How ADHD diagnoses are skewed based on sex assigned at birth



Managing Editor Laken Kincaid writes about the difficulties for those assigned female at birth who have ADHD.

Laken Kincaid, Managing Editor

Imagine you are sitting in your Monday morning class fully rested, ready to learn the material for the day. However, as you sit and attempt to listen to your professor, you feel your mind wander. You notice that the erased chalk marks on the blackboard look interesting and you become desperate to try and decipher them. You hear a cell phone ring and are suddenly worried about all the notifications piling onto your home screen. The person beside you receives a grade on Canvas and you suddenly remember an assignment you were supposed to turn in the previous night. As you log on to your laptop to read the syllabus, you see a news article on a world event that intrigues you. Just as you finish spiraling down a rabbit hole that started with a New York Times piece that ended with a step-by-step recipe on how to cook a casserole in a crockpot – something you have no need for – the professor adjourns the class for the day. You realize you did not pay attention at all. 

For many, this is what their day to day life looks like living with attention-deficit/hyperactivity disorder (ADHD).

Mayo Clinic defines ADHD as “a chronic condition including attention difficulty, hyperactivity, and impulsiveness.” While the causes of ADHD are not confirmed, research shows that this illness potentially stems from a lack of natural dopamine in the brain, a neurotransmitter that the Cleveland Clinic describes as the “reward center” for the nervous system. While some can receive this chemical from paying attention in class, therefore gluing them to the topic, those with ADHD often cannot create enough dopamine to center their focus on a topic at hand unless it sparks their intrigue (often leading to a state of hyperfocus or the development of special interests). 

This disorder’s cognitive symptoms include absent-mindedness, high energy, a short attention span or rapid mood swings. The somatic symptoms include poor sleep habits, consistent fidgeting, obesity or a consistent tremor. Yet, the manifestations of ADHD look different depending on the person afflicted, especially regarding their biological sex.

According to the Center for Disease Control and Prevention, people assigned male at birth (AMAB) are 7% more likely to be diagnosed with ADHD than people assigned female (AFAB) at birth. Yet, this figure may not accurately reflect how many AFAB individuals are truly struggling with ADHD on a daily basis. In fact, The National Library of Medicine says that there is a definite “underdiagnosis and undertreatment” of AFAB individuals in the ADHD sphere. 

ADHD presents itself differently in those assigned female at birth. Dr. Tracy Masterson, a John Carroll psychology professor, told The Carroll News that, even at an early age, inattentive behavior looks very different depending on biological sex.

“The symptoms do look a little bit different,” Masterson said. “For girls, it might be more like doodling and less rough and tumble. Girls and boys are different in that way, especially the hyperactive impulsive subtype. “

Masterson also highlights an important distinction between the diagnosis of ADHD across different sexes: those assigned female at birth often have a different type of ADHD than their male counterparts. Overall, there are three different types of ADHD including the impulsive/hyperactive type (the recognizable, male-driven type), the inattentive type and the combined type. Healthline says that AFAB individuals are much more likely to display inattentive tendencies, which are often dismissed as daydreaming or distractibility compared to its more obvious counterpart.

This is potentially rooted in earlier ADHD studies, which not only predominantly examined male subjects, but also only searched for symptoms that fall into the impulsive/hyperactive subtype. This has created a less equipped knowledge base on not only estrogen-led ADHD but the inattentive subtype altogether.

These studies are also the basis for another issue with the underdiagnosis of ADHD in those assigned female at birth: societal norms.

From a young age, it is expected that AMAB individuals are rambunctious and have an excess of energy. The aforementioned studies also conditioned parents to consider ADHD as a possible cause to these behaviors. Yet, those assigned female at birth are not expected to present these behaviors and may be dismissed as attention seeking rather than afflicted. Because of this pressure, AFAB individuals may be less likely to draw attention to their symptoms.

“I think there’s more pressure on girls, gender norms and stuff, like girls are expected to sit and sew,” Masterson continued. “Girls will mask more, there is a societal pressure to sort of act and be a certain way. There’s an acceptability of girls being anxious but not hyperactive.”

Because of these two factors, those assigned female at birth are less likely to seek treatment for disorders like ADHD. Hailey Sackoor ‘25, an executive board member for John Carroll’s Women and Allies Coalition, states that this could have multiple impacts on AFAB people especially in college.

“When people think of ADHD they associate it with males and children rather than women or people who are assigned female at birth,” Sackoor stated. “These stereotypes can cause a great discrepancy and lead women and people assigned female at birth to go down some type of a rabbit hole. This rabbit hole can cause them to think less of themselves as well as make others look down upon them and just associate it with them being a basic women stereotype.”

However, with new findings, research may soon accommodate AFAB individuals with ADHD. Research from facilities like Duke’s Center for Girls and Women with ADHD continues to discover new factors influencing this diagnosis skew, as well as methods of attacking and defeating the stigma around gender and cognitive disorders altogether.