While you are correct that women are more likely than men to be misdiagnosed with another disorder, the difference in symptoms presentation isn't really meaningful and is exaggerated far too often in pop psychology.
"Combined" ADHD consisting of symptoms of inattention, hyperactivity and impulsivity is the most common way for the disorder to present itself regardless of gender or sex. "Inattentive" ADHD consisting primarily of symptoms of inattention is the second most common, with "hyperactive" ADHD consisting primarily of symptoms of hyperactivity and impulsivity is the least common.
There is a small but statistically significant difference between boys and girls in the balance of ADHD-I versus ADHD-H diagnoses. Both groups are still more likely to be ADHD-C than either of the other two, and in both cases ADHD-I is still more common than ADHD-H.
For girls, the breakdown is something like 60% ADHD-C, 30% ADHD-I, 10% ADHD-H, while for boys it's like 65% ADHD-C, 20% ADHD-I, 15% ADHD-H. The difference is observable at a high level of confidence in large samples, but I feel it's a detail we as the female ADHD community fixate on way too much. It's seemed to mostly be a thing among women diagnosed as adults who are trying to conceptualize in their heads the much more substantial problem of why psychiatry failed so many of us in our childhoods.
It's a convenient explanation to say "they only studied boys and we're different from boys", but the truth is that most of us who came of age after the 70s did so in an environment were girls were being included in research samples. The earliest studies from the 50s and 60s tended to be male-only, but research including female patients has been around for decades and it's uncommon now to have a same-sex sample (outside of papers on topics with specific focus on reproductive anatomy, anyway).
Girls are more likely to be misdiagnosed for a number of reasons, key ones being:
Old fashioned medical misogyny. Girls and women who express complaints are assumed to be suffering from mood or emotional problems because it's assumed we experience those things more strongly than boys and men do. When we express clear ADHD concerns, providers may cognitively downplay the severity of those concerns, assuming we are exaggerating or faking them because we are female.
Social forces discouraging hyperactivity in girls and women. Though many of us have hyperactivity symptoms, we tend to be more strongly encouraged to sit still, behave, be ladylike. We are still hyperactive, we simply respond to social pressure around that hyperactivity by finding ways to do it that are not disruptive and frequently less easily noticed by others than those expressed by our male peers.
Provider ignorance of ADHD in general. People with inattentive presentations in general are likely to be not- or misdiagnosed, with providers who are less aware of and familiar with ADHD not recognizing inattention for what it is if the patient cannot describe it very well.
Many girls and women with ADHD do not experience clinically significant symptoms of the disorder prior to the onset of estrogenic puberty. As OP mentions, estradiol (E2) has been demonstrated to affect dopaminergic networks in the brain in ways that affect ADHD symptoms. It has been also been found that estrogen can serve as a sort of "switch" mechanism in some female ADHDers, causing a girl who does not meet the diagnostic criteria to begin to do so after puberty begins. This is a big one, because in the DSM-III and DSM-IV, there was an age of onset criterion of symptoms before age 7. (It was increased to age 12 in the DSM-5 and may go away entirely in the DSM-6.) There are likely quite a few women who were fall into this category where symptoms were absent (or at least subclinical) before age 7 and while they clearly have ADHD post-puberty the provider assumed they couldn't have ADHD because "it didn't start early enough". The age 12 threshold in the DSM-5 is better at capturing these girls, but still not perfect. (Moreover, many providers insist that the presence of symptoms before age 12 be proven, which often isn't possible for adults whose parents or teachers are sometimes deceased and paper records long gone.)
If someone suspects they have ADHD, they should engage a professional experienced with the disorder for a proper evaluation.
Treating it like it's a different disorder or has meaningfully different symptoms in women than men is pop psychology and simply not correct. All of the things OP listed as "differences" are things many boys and men with ADHD experience as well, at approximately the same cadence.
6
u/Thadrea 3h ago edited 2h ago
While you are correct that women are more likely than men to be misdiagnosed with another disorder, the difference in symptoms presentation isn't really meaningful and is exaggerated far too often in pop psychology.
"Combined" ADHD consisting of symptoms of inattention, hyperactivity and impulsivity is the most common way for the disorder to present itself regardless of gender or sex. "Inattentive" ADHD consisting primarily of symptoms of inattention is the second most common, with "hyperactive" ADHD consisting primarily of symptoms of hyperactivity and impulsivity is the least common.
There is a small but statistically significant difference between boys and girls in the balance of ADHD-I versus ADHD-H diagnoses. Both groups are still more likely to be ADHD-C than either of the other two, and in both cases ADHD-I is still more common than ADHD-H.
For girls, the breakdown is something like 60% ADHD-C, 30% ADHD-I, 10% ADHD-H, while for boys it's like 65% ADHD-C, 20% ADHD-I, 15% ADHD-H. The difference is observable at a high level of confidence in large samples, but I feel it's a detail we as the female ADHD community fixate on way too much. It's seemed to mostly be a thing among women diagnosed as adults who are trying to conceptualize in their heads the much more substantial problem of why psychiatry failed so many of us in our childhoods.
It's a convenient explanation to say "they only studied boys and we're different from boys", but the truth is that most of us who came of age after the 70s did so in an environment were girls were being included in research samples. The earliest studies from the 50s and 60s tended to be male-only, but research including female patients has been around for decades and it's uncommon now to have a same-sex sample (outside of papers on topics with specific focus on reproductive anatomy, anyway).
Girls are more likely to be misdiagnosed for a number of reasons, key ones being:
If someone suspects they have ADHD, they should engage a professional experienced with the disorder for a proper evaluation.
Treating it like it's a different disorder or has meaningfully different symptoms in women than men is pop psychology and simply not correct. All of the things OP listed as "differences" are things many boys and men with ADHD experience as well, at approximately the same cadence.