Women with ADHD face delayed diagnosis and greater challenges

Scientists have found that ADHD (Attention-Deficit/Hyperactivity Disorder) in women is diagnosed approximately 5 years later than in men, despite symptoms appearing at the same age. Women with ADHD also suffer greater emotional and functional difficulties than men. This work will be presented at the ECNP Congress in Amsterdam, after recent publication.

Lead researcher Dr. Silvia Amoretti (Barcelona) said:

"ADHD affects millions of people, but our understanding of how it presents and impacts males and females differently remains limited. We found that females are underdiagnosed, often receiving a diagnosis years later than males. This delay may lead to worse clinical outcomes, including depression, anxiety, and functional impairment. Males on the other hand showed a higher level of involvement in delinquent behaviours such as legal problems and driving-related difficulties. We believe that a better understanding these sex-based differences might improve diagnosis and treatment."

The researchers analysed a large clinical sample of 900 adults (54.9% male, 45.1% female, average age 36.94) diagnosed with ADHD for the first time at a specialized outpatient program in Barcelona. They assessed differences between males and females in terms of age at diagnosis, ADHD symptom severity, psychiatric comorbidities, psychosocial functioning, and disability. Participants underwent a standardized battery of clinical interviews and validated rating scales. They found that females had been diagnosed with ADHD at an average age of 28.96 years, whereas males were diagnosed at age 24.13 on average. Symptoms appeared in both males and females at approximately the same age. Males were around 3 times more likely to have encountered legal problems (18.1%) than were females (6.6%).

Silvia Amoretti said:

"We found that although ADHD symptoms started at a similar age in males and females, women were diagnosed about five years later. By the time of diagnosis, they showed more severe symptoms, worse functioning in daily life, and higher rates of depression and anxiety.

This is important because it shows that ADHD often goes unnoticed in women until it becomes a serious problem. Our findings suggest that we may be missing the early signs in girls and women, especially when their symptoms are less disruptive but still impactful. This has clear implications for earlier screening and sex-sensitive diagnostic tools.

We didn't set out to compare the age of diagnosis in males and females, we were aiming to understand the general age when symptoms appear, regardless of sex. This finding was not part of our initial hypotheses but became evident during the analysis but became evident during the analysis, and the scale of the difference in diagnosis between the sexes was a surprise.

It's likely that women are diagnosed later because the symptoms of ADHD manifest themselves differently in men and women. Boys are more likely to be hyperactive or impulsive, and this behaviour is more visible to parents, teachers and clinicians. On the other hand, girls with ADHD are more likely to seem inattentive and generally less disruptive. This becomes clinically important, as it means that women are just not treated early enough, and often are just not diagnosed at all. We have seen similar tendencies internationally, so it is likely that this is a global problem. The nature of the condition leads to poorer diagnosis in women everywhere, meaning that women can lose on average five years of treatment, 5 years of a better life".

Commenting, Professor Sandra Kooij (Amsterdam UMC/VUmc and PsyQ, the Hague, the Netherlands) said:

"This study by Sylvia Amoretti and colleagues shows the delay in diagnosis in girls and women with ADHD compared to boys and males. Different presentation of symptoms, lack of awareness among clinicians that women have ADHD too, and the hormonal changes leading to severe mood instability in the last week of the cycle are all responsible for the gender differences in time to diagnosis of ADHD. 

Increasing awareness in both society and medicine helps girls and women to get earlier help when they need it". 

Professor Kooij was not involved in this research; this is an independent comment. Professor Kooij is founder and chair of the European Network Adult ADHD.