When most people think of ADHD, the image that often springs to mind is a hyperactive little boy bouncing off the classroom walls.
But what happens when the person with ADHD is a quiet, dreamy girl or a chronically overwhelmed mom juggling work, family, and the relentless pressure to hold it all together?
This Women’s Month, the South African Society of Psychiatrists (SASOP) is shining a light on a reality that many women have lived with for years, often silently, and without a diagnosis. ADHD (Attention Deficit Hyperactivity Disorder) doesn’t just affect boys.
It doesn’t magically disappear after childhood. And it doesn’t always look like disruptive behaviour.
The “invisible” ADHD
“ADHD in women is not less severe. It’s just less visible,” says Dr Wisani Makhomisane, a specialist psychiatrist and member of SASOP. “These women are not lazy, disorganised or overemotional. They are living with a neurodevelopmental condition that has been poorly understood through a gendered lens.”
The stereotype of ADHD as a “boy problem” has persisted for years, masking how the condition presents differently in girls and women. While boys are often more outwardly hyperactive and impulsive, girls tend to internalise their symptoms.
“Girls are often seen as dreamy, anxious, sensitive or perfectionistic – traits that are easily mistaken for personality quirks or emotional immaturity,” says Dr Makhomisane.
Diagnosis delayed – sometimes for decades
The stats speak for themselves: globally, boys are diagnosed with ADHD at nearly twice the rate of girls – 14.5% versus 8%, according to data from the CDC. As they grow older, many women still find themselves overlooked, with diagnosis often coming four to five years later than for men.
“In South Africa, ADHD remains underdiagnosed in general, but particularly so in adult women,” Dr Makhomisane explains.
“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.”
And because ADHD isn’t always considered in women, many are first given sedatives or antidepressants. The result? “Mismanaged care, fragmented support and rising co-morbidities, including eating disorders and mood instability,” says Dr Makhomisane.
Masking, burnout and the weight of expectations
Trying to keep up appearances is a familiar story for many women with ADHD. They’re often perfectionists, overachievers, or serial people-pleasers – all of which can mask the chaos happening beneath the surface.
“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,” says Dr Makhomisane.
“This masking is mentally exhausting, often leading to burnout, low self-esteem and a painful sense of never being ‘enough’.”
And then there’s motherhood. “Executive dysfunction turns everyday caregiving into an overwhelming experience,” Dr Makhomisane notes. “Emotional overload becomes routine, while guilt and shame grow in silence.”
So what does ADHD look like in women and girls?
In girls (often mistaken for immaturity or anxiety):
- Easily distracted, forgetful and misplacing items
- Struggling to complete tasks or manage time
- Emotionally sensitive with frequent mood swings
- Verbally impulsive and hyper-talkative
In women:
- Chronically overwhelmed and forgetful
- Low self-esteem and constant “masking”
- Emotional dysregulation, especially rejection sensitivity
- Anxiety, depression, and burnout
Unhealthy coping strategies that can delay diagnosis
Dr Makhomisane highlights the many ways women try to self-manage ADHD without even realising it:
- Withdrawing emotionally to avoid rejection
- Escaping into impulsive behaviours (like binge shopping or risky decisions)
- Overcommitting to prove their worth
- Striving for perfection to hide disorganisation
“These inefficient coping behaviours hide the real challenges, delaying diagnosis or support,” says Dr Makhomisane. “It often leads to burnout, anxiety or depression because one blames oneself instead of understanding that your brain works differently and needs different strategies.”
What can be done?
Dr Makhomisane urges healthcare professionals, educators, and families to start looking beyond the loud, disruptive stereotype. “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.”
Effective treatment usually includes a combination of medication and psychotherapy. Therapy can help women build emotional regulation, reframe negative thought patterns, and improve daily functioning. Lifestyle changes – such as regular exercise, good nutrition, mindfulness and quality sleep – also play a crucial role in managing ADHD symptoms.
“If we can shift the lens, we can transform lives,” says Dr 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.”
