Disparities in Neurodevelopmental Conditions in Women: Bridging the Gap Between Research and Practice
When psychiatric conditions are studied in clinical trials, women are often excluded from the study sample. This creates a critical problem: women are constantly over- and underdiagnosed, depending on the psychiatric condition. Up until recently, these trials only included males because female reproductive hormones often influence results. Reproductive hormones constantly fluctuate in the female body, but most scientists consider these fluctuations as variables that cannot be handled. However, taking this “easier” route has caused countless clinical disadvantages to women for decades. These fluctuations are the exact reason why treatment plans and interventions made based on male trials cannot be generalized to females. Hormone fluctuations change how certain conditions present symptomatically in women, which can leave them misdiagnosed due to the use of male-based diagnostic criteria.
What Conditions are Underdiagnosed in Women?
Autism spectrum disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are two neurodevelopmental1 conditions that are overlooked in women because their symptoms present differently than what we normally imagine. Parents, teachers, and the general public are also unaware of these differences due to the male-oriented stereotypes and the lack of publicity. This prevents them from recognizing conditions early on and seeking help in the first place.
Autism Spectrum Disorder (ASD)
ASD is a lifelong condition with a wide variety of possible symptoms due to differences in the brain. It involves challenges with communication, social skills, and repetitive behaviors, which may vary in intensity or presentation in different people [1]. Early research claims ASD to be an extreme version of “typical male cognition,” which has led to the view of ASD as a male-dominated condition. Baron-Cohen characterized typical male cognition as a tendency toward “systemising,” which means following patterns, structures, and rigid rules over “empathising” [2]. This framing has drawn significant criticism for reflecting diagnostic criteria that were primarily built on male presentations of autism.
Females living with ASD generally present with different, less overt symptomatology compared to males, but the whole picture as to why this occurs is not yet complete. One factor we do know is masking: women with ASD tend to feel a greater pressure to camouflage their symptoms in everyday settings than men do [3]. In workplaces, schools, and sometimes even at home, there is a lack of understanding towards women as they are expected to be more emotionally responsive and have closer social relationships with others [4]. Another factor is how the restricted and repetitive behaviors mentioned in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a core requirement are not seen as often in women with ASD [5]. In the instances that these behaviors are present, they fall within socially expected interests for girls, such as interests in animals, fictional characters, or celebrities. They are less likely to be flagged as clinically significant even if the intensity and rigidity are comparable to interests of autistic boys [5].
Attention-Deficit / Hyperactivity Disorder (ADHD)
ADHD is a developmental disorder with symptoms including inattention, hyperactivity, and impulsivity [6]. These symptoms present differently in girls and boys, where girls are often diagnosed with ADHD-Inattentive compared to boys who are diagnosed with ADHD-Hyperactivity/Impulsivity. Girls with ADHD tend to be forgetful, distracted, and disorganized, which are internalized behaviors that often go unrecognized, especially because of the male-centric model for ADHD [7]. These symptoms also get misdiagnosed as depression or anxiety, causing delays in correct diagnosis and worsening of quality of life [8].
For girls and adult women who do get diagnosed with ADHD, we also know estrogen levels strongly influence symptom severity, meaning women must constantly adapt to their changing symptoms throughout the month and their lifetime [9]. Specifically, low estrogen, which occurs during the luteal phase, postpartum, and menopause, worsens symptoms [9]. There is also a cultural bias in diagnosing ADHD because the symptoms- hyperactivity in boys and inattention in girls- are considered normal in some ethnic minorities.
The research on the disparities in ADHD diagnosis in women is not lacking. But why are there still people left undiagnosed and misdiagnosed? The diagnostic criteria is lagging behind; the DSM hasn’t been updated to include the features common to women, and especially how they can present differently in adult women. ADHD assessment tools aren’t up to date either. They still follow the generic screening without being gender-specific. Training is also not aligned with current research, so healthcare providers must take appropriate actions themselves to close the gap between research and practice.
Societal standards have always defined a woman’s identity in comparison to masculinity, and this applies to emotional expression as well. Emotional distress is often expressed verbally by women, however, these signs go overlooked and get misdiagnosed as anxiety or depression instead. The underlying causes of this distress are left ignored while ordinary life experiences are made pathological. The result is a systematic overdiagnosis of clinical anxiety and depression in women due to fundamental misunderstandings about why women express emotional distress. The underdiagnosis of neurodevelopmental conditions feeds into this overdiagnosis and highlights an indifference towards women in the clinical space [10].
What Can You Do?
Neurodevelopmental conditions such as ASD and ADHD aren’t more prevalent in men, it’s simply diagnosed more often in boys and men because the foundational guidelines only cater to symptoms commonly seen in them. This system inherently excludes young girls and adult women who are struggling with the same conditions. As parents and teachers of young children, you can be mindful of how ADHD and ASD may present differently in boys and girls and advocate for them when they need help. Your voice is important in getting an early and correct diagnosis that can improve someone’s life course greatly. Additionally, medical institutions and professional bodies have a responsibility to revise diagnostic guidelines and clinical protocols to stay current with emerging research and not fall short in the standard of care women deserve. Advocating for this change whenever the opportunity presents itself is critical to making the progress that girls and women need.
References
Autism Speaks. Autism spectrum disorder (ASD) [Internet]. New York: Autism Speaks; 2023 May 3 [cited 2026 Aug 14]. Available from: https://www.autismspeaks.org/what-autism
Baron-Cohen S. The extreme male brain theory of autism. Trends in cognitive sciences. 2002 Jun 1;6(6):248-54.
Cage E, Troxell-Whitman Z. Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of autism and developmental disorders. 2019 May 15;49(5):1899-911.
Hull L, Mandy W, Lai MC, Baron-Cohen S, Allison C, Smith P, Petrides KV. Development and validation of the camouflaging autistic traits questionnaire (CAT-Q). Journal of autism and developmental disorders. 2019 Mar 15;49(3):819-33.
Bourson L, Prevost C. Characteristics of restricted interests in girls with ASD compared to boys: A systematic review of the literature. European Child & Adolescent Psychiatry. 2024 Apr;33(4):987-1004.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed., text rev. Washington (DC): American Psychiatric Association Publishing; 2022.
Mowlem FD, Rosenqvist MA, Martin J, Lichtenstein P, Asherson P, Larsson H. Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. European child & adolescent psychiatry. 2019 Apr 1;28(4):481-9.
Klefsjö U, Kantzer AK, Gillberg C, Billstedt E. The road to diagnosis and treatment in girls and boys with ADHD–gender differences in the diagnostic process. Nordic journal of psychiatry. 2021 May 4;75(4):301-5.
Osianlis E, Thomas EHX, Li Q, Bellgrove M, May T, Chapman D, et al. ADHD in females: survey findings on symptoms across hormonal life stages. J Psychiatr Res. 2026;193:208-15.
Bernal Arenas M, Arroyo-Sánchez A, Torres Parejo Ú, Muñoz-Negro JE. A systematic review and meta-analysis on gender differences in the treatment of anxiety and depression. International Journal of Social Psychiatry. 2025 Aug;71(5):835-43.
1 Neurodevelopmental conditions are disorders that start from atypical brain development in early life, and they affect cognitive, social, emotional, or motor functioning.
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