Women diagnosed with ADHD five years later than men

Women are diagnosed with ADHD around five years later than men, despite symptoms appearing at the same age, new research has revealed.

The delay in diagnosis is linked to worse outcomes for women with attention-deficit/hyperactivity disorder (ADHD), which affects concentration and impulse control.

It is associated with higher rates of depression, anxiety and everyday impairment.

Scientists analysed 900 adults (54.9 per cent male, 45.1 per cent female, average age 36.94) newly diagnosed with ADHD at a specialised outpatient programme in Barcelona.

Women were diagnosed at an average age of 28.96 years compared to 24.13 for men, despite symptoms starting at similar ages.

By the time of diagnosis, women showed more severe symptoms, with higher rates of depression and anxiety and poorer daily functioning.

Men, meanwhile, were around three times more likely to have legal issues, with 18.1 per cent reporting such problems compared to 6.6 per cent of women.

“ADHD affects millions of people, but our understanding of how it presents and impacts males and females differently remains limited,” said Dr Silvia Amoretti, lead researcher from Barcelona.

“We found that females are underdiagnosed, often receiving a diagnosis years later than males.

“This delay may lead to worse clinical outcomes, including depression, anxiety and functional impairment.

“Males, on the other hand, showed a higher level of involvement in delinquent behaviours such as legal problems and driving-related difficulties.

“We believe that a better understanding of these sex-based differences might improve diagnosis and treatment.”

The research compared males and females across factors such as age at diagnosis, symptom severity, psychiatric comorbidities, psychosocial functioning and disability.

Participants underwent standardised clinical interviews and validated rating scales.

Dr Amoretti said the finding had not been expected: “We didn’t set out to compare the age of diagnosis in males and females.

“We were aiming to understand the general age when symptoms appear, regardless of sex.

“This difference emerged during the analysis, and the scale of it came as a surprise.”

Experts believe delayed diagnosis in women often results from differences in symptom presentation.

Boys tend to show more visible hyperactive or impulsive behaviour, making ADHD easier to spot. Girls are more likely to display inattentive traits that seem less disruptive.

“It’s likely that women are diagnosed later because ADHD manifests differently in men and women,” Dr Amoretti said.

“Boys are more likely to be hyperactive or impulsive, behaviour that is more obvious to parents, teachers and clinicians. Girls are more often inattentive and less disruptive.

“Clinically, this means women are not treated early enough and are sometimes not diagnosed at all. We have seen similar tendencies internationally, so it is likely this is a global problem.

“The nature of the condition leads to poorer diagnosis in women everywhere, meaning they can lose on average five years of treatment — five years of a better life.”

Professor Sandra Kooij from Amsterdam UMC/VUmc and PsyQ in The Hague, who was not involved in the research, said differences in symptoms, limited clinician awareness of ADHD in women and hormonal changes affecting mood all contribute to delays in diagnosis.

“Increasing awareness in both society and medicine helps girls and women to get earlier help when they need it,” Professor Kooij said.