ADHD in Women and AFAB (Assigned Female at Birth) Individuals
- Kaitlyn Boudreault
- Sep 15
- 11 min read
Updated: Oct 18
When you think of ADHD (attention deficit hyperactivity disorder), what first comes to mind for you?
For most people, it might be the stereotypical picture of an energetic young boy who can’t stop bouncing off the walls.
For decades, research and diagnostic criteria have framed it as a childhood condition that mostly affects boys.
Media depictions, school systems, and diagnostic manuals have reinforced the image of the “hyperactive little boy who can’t sit still.”
As a result, countless women and AFAB (assigned female at birth) individuals, especially those at the intersection of other marginalized communities, have grown up without a diagnosis and without understanding or recognition of their struggles.
This lack of understanding, awareness, and diagnostic criteria has had serious consequences, including delayed or missed diagnoses, years of internalized shame, and labelling as “lazy,” “emotional,” “messy,” or “rude.
Many grow up believing their struggles are personal failings, when in reality they reflect a different brain wiring.
People may also force themselves to mask, which involves hiding their ADHD traits in public in an attempt to appear organized or capable. But in private, these same individuals struggle with exhaustion, overwhelm, self-doubt, and burnout.
Thankfully, as of recently, there is an increase in awareness of ADHD in populations beyond cis males. Society is beginning to challenge stereotypes and raise awareness for the unique ways that ADHD can present in women and AFAB individuals.
The more we widen our understanding of ADHD presentations, the more we can challenge stereotypes, reduce misdiagnosis, and create support systems that truly work.
If you or someone you love is exploring an ADHD diagnosis, a psychologist at our partner organization can guide the process. You may also benefit from working with an ADHD coach or therapist who can help you develop strategies for daily life while affirming your strengths.
This blog explores the signs of ADHD in women and AFAB individuals, why it is often missed, the costs of underdiagnosis, and how schools, workplaces, healthcare providers, and families can provide affirming support.
ADHD is a neurodevelopmental difference and form of neurodivergence that impacts the structure and functioning of the brain. These neurocognitive differences impact attention, emotional regulation, impulse control, and executive functioning.
There are some common symptoms of ADHD in adults, including:
Distractibility
Forgetfulness
Impulsivity
Restlessness
Poor planning
Rejection sensitivity
The symptoms of ADHD may be heightened when an individual is stressed or the sensory input coming through the senses is too much, which causes sensory overload.
Despite these common symptoms, ADHD is not one-size-fits-all. It will look different depending on the person and the environment.
Recognizing ADHD in Women and AFAB Individuals
Although women and AFAB individuals generally experience the general symptoms of ADHD listed above, there is some research and lived experience that reveal some patterns that are more common among these individuals. These symptoms include
Inattentiveness over hyperactivity: Women and AFAB individuals are more likely to experience the combined or inattentive type of ADHD. As a result, symptoms may reflect more inattentive traits than hyperactive ones. These symptoms may include daydreaming, zoning out, or difficulty concentrating rather than bouncing off the walls.
Internalized struggles: Unlike cis boys who are more likely to externalize their ADHD symptoms and display these as high energy, disruptive behaviour, or anger, women and AFAB individuals usually turn their challenges inward, which shows up as perfectionism, anxiety, depression, guilt, or self-criticism.
Masking: Many ADHD women and AFAB individuals tend to hide their ADHD traits by attempting to appear well put together. This may show up as perfectionism, late-night catch-up sessions, or people-pleasing to hide difficulties.
Comorbid conditions: Anxiety, depression, eating disorders, or trauma are often diagnosed first, which is one reason why women and AFAB individuals often go undiagnosed or misdiagnosed when it comes to ADHD.
Why Do Women and AFAB Individuals Often Go Undiagnosed or Misdiagnosed?
For the last decades, ADHD has continued to be thought of as a diagnosis only for cis boys. Some research from the past thought that ADHD affects cis boys three times as much as it does girls and AFAB individuals.
However, recent research reveals that the rates between genders are far closer. Even though the gap in the rates of ADHD is closer between genders, there remains a gap in diagnosis.
Here are several reasons why ADHD often goes unnoticed in women and AFAB individuals:
Masking to Meet Expectations: Women and AFAB individuals are more likely to mask and try to fit in. These groups attempt to appear “organized,” “helpful,” or “calm,” even though they are struggling internally. As a result, people don’t often notice the traits of ADHD, and a diagnosis becomes less likely.
Inattentive ADHD Presentation: Because girls and AFAB individuals are more likely to display inattentive ADHD traits, which isn’t the stereotypical hyperactive view of ADHD, these traits may not be seen as ADHD. They may be seen as shyness or a lack of effort.
Misdiagnosis with Other Conditions: The symptoms of ADHD often overlap with other diagnoses, such as anxiety, depression, bipolar disorder, or borderline personality disorder. Women and AFAB individuals are more likely to internalize distress, which often leads to misdiagnoses.
Gender Stereotypes: Cultural norms cause women and AFAB individuals to be viewed as expected to be tidy, reliable, and emotionally regulated. If these individuals struggle, they are seen as failing or lacking discipline, rather than an attempt being made to see what could be the underlying cause of the struggles.
Outdated Diagnostic Criteria: Most assessment tools, even current ones, are developed around young cis boys. This means that any population group that doesn’t fit into these stereotypical views of ADHD, including women and AFAB individuals, will be more likely to be missed.
Hormonal Influences: Those with menstrual cycles often display hormonal shifts during their cycles, which can amplify ADHD symptoms. The symptoms of menstruation, mood cycles, pregnancy, or menopause in women and AFAB individuals can often make it difficult to know if it is hormonal symptoms or ADHD. This makes diagnosis more complicated.
Success Bias: People often view those who succeed academically or professionally as not having ADHD. So, if a woman or AFAB individual is struggling internally but masking her traits well enough to do well in school or at work, ADHD may be dismissed. The high achievement often masks the unseen costs of overcompensation.
Intersectional Barriers: There are certain population groups, such as women and AFAB people of colour, LGBTQ+ individuals, and those from low-income backgrounds, who face compounded barriers to a diagnosis. These barriers include cultural stigma, lack of access to care, or being stereotyped.
The Role of Masking and Overcompensation
Masking is often used as a survival strategy by women and AFAB ADHDers as a way to fit in. This can involve hiding your challenges and trying to imitate neurotypical behaviors to avoid stigma.
Examples include:
Overusing planners and reminders to appear “on top of things”
Forcing themselves to sit still despite restlessness
Staying up late to finish work after procrastination
Saying “yes” to everything to avoid rejection or criticism
While masking may be beneficial in the short term as a way to cope with stereotypes and stigma, it can also have long-term consequences.
Impact of Being Undiagnosed
Some people go years before being diagnosed with ADHD. This has dire consequences on the individual's health and everyday life. Some of the consequences of long-term masking include:
Burnout from years of overcompensating
Mental health struggles, including anxiety, depression, or eating disorders
Relationship difficulties, often rooted in miscommunication or emotional dysregulation
Career challenges, such as trouble with deadlines or workplace misunderstandings
Identity struggles, fueled by constant comparisons to neurotypical peers
Lower self-esteem, from years of being told to “try harder”
Myths vs. Realities About ADHD in Women and AFAB Individuals
Despite the positive strides we have made in ADHD research in recent years, there are still a variety of stereotypes that exist about how ADHD should look.
We will debunk some of these myths below in the hopes of raising awareness for how ADHD can present in women and AFAB individuals.
Myth 1: ADHD is mostly a male condition.
Reality: Early research focused on cis boys, which means that women and AFAB individuals are more likely to be underdiagnosed or misdiagnosed. Many grow up without answers and blame themselves for their struggles. Despite the underrepresentation of these groups within the literature, ADHD can occur in anyone of any gender.
Myth 2: Women with ADHD are just anxious or emotional.
Reality: Emotional regulation challenges, such as frustration, mood swings, or rejection sensitivity, can occur in anyone with ADHD. But when they occur in women and AFAB individuals, they are frequently labeled “mood” or “hormonal” problems, rather than seen as ADHD. This can lead to inappropriate treatments and delayed ADHD recognition.
Myth 3: Success means you don’t have ADHD.
Reality: Although they achieved something, it doesn’t mean they didn’t struggle. Women and AFAB individuals are more likely to mask their ADHD traits and engage in perfectionism and overcompensation to attempt to fit in with society. When they achieve outward success through these means, their achievements often hide the heavy internal cost. The cost often involves chronic fatigue, burnout, and mental health decline.
Myth 4: ADHD always means hyperactivity.
Reality: The stereotypical view of ADHD usually involves a boy bouncing off the walls. But women and AFAB individuals are more likely to have inattentive ADHD. This presents as daydreaming, poor working memory, disorganization, or internal restlessness. Because it’s quieter and doesn’t fit the stereotypical view of ADHD, teachers, clinicians, and family members are more likely to miss it.
Myth 5: If you’ve made it to adulthood without a diagnosis, your ADHD must be mild.
Reality: Many adult women and AFAB individuals report significant impairment along with their late diagnosis. Late diagnosis is usually not a reflection of how mild the symptoms are. Instead, it is most likely a reflection of the stereotypes and blind spots in the literature, including masking, gendered expectations, and diagnostic criteria that are built on male presentations.
Myth 6: ADHD only affects school performance.
Reality: Because ADHD is usually diagnosed in childhood for boys, it is thought that it only impacts this area. But, for women and AFAB individuals, ADHD often intersects with expectations around caregiving, household management, and emotional labour. This means ADHD affects everyday life, relationships, finances, and careers. These impacts are sometimes more visible in adulthood than during school years.
Myth 7: ADHD is an excuse for laziness.
Reality: ADHD is about differences in executive functioning, not effort. Women and AFAB individuals frequently work harder than their peers to achieve the same results, often without recognition. Labelling their struggles as laziness increases stigma and delays appropriate support.
There are other layers of ADHD in women and AFAB individuals, which usually revolve around interpersonal dynamics. It typically influences family life, friendships, and romantic partnerships.
Since women and AFAB individuals tend to display inattentive or combined-type traits more, communication challenges often arise around these symptoms. They can arise due to forgetfulness, emotional dysregulation, or impulsivity.
Some examples may include forgetting anniversaries or chores, or interrupting conversations.
These forgotten responsibilities and interruptions can be seen as carelessness, rather than a brain difference.
Emotional dysregulation may also cause small disagreements to become overwhelming and difficult to resolve.
Healthy communication strategies, such as using reminders, openly discussing needs, and practicing patience, help partners reframe these differences as quirks rather than flaws.
Supporting Women and AFAB Individuals with ADHD
ADHD support, up until recently,. focused on fixing the individual.
But there is a shift in recent years toward a neurodiversity-affirming approach, which aims to affirm differences rather than “fix” them.
Every woman or AFAB individual will have unique needs that should be affirmed. With the right accommodations, these groups can thrive.
At Home
Share responsibilities: Reduce overwhelm and avoid the “default caregiver” role that women and AFAB people are often expected to fill by sharing responsibilities between partners and kid(s), if applicable.
Flexible routines and transitions: Look to gradually shift between activities rather than involve abrupt changes.
Celebrate creative solutions instead of focusing only on “flaws.” For instance, if sticky notes on every surface help, embrace them as tools rather than “messy habits.”
External support: Meal-prep services, shared family calendars, or reminders from smart home devices.
Rest: Downtime is not laziness. It is essential for energy regulation and executive function recovery.
Accommodations (alternative assessments and flexible deadlines): These allow students to demonstrate understanding in multiple ways. Examples could include oral presentations, written projects, and solo creative work.
Train educators: Teach educators what the traits of ADHD may look like in girls and AFAB individuals. This includes emphasizing that inattentiveness or perfectionism may mask deeper struggles.
Sensory-friendly classrooms: Consider adding quiet spaces, movement breaks, and flexible seating options.
Strengths-based learning: Encourage your students to use their strengths. This may involve allowing hyperfocus on interest areas to improve motivation and confidence.
Executive functioning coaching: Integrate external support into your classroom, which may involve the use of academic support. This can help to teach strategies for planning, organization, and time management.
Screening tools adapted for women and AFAB experiences: Look into how ADHD presents in these populations, including internalized symptoms like shame, overthinking, or chronic overwhelm.
Avoid dismissing symptoms as “stress” or “hormonal.” Many individuals are told their struggles stem only from PMS, menopause, or anxiety, delaying accurate diagnosis.
Therapy that addresses masking and identity struggles: Helps individuals unlearn years of self-blame.
Psychoeducation for families and partners: This can help loved ones better understand ADHD differences rather than misinterpreting them as character flaws.
Multidisciplinary care: Women and AFAB individuals may benefit best from a combination of therapy, coaching, medication, and lifestyle support, rather than a one-size-fits-all approach.
Accommodations (flexible hours or remote work options): This can reduce pressure from rigid schedules that often clash with ADHD energy cycles.
Clear, written expectations: Minimize misunderstandings and memory lapses.
Recognize creativity and problem-solving as valuable contributions, not just speed or productivity.
Normalize accommodations, such as noise-canceling headphones, project management tools, or flexible deadlines, without stigma.
Mentorship programs: Pair ADHD employees with supportive supervisors or colleagues for guidance and advocacy.
Intersectionality Matters
Women and AFAB individuals with ADHD don’t exist in a vacuum. The experiences with ADHD are shaped by various aspects of an individual's identity, including race, culture, sexuality, religion, and socioeconomic status.
Women of colour may face racism and ableism, leading to underdiagnosis or dismissal.
LGBTQ+ and neuroqueer ADHDers often face overlapping stigma and higher mental health challenges.
Low-income individuals may lack access to costly assessments and support.
Making sure that an intersectional approach is used in awareness and care looks to make sure that ADHD support is inclusive, equitable, and affirming.
Diagnosis: When and How to Seek Help
If you are currently thinking that you may be a woman or AFAB individual with ADHD after reading this, it is important to know that pursuing an ADHD diagnosis is your personal decision.
For many, a diagnosis may bring relief or validation after years of not understanding what was going on and why they were struggling. For others, it may come with the opposite.
There may be grief for the missed recognition and support that they didn’t receive for all these years.
Here are some signs you might consider an assessment:
Exhaustion from constant overcompensation
Longstanding struggles with organization, memory, or time management
Frequent misdiagnoses of anxiety or depression
A persistent feeling of being “broken” or “lazy” despite trying your best
What to expect in an assessment:
Clinical interviews and developmental history
Self-report questionnaires
Input from family or teachers (if relevant)
Screening for co-occurring conditions
Book a Free Consultation With Blue Sky Learning
If you or someone you love relates to these experiences, consider reaching out to our partner organization, Fusion Psychological Services, for an ADHD assessment.
Blue Sky Learning can also connect you with a neurodiversity-affirming therapist or ADHD coach who will help you embrace your strengths while building strategies for everyday life.
Book a free 20-minute consultation today by emailing hello@blueskylearning.ca or booking through our website.
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