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Quality in Sport

Underdiagnosis of ADHD in Women as a Hidden Hurdle and Its Consequences for Functioning in Adulthood— A Literature Review
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  • Underdiagnosis of ADHD in Women as a Hidden Hurdle and Its Consequences for Functioning in Adulthood— A Literature Review
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Underdiagnosis of ADHD in Women as a Hidden Hurdle and Its Consequences for Functioning in Adulthood— A Literature Review

Authors

  • Nikola Agnieszka Samp Independent researcher, 03-982 Warszawa, Poland https://orcid.org/0009-0003-3955-7535
  • Paweł Arkadiusz Trzepizur Independent researcher, 03-982 Warszawa, Poland https://orcid.org/0009-0008-1924-3869
  • Kamila Zera Independent researcher, 01-320 Warszawa, Poland https://orcid.org/0009-0006-8510-4803
  • Beniamin Andrzej Bekrycht Independent researcher, 95-002 Skotniki, Poland https://orcid.org/0009-0004-7773-1597
  • Jędrzej Marek Foryński Independent researcher, 62-081 Baranowo, Poland https://orcid.org/0009-0007-5339-9149
  • Michelle Martina Stachurska Independent researcher, 11-500 Giżycko, Poland https://orcid.org/0009-0005-9445-7101
  • Weronika Piekarska Independent researcher, 05-825 Grodzisk Mazowiecki, Poland https://orcid.org/0009-0004-1074-1811
  • Konstancja Radiczew Independent researcher, 00-430 Warszawa, Poland https://orcid.org/0009-0008-7114-8586
  • Karolina Rogala Independent researcher, 05-830 Nadarzyn, Poland https://orcid.org/0009-0004-1942-4310
  • Rafał Wilczyński Independent researcher, 50-443 Wrocław, Poland https://orcid.org/0009-0006-8459-4740

DOI:

https://doi.org/10.12775/QS.2026.62.73296

Keywords

Underdiagnosed ADHD in women, adult women with late ADHD diagnosis, female ADHD underdiagnosis, underdiagnosed ADHD in women quality of life, women diagnosed with ADHD as adults

Abstract

Background: ADHD is characterized by inattention, hyperactivity, impulsivity, and affects 8.4% of children and 2.5% of adults. Lower diagnosis rates in females suggest a different clinical presentation, contributing to delayed diagnoses and negative outcomes across multiple domains of functioning.

Aim: This study examines underdiagnosed ADHD in women, assessing its impact on functioning in adulthood, including mental health, quality of life, and long-term impairments.

Material and methods: A literature review using PubMed/MEDLINE (2010–2025) included clinical, longitudinal cohort, and epidemiological research addressing sex differences in ADHD diagnosis, symptom presentation, and long-term functional outcomes, with a focus on the female population.

Results: Women with ADHD are significantly underdiagnosed in childhood, often receiving diagnosis only in adulthood after years of treatment for comorbidities such as anxiety, depression, or personality disorders. Internalized symptoms and emotional dysregulation frequently mask core ADHD features. Late diagnosis is associated with impaired educational and occupational achievement, relationship instability, low self-esteem, substance misuse, reduced quality of life, and increased risk of self-harm and suicide attempts. ADHD in women also increases risk of psychiatric and obstetric complications, including teenage pregnancy, smoking during pregnancy, substance misuse, and postpartum depression and anxiety.

Conclusions: Underdiagnosis of ADHD in women remains a significant clinical and public health issue. Greater awareness of sex-specific symptom presentation and improved diagnostic strategies are essential to prevent long-term psychosocial consequences and improve quality of life in affected women.

References

1. American Psychiatric Association. (n.d.). What is ADHD? https://www.psychiatry.org/patients-families/adhd/what-is-adhd

2. Stibbe, T., Haung, J., Paucke, M., Ulke, C., & Strauss, M. (2020). Gender differences in adult ADHD: Cognitive function assessed by the test of attentional performance. PLOS ONE, 15(10), e0240810. https://doi.org/10.1371/journal.pone.0240810

3. Hinshaw, S. P., Nguyen, P. T., O‘Grady, S. M., & Rosenthal, E. A. (2022). Annual Research Review: Attention-deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions. Journal of Child Psychology and Psychiatry, 63(4), 484–496. https://doi.org/10.1111/jcpp.13480

4. Babinski, D. E., Pelham, Jr W. E., Molina, B. S. G., Gnagy, E. M., Waschbusch, D. A., Yu, J., Maclean, M. G., Wymbs, B. T., Sibley, M. H., Biswas, A., Robb, J. A., & Karch, K. M. (2011). Late adolescent and young adult outcomes of girls diagnosed with ADHD in childhood: An exploratory investigation. Journal of Attention Disorders, 15(3), 204–214. https://doi.org/10.1177/1087054710361586

5. Solberg, B. S., Halmøy, A., Engeland, A., Igland, J., Haavik, J., & Klungsøyr, K. (2018). Gender differences in psychiatric comorbidity: A population-based study of 40 000 adults with attention deficit hyperactivity disordert. Acta Psychiatrica Scandinavica, 137(3), 176–186. https://doi.org/10.1111/acps.12845

6. Biederman, J., Petty, C. R., Monuteaux, M. C., Fried, R., Byrne, D., Mirto, T., Spencer, T., Wilens, T. E., & Faraone, S. V. (2010). Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder: 11-Year Follow-Up in a longitudinal case-control study. American Journal of Psychiatry, 167(4), 409–417. https://doi.org/10.1176/appi.ajp.2009.09050736

7. Osianlis, E., Thomas, E. H. X., Jenkins, L. M., & Gurvich, C. (2025). ADHD and sex hormones in females: A systematic review. Journal of Attention Disorders, 29(9), 706–723. https://doi.org/10.1177/10870547251332319

8. Eng, A. G., Nirjar, U., Elkins, A. R., Sizemore, Y. J., Monticello, K. N., Petersen, M. K., Miller, S. A., Barone, J., Eisenlohr-Moul, T. A., & Martel, M. M. (2024). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and Behavior, 158, 105466. https://doi.org/10.1016/j.yhbeh.2023.105466

9. Holden, E., & Kobayashi-Wood, H. (2025). Adverse experiences of women with undiagnosed ADHD and the invaluable role of diagnosis. Scientific Reports, 15, 20945. https://doi.org/10.1038/s41598-025-04782-y

10. Barclay, I., Sayal, K., Ford, T., John, A., Taylor, M. J., Thapar, A., Langley, K., & Martin, J. (2024). Investigating the reasons behind a later or missed diagnosis of attention-deficit/hyperactivity disorder in young people: A population cohort study. JCPP Advances, 5(3), e12301. https://doi.org/10.1002/jcv2.12301

11. Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., Schrodek, E., & Swanson, E. N. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: Continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of Consulting and Clinical Psychology, 80(6), 1041–1051. https://doi.org/10.1037/a0029451

12. Skoglund, C., Sundström Poromaa, I., Leksell, D., Ekholm Selling, K., Cars, T., Giacobini, M., Young, S., & Kopp Kallner, H. (2024). Time after time: Failure to identify and support females with ADHD - a Swedish population register study. Journal of Child Psychology and Psychiatry, 65(6), 832–844. https://doi.org/10.1111/jcpp.13920

13. Meza, J. I., Owens, E. B., & Hinshaw, S. P. (2016). Response inhibition, peer preference and victimization, and self-harm: Longitudinal associations in young adult women with and without ADHD. Journal of Abnormal Child Psychology, 44(2), 323–334. https://doi.org/10.1007/s10802-015-0036-5

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17. Matthies, S., Holzner, S., Feige, B., Scheel, C., Perlov, E., Ebert, D., Tebartz van Elst, L., & Philipsen, A. (2013). ADHD as a serious risk factor for early smoking and nicotine dependence in adulthood. Journal of Attention Disorders, 17(3), 176–186. https://doi.org/10.1177/1087054711428739

Quality in Sport

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Published

2026-07-11

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1.
SAMP, Nikola Agnieszka, TRZEPIZUR, Paweł Arkadiusz, ZERA, Kamila, BEKRYCHT, Beniamin Andrzej, FORYŃSKI, Jędrzej Marek, STACHURSKA, Michelle Martina, PIEKARSKA, Weronika, RADICZEW, Konstancja, ROGALA, Karolina and WILCZYŃSKI, Rafał. Underdiagnosis of ADHD in Women as a Hidden Hurdle and Its Consequences for Functioning in Adulthood— A Literature Review. Quality in Sport. Online. 11 July 2026. Vol. 62, p. 73296. [Accessed 25 July 2026]. DOI 10.12775/QS.2026.62.73296.
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Vol. 62 (2026)

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Copyright (c) 2026 Nikola Agnieszka Samp, Paweł Arkadiusz Trzepizur, Kamila Zera, Beniamin Andrzej Bekrycht, Jędrzej Marek Foryński, Michelle Martina Stachurska, Weronika Piekarska, Konstancja Radiczew, Karolina Rogala, Rafał Wilczyński

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