Understanding ADHD in women with ThinkDivergent’s Dr Jasmine Murphy
For ADHD Awareness Month, we spoke with Dr Jasmine Murphy, Chief Clinical Officer at ThinkDivergent – an AI operating system for neurodevelopmental care – about how we can better understand ADHD in women.
The team at ThinkDivergent recently released a white paper documenting the lack of gender equality in ADHD. At our Trust, and across the UK, there has been a sharp increase in women seeking a diagnosis and support but as demand grows, waiting lists become longer.
In the next few months, our 3 borough service will start a pilot with ThinkDivergent’s AI solution to reduce the time it takes to diagnose those on our waiting list, ensuring they are offered the support and guidance they need.
What is ADHD?
ADHD is a neurodevelopmental condition that affects a person's ability to focus, regulate impulses and manage attention/activity levels in everyday life. It is characterised into three main presentations: Inattentive, Hyperactive-Impulsive and Combined.
Find out more about ADHD on our website: Attention Deficit Hyperactivity Disorder (ADHD) - South London and Maudsley
Why is there a gender bias in ADHD diagnosis?
ADHD affects men and women at roughly the same rate, but men are diagnosed far more often—13% of men compared to only 4.2% of women.
There has been a historical gender bias in the diagnosis of ADHD as many of the initial studies were male dominated and disregarded the female specific traits. Girls and women don’t tend to match the stereotypical ADHD profile which can result in late life diagnosis.
How does ADHD present in women?
ADHD in women is often under-recognised because symptoms tend to be less overt and more internalised compared with men. Difficulties often show up in quieter ways, such as:
- Forgetfulness and distractibility
- Mental fog or feeling “scattered”
- Difficulty with organisation, planning, and time awareness
- Indecisiveness or difficulty prioritising tasks
- Daydreaming or appearing withdrawn
- Heightened emotional sensitivity (including rejection sensitivity)
- Mood fluctuations
- Perfectionism and overcompensating strategies
These traits can mask ADHD and are sometimes misattributed to stress, anxiety, or depression. As a result, many women are diagnosed later in life, often only after their coping strategies stop being sustainable.
What can we do to support women during the ADHD diagnosis process?
Prioritising trauma-informed care
Research finds that trauma is significantly more prevalent in girls with ADHD and can begin early in development. This makes it a challenge for clinicians to separate the traits of trauma from the traits of ADHD.
To support this, clinicians can use trauma-informed approaches to screen for trauma history, map traumatic life experience with ADHD trait severity and ensure an empathetic and holistic approach to diagnosis.
At SLaM, we have training modules available to support the work toward trauma informed care: https://slam.nhs.uk/search/event/module-1-becoming-trauma-infromed-45.
Using a neuro-affirmative approach
One of the ways that healthcare professionals can support women with suspected ADHD is to create a neuro-affirmative approach to help shift the focus from deficit-based thinking toward recognising and valuing their experiences. By doing this, we move away from trying to “fix” individuals and promote understanding, respect and empowerment.
Creating a neuro-affirmative approach includes validating the individuals lived experience, avoiding dismissive, using affirming statements and focusing on strengths, resilience and appreciation for adaptive strategies.
Provide gender-sensitive assessments
Traditional diagnostic tools often focus on male presentations of ADHD which in some cases, can lead to misdiagnosis. By using assessments that reflect internalised and emotionally sensitive traits that are more common in women, we can work toward processes that encourage gender equality.
Recognise masking and compensation
Women often develop coping mechanisms that can lead to burnout, anxiety and missed diagnoses. Some examples of this include perfectionism, people-pleasing and meticulous organisations that can often make their struggles harder to detect and diagnose.
By asking questions around coping strategies, internal experiences, social dynamics and emotional effort, healthcare professionals can start to see a clearer picture of the person.
Accounting for hormonal influences
ADHD symptoms can be significantly impacted by the hormonal fluctuations that take place during menstruation, puberty, pregnancy and menopause.
Due to the prevalence of complications related to hormonal influences and ADHD, diagnosis and treatment plans should consider these biological factors which are often overlooked.
Consider comorbidities
Women are at a higher risk of experiencing anxiety, depression and eating disorders alongside their ADHD. By screening for co-occurring conditions at the time of diagnosis, we can ensure holistic care planning to support the individual in a more rounded way.
Support we offer
Within our boroughs: If you live within our boroughs and need support, your GP or mental health team can refer you to our 3-borough service – a local outpatient service for adults registered with a GP in Croydon, Lambeth and Lewisham. More about the 3-borough service: https://slam.nhs.uk/search/service/croydon-lambeth-and-lewisham-adult-attention-deficit-hyperactivity-disorder-adhd-and-autism-service-213
Outside our boroughs: If you are outside our catchment area, your local area doesn’t provide support and you need help, please contact your GP who can consider whether a referral to the National Adult ADHD and Autism Service (NAAAPS) could help. More about NAAAPS: https://slam.nhs.uk/search/service/national-adult-adhd-and-autism-psychology-service-naaaps-322
