The Impact of Under-Diagnosing ADHD in Young Females

When I was in adult psychiatry residency, I was shocked by the frequency of which young adult female patients would request evaluation for potential ADHD. Many of these young women presented as well with mood and anxiety symptoms, and it was imperative to determine whether the predominant impairment was secondary to untreated ADHD or other psychiatric conditions. In full disclosure, I was unfortunately primed to be skeptical of these college-aged students who were seeking a diagnosis of ADHD, and I naively felt that their presenting concerns of inattentiveness, difficulty with concentration, and reduced motivation was more likely attributed to untreated depression in this population rather than an undetected ADHD. After all, I wondered, how would ADHD have gone unnoticed for all of their childhood and only now manifest in young adulthood? Oddly enough, I encountered very few young adult males with signs concerning for untreated ADHD; if anything, I saw more males on stimulants for ADHD than women, despite encountering more young women reporting concerns for untreated ADHD.