By day, Sarah Singh* leads strategy for a Fortune 500 company. Her colleagues see a decisive executive who can hyperfocus through complex problems and generate innovative solutions. But at home, a different reality unfolds.
“I spent decades thinking I was just lazy and unmotivated,” she tells me, her voice carrying a mix of frustration and relief. “I’d make elaborate to-do lists and planning systems, only to abandon them after a few days. My team never saw the piles of unopened mail, the missed appointments, the constant internal chaos. The shame was crushing.”
Sarah was diagnosed with ADHD at 38, joining a growing number of high-achieving women discovering their neurodivergence later in life. As a therapist and executive coach who relates to Sarah’s “double life” deeply, I can attest that her story reflects a broader pattern of how ADHD manifests—and is frequently missed—in women who appear to “have it all together.”
The Gender Gap in ADHD Diagnosis
While ADHD affects people of all genders, women are routinely underdiagnosed or misdiagnosed. According to 2022 CDC data, boys (fifteen percent) are nearly twice as likely to be diagnosed with ADHD compared to girls (eight percent). This disparity isn’t because ADHD is less common in women—it’s because we’ve been looking for the wrong signs.
Hidden in Plain Sight: ADHD Symptoms In Women
Women with ADHD often present differently than the stereotypical hyperactive child. “Women have twice the amount of hyperactivity that men do,” shares Tracy Otuska, ADHD expert and author of ADHD For Smart Ass Women. “ But it can show up as being super chatty, which society just thinks is normal for women—it’s not.”
Common symptoms include:
- Chronic disorganization despite countless attempts at creating systems
- Difficulty with emotional regulation
- Intense hyperfocus on topics of interest
- Struggles with task initiation and completion
- High sensitivity and empathy
- Internal hyperactivity (racing thoughts)
- Co-occurring mental health conditions in seventy-eight percent of those diagnosed, including: anxiety, depression, substance use disorders, sleep disorders, eating disorders, obsessive-compulsive disorder (OCD), and autism spectrum disorder
“In school, I was the daydreamer staring out the window,” Sarah recalls. “Not the kid bouncing off the walls. Teachers just said I needed to ‘apply myself more.'” This internal presentation of ADHD—characterized by inattention rather than hyperactivity—is more common in women but often flies under the radar.
The Neurobiological Basis
“ADHD is a neurobiological condition,” Otsuka explains. “Our brains don’t make enough dopamine, or we process it differently. This impacts our prefrontal cortex, which is responsible for our executive functions—all of the things you need to do to get stuff done.”
ADHD Subtypes
ADHD presents in three ways: predominantly inattentive, predominantly hyperactive-impulsive, and combined type. While research historically focused on the hyperactive presentation common in boys—fidgeting, interrupting, inability to sit still—women often present with the inattentive type or show hyperactivity differently (as Otsuka notes, hyperactivity in women frequently manifests as chattiness, racing thoughts, or constant mental activity rather than physical restlessness). This difference in presentation helps explain why ADHD in women is often overlooked or misdiagnosed.
The Hormonal Connection
“Dopamine is modulated by estrogen,” Otsuka explains. “You’re going to see certain times in a woman’s life or cycle where she may struggle more with ADHD.” These key periods include:
- Puberty
- Pregnancy
- Postpartum
- Perimenopause
- Menopause
- Premenstrual Syndrome (PMS) or Premenstrual Dysphoric Disorder (PMDD)
The Masking Phenomenon
“Over and over, I would meet these women that were literally brilliant in their careers, like at the top. But they couldn’t see it because when they went home, they couldn’t keep the house in order,” Otsuka shares.
“I could spend hours researching a random topic that caught my interest,” Sarah recounts, “but basic tasks like paying bills or scheduling appointments felt impossibly overwhelming.”
Many women with ADHD become experts at masking their symptoms, developing coping mechanisms that hide their struggles from others—and sometimes even themselves. This adaptation often comes at a significant cost to their mental health and self-esteem, perpetuating the belief that underneath their “together” personas, they are failing at everyday life.
“All these things that we think we’re supposed to do just by virtue of the fact that we’re female, it’s just BS.”
Treatment Options: A Personal Journey
For women who suspect they may have ADHD, seeking professional evaluation is an important first step. When it comes to treating the condition, research shows there’s no one-size-fits-all approach. Research suggests that medication treatment for ADHD can lead to improved educational outcomes, better occupational status, enhanced self-esteem, and reduced functional impairments for many individuals. While long-term studies are still needed, evidence indicates that when patients maintain appropriate treatment under medical supervision, the prognosis is generally positive.
However, treatment decisions are deeply personal and should be made in consultation with healthcare providers. Whether choosing medication, non-pharmacological approaches, or a combination of both, what matters most is finding what works for you. While a psychiatrist or psychiatric nurse practitioner can help evaluate medication options, a comprehensive treatment team might also include psychologists, ADHD coaches, and other mental health professionals who can provide additional support and strategies.
Importantly, lifestyle interventions play a crucial role in managing ADHD symptoms, regardless of whether medication is part of your treatment plan. As Otsuka notes, “Every brain is different,” and understanding your unique needs is key to developing effective management strategies.
Holistic Management Strategies
1. Physical Activity: “The best thing you can do to manage symptoms is twenty minutes of physical activity at seventy percent of your max heart rate,” Otsuka recommends. “Exercise produces both serotonin and dopamine” (the motivating and positive-mood chemicals the ADHD brain lacks).
2. Diet and Gut Health: Recent research has established a strong connection between gut health and ADHD. The gut-brain axis appears to play a crucial role in dopamine regulation, while leaky gut syndrome puts individuals at risk of inflammation-related symptoms.
Craig Rouskey, M.S. and CEO of Floré, elaborated further: “Lactobacilli and Bifidobacteria play a key role in producing essential molecules to attenuate [ADHD] and improve individual outcomes.” In addition to supporting gut health through fermented foods, fiber, or supplementary pre- and probiotics, effective dietary considerations include:
- Reducing refined sugars and simple carbohydrates
- Increasing omega-3 fatty acids (found in fatty fish, walnuts, and flaxseeds)
- Maintaining stable blood sugar through regular, nutrient-dense meals
Dietary interventions focusing on reducing processed foods and increasing whole foods led to significant improvements in ADHD symptoms.
3. Sleep Optimization: Sleep problems significantly impact adults with ADHD, with studies showing that forty to eighty percent experience disordered sleep—considerably higher than the general population’s fifteen percent rate. Otsuka adds that women with ADHD struggle with “revenge bedtime procrastination”—putting off going to bed because they believe they’re “getting the time back” that they lost during the day. Not to mention the Herculean task of getting ready for bed, which does not fall under the “interesting” category for most women and thus gets delayed.
That said, practicing sleep hygiene and prioritizing quality sleep is of the utmost importance when it comes to ADHD management, given sleep deprivation tends to spike ADHD symptoms.
4. Environmental Modifications: Experimenting with work environments that align with your brain’s needs is essential. This might mean working in different locations, during non-traditional hours, or in environments that you associate with work only (versus trying to work from home, where there are more familiar and accessible distractions). She also advises being honest with yourself about your strengths and weaknesses, and outsourcing where the weaknesses lie.
Sarah embraces this strategy. “I used to feel guilty about hiring help, but now I see it differently. My time and energy are better spent on strategic work than fighting with spreadsheets or laundry. Having a bookkeeper and weekly cleaning service isn’t a luxury—it’s what allows me to show up as my best self at work and home.”
5. Mindset Work: Studies emphasize the importance of practicing mindfulness and self compassion when it comes to managing mental health with ADHD. Mindfulness helps train the brain in focusing on one thing at a time, while self compassion helps mitigate and metabolize any shame that shows up as a result of that “failing at everyday life” feeling. Otsuka suggests asking two questions: “Who do I want to be in this moment?’ and ‘How do I want to feel?'”
Beyond the Challenges: ADHD’s Unique Strengths
While ADHD presents its challenges, many women are learning to leverage their unique neurological wiring as a strength. “What I have discovered is that a lot of us are highly entrepreneurial,” Otsuka shares. “We are mission-driven people. We are really smart, and we are so creative.”
Common ADHD strengths include:
- Enhanced Creativity and Innovation: “The very reason we are so creative is because we’re inattentive,” Otsuka explains. “We’re not paying 100% attention to what’s going on… we get a bigger picture and a better picture than someone who’s just paying attention to the words.”
- Heightened Empathy and Intuition: Many ADHD women possess remarkable interpersonal intuition and emotional sensitivity, making them exceptional at reading people and situations.
- Hyperfocus Capabilities: While starting tasks can be challenging, ADHD brains can achieve extraordinary levels of focus and productivity in areas of interest.
- Strong Sense of Justice: “We tend to be highly justice sensitive,” Otsuka notes. “We will be the people that will go out and support someone else, even when it’s not in our best interest.”
- Out-of-the-Box Problem Solving: The ADHD brain’s tendency to make unique connections often leads to innovative solutions and creative approaches to challenges.
Embracing Your Unique Brain
“Every brain is different,” Otsuka emphasizes. “What I have discovered is that all ADHD women are brilliant in some area. We have hyperfocus—once we can get people to hyperfocus on what they’re really interested in, my God, we do it better and we do it faster than anyone.”
The key isn’t trying to conform to neurotypical standards but rather understanding and working with your unique brain wiring. With proper support and strategies, women with ADHD can thrive not despite their differences, but because of them.
“The most important thing you can do to reduce the shame is to get around your people,” Otsuka advises. “As ADHD women, we have been taught to fit in. But I don’t believe we’re meant to fit in—we’re meant to stand out and lead in the area of our interest.”
“Now I see that my ‘scattered’ thinking is actually connecting dots in unique ways,” Sarah explains. “When I stopped trying to force myself into a neurotypical box and started leveraging my natural strengths, everything changed. Yes, I still have twelve browser tabs open and jump between projects, but that’s how I innovate.”
*Name changed to protect privacy