"Masking" refers to the coping strategies women often use to hide their ADHD symptoms. It’s common for women to exert enormous effort to appear organized, attentive, and calm—even when they're struggling internally. Dr. Sandra Kooij highlights that societal expectations around women’s roles often pressure women to mask symptoms, leading to chronic stress, anxiety, and feelings of inadequacy (Kooij et al., 2019).

As clinicians, educators, and advocates, recognizing masking behaviors is critical. When we understand that women may be silently struggling behind a composed exterior, we can approach assessment and treatment with greater sensitivity and effectiveness.

Women with ADHD often present with co-occurring mental health conditions, particularly anxiety and depression. Dr. Martin Katzman's research has shown that women with ADHD are significantly more likely to experience anxiety disorders, mood disorders, and emotional dysregulation compared to their male counterparts (Katzman et al., 2017). This overlap can further complicate diagnosis because clinicians may initially identify anxiety or depression without recognizing the underlying ADHD.

In my experience, uncovering ADHD beneath anxiety or depression can be life-changing for women. It opens the door to targeted interventions that address the root cause of their struggles, rather than just managing symptoms superficially.

The Canadian ADHD Resource Alliance (CADDRA) guidelines and the World Federation for ADHD guidelines both stress the importance of gender-sensitive and culturally competent approaches to diagnosing and treating ADHD. They recommend clinicians actively screen for inattentive symptoms, emotional dysregulation, and co-occurring anxiety or mood disorders—especially in women who might not fit traditional ADHD stereotypes (CADDRA, 2020; World Federation of ADHD, 2021).

In my practice, I’ve found that simply asking women about their internal experiences—feelings of overwhelm, difficulty staying organized, or emotional sensitivity—can reveal hidden ADHD symptoms that might otherwise go unnoticed.