Underdiagnosis of ADHD in Women as a Hidden Hurdle and Its Consequences for Functioning in Adulthood— A Literature Review

Abstract

Background: ADHD is characterized by inattention, hyperactivity, impulsivity, and affects 8.4% of children and 2.5% of adults. Lower diagnosis rates in females suggest a different clinical presentation, contributing to delayed diagnoses and negative outcomes across multiple domains of functioning. Aim: This study examines underdiagnosed ADHD in women, assessing its impact on functioning in adulthood, including mental health, quality of life, and long-term impairments. Material and methods: A literature review using PubMed/MEDLINE (2010–2025) included clinical, longitudinal cohort, and epidemiological research addressing sex differences in ADHD diagnosis, symptom presentation, and long-term functional outcomes, with a focus on the female population. Results: Women with ADHD are significantly underdiagnosed in childhood, often receiving diagnosis only in adulthood after years of treatment for comorbidities such as anxiety, depression, or personality disorders. Internalized symptoms and emotional dysregulation frequently mask core ADHD features. Late diagnosis is associated with impaired educational and occupational achievement, relationship instability, low self-esteem, substance misuse, reduced quality of life, and increased risk of self-harm and suicide attempts. ADHD in women also increases risk of psychiatric and obstetric complications, including teenage pregnancy, smoking during pregnancy, substance misuse, and postpartum depression and anxiety. Conclusions: Underdiagnosis of ADHD in women remains a significant clinical and public health issue. Greater awareness of sex-specific symptom presentation and improved diagnostic strategies are essential to prevent long-term psychosocial consequences and improve quality of life in affected women.