Is ADHD Different in Women and Men?

Summary: Yes, ADHD is different in women and men. New studies on ADHD in adults show differences in age at diagnosis, the type of symptoms, the severity of symptoms, and the levels of disability and function associated with ADHD.

Key Points:

• The latest data show a worldwide prevalence of 3.1% for adult ADHD
• Adult men show a greater prevalence of ADHD than adult women
• Among the three types of ADHD diagnoses in adults, inattentive-type ADHD is the most common, hyperactive-type ADHD is second most common, and combined-type ADHD is the least common.
• Increased understanding of sex differences in ADHD among adults can help improve treatment outcomes

ADHD in Adults: Increasing Awareness About How ADHD is Different and Women and Men

Attention-deficit disorder (ADHD) is a neurodevelopmental disorder that most often appears in childhood or adolescence. In many cases, ADHD goes undiagnosed in childhood and adolescence, and both male and female patients may receive an ADHD diagnosis during adulthood.

Research shows the following statistics on comorbid mental health and behavioral diagnoses among adults with ADHD:

• Any comorbid diagnosis: 80%
• Alcohol/substance misuse: 45%
• Anxiety disorders: 44%
• Depressive disorders: 28%
• Bipolar disorder: 44%

A significant volume of research exists on ADHD in children and teens, with extensive information available from various resources, including the Centers for Disease Control (CDC), Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), and the National Institute on Mental Health (NIMH).

However, research on ADHD among adults lags far behind research on ADHD in children and adolescents. To date, very few studies examine how ADHD may be different in women and men. That’s why a new article called “Sex Differences in Adults With Attention-Deficit/Hyperactivity Disorder: A Population-Based Study” is important. It’s one of the first large-scale studies conducted on adult ADHD, and one of the only studies with a focus on how symptoms and effects of ADHD may manifest in different ways between women and men.

Here’s how the study authors explain why understanding how ADHD is different in women and men is important:

“Sex differences influence ADHD presentation, with females experiencing delayed diagnosis and distinct patterns of severity and comorbidities. Exploring these differences is essential for improving diagnostic accuracy and developing tailored interventions.”

The research team designed the study to analyze potential gender differences in:

• ADHD severity
• Psychiatric comorbidities
• Functional impairment by ADHD

Let’s take a closer look at the study, and at what the researchers found.

How ADHD is Different in Women and Men: Study Design and Outcomes

The research team analyzed records from 900 adult patients with the following characteristics:

• Diagnosed with ADHD
• Participating in and adult ADHD treatment program at Vall d’Hebron University Hospital in Barcelona, Spain
• No diagnosis of schizophrenia/psychotic disorders
• Absence of disorders that can better explain ADHD symptoms

Here’s how they conducted the study:

1. Initial interview and assessment.
2. Measurement of ADHD severity.
3. Identification of comorbid mental health diagnoses:

• • • Depression
    • Anxiety
    • Trait impulsivity

4. Assessment of sleep quality
5. Measurement of functional impairment
6. Assessment of disability

After collecting the relevant data, the researchers conducted extensive statistical analysis to identify sex differences in all categories listed above.

Here’s what they found.

Gender Differences in ADHD Among Adult Women and Men

Compared to men, women showed increased/higher:

• • ADHD symptom severity
  • Depressive symptoms
  • Anxiety symptoms
  • ADHD-related disability

Compared to men, women showed decreased/lower:

• • Substance use
  • Daily function

Results showed no differences in sleep quality between women and men

Substance use details:

• • Alcohol use:
    • Men: 39.4%
    • Women: 28.2%
  • Tobacco use:
    • Men: 32.7%
    • Women: 26.6%
  • Cannabis use:
    • Men: 22.6%
    • Women: 12.9%

There were no differences in type of ADHD or age of onset of symptoms, but females received ADHD diagnoses later (older age) than males, on average. In addition, researchers found that for both women and men, diagnosis with the combined subtype was associated with:

• Greater severity of symptoms
• Higher levels of depression
• Higher levels of anxiety
• More frequent impulsive symptoms
• Increased substance use
• Greater overall disability

Here’s how the research team describe their results:

“ADHD presents differently across sexes and subtypes, with specific interactions influencing disability. These findings emphasize the importance of considering sex and ADHD subtype independently to enhance diagnostic accuracy and develop targeted treatment strategies.”

We agree completely: this information will help us improve adult ADHD treatment for both women and men. We’ll discuss these results further below.

Why is ADHD Different in Women and Men?

The research team theorizes that gender differences in adult ADHD diagnosis and presentation are the result of a wide variety of factors.

Gender Differences in Adult ADHD: Possible Causes

• Later diagnosis may be explained by the fact that male children and adolescents more often present with the more easily identifiable hyperactive/impulsive subtype, which means they may see a specialist – and receive a diagnosis – at an earlier age than girls.
• Greater symptom severity, increased impairment, and greater functional impairment among adult women with ADHD may be explained by the delayed diagnostic phenomenon described in the bullet point above.
  • Psychosocial factors may play a role: expectations for women to be more organized may impact “perceived impairment when expectations are not met.”
• Greater prevalence of depressive symptoms and anxiety symptoms may be explained by the greater overall prevalent of depression and anxiety among women in the general population.
  • Gender differences in coping mechanisms may play a role: males may be more likely to “externalize symptoms through impulsivity and risk-taking,” while women may be more likely to internalize symptoms by “develop[ing] compensatory strategies such as excessive self-monitoring and emotional suppression.” 
• Greater prevalence of depression and anxiety may also be explained by the cumulative stress and emotional fatigue caused by managing ADHD symptoms throughout childhood, adolescence, and early adulthood in the absence of an accurate diagnosis and effective, evidence-based support.

That last bullet point hits home. This article is about how ADHD is different in women and men, but the idea that we, collectively, might not recognize ADHD in young girls, and cause them to spend years managing an undiagnosed neurological disorder, is difficult to accept.

But we can’t change the data, which means we need to change our approach.

In this context, that means that when we diagnose an adult female with ADHD, we need to explore their symptom and treatment history carefully and design their treatment plan to account for cumulative stress and emotional fatigue that may exacerbate their symptoms and affect their response to treatment.

We’ll do the same for men, of course. However, this study reveals that adult women with ADHD experience greater difficulty, on the whole, than adult men. Therefore, our takeaway from this article is primarily about how we can improve treatment and support for adult women with ADHD.