If the words “attention-deficit hyperactivity disorder (ADHD)” only evoke images of overactive children, it may be time to update your understanding of ADHD. ADHD is a disorder that makes it hard for you to pay attention. You may be frequently restless or unable to control impulsive behavior. And while it is more commonly diagnosed in children, the symptoms can and often do persist into adulthood. If you’re an adult who’s spent most of your life battling poor concentration, inattentiveness, and disorganization, you might have ADHD and not even know it. It’s even more likely if you’re female, as ADHD is often underdiagnosed and misdiagnosed in girls and women. 1. ADHD is underdiagnosed in women. Adult women are much more likely to go undiagnosed—or be misdiagnosed—than men. Many people, for better or for worse, associate ADHD with hyperactivity. Women may not exhibit this symptom very often, however. She may show other, more subtle signs, but her doctor may not readily pick up on them. Also, women are more likely than men to get misdiagnosed with a condition that may show similar symptoms or may appear more obvious than ADHD. A common misdiagnosis is a condition like anxiety or depression. In some cases, these women may actually have both ADHD and anxiety or depression, but the ADHD gets overlooked. Because girls are often not diagnosed, many grow up to become women who are undiagnosed. Often, women don’t recognize signs of ADHD in themselves until they have children who develop signs of ADHD and receive a diagnosis. That’s when they realize that they might need to get evaluated for ADHD themselves. 2. Inattentiveness, rather than hyperactivity, is key. ADHD typically presents differently in women. Instead of being overactive and behaving impulsively, a woman tends to exhibit more internalized symptoms. She may appear to be daydreaming or just inattentive. Women with ADHD may have trouble staying on task, and they may be easily distracted or forgetful. They may feel unfocused and unable to keep their lives organized. They may even feel anxious or depressed. But they may not constantly fidget or run around. 3. Low self-esteem is common. Many adult women with ADHD struggle with low self-esteem—in fact, it’s much more likely to develop in women with ADHD than in men with ADHD. They’ve spent many years struggling to get organized or stay on top of their responsibilities. They worry that their situation is due to a character flaw, rather than a diagnosable disorder. Some even report feeling shame about their situation. Their self-confidence plummets—and stays down. As a result, they constantly feel exhausted or overwhelmed. This can develop into a state of chronic stress for them. Compounding the problem is the fact that many adult women with ADHD also have children with ADHD, whom they have to manage, which can also be stressful. 4. Other co-existing conditions may be present. Women with ADHD are also much more likely than women without ADHD to develop anxiety or depression. Researchers are concerned that many of them also turn to alcohol or food as a coping strategy, leading them down a path toward alcohol abuse or compulsive overeating. Chronic sleep deprivation is a problem for some adult women with ADHD, too. 5. Hormones may play a role. Every month, most women’s bodies experience a fluctuation in hormone levels. Experts suspect those fluctuations may contribute to ADHD symptoms in adult women with ADHD. When levels of the hormone estrogen are low, symptoms can get worse. But when estrogen levels are high, their symptoms may improve. The surging levels of estrogen during the first couple of weeks of an average menstrual cycle promote the release of chemicals in the brain like serotonin and dopamine. These chemicals, which are called neurotransmitters, can improve a person’s mood and reduce depressive symptoms. But during the next two weeks, progesterone levels begin to rise, which decreases the benefits of the estrogen in the brain. The fluctuation may also affect any treatment that a woman is taking. For example, the dropping estrogen may seem to reduce the effectiveness of any stimulant medication used for improving ADHD symptoms. Additionally, by the time a woman reaches menopause, her estrogen levels have dropped substantially, which may necessitate some changes in any medication or treatment she’s taking for ADHD. If you are an adult woman and suspect that you may have ADHD, seek out a physician who has expertise in working with women with ADHD. It may take some time to make a diagnosis and determine the best treatment for you.