ADHD is often misunderstood as a condition that only affects young boys. As girls present more introspective symptoms, they’re overlooked, misdiagnosed or dismissed entirely. Women’s Month spotlights the plight of South African women, and the South African Society of Psychiatrists (SASOP) wants to highlight women living with undiagnosed or misunderstood ADHD.
Image credit: Maria Bolinder on Dupe Photos
Masculine mask
Dr Wisani Makhomisane, SASOP member and specialist psychiatrist, says for too long, ADHD has worn a masculine mask, depicted as a disorder of noisy, impulsive boys bouncing off classroom walls.
“But this stereotype has hidden a different, quieter experience, one lived by women and girls who internalise their symptoms and are often overlooked, misdiagnosed or dismissed entirely.”
“ADHD in women is not less severe. It’s just less visible,” says Makhomisane.
“These women are not lazy, disorganised or overemotional. They are living with a neurodevelopmental condition that has been poorly understood through a gendered lens.”
ADHD is diagnosed in boys at nearly twice the rate of girls. Global data from the CDC reveals diagnosis rates of 14.5% in boys versus 8% in girls.
These disparities grow with age, with women often waiting four to five years longer than men for a diagnosis.
“In South Africa, ADHD remains underdiagnosed in general, but particularly so in adult women,” says Makhomisane.
“Many are first misdiagnosed with anxiety, depression or even borderline personality disorder. Their ADHD is only recognised much later, often after years of ineffective treatment and self-doubt.”
Mismanaged care
“Women are also more likely to be prescribed sedatives or antidepressants before ADHD is even considered.
The result? Mismanaged care, fragmented support and rising co-morbidities, including eating disorders and mood instability.”
Makhomisane says that, unlike boys who may display externalised hyperactivity, girls tend to internalise their struggles.
They are often seen as dreamy, anxious, sensitive or perfectionistic — qualities that are mistaken for personality traits or emotional immaturity rather than symptoms of a neurodevelopmental disorder.
“Trying to meet societal expectations of being emotionally composed, high-achieving and socially pleasing, many girls develop sophisticated coping strategies, masking their symptoms through overachievement, rigidity or people-pleasing.
"This masking is mentally exhausting, often leading to burnout, low self-esteem and a painful sense of never being ‘enough’,” says Dr Makhomisane
Profaster Media
6 Nov 2024“Motherhood can bring this struggle into sharp relief. Executive dysfunction turns everyday caregiving into an overwhelming experience.
“Emotional overload becomes routine, while guilt and shame grow in silence.”
ADHD in women and girls
ADHD manifests differently in females, often leaning toward inattentiveness and emotional dysregulation.
Here are the signs:
ADHD in girls is often misinterpreted as immaturity or anxiety:
- Easily distracted, forgetful and frequently misplaces items.
- Difficulty completing tasks, organising or managing time.
- Emotional sensitivity and frequent mood shifts.
- Verbally impulsive and hyper-talkative.
ADHD in women:
- Chronic overwhelmed, forgetfulness and procrastination.
- Low self-esteem and masking behaviours.
- Emotional dysregulation, especially rejection-sensitive dysphoria.
- Co-occurring anxiety and depression.
“For women living with undiagnosed ADHD, daily life can feel chaotic or overwhelming, but instead of getting support, many try to hide or manage their symptoms with unhealthy coping strategies that seem successful but are draining,” says Makhomisane.
“These inefficient coping behaviours hide the real challenges, delaying diagnosis or support and lead to burnout, anxiety or depression because one blames oneself instead of understanding that your brain works differently and needs different strategies.”
Executive dysfunction
These unhealthy strategies include emotional withdrawal from fear of criticism or rejection, engaging in impulsive escapism such as binge shopping or making risky decisions, overcommitting and people-pleasing, and masking and perfectionism to compensate for executive dysfunction.
“We urge healthcare professionals, educators and families to become more attuned to how ADHD presents in women not as loud behaviour, but as persistent overwhelm, perfectionism, and emotional burnout.”
Treatment options include medication along with psychotherapy to build emotional regulation, reframe self-critical thoughts, and enhance day-to-day management and functioning.
Effective lifestyle changes, such as exercise, nutrition, mindfulness, and good sleep hygiene, strengthen both physical and mental health.
“If we can shift the lens, we can transform lives,” concludes Makhomisane.
“We need gender-sensitive diagnostic tools, increased public awareness, and support systems that meet women where they are, not where outdated stereotypes place them.”
