Why ADHD Hits Women Harder — and Later

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Despite similar symptom onset, women are diagnosed with attention-deficit/hyperactivity disorder (ADHD) years later than men — leading to greater emotional and functional struggles, according to research published in European Psychiatry.

ADHD is often thought of as a childhood condition, but it commonly continues into adulthood, affecting focus, organization, emotions and daily life. This new study sheds light on how ADHD symptoms, related mental health conditions and everyday challenges can look different in men and women — and why recognizing those differences matters for diagnosis and care.

“ADHD affects millions of people, but our understanding of how it presents and impacts males and females differently remains limited,” said lead investigator Silvia Amoretti, Ph.D., associated with Group of Psychiatry, Mental Health and Addictions, Vall d’Hebron Research Institute (VHIR), Spain, in a statement. “We found that [women] are underdiagnosed, often receiving a diagnosis years later than males. This delay may lead to worse clinical outcomes, including depression, anxiety and functional impairment.”

The team of investigators examined data from 900 adults diagnosed with ADHD, exploring how symptom severity, coexisting conditions (such as depression or anxiety) and overall functioning vary by sex (male vs. female) and ADHD subtype. The subtypes include inattentive (mainly trouble focusing), hyperactive-impulsive (mainly restlessness and impulsivity) and combined (a mix of both).

Key Findings

• Women experience greater symptom severity and emotional burden
  • Women in the study had more severe ADHD symptoms overall and reported significantly higher rates of depression and anxiety than men. While men were more likely to show substance use problems, women’s symptoms were linked to poorer daily functioning and a greater sense of disability — meaning their ADHD symptoms interfered more with work, relationships and daily responsibilities.
• Diagnosis comes later for women
  • Even though men and women had similar ages when symptoms first appeared, women were typically diagnosed with ADHD much later. This delay may stem from how symptoms are expressed — women often show less outward hyperactivity and more inward symptoms, such as inattention, disorganization or emotional overwhelm.
• The combined subtype brings the highest risk for challenges
  • Adults with the combined subtype — showing both attention and hyperactivity/impulsivity symptoms — experienced more severe ADHD, as well as higher rates of depression, anxiety, impulsivity and disability. This pattern held true across sexes, but the impact on daily functioning was most pronounced in women with the combined subtype, suggesting that they may face unique challenges in managing symptoms and maintaining quality of life.
• Substance use differs by sex
  • Men reported higher levels of substance use, delinquent behaviors such as legal problems and driving-related difficulties, while women were less likely to engage in substance-related behaviors. However, women’s emotional and functional challenges were often greater, highlighting that risk factors and coping mechanisms differ between the sexes.

What This Means for Patients

This study highlights that ADHD doesn’t look the same for everyone — and that men and women can experience the condition in distinct ways. For women, symptoms often go unrecognized for years. These findings emphasize the need for more personalized approaches to diagnosis, treatment and support.

“ADHD often goes unnoticed in women until it becomes a serious problem,” said Amoretti. “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.”