Behind the Mask: Understanding ADHD in Women
High Masking ADHD: What is it?
When you think of ADHD- what do you think of? And why is it so often a school aged white boy who can’t sit still?! What is so unique about school aged white boys that makes them prone to ADHD in ways that the rest of us don’t seem to be even considered for? Well, stigma and stereotypes for starters. ADHD has historically been seen as something that can only begin in childhood, and most often to young, white boys. Some of this reflects racial bias- a young white boy with behavioral issues is afforded curiosity about neurodevelopmental struggles while a BIPOC young boy with behavioral issues is seen in an entirely different light, and much less often given supports or approached with compassion. And young girls? Forget it. They can sit still, they don’t have ADHD!
In order to “not cause issues” or be further marginalized- many gender and racial minorities learn to “mask” their symptoms. Being labeled comes with a different social price compared to our white boy peers. So we compensate, cover up, shame ourselves for not being able to get it together. But how long can this last? And what even is ADHD?
ADHD, According to the DSM-5TR:
The DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision) lays out the “official” criteria for diagnosing ADHD. These criteria are almost entirely deficit-based; meaning they focus on what a person can’t do, what’s “wrong” with them, or where they fall short compared to a neurotypical norm. Phrases like “fails to give close attention to details,” “often has difficulty sustaining attention,” and “is often forgetful in daily activities” frame ADHD as a list of personal failures rather than describing the reality of living with a brain that is just wired differently. Side note- have you ever thought about the eugenics origins of a brain that is considered “normal”-- ie “better” You can read up on that in Roy Grinker’s book, Nobody’s Normal. For now, I digress- but you should definitely check out the book. Back to how ADHD is characterized in the DSM:
The DSM-5-TR lays out specific diagnostic criteria for ADHD. The focus is almost entirely on what a person is not doing “correctly” compared to a neurotypical standard. For a diagnosis, symptoms must be present before age 12, occur in two or more settings (such as home, school, work), and interfere with functioning.
Inattention symptoms:
(six or more for children, five or more for adults, persisting for at least six months):
Often fails to give close attention to details or makes careless mistakes.
Often has difficulty sustaining attention in tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish tasks.
Often has difficulty organizing tasks and activities.
Often avoids or is reluctant to engage in tasks requiring sustained mental effort.
Often loses things necessary for tasks and activities.
Is often easily distracted by extraneous stimuli.
Is often forgetful in daily activities.
Hyperactivity and impulsivity symptoms:
(six or more for children, five or more for adults, persisting for at least six months):
Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in inappropriate situations (for adults, may be limited to restlessness).
Often unable to play or engage in leisure activities quietly.
Is often “on the go,” acting as if “driven by a motor.”
Often talks excessively.
Often blurts out answers before a question has been completed.
Often has difficulty waiting their turn.
Often interrupts or intrudes on others.
This list is presented in a rigid, deficit-based way that doesn’t reflect the nuance of everyone’s lived experience. For example, “difficulty sustaining attention” ignores that many ADHD brains can sustain intense focus when deeply interested. “Blurting out answers” might actually be quick pattern recognition or excitement to contribute. But because it disrupts a social norm- the expectation to wait your turn and be polite- it’s seen as deviant. The DSM language is useful for formal diagnosis, but it’s not the whole story and certainly not the most affirming one
How ADHD can look- beyond DSM “symptoms” and the medical model:
ADHD can manifest differently depending on many factors- one being gender role socialization. Young girls and women are taught from an early age not to be disruptive, not to speak out, to be compliant to authority, etc. AFAB (assigned female at birth) folks are socialized to mask their symptoms, and so we end up developing compensating strategies to manage ADHD internally. This can look like mental hyperactivity- having lots of thoughts, constant inner chatter, rumination, flight of ideas and having a rich inner world full of imagination and/or daydreaming. If you grow up with ADHD, you don’t even realize this is not how everyone’s brain operates. Hyperactivity can also look like being very talkative with friends (constant note passing in school counts!), overexercising, difficulty sleeping and so much more. Innattentiveness doesn’t mean you can never focus, however ADHD brains have interest based nervous systems meaning we hyper focus on tasks we find interesting- our special interests. So if a school aged person finds a lot of interest in learning, you might not see the typical “learning/school issues” in their history. You might see the inattentiveness pop up more at home when asked to do certain chores or tasks that feel boring and meaningless.
My personal expeirence:
The average age of ADHD diagnosis for women is 35. I was 32 when I was finally diagnosed. One of my first thoughts when I began exploring ADHD for myself was, Why now- doesn’t this make me a fraud? I’d made it this far without the label, so why did my ADHD suddenly feel unmanageable?
One of my best friends, colleague, and fellow ADHDer, Stacie Fanelli,LCSW, explained that ADHD often becomes more visible when life’s demands outpace our ability to compensate. In other words, masking works… until it doesn’t. Being the breadwinner for my family, managing a busy therapy practice with both clients and employees, being a new parent, keeping a household running, and trying to maintain relationships (let alone my own self care) meant my executive functioning was constantly beyond full capacity. The cracks began to show, not because my ADHD suddenly got “worse,” but because the cost of hiding it became unsustainable.
The effort it takes to mask for years can also lead to burnout, and burnout amplifies ADHD symptoms. What I once could “push through” now felt impossible, and that was my signal that something had to change.
ADHD traits- explained in more affirming language:
When I began learning about ADHD from neurodivergent folks instead of only medical texts, everything shifted. I learned concepts like the interest-based nervous system, which explains why I can hyperfocus for hours on something I care about but can’t start a two-minute chore that feels pointless. I discovered that what’s labeled “inattention” could also be called broad focus — my mind constantly scanning for connections, ideas, and patterns.
Other language shifts helped me understand and affirm my experience:
“Hyperactivity” → stimulation-seeking
“Impulsivity” → spontaneity and quick decision-making
These aren’t euphemisms — they’re more accurate, less shame-based descriptions. My brain isn’t wrong or broken. It’s just wired differently, and that’s okay.
I owe a lot of this new understanding to the podcast, Divergent Conversations, and again, my dear friend Stacie.
Healing internalized ableism and shame
Learning about accommodations and supports
Learning about accommodations and supports goes hand-in-hand with healing the internalized ableism and shame that so many of us with ADHD carry. One of the most powerful tools in this process is community- especially with other neurodivergent folks who share values like anti-oppression and a refusal to buy into the idea that neurotypical automatically means “better.” These spaces, whether in person or online, become places to share resources, compare notes on accommodations (sometimes called “hacks”), and support one another’s autonomy in choices like whether or not to use medication. Reddit forums, social media accounts, podcasts and local meetups often provide a treasure trove of real-life strategies like: keeping a “brain dump” Google Doc for ideas without the pressure to organize them, giving yourself extra time for tasks, using visual cues and reminders, pairing new habits with existing routines (“habit stacking”), or making mundane chores more tolerable by adding stimulation (like folding laundry while listening to a podcast on a special interest). Low-spoons meals such as frozen or non-perishable foods you can heat up quickly — can be a lifesaver on difficult days. Another important skill is practicing how to call out ableism when it shows up, starting with people who are likely to respond with openness and understanding. For me, that’s my partner or close friends. Instead of spiraling into shame if my partner is frustrated about something ADHD-related, I might say, “I understand why that was frustrating, and this happened in part because my brain struggles with [x, y, z]. In the future, it would help to have [specific accommodation] and I can work on [utilizing and practicing the accommodation].” This blends accountability with self-advocacy, reminding both of us that my ADHD traits aren’t about laziness, frivolity or lack of care, they’re part of how my brain is wired. Understanding our needs and communicating them openly transforms these moments from points of tension into opportunities for support and connection.
Final Thoughts
Living with ADHD (especially as a woman or AFAB person) can feel exhausting, isolating, and vulnerable to misperception. But a late diagnosis is not the end of the story; it’s the beginning of finally understanding your brain (it’s strengths and support needs!), unlearning shame, and building a life that honors your needs. If you’re ready to explore neurodivergent-affirming therapy that embraces your uniqueness and helps you thrive, my team and I would be honored to walk alongside you. Reach out today to start your journey toward self-understanding, self-compassion, and a life that fits you.
