Attention deficit hyperactivity disorder (ADHD) isn’t just about hyperactive little boys who can’t sit still.
That’s the outdated image many of us were taught, and it’s part of the reason why so many women are silently living with undiagnosed ADHD, blaming themselves for years of mental overload, emotional exhaustion, and never feeling “together enough”.
This Women’s Month, the South African Society of Psychiatrists (SASOP) is urging the public to reframe how we understand Attention Deficit Hyperactivity Disorder, particularly in women and girls.
For too long, ADHD has worn a masculine mask, hiding the often invisible reality of how it presents in females.
“ADHD in women is not less severe. It’s just less visible, says Dr Wisani Makhomisane, psychiatrist and SASOP member. These women aren’t lazy, disorganised or overemotional; they’re living with a neurodevelopmental condition that’s been misunderstood through a gendered lens.”
Why does ADHD get missed in women?
Research backs it up. According to the CDC, boys are nearly twice as likely to be diagnosed with ADHD (14.5%) compared to girls (8%). As they grow older, the gap only widens – with many women waiting 4–5 years longer than men for a correct diagnosis.
Women are more likely to have the inattentive type of ADHD, marked by forgetfulness, poor time management, disorganisation and emotional overwhelm, not the impulsivity and hyperactivity more common in men. It often gets brushed off as stress, or worse, personality flaws.
In South Africa, the general awareness around adult ADHD is still in its infancy; this gendered misreading has serious consequences. Many women are first misdiagnosed with depression, anxiety, or even borderline personality disorder – leading to years of ineffective treatment and growing self-doubt.
When “coping” means hiding
Trying to keep up with societal expectations to be emotionally composed, productive, presentable, and endlessly organised, women with ADHD often develop masking behaviours.
- They overcompensate with perfectionism.
- People-pleasing.
- Overcommitting and rigid routines to avoid being “found out”.
It works until it doesn’t. Burnout becomes a regular occurrence. So does chronic guilt, shame, and the sinking feeling of “What’s wrong with me?”
Makhomisane explains, “Women use sophisticated coping mechanisms that can appear successful from the outside, but are mentally exhausting. These can include emotional withdrawal, impulsive spending, binge eating, or risky behaviours, not because they’re reckless, but because their brains are overwhelmed.
“We urge healthcare professionals, educators, and families to be more attuned to how ADHD manifests in women. It often presents not as overt behavioural issues, but as ongoing feelings of overwhelm, perfectionism and emotional burnout.”
Hormonal fluctuations throughout menstruation, pregnancy, and menopause also complicate the picture. Estrogen has a known effect on dopamine regulation in the brain, which means ADHD symptoms can worsen during low estrogen phases.
This makes diagnosis and treatment in women even more complex, especially when symptoms spike in reproductive transitions and are dismissed as “hormonal mood swings.”
Meanwhile, studies suggest testosterone may offer some protective effect against ADHD symptoms, which may partly explain the higher visibility of hyperactivity in boys compared to girls, who tend to display inattentive and emotionally internal symptoms.
Daily life for undiagnosed women with ADHD can feel like walking through molasses while carrying the emotional load of an entire household. Tasks like grocery shopping, managing school runs, or responding to emails become mountains.
Here are some common signs of ADHD in women and girls:
In girls (often misread as anxiety or immaturity):
- Easily distracted, forgetful and misplaces items.
- Struggles to finish tasks or follow through.
- Mood swings and emotional sensitivity.
- Excessive talking or impulsive chatter.
In women:
- Constantly overwhelmed or anxious.
- Chronic procrastination, forgetfulness.
- Rejection-sensitive dysphoria (extreme emotional reaction to perceived rejection).
- People-pleasing, pr rectionism, or emotional burnout.
Motherhood, often romanticised as a natural phase of womanhood, can amplify these struggles. Executive dysfunction makes routine caregiving feel chaotic.
Emotional overload becomes the norm, while guilt grows in silence. ADHD is a neurodevelopmental condition, not a moral failure. And the good news? Treatment works.
According to Makhomisane, an effective ADHD treatment plan may include:
- Medication to support brain function and executive management.
- Therapy to reframe self-critical thoughts, regulate emotions and break unhealthy coping patterns.
- Lifestyle changes such as regular exercise, mindfulness practices, healthy sleep habits and balanced nutrition.
These approaches aim to support the brain, not “fix” the woman.
“We need gender-sensitive diagnostic tools, more public awareness, and support systems that meet women where they are, not where outdated stereotypes place them,” says Makhomisane.
“If we shift the lens, we can truly change lives. For every woman who was told she’s ‘just emotional’, or who’s lived with decades of unspoken overwhelm, this shift can mean validation, healing, and empowerment. ADHD in women isn’t rare; it’s just been hidden.”
