ADHD and Anxiety in Women

If you've spent years feeling like you're working twice as hard to achieve half as much. And if anxiety has become your constant companion while you try to stay organised and meet expectations, there's likely a reason.

ADHD and anxiety frequently occur together in women—not by coincidence, but through a complex interplay of biology, hormones, and the exhausting work of compensation and masking. The research is clear: women experience anxiety at twice the rate of men (23.4% vs 14.3%), and girls with ADHD are significantly more likely than boys to develop co- morbid mental health conditions (83.5% vs 62.7%).

Understanding why these conditions cluster together, starts with knowing what the evidence shows.

How Common Is Anxiety and ADHD, Really?

The numbers tell a striking story about missed diagnoses and gender differences:

ADHD prevalence:

In childhood, boys are diagnosed 3 times more often than girls in community samples (and up to 16 times more in clinical settings)
By adulthood, ADHD rates are nearly equal between men and women—the gap closes not because boys "grow out of it," but because women's ADHD was missed in childhood
An estimated 2-5% of adults have ADHD, with many women first diagnosed in their 30s or 40s

Anxiety prevalence:

Women are nearly twice as likely as men to have an anxiety disorder
This gap emerges at puberty (before adolescence, boys and girls have equal anxiety rates)
Roughly 25% of women will experience an anxiety disorder in a given year

The overlap:

25-40% of children with ADHD have a comorbid anxiety disorder
Up to 50% of adults with ADHD meet criteria for an anxiety disorder
The risk of anxiety in people with ADHD is 3-4 times higher than the general population

This isn't just correlation. The relationship is bidirectional: ADHD creates conditions that generate anxiety, and anxiety makes ADHD symptoms harder to manage.

Why ADHD Gets Missed in Women

The diagnostic gender gap isn't about behaviour, it's about which behaviours get noticed.

What happens in childhood:

Boys with ADHD typically present with hyperactivity: running, fidgeting, interrupting, classroom disruption. These behaviours are visible and disruptive, prompting referrals.

Girls with ADHD are more likely to have inattentive presentations: daydreaming, forgetfulness, disorganisation, internal restlessness. They might chatter excessively or seem "spacey," but they don't disrupt classrooms. Teachers and parents are less likely to suspect ADHD.

The result: boys get diagnosed, girls get labeled as anxious, unmotivated, or simply struggling. The actual ADHD goes unrecognised.

The masking phenomenon:

Girls develop sophisticated coping strategies early. They work harder, stay up later, over-prepare, and develop perfectionist tendencies to compensate for disorganisation. Women are described as becoming "master maskers" of their struggles.

This compensation works—until it doesn't. Life transitions (university, demanding jobs, parenthood) expose the limits of these strategies. Many women seek help in their 20s, 30s, or 40s when coping mechanisms finally fail under increased demands.

What gets misdiagnosed:

A girl or woman with undiagnosed ADHD often gets diagnosed with:

Anxiety disorder (because of constant worry about forgetting things)
Depression (from chronic failure and low self-esteem)
"Stress" or being "overwhelmed"

The inattention, executive dysfunction, and emotional dysregulation (core ADHD symptoms) remain untreated because they're misattributed to these other conditions.

The Biology of Gender Differences

The research points to specific mechanisms behind these patterns:

Pubertal hormones shape stress response:

A 2023 UC study found that testosterone during puberty has a protective "buffering" effect on stress reactivity in males. In the study, prepubertal male and female animals showed equal anxiety-like behaviour, but adult females were far more prone to anxious behaviour. When males were deprived of testosterone during development, they lost this protective effect.

In girls, rising oestrogen during puberty appears to heighten stress sensitivity rather than buffer it. This biological shift coincides with the emergence of higher anxiety rates in females.

Oestrogen affects dopamine activity:

ADHD involves atypical dopamine signaling in frontal-striatal brain networks. Oestrogen enhances dopaminergic function—when it drops (premenstrually, postpartum, during menopause), ADHD symptoms often worsen.

Many women report their ADHD symptoms intensify in the week before their period. A small 2020 study even experimented with increasing stimulant dosage premenstrually to counteract these effects, with promising results.

The heritability factor:

ADHD is one of the most heritable psychiatric disorders, with 70-80% heritability in both children and adults. There's evidence for a "female protective effect"—girls may require a higher genetic or environmental load to manifest ADHD, which explains lower childhood prevalence but higher familial risk when females are affected.

How ADHD Creates Anxiety (And Vice Versa)

The comorbidity isn't random. These conditions fuel each other through multiple pathways:

ADHD symptoms generate anxiety:

Chronic inattention and disorganisation create repeated failures: missed deadlines, forgotten obligations, social blunders, poor academic or work performance. Over time, this becomes internalised as constant worry: "What will I forget next? What will go wrong?"

Research shows anxiety in ADHD often reflects "social and relational difficulties induced by ADHD." The disorder creates stress, and that stress crystallises into an anxiety disorder.

Women with ADHD particularly report anxiety stemming from compensation efforts. The perfectionism, over-preparation, and hypervigilance used to appear "together" are exhausting and anxiety-provoking.

Anxiety worsens ADHD symptoms:

Racing anxious thoughts monopolise mental bandwidth, making inattention worse. The physical tension of anxiety makes it harder to focus. Avoidance behaviours (a hallmark of anxiety) compound ADHD-related task initiation problems.

Studies show children with both ADHD and anxiety have more severe ADHD and worse outcomes than those with ADHD alone. Anxiety can even attenuate medication response—some research finds children with comorbid anxiety have a somewhat blunted stimulant response.

The cycle:

ADHD-related failures → anxiety about performance → worry further distracts and disorganises → more failures → increased anxiety. Without intervention, this cycle can lead to depression, substance use (self-medication), and severe functional impairment.

What Actually Works: Treatment Evidence

For ADHD:

Stimulant medications are first-line treatment. The evidence is robust:

~70% of patients respond to the first stimulant tried
~90% respond after trying two different stimulants
No sex differences in medication response—women and men show comparable symptom improvement

Network meta-analyses consistently rank stimulants as the most effective ADHD intervention.

Non-stimulant options:

Atomoxetine (a norepinephrine reuptake inhibitor) is particularly valuable for comorbid ADHD and anxiety. Studies show it:

Improves ADHD symptoms without worsening anxiety
Can reduce anxiety symptoms in some ADHD patients
Works more gradually than stimulants (over weeks) but doesn't cause jitteriness

Alpha-2 agonists (guanfacine, clonidine) have calming effects and can help with insomnia or tics that sometimes accompany ADHD.

Behavioural interventions:

Cognitive-behavioural therapy adapted for ADHD teaches:

Time management and planning skills
Breaking tasks into manageable steps
Using external cues (timers, reminders, visual organisation)
Challenging negative self-talk related to ADHD failures

Clinical trials show CBT produces moderate improvements in ADHD symptoms and functioning, especially when combined with medication. Parent training and classroom interventions are effective for children.

Multimodal treatment works best:

The landmark NIMH Multimodal Treatment Study found medication alone was effective for core symptoms, but medication plus behavioural therapy yielded the greatest improvements in functional outcomes. This is now the recommended approach.

For Anxiety:

Cognitive-behavioural therapy with exposure is the gold standard. CBT teaches:

Identifying and challenging irrational fears
Gradual exposure to feared situations to desensitise anxiety responses
Behavioural strategies to reduce avoidance

Meta-analyses consistently show CBT yields significant, lasting reductions in anxiety symptoms.

Medications:

SSRIs (sertraline, escitalopram) and SNRIs (venlafaxine, duloxetine) are first-line for chronic anxiety. Randomised trials support their use for GAD, panic disorder, social anxiety, and PTSD. They take several weeks to work but are effective in 50-60% of patients.

Benzodiazepines work quickly for acute anxiety but aren't appropriate for long-term use due to dependence risk, tolerance, and cognitive impairment.

For Comorbid ADHD and Anxiety:

The evidence supports several approaches:

Treat ADHD first: Because stimulants work rapidly (within days), many clinicians start here. When ADHD improves—better organisation, timely task completion—situational anxiety often diminishes. A multi-site study found that treating ADHD first led to anxiety improvement in many children; those whose anxiety persisted benefited from adding an SSRI.
Use Non-stimulants: For patients where stimulants exacerbate anxiety, non stimulant treats both conditions. Studies in adults with ADHD and social anxiety showed non stimulants reduced both sets of symptoms.
Combine medications if needed: SSRIs and stimulants can be safely co-prescribed with monitoring. This parallel approach targets both disorders simultaneously.
Adapted CBT: Therapy can address both conditions—teaching organisational skills for ADHD while including relaxation training and cognitive restructuring for anxious thoughts.
Start low, go slow: In patients with significant anxiety, titrate stimulants carefully. Many patients' anxiety improves when ADHD is controlled; if it worsens, adjust the dose or switch medications.

The key finding: treating ADHD effectively can reduce comorbid anxiety and mood problems. Longitudinal studies show stimulant-treated ADHD patients have lower rates of anxiety and depression than untreated peers.

Female-Specific Treatment Considerations

Hormonal fluctuations:

Some women report ADHD symptoms worsen premenstrually or during menopause when estrogen drops. While more research is needed, clinicians may consider:

Tracking symptoms across menstrual cycles
Adjusting medication timing or dosage during low-Oestrogen phases
Using non-stimulants or behavioural strategies during pregnancy

Postpartum is a particularly vulnerable time—Oestrogen drops sharply, and research shows postpartum anxiety and OCD symptoms can emerge or worsen in susceptible women.

Eating disorder risk:

Women with ADHD have elevated rates of eating disorders. Since stimulants suppress appetite, this creates a clinical dilemma. In patients with eating disorder history:

Non-stimulants may be preferred
Very careful monitoring is required if using stimulants
Treating the eating disorder may need to be prioritised

Parenting demands:

Research shows women with ADHD report greater challenges in parenting roles. They struggle with the executive function demands (organising schedules, remembering appointments, managing household tasks) and experience anxiety about being inadequate parents.

Treatment should address these specific functional domains. ADHD coaching focused on parenting strategies, combined with therapy addressing self-compassion and realistic expectations, can be particularly helpful.

Treatment response is the same:

Despite biological differences, treatment efficacy doesn't differ by sex. Women respond to stimulants as well as men. The issue isn't whether treatments work—it's that women are less likely to be diagnosed and treated in the first place.

Additional Tools Across Life Domains

At Work:

Many women with ADHD describe feeling highly capable yet constantly behind. Perfectionism, missed deadlines, difficulty switching between tasks, or overthinking simple decisions can make their workdays feel much heavier than they appear to be.

Inside, there might be worry about making mistakes, fear of disappointing others, or a sense of having to “prove yourself” again and again.

What helps:

Break tasks into smaller steps using visual checklists or time management tools.
Use external cues (like alarms, calendar prompts, or colour-coding) in order to reduce the mental effort of having to track everything on your own.
Cognitive behavioural therapy (CBT) can help challenge any of that perfectionistic thinking and reduce work-related anxiety. Research shows that CBT improves functioning for both ADHD and anxiety, especially when it’s properly combined with some practical organisational strategies

Parenting:

Parenting can amplify the impact of ADHD. There’s the executive load of having to remember everything, along with the emotional load of having to carry everyone’s feelings. Both of these things can intensify your anxiety.

Women often describe feeling overstretched, guilty, or worried that they’re missing something important, even when they’re doing an incredible job.

What helps:

Simplify routines using visual schedules or “family command centres.”
Use shared reminders or technology to help you reduce the mental load that you have to carry.
Consider ADHD-specific parenting resources or getting coaching for some extra support.

Relationships:

ADHD can make all of your emotional experiences feel stronger which is also known as ADHD emotional dysregulation. This may display itself as overthinking the conversations you are having, feeling easily hurt, or worrying about being “too much.”

Partners may see capability, warmth, and strength, while internally, there might be anxiety about letting someone down or not being able to communicate “well enough.”

What helps:

Use practice emotional regulation skills
Share your needs openly with your partner using simple scripts like - “When X happens, I feel overwhelmed. What would help is…”
Couples therapy can create greater levels of understanding and reduce any instances of miscommunication.

Wellbeing:

Chronic fatigue, overwhelming feelings, “crashing” after social events, and mental exhaustion are very common. Masking, like quietly appearing organised, calm, and socially “on,” can lead to emotional burnout, especially when you have anxiety that is layered on top of everything else.

What helps:

Build in a bit of recovery time after demanding days or social events.
Use sensory-friendly calming routines in the evenings, especially after challenging days.
Look into telehealth options for therapy or ADHD support, which research shows can be just as effective as in-person care.

What the Research Gaps Tell Us

Several critical questions remain:

How do hormones affect medication needs? Despite growing research interest in this area, we need more formal studies on whether medication dosing should adjust across menstrual cycles, during pregnancy, or at menopause. Up until 5 years ago majority of our understanding relied primarily on anecdotal clinical reports and individual experimentation.

How should co-morbid ADHD and Anxiety be treated? Most clinical trials exclude patients with comorbidities to maintain "clean" samples. This means limited trial data specifically guiding treatment for co-occurring ADHD and anxiety. We need studies designed for comorbid populations.

Are current diagnostic tools gender-biased? ADHD rating scales were largely developed studying boys. Some are being reevaluated for gender bias. More generally there have been calls to develop diagnostic frameworks that better reflect female-typical and lifespan-specific ADHD presentations. Future diagnostic frameworks may incorporate presentations that are more common in women.

What This Means in Practice

If you recognise yourself in these patterns:

Seek evaluation from someone who understands female ADHD presentations. Don't accept "you can't have ADHD because you did well in school" or "you're just anxious." Many women with ADHD have been misdiagnosed for years with anxiety or depression alone.

Know that late diagnosis doesn't mean you missed your chance. Adult ADHD is treatable. Studies show treated adults have better educational, occupational, and safety outcomes than untreated peers.

Consider that treating ADHD might improve anxiety. If your anxiety seems tied to feeling disorganised, overwhelmed, or constantly behind, addressing underlying ADHD could reduce the worry.

Understand that "high functioning" ADHD is still impairing. Working twice as hard to appear organised counts as impairment. The hidden effort you're expending trying to compensate is a sign you need support, not a sign you're "managing fine."

Moving Forward

It’s no secret that living with ADHD and anxiety in women can feel confusing - especially when you’ve spent years trying to deal with and make sense of everything on your own. But bringing all of these experiences into focus can be incredibly empowering. It helps you understand why certain moments feel harder, why your mind works the way it does, and why the pressure you’ve been carrying all this time has felt so heavy.

Both ADHD and anxiety in women are highly manageable when you have the right support in place.Self-compassion plays a very powerful role here, and it can make a massive difference when you give yourself permission to rest, make adjustments to your routines, and get a bit of extra help when you need it.

At Kantoko

We offer evidence-based assessment and treatment for ADHD and anxiety in women and adults.

If you're ready to explore whether ADHD, anxiety, or both are affecting your life Get started with us today.

FAQ

Does ADHD medication help with anxiety?

It depends on the source of the anxiety. If anxiety stems from ADHD-related disorganisation and chronic failure, medication often reduces anxiety by improving functioning. Studies show long-term stimulant treatment is associated with lower rates of anxiety disorders.

Can anxiety look like ADHD?

Yes. Worry, rumination, and the physical tension of anxiety can cause concentration problems that mimic ADHD. Avoidance behaviours in anxiety can look like ADHD-related procrastination.

The difference: ADHD symptoms are lifelong (beginning in childhood) and pervasive across situations. Anxiety symptoms might be more situation-specific or have a clear onset. A thorough evaluation examines developmental history and current functioning patterns to distinguish them.

Importantly, both can be present—the comorbidity rate is 25-50%.

Why are women diagnosed with ADHD later than men?

Girls' ADHD is less visible. They have more inattentive symptoms (daydreaming, forgetfulness) and fewer disruptive hyperactive behaviours. They develop compensatory strategies (perfectionism, working harder) that mask symptoms. They're more likely to internalise distress as anxiety or depression rather than act out.

The result: childhood ADHD in girls often goes unrecognised. Many women are first diagnosed when life demands exceed their coping strategies—in university, demanding careers, or when managing households and children.

Is high-functioning ADHD real?

Yes. "High-functioning" typically means someone achieves external markers of success (good grades, stable job) while experiencing significant internal struggle and working much harder than necessary to maintain that appearance.

This is particularly common in women with ADHD. Research shows many become "master maskers"—they hide their symptoms through extreme effort, perfectionism, and over-preparation. The exhaustion and anxiety from this compensation are real impairments, even if outward performance looks fine.

Do I need medication or is therapy enough?

The evidence strongly favours combining both for best outcomes. The NIMH Multimodal Treatment Study found medication plus behavioural therapy produced better functional improvements than either alone.

For ADHD: medication addresses the neurobiological basis (dopamine/norepinephrine signaling), producing rapid symptom improvement in 70-90% of patients. Therapy teaches compensatory strategies and skills for long-term management.
For anxiety: CBT is highly effective, but medication (SSRIs) can lower symptom intensity enough to engage in therapy more effectively. Many patients eventually taper medication after developing strong coping skills through therapy.

In comorbid cases, an integrated approach—addressing both conditions with appropriate treatments—typically yields the best results

What are the symptoms of female ADHD?

Female ADHD symptoms often include inattentiveness, forgetfulness, difficulty initiating tasks, emotional sensitivity, mental restlessness, and overwhelm. These traits are real and are commonly overlooked in girls and women.

How do I tell if I have ADHD as an adult woman?

Many women explore ADHD later in life, which is known as late diagnosed ADHD in women, after noticing long-standing challenges with focus, organisation, time-management, or emotional regulation. If these patterns feel familiar, an ADHD-trained clinician can help guide you through a proper assessment.

This article is for informational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment options.