We Demand Attention on the Mental and Physical Health Consequences of Late-Life Diagnoses on Women

What We Know

Research tells us that girls and women with ADHD are diagnosed much later in life than are boys and men due to misunderstood symptom profiles in women ¹, outdated gender stereotypes, strong coping mechanisms among women, poor clinician awareness, and a high prevalence of comorbidities. ^{2 3 4}

Studies on gender differences show that ADHD is consistently under-diagnosed, misdiagnosed, or undiagnosed in girls and women for the reasons above — and many more. For one, we know that women and girls are socialized to be organized, generous, empathetic, and obedient. When ADHD makes it difficult to fulfill these ideals, girls and women are more likely to mask their symptoms to avoid judgment and ostracism. Women are also twice as likely as men to experience depression, leading many clinicians to diagnose a mood disorder but miss the ADHD underneath it all. As a result, many women with ADHD come of age feeling there is something fundamentally wrong with them.

The short- and long-term effects of delayed ADHD diagnosis and treatment for women are wide ranging and may include the following: ⁵

• Broad academic and social problems during childhood and adolescence ⁶
• Lower and more anxiety ⁷
• Higher emotional lability including anger-management problems
• A higher likelihood of requiring mental health treatment
• Difficulties in coping with home life ⁸
• Feelings of disorganization
• Somatization (including headaches, stomachaches) ⁹
• Sleep difficulties ¹⁰
• Elevated risk for eating disorders ¹¹
• Workplace performance problems
• A higher risk of self-medication with drugs and alcohol
• Risky sexual behavior and higher rates of unplanned pregnancy
• A higher likelihood of unsafe driving and traffic accidents
• Elevated rates of intimate partner violence ¹² and sexual violence ¹³

A 2023 analysis of eight articles published in the Journal of Attention Disorders found that living with undiagnosed ADHD in childhood profoundly impacts self-esteem, mental health, well-being, and relationships. A diagnosis, not surprisingly, improves self-acceptance. Prior research has also demonstrated that ADHD treatment improves outcomes for most patients across these domains: driving, obesity, self-esteem, social function, academic outcomes, and drug use or addictive behaviors.

“ADHD is worse than any single other life expectancy risk factor that we are concerned about as a population — diabetes, smoking, obesity, alcohol use, and so on. ADHD is worse than all of them,” says Russell Barkley, Ph.D., in the ADDitude webinar titled, “How ADHD Shortens Life Expectancy: What Parents and Doctors Need to Know to Take Action.”

“Women who live undiagnosed until adulthood experience significant negative outcomes in the areas of self-esteem, social interaction, and psychosocial wellbeing beginning in childhood and continuing into adulthood,” reads a systematic review of research published in March 2023. “Earlier diagnosis and treatment may help to mediate these negative outcomes.”

What We Don’t Know

The full extent of the long-term health implications associated with delayed ADHD diagnosis and/or misdiagnosis for women is unknown.

According to every available metric, undiagnosed individuals with ADHD fare worse than their diagnosed counterparts. More in-depth, first-hand research is needed to understand the ways in which a patient’s mental health and happiness deteriorate as diagnosis is delayed, and whether that degradation worsens exponentially with time and/or hormonal changes in women.

• Does a delayed ADHD diagnosis cause enduring emotional and psychological damage to women?
• Does it increase the chances of developing a secondary comorbidity like anxiety or depression?
• Does it increase the risk of physical health problems, serious accidents, and/or intimate partner violence?
• And, if so, what can be done to minimize and mitigate this damage? How would early diagnosis improve overall health outcomes across the lifespan?

“Distracted from their own self-care, women with ADHD postpone checkups and procedures, and function with serious sleep deficits,” says Ellen Littman, Ph.D., clinical psychologist and co-author of the book Understanding Girls with ADHD. (#CommissionsEarned) “Inconsistent eating patterns, shaped by inattention and impulsivity, can result in complications. Chronically stressed, they may depend on prescription medications to manage anxiety, mood disorders, sleep, or pain, or they may self-medicate with alcohol or drugs.”

Why It Matters

Undiagnosed and untreated ADHD may reduce an individual’s life expectancy by 13 years. Understanding the signs of early distress could improve mental health and quality of life — and literally save lives.

Clinicians need to better understand the health consequences of dismissing or failing to recognize the signs of ADHD in women, and the empirical evidence that effective treatment is the key to unlocking better, even life-saving health outcomes. Research like this will illuminate the long-term implications of untreated ADHD and underscore the importance of diagnosis to healthcare providers who may otherwise shrug off reports of emotional dysregulation, impulsivity, or disorganization by female patients. Research unlocks education, which unlocks better healthcare.

This research may also help to identify early warning signs that may suggest to caregivers, clinicians, and educators that an ADHD evaluation may be appropriate.

 

What ADDitude Readers Tell Us

Women diagnosed with ADHD later in life carry a heavy burden that continues to impact their mental and physical health, relationships, careers, and treatment outcomes even after diagnosis.

“I was an older woman (60+) when I realized that ADHD is real and that I have it,” writes one respondent to ADDitude’s survey of 700 readers regarding research priorities. “I have lived with the misleading belief that I was a loser, lazy, incompetent… What are the long-term impacts of these self-defeating beliefs? Where does one this old go for help this late in life?”

“I believe the forgetfulness of ADHD and my tendency toward rumination and self-doubt kept me with my abuser longer, as it contributed to second-guessing myself, shame, self-blame, and not trusting what I saw or valuing how I felt,” wrote another ADDitude reader diagnosed late in life.

What ADHD Experts Say

Research shows that the long-term outcomes for women with ADHD are worse than they are for men with the condition. We need to understand why, and the critical points at which intervention is essential.

“It is critical that research explore why ADHD exacts a far greater toll on women,” Littman says. “Perhaps the perfect storm of internalized symptoms, hormonal fluctuations, and the pressure of societal expectations combine to create a context of stressors unique to females.”

“What are the strategies and supports that teen girls and women with ADHD find most helpful in self-advocacy and thriving?” asks Stephen Hinshaw, Ph.D., director of the Berkeley Girls and ADHD Longitudinal Study (BGALS).

Next Steps

Consider joining a research study on women with ADHD.

• CHADD offers a database of ADHD-related research studies that is searchable according to region.
• The U.S. Food & Drug Administration maintains a database of clinical trials for women that is searchable by condition and location.
• ResearchMatch is a free and secure tool that helps match willing volunteers with eligible researchers and their studies at institutions across the United States.
• ClinicalTrials.gov is a U.S. government database of clinical trials that is searchable by condition, treatment, or location.
• Though it is not currently running any studies on adult women with ADHD, the National Institute of Mental Health (NIMH) does maintain a database of related research studies underway now.

Late Diagnosis of ADHD in Women: Related Reading

• Study: Women with Undiagnosed ADHD Suffer Poor Self-Esteem, Mental Health
• How Undiagnosed ADHD Triggers Depression and Anxiety
• Women with ADHD: No More Suffering in Silence
• The Transformative Power of an ADHD Diagnosis for Older Women
• Why Women with ADHD Feel Disempowered — and What We Can Do About It
• “Regret and Resolve: How Women with ADHD Can Transform the Challenges of a Late Diagnosis”
• 10 Books Every Woman Should Read After Her ADHD Diagnosis

We Demand Attention: A Call for Greater Research on ADHD in Women

Intro: Top 10 Research Priorities

1. Sex Difference in ADHD
2. The Health Consequences of Delayed ADHD Diagnoses on Women
3. How Hormonal Changes Impact ADHD Symptoms in Women
4. How Perimenopause and Menopause Impact ADHD Symptoms, and Vice Versa
5. The Elevated Risk for PMDD and PPD Among Women with ADHD
6. The Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing
7. How ADHD Medication Adjustments During the Monthly Menstrual Cycle Could Improve Outcomes for Women
8. The Long-Term and Short-Term Implications of Hormonal Birth Control and Hormone-Replacement Therapy Use Among Women with ADHD
9. How and Why Comorbid Conditions Like Anxiety, Depression, and Eating Disorders Uniquely Impact Women with ADHD
10. Early Indicators of Self-Harm, Partner Violence, and Substance Abuse Among Girls and Women with ADHD

ADDitude is dedicated to honoring gender diversity and fluidity. For the purposes of this reporting, we use the terms “girls” and “women” to refer to individuals assigned female at birth and/or who identify as female.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Sources

¹ Biederman, J., Faraone, S., Mick, E., and Lelon, E. (1995). Psychiatric comorbidity among referred juveniles with major depression: fact or artifact? J. Am. Acad. Child Adolesc. Psychiatry 34, 579–590. doi: 10.1097/00004583-199505000-00010

² Mowlem, F. D., Rosenqvist, M. A., Martin J., Lichtenstein, P., Asherson, P., Larsson, H. (2018). Sex Differences in Predicting ADHD Clinical Diagnosis and Pharmacological Treatment. European Child & Adolescent Psychiatry. 28, 481–489. https://doi.org/10.1007/s00787-018-1211-3

³ Quinn, P., Wigal, S. (2004). Perceptions of Girls and ADHD: Results from a National Survey. Medscape General Medicine, 6(2), 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395774/#__ffn_sectitle

⁴ Waite, R. (2010). Women with ADHD: It Is An Explanation, Not the Excuse Du Jour. Perspectives in Psychiatric Care. 46(3), 182–196. https://doi.org/10.1111/j.1744-6163.2010.00254

⁵ Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of Attention Disorders. 27(7), 645–657. https://doi.org/10.1177/10870547231161533

⁶ Quinn P, Wigal S. Perceptions of girls and ADHD: results from a national survey. MedGenMed. 2004;6(2):2

⁷ Rucklidge JJ, Kaplan BJ. Psychological functioning of women identified in adulthood with attention-deficit/hyperactivity disorder. J Atten Disord. 1997;2(3):167–176.

⁸ Fedele DA, Lefler EK, Hartung CM, et al. Sex differences in the manifestation of ADHD in emerging adults. J Atten Disord. 2012;16(2):109–117.

⁹ Graetz BW, Sawyer MG, Baghurst P. Gender differences among children with DSM-IV ADHD in Australia. J Am Acad Child Adolesc Psychiatry. 2005;44(2):159–168.

¹⁰ Rasmussen K, Levander S. Untreated ADHD in adults: are there sex differences in symptoms, comorbidity, and impairment? J Atten Disord. 2009;12(4):353–360.

¹¹ Fernández-Aranda F, Agüera Z, Castro R, Jiménez-Murcia S, Ramos-Quiroga JA, Bosch R, Fagundo AB, Granero R, Penelo E, Claes L, Sánchez I, Riesco N, Casas M, Menchon JM. ADHD symptomatology in eating disorders: a secondary psychopathological measure of severity? BMC Psychiatry. 2013 Jun 11;13:166. doi: 10.1186/1471-244X-13-166. PMID: 23758944; PMCID: PMC3693886.

¹² Guendelman, M.D., Ahmad, S., Meza, J.I. et al. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol 44, 155–166 (2016). https://doi.org/10.1007/s10802-015-9984-z

¹³ Arrondo G, Osorio A, Magallón S, Lopez-Del Burgo C, Cortese S. Attention-deficit/hyperactivity disorder as a risk factor for being involved in intimate partner violence and sexual violence: a systematic review and meta-analysis. Psychol Med. 2023 Dec;53(16):7883-7892. doi: 10.1017/S0033291723001976. Epub 2023 Jul 24. PMID: 37485948; PMCID: PMC10755239.

Removed