Attention-deficit/hyperactivity disorder (ADHD) can manifest differently in girls than it does in boys which can explain why so many girls are underdiagnosed. We can see certain differences in symptom presentation and the course of ADHD in girls and women versus boys. 

Why do so many girls go undiagnosed?

There are many reasons why girls and women are often underdiagnosed with ADHD. For starters, there is a long-standing history of the assumption that ADHD was “rare” in girls and more common in boys. Another reason, mentioned by Hinshaw et al., is that inattentive symptoms are more prominent in girls than boys which are easier to miss versus hyperactive symptoms that are common for boys to present. A third reason being girls have lower rates of co-occurring disruptive behaviour disorders, with these behaviours developing later in life versus earlier in boys. Females also have higher rates of compensatory behaviours than males causing ADHD symptoms to be masked.

Lastly, ADHD symptoms in girls go underrecognized and reported, with girls being less referred than boys. An observational study by Meyer et al. found that parents and teachers underreport observed ADHD behaviours in girls versus boys which contributes to the under recognition in females. Further, another study found that teachers are more likely to refer boys for treatment for ADHD than girls, even if both boys and girls are demonstrating the same symptoms.

Symptom presentation

The presentation of symptoms is a major way that ADHD can differ between boys and girls. Girls and women most often appear to present with predominantly inattentive symptoms of ADHD which can be easily missed by teachers and parents.

Examples of inattentive symptoms include:

  • Fails to give close attention to details or makes careless mistakes.
  • Has difficulty sustaining attention, does not appear to listen.
  • Struggles to follow through with instructions.
  • Avoids or dislikes tasks requiring sustained mental effort.
  • Loses things easily and has difficulty with organization.
  • Is easily distracted and forgetful in daily activities.

Hinshaw et al. also note that externalizing problems, such as impulsive, aggressive, or acting-out behaviours, are more likely to present at an early age in boys with ADHD, whereas in girls they are either less likely to present or they present later in life. Internalizing problems, like depression and anxiety, are more common in girls with ADHD which can become diagnosed before ADHD and can mask ADHD symptoms.

The course of ADHD in girls and women

Young et al. contend that females with ADHD are more likely to adopt compensatory strategies that help mask or limit ADHD symptoms and behaviours. Some women become so good at masking their ADHD symptoms that it causes them to minimize their symptoms. Also, these strategies can be functional like finding ways for them to remain focus, disguise stress, and be socially competent. However, the behaviours can also be negative, like avoiding certain things or people, not getting help when needed, and turning to substances.

Young et al. also mention that children and adolescents with ADHD are more likely to experience peer rejection and maintain fewer friendship, with girls with ADHD having more disruptive relationships with family members and peers. Further, girls with ADHD experience more interpersonal difficulties with lower satisfaction with relationships and self-esteem. This leads girls with ADHD to apply compensatory strategies to combat difficulties.

ADHD symptoms can be overlooked or misinterpreted in females in highly structured environments, receiving high levels of support, and those who use masking strategies to compensate for their ADHD. As one gets older, Young et al. note that their environmental demands, like education, work, finances, and so on become more challenging with their level of support declining. Many women with ADHD begin to struggle once they reach adulthood with their symptoms becoming more apparent. Additionally, hormonal fluctuations (e.g., associated with start of menstruation, perimenopause) can exacerbate symptoms. Furthermore, Young et al. communicate that periods of transition cause individuals with ADHD to be more vulnerable, overwhelmed, anxious, and can impact their self-esteem by exacerbating symptoms. Although, there is an increase in more self-referrals in adulthood as women become more aware of their symptoms and difficulties.

Unsure about how ADHD therapy can make progress in life feel normal? Explore more.

Risk factors of ADHD in girls and women

There are many risk factors and impairments that can persist into adulthood for women with ADHD. One from Hinshaw et al. being increased problems in close relationships and engagement in self-harm and suicidal behaviour. There are also higher rates of co-occurring disorders such as, antisocial, substance abuse, mood, anxiety, and eating disorders. Further, women with ADHD are more likely to have anxiety and mood disorders (depression, bipolar, etcetera). Studies reviewed by Hinshaw et al. have also found impairments in academic performance, internalizing disorders, poor executive function, and employment, with higher rates of unplanned pregnancy and risk of intimate partner violence.

Overall, ADHD in women and girls is associated with different symptom presentation, risk factors and experiences that can be different in males with ADHD. Individuals should contact their healthcare practitioner if they are experiencing difficulties or if they think they might have ADHD.

If you or a friend are unsure where to find support, book your free 20-minute consultation to begin your journey with therapists, like Michelle Holder and Amy Battistone, whose areas of support includes ADHD.

References

Biederman, Ball, S. W., Monuteaux, M. C., Mick, E., Spencer, T. J., Mccreary, M., Cote, M., & Faraone, S. V. (2008). New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. Journal of the American Academy of Child and Adolescent Psychiatry, 47(4), 426–434. https://doi.org/10.1097/CHI.0b013e31816429d3

Biederman, J., Petty, C.R., Monuteaux, M.C., Fried, R., Byrne, D., Mirto, T., … & Faraone, S.V. (2010). Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder: 11-year follow-up in a longitudinal case-control study. American Journal of Psychiatry, 167(4), 409–417. https://doi.org/10.1176/appi.ajp.2009.09050736

CHADD. (2023). Symptoms of ADHD in women and girls. CHADD. https://chadd.org/for-adults/symptoms-of-adhd-in-women-and-girls/

Hinshaw, Nguyen, P. T., O’Grady, S. M., & Rosenthal, E. A. (2022). Annual research review: Attention‐deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions. Journal of Child Psychology and Psychiatry, 63(4), 484–496. https://doi.org/10.1111/jcpp.13480

Meyer, Stevenson, J., & Sonuga-Barke, E. J. S. (2020). Sex differences in the meaning of parent and teacher ratings of ADHD behaviors: An observational study. Journal of Attention Disorders, 24(13), 1847–1856. https://doi.org/10.1177/1087054717723988

Sciutto, Nolfi, C. J., & Bluhm, C. (2004). Effects of child gender and symptom type on referrals for ADHD by elementary school teachers. Journal of Emotional and Behavioral Disorders, 12(4), 247–253. https://doi.org/10.1177/10634266040120040501

Skogli, Teicher, M. H., Andersen, P. N., Hovik, K. T., & Øie, M. (2013). ADHD in girls and boys–gender differences in co-existing symptoms and executive function measures. BMC Psychiatry, 13(1), 298–298. https://doi.org/10.1186/1471-244X-13-298

Uchida, Spencer, T. J., Faraone, S. V., & Biederman, J. (2018). Adult outcome of ADHD: An overview of results from the MGH longitudinal family studies of pediatrically and psychiatrically referred youth with and without ADHD of both sexes. Journal of Attention Disorders, 22(6), 523–534. https://doi.org/10.1177/1087054715604360

Young, Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., … & Woodhouse, E. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry, 20(1), 404–404. https://doi.org/10.1186/s12888-020-02707-9

Author: Barbara Ledezma, Undergraduate Student Volunteer

Last edited by: Caden Grandy on February 16, 2026