The Gendered Role of Anxiety in Delayed ADHD Diagnosis Among Women

Purpose :Although Attention Deficit/Hyperactivity Disorder (ADHD) has historically been described in male children, its clinical presentation varies across age and gender. As a result, ADHD remains under-recognized in adulthood, particularly among women, often leading to delayed diagnosis. This study aimed to examine the association between gender and time to ADHD diagnosis in adulthood, while accounting for established influencing factors, including psychiatric comorbidities. Methods :Data were collected at a referral adult ADHD center in Bordeaux, France. Adults recently diagnosed with ADHD in adulthood completed a self-report questionnaire. The primary outcome was the duration between first psychiatric consultation and ADHD diagnosis. Associations with self-identified gender (woman, man, non-binary) were examined while adjusting for socio-demographic characteristics, ADHD presentation and treatment, comorbidities, age, and prior childhood mental health care. Results :The sample included 187 adults with a confirmed ADHD diagnosis. Most participants reported functionally impairing symptoms beginning in childhood. Diagnostic delay was significantly associated with gender and comorbid anxiety disorders. Women and non-binary individuals experienced substantially longer delays compared to men. After adjustment for age and anxiety, women were diagnosed on average four times later than men, while non-binary individuals experienced delays approximately three times longer. Women with comorbid anxiety exhibited the longest delays, with a mean duration exceeding seven years. Conclusion :These findings highlight a gender-related diagnostic delay in adult ADHD, strongly influenced by anxiety comorbidity. Improving diagnostic accuracy requires gender-sensitive clinical approaches, including systematic exploration of childhood symptoms and consideration of ADHD screening in women presenting with anxiety.