Discrepancies in the Symptomology and Presentation of ADHD: The Gendered Dilemma

Authors: Veronica du Plessis & Liv Mace

Attention-deficit/hyperactivity disorder (ADHD) is a very well-known diagnosis, having garnered a lot of attention and research over time. Even so, most people hold the perspective of ADHD being purely hyperactive in nature, often overlooking the inattentive element of the neurodevelopmental disorder. Hyperactivity is more easily observable and more common in males than in females, while predominantly inattentive ADHD (ADHD-PI) is more common in females. In fact, the ratio for diagnosis between males and females is 4:1. This is due to the neglect of inattention as a presentation of ADHD, thus resulting in females being overlooked when it comes to ADHD diagnoses. 
  
Karley Dobronski, a college-age female, shared her personal story through a TEDTalk titled “Invisible struggle of ADHD in women and girls”. In this talk, she spoke of her own personal experience in which her ADHD was overlooked, until she was finally diagnosed in college. She had spent most of her life being treated for previously diagnosed depression and anxiety, feeling as though something was inherently wrong with her, and she was the reason behind her academic challenges. She noted how others recognized her symptoms but misattributed them as personality traits, labeling her as quiet, disorganized, careless, and airheaded. She discussed how her diagnosis of ADHD in college helped her recognize and accept her full, authentic self, in turn improving her self-esteem.  
  
Martin et al. (2024) further supported the observable gendered discrepancies in ADHD diagnoses, stating that females are diagnosed at a later age and often delayed in receiving ADHD stimulant medication. Furthermore, females were more likely to be diagnosed with co-occurring anxiety, depression, and other mental health diagnoses, often having been diagnosed before ever being considered for ADHD. Females were also more likely to receive antidepressant medication both at a younger age than males and before receiving a stimulant medication prescription (Martin et al., 2024). This aligns with points made by Dobronski, stating that the average age of ADHD diagnosis is seven in males and twelve in females. She also pointed out the tendency for females with ADHD to develop emotion-focused coping mechanisms, mood disorders, dysregulated eating, and higher rates of self-harm and suicide.  
  
These harrowing facts inspired our discussion, in which the validity of ADHD diagnostic criteria, the controversy between early and late diagnoses, and the debate between comorbidity of diagnoses or misdiagnoses were addressed. With the advent of co-occurring diagnoses being so prevalent in females with ADHD, the question arises whether these diagnoses are comorbid or perhaps the result of a misdiagnosis. The answer is not clear, as it depends on a multitude of factors. Historically, research on ADHD was founded on men, in turn dismissing female presentation due to lack of scientific inquiry on the topic. The consideration that biological predisposition to depression and anxiety is different from the neurodevelopmental nature of ADHD suggests that comorbidity is possible, if not likely. On the other hand, the advent of a misdiagnosis and living with unsupported ADHD could have a causal effect on depression and anxiety, either developing or heightening the presentation of the diagnosis due to added environmental stressors and the debilitating internalization of the symptoms.   
  
These effects push for the need of earlier diagnosis, as it could prevent further decline in mental health. However, the question of how early arises. In addressing this, one must recognize that a diagnosis is separate from an intervention. The ideal pathway is to begin with a diagnosis, followed by behavioral interventions and parental management training. Following this, medication can be introduced, slowly increasing dosage if needed while continuously reinforcing behavioral management techniques. Finally, one wonders what can be done to address and diminish this gendered discrepancy in ADHD diagnosis. We agreed that education is key. Approaching an ADHD diagnosis is most effective from a holistic and intersectional lens, considering all types of ADHD that may be present and understanding where symptoms interfere, especially contextually. By continuously raising awareness and increasing education, we can generate a new generation of competent care providers.  

References  
Dobronski, K. (2025, March). Invisible struggle of ADHD in women and girls [Video]. TED Conferences. https://youtu.be/Px_EPsMt71Y?si=vYVFVxzB-DQy6qpm  
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Martin, J., Langley, K., Cooper, M., Rouquette, O. Y., John, A., Sayal, K., Ford, T., & Thapar, A. (2024). Sex differences in attention‐deficit hyperactivity disorder diagnosis and clinical care: A national study of population healthcare records in wales. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.13987