Part 2 of 3 | Estimated read: 7 minutes

By Kia Bishop (Psychologist)

This is Part 2 of our series on ADHD in women. If you missed Part 1, you can read it here: Why So Many Women with ADHD Go Undiagnosed.

What ADHD Actually Looks Like in Women

Forget the image of the bouncing, distracted child. Women with ADHD more commonly present with the inattentive subtype — quieter, more internalised, and far easier to miss. Here’s what it can actually look like:

A mind that won’t stop — but won’t focus either. Racing thoughts, difficulty switching off, a brain that generates ideas endlessly but struggles to execute them in sequence. This isn’t laziness. It’s a nervous system wired for novelty and urgency rather than routine and obligation.
Time blindness. Not just being late — but genuinely losing track of time in ways that confuse even yourself. Hours disappear. Deadlines arrive as shocks. The future feels strangely abstract.
Emotional dysregulation. Intense emotional responses that feel disproportionate to others. Quick to feel hurt, criticism, or rejection deeply. Difficulty returning to baseline once dysregulated. This is one of the most impairing and least-discussed features of ADHD in women — and it is frequently misdiagnosed as a mood or personality disorder.
Rejection-sensitive dysphoria (RSD). An extreme emotional response to perceived failure, rejection, or criticism — often described as a sudden, overwhelming wave of pain. Many women with ADHD describe RSD as one of the most debilitating aspects of their experience. RSD is increasingly recognised as a key feature of ADHD that is rarely discussed in clinical settings.
Executive dysfunction. Difficulty starting tasks (even ones you genuinely want to do), trouble organising and sequencing, losing things constantly, forgetting appointments, struggling to hold multiple threads of thought at once.
Performing competence. Many women with ADHD are high-achieving on the outside. They’ve built sophisticated coping systems, work twice as hard to keep up, and present well. Meanwhile, privately, they feel like they are barely holding it together. The gap between how capable others perceive them to be and how they feel on the inside is often a source of profound shame.
Hyperfocus. The flip side of distractibility — the ability to sink completely into something absorbing for hours, losing track of time, hunger, and the world around them. Often mistaken for a contradiction (“but you can focus when you want to”). It isn’t a contradiction. It’s the same dysregulated attention system, locked in rather than scattered.
Chronic underachievement relative to potential. The persistent sense of knowing you are capable of more, but being unable to consistently access that capability. The gap between intelligence and output that nobody around you seems to understand — including yourself.

The Masking Tax: Why ADHD in Women Goes Undetected

One of the reasons ADHD in women goes undetected for so long is masking — the enormous cognitive and social effort of appearing neurotypical.

Societal expectations of feminine norms lead girls and women to spend considerable time and energy suppressing their symptoms. Socialised from a young age to be responsible for others, many women with ADHD feel they should have an innate ability to manage, organise, and caretake — and experience significant guilt and shame when they can’t (Holthe & Langvik, 2017).

The cruel irony is that the masking often works — at least on the surface. Women with ADHD frequently manage to appear functional, even accomplished, in ways that lead clinicians to dismiss the seriousness of their symptoms. Research found that women with late-diagnosed ADHD reported medical professionals using their age, their success, or their ability to have “survived this long” as reasons to dismiss their concerns (Scientific Reports, 2025).

Over time, the experience of repeated failures — combined with internalising negative feelings and expending enormous mental energy on concealment — erodes self-esteem in ways that are cumulative and profound. This is believed to contribute significantly to the high rates of anxiety, depression, and eating disorders seen in women with ADHD (Holthe & Langvik, 2017).

The Twice-Exceptional Puzzle: High IQ and ADHD

Here’s one that gets even less attention: women with both high intelligence and ADHD.

Research has shown that high IQ does not protect against ADHD — it obscures it. Children and adults with high IQ and ADHD tend to perform comparably to their average-IQ neurotypical peers in many domains. Teachers, parents, and clinicians interpret this as evidence that there is no significant impairment. There is — it’s just hidden beneath compensatory effort.

These “twice exceptional” individuals — simultaneously gifted and neurodivergent — have been found to have higher rates of psychiatric comorbidities, particularly mood disorders, than their peers with either high IQ or ADHD alone (Lee & Olenchak, 2015). The compensation costs enormously. And because the outputs look fine, the internal cost is rarely seen.

IQ only accounts for around 9% of the variance in executive function — meaning a high IQ does not meaningfully protect against the executive functioning deficits that define ADHD (Antshel, 2008). For women who have spent decades being told they’re “too smart” to have ADHD, this is often one of the most validating pieces of information they encounter.

📖 Continue reading: Part 3 — Hormones , and What to Do If You Recognise Yourself Here

At The Wellness Emporium, our psychologist Kia Bishop works with a neurodiversity-affirming, trauma-informed lens and has experience supporting women through ADHD assessment on the Gold Coast and across Australia. You don’t have to keep figuring this out on your own.

To speak with one of our psychologists about ADHD assessment or support, get in touch — we’d love to hear from you.

References

Antshel, K. (2008). Attention-deficit hyperactivity disorder in the context of a high intellectual quotient/giftedness. Developmental Disabilities Research Reviews, 14, 293–299.

Holthe, M., & Langvik, E. (2017). The strives, struggles, and successes of women diagnosed with ADHD as adults. Psychology, 7, 1–12.

Lee, K., & Olenchak, F. (2015). Individuals with a gifted/attention deficit/hyperactivity disorder diagnosis. Gifted Education International, 31(3), 185–199.

Scientific Reports. (2025). Adverse experiences of women with undiagnosed ADHD and the invaluable role of diagnosis. Nature.