize negative feedback, believing they are “careless” or “unreliable.” Professionally, the condition may manifest as missed deadlines, impulsive decisions, or difficulty managing workloads. At home, multitasking under pressure can lead to frustration and strained relationships. These experiences often culminate in secondary anxiety or depressive symptoms, not because of ADHD itself, but due to years of misunderstanding and self-blame.

// Recognizing the Psychological Patterns:

While ADHD manifests uniquely in each individual, common signs in women include:

* Chronic disorganization and mental clutter

* Difficulty sustaining attention or completing tasks

Emotional intensity and impulsive reactions Procrastination or perfectionism

* Feeling chronically overwhelmed despite effort

Recognizing these experiences is not about self-diagnosis but about understanding the cognitive

and emotional mechanisms behind them.

// Pathways to Support and Recovery

Awareness and accurate assessment are vital. Women who identify with these symptoms should seek evaluation from a qualified psychiatrist or clinical psychologist familiar with adult ADHD presentations. Comprehensive assessment involves developmental history, clinical interviews, and validated rating scales. Evidence-based treatment is multimodal, combining medication, psychotherapy, and behavioral interventions.

* Medication (stimulant or non-stimulant) helps improve attention and executive function by optimizing dopamine and norepinephrine transmission.

* Cognitive Behavioral Therapy (CBT) assists in restructuring unhelpful thought patterns, building organization strategies, and managing emotional reactivity.

* Mindfulness-based approaches improve emotional regulation and reduce stress.

* Lifestyle interventions, such as structured routines, visual planners, and environmental organization, enhance daily functioning.

“ADHD is not a character flaw it is a different cognitive profile,” explains Ms. Gayatri. “When women receive an accurate diagnosis and learn evidence-based strategies, they often experience profound relief and self-understanding.”

Support groups, coaching, and psychoeducation can further reduce isolation and build resilience.

// Reframing the Narrative

Addressing ADHD in women requires a shift in both clinical practice and public perception. Mental health professionals, educators, and employers must recognize that neuro diversity extends beyond visible behavior. Empathy and flexibility rather than judgment are key to

supporting women who live with ADHD.

By normalizing discussions about neuro developmental differences, we create a culture where

women no longer feel the need to hide behind exhaustion and self-blame.

// A Final Thought

Understanding ADHD in women is not about assigning labels it’s about offering clarity and

compassion. When recognized early and managed effectively, ADHD can become a source of

creativity, adaptability, and empathy.

Every woman deserves to understand her mind, reclaim confidence, and thrive on her own terms. Recognizing ADHD is not an end it is the beginning of empowerment and self-acceptance

// Ms Gayatri Govind Gajjam, Clinical Psychologist, Aster DYU Child Development Centre, Bur Dubai (AJMC)