Late-Diagnosis of AuDHD in Girls & Women

Introduction

For many girls and women with AuDHD, receiving appropriate support or a diagnosis can be a long journey. When AuDHD traits are overlooked, the impact can extend far beyond the symptoms themselves, affecting emotional wellbeing, education/work and everyday life.

One reason for this is AuDHD often presents differently in females than it does in males. Couple this with traditional diagnostic approaches and AuDHD can be more difficult to recognise in females.

In this research summary, we explore:

Why AuDHD presentations are often overlooked in girls and women
Typical AuDHD symptoms alongside common presentations in girls and women
How hormones can influence AuDHD symptoms

Common AuDHD Symptoms and Presentations in Females

The table below explores some common AuDHD traits and compares how they might typically present as well as how trait presentation could differ for neurodivergent females.

Common AuDHD Traits	Typical Presentation	How It Can Present in Women & Girls
Hyperactivity & Impulsivity	Being active or restless Disruptive Boisterous Acting hastily	Internal restlessness Excessive talking Impulsive friendships or relationships Irritability Risk-taking in peer or romantic contexts
Inattention	Difficulty concentrating or focusing Finding it hard to complete tasks	Disorganisation Forgetfulness Procrastination Task avoidance
Emotional Dysregulation	Visible frustration Arguing Temper outbursts Reacting strongly in situations	More sensitive to criticism Low self-esteem Anxiety Rumination (repetitive thinking)
Social Communication Differences	Difficulty initiating or maintaining social interactions Difficulties with reciprocal social communication	Masking or camouflaging Copying peers e.g. mimicking tone or facial expressions Rehearsing conversations Persistent attempts at connecting with individuals socially
Sensory Processing Differences	Heightened sensitivity to noise, touch, clothing or busy environments	Internal distress which may appear as being quiet, shy, or withdrawn
Restricted Interests & Repetitive Behaviours	Intense interests Repetitive patterns of behaviour	Lack of flexibility around topic or behaviour (these topics may seem age appropriate or align with socially acceptable topics such as animals or video games but still can cause internal difficulties)

This list is not exhaustive and AuDHD traits will differ depending on the person. These differences do not mean girls and women experience fewer autistic or ADHD traits, but show how their presentations often differ from traditional diagnostic expectations. The above information summarises that AuDHD traits in females may present as more internalised, masked or misunderstood, making AuDHD in females more difficult to diagnose.

Why AuDHD Presentations Are Overlooked in Girls and Women

Below are the 3 main reasons why females with AuDHD are commonly overlooked:

Diagnostic criteria based on male oriented traits
Gender expectations of females resulting in trait masking
Co-occurring mental health conditions which are identified first

Male-Orientated Diagnostic Criteria

Most current diagnostic tools have been developed predominantly using male experiences. As a result, they are less effective at identifying presentations that can appear differently in girls and women. For example, internalised distress, camouflaging/masking and sensory sensitivities may be overlooked during assessments because they often present differently from the characteristics described in traditional diagnostic criteria.

As a result, many girls and women may not meet the expectations clinicians have traditionally associated with autism or ADHD, despite experiencing significant challenges in everyday life.

Gender Expectations and Masking

Alongside male-orientated diagnostic criteria, the everyday expectation put on females can make AuDHD presentations in girls and women even more difficult to recognise.

Many girls learn to mask their differences by copying neurotypical behaviours to fit into social situations.

For example, girls have been found to use more social language during assessments, leading to their social communication skills to be perceived as better. This is despite experiencing similar levels of social communication difficulties to boys. Although this can create the appearance of social confidence, it often hides significant emotional distress, sensory overwhelm and over time, burnout.

Alongside this, gender expectations can influence how AuDHD symptoms are interpreted. A common experience is for girls and women with heightened sensitivities to touch or noise to be described as "shy", particularly in busy or unfamiliar environments.

Similarly, restricted interests may be easier to overlook in girls and women. This is because boys' interests are more likely to match the traditional profile associated with autism, such as an intense interest in trains or cars. In contrast, girls' interests often centre on topics that appear typical for their age or gender, such as animals, books or celebrities. As a result, the intensity of these interests may be overlooked, making the underlying AuDHD traits less likely to be recognised. These descriptions often align with traditional expectations of femininity, making underlying AuDHD traits less likely to be recognised.

Co-occurring Mental Health Conditions

Co-occurring mental health conditions can create a further barrier to recognising AuDHD in females. Many girls and women receive support for mental health difficulties without underlying AuDHD being recognised. This is because some AuDHD traits overlap with symptoms seen in other mental health conditions, making it more difficult to identify the underlying neurodivergence.

For example, sensitivities to food textures or tastes can resemble eating disorder symptoms. Similarly, compulsions associated with OCD can overlap with autistic repetitive behaviours, making it more difficult to distinguish between the two conditions.

These overlapping characteristics between mental health conditions and neurodivergence, together with the historical perception that autism and ADHD are less common in females, can make AuDHD presentations more difficult to recognise and increase likelihood of late-diagnosis.

The Influence of Hormones on AuDHD Symptoms for Women and Girls

Hormonal changes can influence AuDHD symptoms in girls and women across different stages of life. As these changes can affect attention, impulsivity and emotional regulation, recognising AuDHD may become more challenging at different points throughout a female’s lifespan.

Higher oestrogen levels during ovulation have been linked with increased impulsivity, which may be viewed as being more driven to pursue or seek rewarding experiences. During the later stages of the menstrual cycle, increased inattention and depressive moods have also been observed. Together, these hormonal changes may contribute to greater emotional dysregulation.

Hormonal influences have also been identified during puberty, pregnancy, the post-partum period and menopause. At these stages of life, changes in attention, mood and emotional regulation may be attributed to hormones alone rather than being considered alongside an AuDHD presentation. As a result, some girls and women may be overlooked or receive a diagnosis later in life.

Conclusion

Females with AuDHD are often overlooked because their presentations can differ from traditional diagnostic expectations.
Male-orientated diagnostic criteria, masking, co-occurring mental health conditions and hormonal influences can all make recognising AuDHD more challenging.
As awareness of female AuDHD presentations grows, researchers have developed a better understanding of how autism and ADHD can present differently in girls and women.
This increased awareness helps to improve identification and inform more accurate, neuro-affirmative assessment tools.
Ultimately, recognising these differences can help girls and women access support that reflects their individual experiences, strengths and needs, while reducing the likelihood that their AuDHD is overlooked.

References

Gellert B, Ostrowski J, Pinkas J, Religioni U. Underdiagnosed and Misunderstood: Clinical Challenges and Educational Needs of Healthcare Professionals in Identifying Autism Spectrum Disorder in Women. Behavioral Sciences. 2025 Aug 7;15(8):1073.
Perkins SL, Trombley A. The Undiagnosed: Ending the Lost Generation of Girls With ADHD. The Journal for Nurse Practitioners [Internet]. 2026 Apr 7;22(5):105784. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1555415526000978
Cook J, Hull L, Crane L, Mandy W. Camouflaging in autism: A systematic review. Clinical Psychology Review. 2021 Sep;89(0272-7358):102080.
de la Peña IC, Pan MC, Thai CG, Alisso T. Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Subtype/Presentation: Research Progress and Translational Studies. Brain Sciences [Internet]. 2020 May 14;10(5):292. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7287898/
Edwards H, Wright SM, Sargeant C, Cortese S, Wood-Downie H. Research Review: A systematic review and meta‐analysis of sex differences in narrow constructs of restricted and repetitive behaviours and interests in autistic children, adolescents, and adults. Journal of Child Psychology and Psychiatry. 2023 Jul 23;65(1).
Ratto AB. Commentary: What’s so special about girls on the autism spectrum? – a commentary on Kaat et. al, (2020). Journal of Child Psychology and Psychiatry. 2020 Jun 19.
Hull L, Lai MC, Baron-Cohen S, Allison C, Smith P, Petrides KV, et. al. Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism. 2019 Jul 18;24(2):352–63.
Cola M, Yankowitz LD, Tena K, Russell A, Bateman L, Knox A, et. al. Friend matters: sex differences in social language during autism diagnostic interviews. Molecular Autism. 2022 Jan 10;13(1).
Beck JS, Lundwall RA, Gabrielsen T, Cox JC, South M. Looking good but feeling bad: “Camouflaging” behaviors and mental health in women with autistic traits. Autism [Internet]. 2020 May;24(4):809–21. Available from: https://journals.sagepub.com/doi/abs/10.1177/1362361320912147
Brickhill R, Atherton G, Piovesan A, Cross L. Autism, thy name is man: Exploring implicit and explicit gender bias in autism perceptions. PLOS ONE [Internet]. 2023 Aug 23;18(8):e0284013–3. Available from:https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0284013
Schröder S, van Elburg A, Spek A, Danner U. Eating Behaviors of Autistic Women with an Eating Disorder. Nutrients. 2025 May 9;17(10):1622.
Jacob S, Landeros-Weisenberger A, Leckman JF. Autism spectrum and obsessive compulsive disorders: OC behaviors, phenotypes and genetics. Autism Research [Internet]. 2009 Dec;2(6):293–311. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3974607/
D’Mello AM, Frosch IR, Li CE, Cardinaux AL, Gabrieli JDE. Exclusion of females in autism research: Empirical evidence for a “leaky” recruitment‐to‐research pipeline. Autism Research [Internet]. 2022 Aug 22;15(10). Available from: https://onlinelibrary.wiley.com/doi/10.1002/aur.2795
Craddock E. Being a Woman Is 100% Significant to My Experiences of Attention Deficit Hyperactivity Disorder and Autism: Exploring the Gendered Implications of an Adulthood Combined Autism and Attention Deficit Hyperactivity Disorder Diagnosis. Qualitative health Research. 2024 Jul 18;34(14).
Eng AG, Nirjar U, Elkins AR, Sizemore YJ, Monticello KN, Petersen MK, et al. Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and Evidence. Hormones and Behavior [Internet]. 2024 Feb 1;158:105466. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0018506X23001642
Rapoport IL, Groenman AP. A Review of Sex and Gender Factors in Stimulant Treatment for ADHD: Knowledge Gaps and Future Directions. Journal of Attention Disorders. 2025 Jan 29;29(8).
Kooij S, Jong M de, Agnew-Blais J, Amoretti S, Madsen KB, Barclay I, et. al. Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women s Health. 2025 Jul 7;6.