Why this matters

NICE NG87 (recommendation 1.2.2) (NICE describes its guidelines as "for health and care in England and Wales"; NAIT 2022 says NHS staff assessing ADHD in Scotland "are expected to follow the standards for assessment and diagnosis set out in NICE Guidelines") says: "Be aware that ADHD is thought to be under-recognised in girls and women and that: they are less likely to be referred for assessment for ADHD; they may be more likely to have undiagnosed ADHD; they may be more likely to receive an incorrect diagnosis of another mental health or neurodevelopmental condition." The 2020 UK expert consensus statement on females with ADHD (Young et al.) says the discrepancy in the ratio of males to females with diagnosed ADHD "is due, at least in part, to lack of recognition and/or referral bias in females". It also notes that "ADHD symptoms may become more obvious later in females, often during periods of social or educational transition" and that "Adult women may develop awareness of their difficulties leading them to self-present to primary services".

Sex differences in presentation

The expert consensus statement says "Some sex differences have been reported". This does not mean every woman has the same presentation: ADHD is individual.

Inattentive presentation and being missed

The consensus (Table 1) says: "Females present with both inattentive and hyperactive-impulsive symptoms", that "Symptom severity may be lower in females than in males, particularly for hyperactive-impulsive symptoms", and that "Inattention in girls and women with ADHD may present as being easily distracted, disorganised, overwhelmed and lacking in effort or motivation." It adds: "Less overt ADHD symptoms are less likely to lead to referral which means that inattentive girls are more often missed." It also reports that, in population-based samples, "for both sexes the hyperactive-impulsive type predominates in pre-schoolers, whereas the inattentive-type is the most common presentation from mid-to-late childhood and into adulthood".

The consensus abstract lists the barriers that "may hinder recognition": "symptomatic differences, gender biases, comorbidities and the compensatory strategies that may mask or overshadow underlying symptoms of ADHD". (Young S, Adamo N, Ásgeirsdóttir BB, et al. Females with ADHD: An expert consensus statement. BMC Psychiatry, 2020.)

Hyperactivity across development

The consensus describes how experiences of ADHD change over development: "hyperactivity may be replaced by feelings of 'inner restlessness' and discomfort; inattention may manifest as difficulty completing chores or work-based activities (e.g. filling out forms, remembering appointments, meeting deadlines)". This is described for ADHD in general, not for women only.

Emotional dysregulation

Emotional dysregulation is described in the research on ADHD. Shaw and colleagues' review says "emotion dysregulation is prevalent in ADHD throughout the lifespan and is a major contributor to impairment". A 2020 meta-analysis of 13 studies (N = 2535) found adults with ADHD had "significantly higher levels of general ED" than healthy controls and concluded that its findings "support ED symptoms as a core feature of ADHD's psychopathology". The female-focused consensus says "Difficulties with emotional lability and emotional dysregulation may be more severe or common in girls and women with ADHD".

The same consensus says "Internalising symptoms secondary to, or comorbid with ADHD may be misinterpreted as primary conditions. Low mood, emotional lability, or anxiety may be especially common in females with ADHD", and that "Borderline personality traits in ADHD tend to be associated with women". (Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 2014. Beheshti A, Chavanon ML, Christiansen H. Emotion dysregulation in adults with ADHD: a meta-analysis. BMC Psychiatry, 2020.)

Masking and compensation

The consensus statement says "Compensatory behaviours may mask behaviour and impairments, and delay time to referral." A 2014 review (Quinn and Madhoo) says "Females with ADHD may develop better coping strategies than males to mask their symptoms." Research on camouflaging more broadly comes from autism: a 2019 study of 262 autistic people (Cage and Troxell-Whitman) found that "Both camouflaging highly across contexts and 'switching' between camouflaging in some contexts but not in others, related to poorer mental health." That study was of autistic adults, not people with ADHD. (Cage E, Troxell-Whitman Z. Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 2019. Quinn PO, Madhoo M. A review of attention-deficit/hyperactivity disorder in women and girls. Prim Care Companion CNS Disord, 2014.)

Hormones and ADHD

The consensus statement says "Symptoms may be exacerbated by hormonal changes during menstrual cycle, pregnancy and menopause." Quinn and Madhoo (2014) note that "Unique issues related to hormonal effects on ADHD expression and treatment response are also experienced by women and girls."

The menstrual cycle

A 2018 study (Roberts and colleagues) followed 32 regularly cycling young women for 35 days. It found that "decreased levels of E2 in the context of increased levels of either P4 or T was associated with higher ADHD symptoms on the following day, particularly for those with high trait impulsivity", and that "Phase analyses suggested both an early follicular and early luteal, or post-ovulatory, increase in ADHD symptoms." The authors concluded that "ADHD symptoms may change across the menstrual cycle in response to endogenous steroid changes." The sample was small (32 women). (Roberts B, Eisenlohr-Moul T, Martel MM. Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 2018.)

Perimenopause and menopause

The consensus statement lists menopause among the hormonal changes that may exacerbate symptoms, and advises: "Review is advised during and after key periods of hormonal change (menopause, pregnancy)." This page does not make claims about how perimenopause affects ADHD symptoms or medication, because we have not found a primary source for them.

If you are noticing new difficulties with concentration or memory, or if existing ADHD symptoms are worsening, it is worth discussing this with your GP or prescriber.

Why ADHD may be recognised later in women

The sources cited on this page identify these factors:

Referral bias: the consensus says "Gender-based biases in teachers and parents appear to affect referral likelihood." A 2012 study (Bruchmüller and colleagues) sent case vignettes to 1,000 child psychologists, psychiatrists and social workers. In the three vignettes that did not meet ADHD criteria, 16.7% of therapists diagnosed ADHD, and "In the boy version of these vignettes, therapists diagnosed ADHD around 2 times more than they did with the girl vignettes." (Bruchmüller K, Margraf J, Schneider S. Is ADHD diagnosed in accord with diagnostic criteria? Journal of Consulting and Clinical Psychology, 2012.)

Presentation differs from the stereotype: the Royal College of Psychiatrists college report CR235 (2023) says: "The clinician should be aware of gender differences in presentation. ADHD in women can go undiagnosed due to a different symptom profile ... The lack of overt symptoms and less externalised behaviours can impair the recognition of ADHD in girls."

Comorbidity and misdiagnosis: the consensus says "Compared with males with ADHD, internalising disorders (e.g. emotional problems, anxiety, depression) are more often reported in females". On eating disorders, it cites a meta-analysis that "identified increased risk of all eating disorder syndromes ... amongst individuals with ADHD, with similar risk estimates for males and females". NICE NG87 (1.2.2) says girls and women "may be more likely to receive an incorrect diagnosis of another mental health or neurodevelopmental condition".

Cost of assessment: on our provider comparison, the 25 providers that list an adult ADHD assessment price show prices from £650 to £2,050 (ADHD Scot provider data as of 20 October 2026; entries were last checked between July and October 2026). The cost may be a barrier for some people.

What to do if you think you have been missed

If you are a woman in Scotland who suspects you may have undiagnosed ADHD, the following steps are worth considering:

1. Complete a validated screener Our ADHD self-screener is the WHO Adult ADHD Self-Report Scale (ASRS-v1.1), an 18-question screening questionnaire. A screening result does not mean you have ADHD, but it can give you something to take to your GP.

2. Keep a symptom diary Track how your symptoms vary across your menstrual cycle if relevant. Note situations in which difficulties are most pronounced, time management, memory, emotional regulation, sleep. This information helps clinicians understand the pattern.

3. Speak to your GP and be specific NICE NG87 (1.2.2) says girls and women "are less likely to be referred for assessment for ADHD". Being specific about the symptoms you experience, rather than describing them in general terms like "I can't concentrate", may help. It may also help to mention childhood experiences: the consensus notes that symptoms "are pervasive and impairing rather than transient or fluctuating" and that ADHD is present in childhood.

4. Ask for a referral NAIT (2022) says: "In Scotland, most ADHD diagnosis takes place within the NHS." Ask your GP about a referral for NHS ADHD assessment. Waiting times differ by area (see our NHS waiting times page). If your GP is reluctant, Patient Advice and Support Service (PASS) says its advisers support people who use NHS Scotland "to understand their rights and responsibilities as a patient, raise concerns, give feedback, or make a complaint".

5. Consider private assessment if the wait is not manageable Private ADHD assessment in Scotland is available from a number of providers. Our compare tool lists providers with HIS registration status, costs, and shared care support. If you receive a private diagnosis, you can ask your GP about a shared care agreement; NAIT (2022) says this "will only occur with a patient's agreement and when the condition is stable or predictable". See our shared care guide.

ADHD in women and girls