Behind the mask: ADHD, anxiety and the hidden realities of women and girls
There was a quiet pause at the start of this session as people settled in after a talk on sleep. Then Dr Samantha Hiew stepped up with a warm welcome and a clear purpose. “I’m really glad to be here,” she said. “Today I will be talking about behind the mask, ADHD, anxiety and the hidden realities of women and girls.”
What followed was an honest and deeply human look at neurodiversity, shaped as much by lived experience as science.
A story that starts with lived experience
Dr Hiew is the founder of ADHD Girls, a social impact company focused on supporting neurodivergent women and improving understanding. Her journey began with her own late diagnosis.
“I was diagnosed with ADHD at the age of 40 and swiftly identified with being autistic as well,” she shared.
That moment changed everything, not just for her career but for how she saw her life. Balancing work, motherhood and her own health challenges has given her a clear view of how complex and often hidden these experiences can be.
She described parenting as “a mind scrambling experience but also very rewarding” when both parent and children are neurodivergent.
The hidden reality behind the mask
A key theme of the session was masking. Many women with ADHD or autism learn to hide their traits to fit into expectations at work, at home and in society.
“What you see is very rarely what is occurring underneath,” Dr Hiew explained.
She described how years of masking can lead to exhaustion, anxiety and a sense of disconnection from your true self. For some, it becomes so ingrained that it is hard to separate who they are from the persona they present.
“When you’ve masked so long, that mask becomes you,” she said.
This insight struck a chord with many viewers, especially those juggling demanding roles while quietly managing their own wellbeing.
Why more women are being diagnosed
Dr Hiew highlighted a major shift happening right now. More women are seeking ADHD diagnoses than ever before.
“Women aged 23 to 49 years old make up the largest group of people who are seeking ADHD diagnosis,” she noted, adding that this has created a growing demand on services.
For years ADHD has been seen as a condition mainly affecting boys. As a result, many women have been overlooked or misdiagnosed with anxiety or depression instead.
“This has been stigmatised as a male condition,” she said, pointing out how diagnostic criteria have historically failed to reflect female experiences.
The role of hormones and life stages
One of the most powerful parts of the session explored something rarely talked about openly: the impact of hormones.
Dr Hiew explained that hormonal changes can shape how ADHD presents throughout life. From puberty to pregnancy to perimenopause, each stage brings new challenges.
“Half the time what we’re dealing with is hormone impact,” she said.
She also shared that many neurodivergent women experience perimenopause earlier than expected, sometimes from their mid 30s. This can affect mood, focus, energy levels and identity.
“Women tend to experience a time when they don’t know who they are anymore, and they feel anxious for reasons that they don’t understand.”
Anxiety, burnout and physical health
Another key message was that ADHD is not just about focus or behaviour. It can affect the whole body.
Dr Hiew described it as “a whole person condition” that influences mental, physical and emotional health.
Many women, she said, first receive diagnoses for anxiety or depression before realising ADHD or autism is part of the bigger picture.
She also pointed to common co‑occurring issues such as fatigue, pain, digestive problems and sleep disruption.
These challenges are often intensified by masking and by trying to keep up with expectations that do not match how the brain and body work.
Rethinking work and productivity
For a Rail Wellbeing Live audience, one idea really stood out: the need to rethink how we work.
Dr Hiew challenged the traditional nine to five model and introduced a different approach.
“How about energy-based productivity?” she asked.
This means recognising that energy, focus and creativity change throughout the day and across the month, especially for women. Instead of forcing constant output, it is about working with your natural rhythm.
“If you force an ADHDer to sit down and do something when they just can’t light up, it’s like trying to draw blood out of a stone.”
Practical ways to support yourself and others
The session did not just explore challenges. It also offered clear, practical advice.
Dr Hiew encouraged simple but powerful steps:
- Track your cycle and notice patterns
- Set boundaries and protect recovery time
- Communicate needs clearly
- Build supportive networks
“Really get to know your needs. Understand your body, your mind, and how you relate,” she said.
For those supporting colleagues or family members, she highlighted the importance of flexibility, understanding and tailored adjustments.
A conversation that continues
The live Q&A showed just how many people related to the topic. Questions ranged from workplace challenges to parenting and late diagnosis.
One comment captured the feeling of many: work becoming harder with age and masking feeling impossible to maintain.
Dr Hiew reassured the audience.
“Very normal. Very, very normal,” she replied.
Watch the full session
This session is a powerful reminder that wellbeing is not one size fits all. It is shaped by identity, biology, life experiences and the systems we work within.
If you have ever felt exhausted from holding it together or wondered why things feel harder than they should, this conversation will resonate.
Watch the full session above to hear Dr Samantha Hiew’s story, insights and practical advice in her own words.