08-08-2025
Women's Day: ADHD undiagnosed but still showing up
As South Africa marks Women's Day on August 9, the South African Society of Psychiatrists (SASOP) is calling attention to an often-overlooked struggle faced by women and girls living with undiagnosed or misunderstood Attention Deficit Hyperactivity Disorder (ADHD).
This Women's Day, SASOP urges healthcare professionals, educators, and families to expand their understanding of the disorder.
ADHD is often seen as a childhood disorder that affects disruptive, hyperactive boys.
The outdated stereotype has left women and girls invisible in the conversation, their symptoms misunderstood or dismissed entirely.
Dr Wisani Makhomisane, specialist psychiatrist and SASOP member, says that for too long, the disorder has worn a masculine mask: one that has obscured the quieter internal battles many women face every day.
She explains, unlike boys who are more likely to display external hyperactivity, girls often internalise their symptoms.
They are described as dreamy, anxious, sensitive or perfectionistic, qualities that are often misinterpreted as emotional immaturity or personality quirks.
According to Makhomisane, the reality is the disorder in women is not less severe; it is simply less visible.
'These women are not lazy, disorganised or overemotional. They are living with a neurodevelopmental condition that continues to be poorly understood through a gendered lens. And the consequences are far-reaching.'
Globally, boys are diagnosed with ADHD at nearly twice the rate of girls.
According to data from the American Centre for Disease Control and Prevention,14.5% of boys receive a diagnosis, compared to just 8% of girls.
This gap grows wider with age, with women often waiting four to five years longer than men to be correctly diagnosed.
In South Africa, the situation is even more pronounced.
Many women only receive a diagnosis in adulthood, often after years of struggling with anxiety, depression, low self-esteem, and a gnawing sense that something is wrong but not knowing what it is.
Makhomisane explains that these women are frequently misdiagnosed.
'Their ADHD is often mistaken for anxiety disorders, depression or even borderline personality disorder. They are prescribed antidepressants or sedatives long before ADHD is ever considered. As a result, their care is often fragmented and ineffective, and their symptoms continue beneath the surface, contributing to emotional instability, eating disorders, and burnout,' she says.
She points out that trying to meet the social expectations of being emotionally composed, high-functioning, and selfless, many women develop sophisticated masking behaviours to cope.
They become overachievers, perfectionists or chronic people-pleasers not because they are naturally this way, but because they are desperately trying to manage the executive dysfunction and emotional overload that the disorder brings.
'But masking comes at a cost. It is mentally and physically exhausting, often leading to burnout, low self-worth, and a painful internal narrative of never being enough.'
She emphasises this pressure is only amplified by motherhood.
'The demands of parenting expose executive dysfunction in a way that few other life stages do. Managing a household, juggling routines, and responding to emotional needs can become overwhelming. Many mothers with undiagnosed ADHD find themselves sinking under the weight of expectations, gripped by guilt, shame, and exhaustion, all while blaming themselves for not coping better.'
ADHD in women often presents through chronic overwhelm, forgetfulness, disorganisation, emotional sensitivity, and deep rejection sensitivity.
These are not personality flaws: they are symptoms of a neurodevelopmental disorder that deserves recognition, support, and care.
'Unfortunately, too many women blame themselves instead of understanding that their brains function differently and require different tools and strategies.'
Makhomisane notes that this can lead to unhealthy coping mechanisms like emotional withdrawal due to fear of criticism, impulsive behaviours like binge shopping or risky decision-making, overcommitting to please others, and perfectionism to cover up underlying chaos.
These behaviours are often misread, further delaying diagnosis and support.
Treatment for ADHD involves a combination of approaches like medication, psychotherapy, and lifestyle interventions such as regular exercise, mindfulness, adequate sleep, and balanced nutrition.
Therapy is especially important in helping women unlearn self-blame, develop emotional regulation, and build daily coping strategies that align with how their brains work.
Makhomisane emphasises that if society can shift the lens through which ADHD is viewed, lives can be changed.
For her it starts with awareness, early recognition, and the development of diagnostic tools and support systems that are sensitive to gender differences. It starts with believing women when they say, 'I'm struggling,' and listening with compassion and clinical insight.
'On this Women's Day, let us not only honour the strength of women but also create space for their struggles to be seen and supported. ADHD is not a flaw. It is not a failure. But the failure to recognise it, that is something we must urgently address.'
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