RESEARCH BRIEF: New Study on Gender Bias in ADHD Diagnosis

Subtle gender biases in ADHD diagnosis stem from outdated tools, masked symptoms, and the invisibility of women’s neurodivergent experiences.

Apr 04, 2025

A Large Dutch Study Challenges Assumptions About ADHD in Women

In the largest study of its kind, researchers from the Netherlands analyzed over 2,200 adult ADHD assessments using the DIVA-5 diagnostic tool.

The study aimed to explore whether women and men experience and report ADHD “symptoms” differently. I’ve followed Dr. Sandra Kooij’s research ever since I saw her speak at a conference about how hormones affect ADHD in women. She coauthored this study, so it immediately caught my attention.

The results reveal subtle but important gender-related patterns that suggest current diagnostic tools may overlook ADHD in women, especially when those “symptoms” are masked or internalized.

🔎 What You Need to Know About the Study

Sample size: 2,257 adults diagnosed with ADHD (61% women)
Tool used: DIVA-5, a structured diagnostic interview aligned with DSM-5 criteria
Key focus: Gender differences in endorsement of ADHD “symptoms” and life impairments, including which behavioral examples patients identified with
Finding: ADHD appears similarly across genders overall—but women often endorse different “symptoms” and coping strategies than men

🧠 Key Findings

1. Women endorsed more adult ADHD “symptoms” than men

In adulthood, women reported higher rates of both inattentive and hyperactive “symptoms,” particularly:

“Feels restless” – 88% of women vs. 78.5% of men
“Talks excessively” – 63% vs. 52%
“Loses things” – 80.4% vs. 71.4%

2. Men endorsed more childhood “symptoms”

Childhood examples in the DIVA-5 focused heavily on externalized behaviors more typical of boys in school (e.g., “leaves seat in classroom”). This resulted in:

Higher childhood “symptom” endorsement by men
Lower endorsement by women, whose early ADHD traits may have been internalized, masked, or misinterpreted

3. Unsurprisingl,y Self-confidence was the most frequently reported impairment, especially by women

89% of women reported self-confidence impairment in adulthood, compared to 81% of men
In childhood, the difference was also present: 77% of women vs. 65% of men

4. Women reported more difficulty in unstructured time and social connection

⏳ Free Time

Women were more likely to report difficulty using or enjoying unstructured time:

“Difficulty shutting off” or relaxing
Overplanning to avoid restlessness
Trouble finishing books, movies, or creative projects
Guilt during “unproductive” time—even when resting
Boredom intolerance or feeling unable to self-entertain

🫂 Social Contact

More women reported struggles with social interaction and connection:

Difficulty maintaining friendships (e.g., forgetting to reply, canceling plans)
Talking excessively or interrupting in ways that are misunderstood
Seeming inattentive or disengaged—even when they care deeply
Emotional dysregulation or withdrawal in social situations
Heightened rejection sensitivity or shame responses

5. Women endorsed coping strategies; men endorsed failure-based examples

The DIVA-5 includes example prompts that describe lived experiences.
In these, men more often selected:

“Fails to meet deadlines”
“Work is inaccurate”

Women more often endorsed:

“Rigid use of lists”
“Creates schedules but doesn’t use them”
“Inflexible due to the need to stick to a schedule”

These examples point to masking and overcompensation—strategies that help women function externally while struggling internally.

🧩 Interpretation & Implications

Why This Matters

While the gender differences had small effect sizes (φ = .05–.12), they are clinically meaningful. Current diagnostic tools were built around male-centered data and behaviors—leaving many women with ADHD unseen, misunderstood, or misdiagnosed.

“Several of the DIVA-5 examples reflect negative classroom-based behaviours that tend to be more common among boys.”
— Platania et al., 2025

Most tools focus on external disruptions (like hyperactivity in classrooms) and neglect more internalized experiences (like emotional regulation, perfectionism, or mental restlessness).

This can lead to delayed diagnosis, missed support, and a deeply ingrained sense of self-doubt in neurodivergent women.

✅ Recommendations for More Accurate ADHD Diagnosis in Women

Revise diagnostic “symptom” examples to reflect female and gender-diverse experiences
Measure real-life impact, not just count of “symptoms”
Incorporate emotional masking and self-regulation challenges in assessments
Train clinicians to recognize perfectionism, social masking, and overcontrol as potential flags
Broaden research to include underrepresented and subclinical neurodivergent populations

📚 Citation

Platania, N. M., Starreveld, D. E. J., Wynchank, D., Beekman, A. T. F., & Kooij, S. (2025). Bias by gender: Exploring gender-based differences in the endorsement of ADHD symptoms and impairment among adult patients. Frontiers in Global Women’s Health, 6, 1549028. https://doi.org/10.3389/fgwh.2025.1549028