Emotional vs. Behavioural Symptoms in Males and Females

Discover tips, treatment options, and support strategies from the Finding Focus Care Team

Last Update: June 2nd, 2025 | Estimated Read Time: 6 min    

Understanding the Gender Divide in ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) does not manifest uniformly across individuals, and gender-based differences in symptom presentation are well-documented. While males are more frequently diagnosed during childhood, emerging evidence indicates that females are often underdiagnosed or misdiagnosed due to differences in symptom expression. Specifically, distinctions between emotional and behavioural symptoms offer a critical lens through which to understand these disparities.

Identifying these gendered patterns contributes to more accurate diagnoses and facilitates the development of targeted support strategies. Whether for parents, educators, clinicians, or individuals navigating their own experiences, understanding how ADHD presents differently by gender is essential for comprehensive care.

Behavioural Symptoms: Externalizing Patterns Predominantly Observed in Males

Historically, ADHD has been associated with externalizing behaviours such as hyperactivity, impulsivity, and oppositionality. These traits are more frequently observed in males and tend to be disruptive in structured settings such as classrooms, leading to earlier and more frequent referrals for assessment.

Males with ADHD are more likely to exhibit:

• Physical hyperactivity (e.g., excessive movement, difficulty remaining seated)
• Verbal impulsivity (e.g., interrupting, difficulty waiting turns)
• Defiant or oppositional behaviour
• Aggressive outbursts

These overt behaviours increase the likelihood of detection and diagnosis. According to Rucklidge (2010), the diagnostic ratio of males to females with ADHD is nearly 2:1, primarily due to the visibility of externalizing symptoms.

Emotional Symptoms: Internalizing Patterns More Common in Females

In contrast, females with ADHD are more likely to experience internalizing symptoms, which are less disruptive and therefore more easily overlooked. These symptoms are frequently misattributed to anxiety, depression, or personality characteristics rather than recognized as manifestations of ADHD.

Common emotional symptoms in females include:

• Persistent feelings of overwhelm and emotional sensitivity
• High levels of anxiety and perfectionistic tendencies
• Chronic low self-esteem and self-criticism
• Social withdrawal and excessive concern with peer approval
• Mood instability and internal restlessness

Research suggests that emotional dysregulation is a prominent feature of ADHD in females and may contribute significantly to functional impairment (Gershon, 2002).

Underlying Causes: Biological and Sociocultural Influences

The divergence in symptom presentation is influenced by both neurobiological and social factors. Neuroimaging studies reveal that females with ADHD may exhibit more subtle deficits in executive functioning rather than overt hyperactivity (Mahone & Wodka, 2008). These findings highlight the role of differential brain development and function in shaping behavioural outcomes.

Sociocultural expectations further compound these differences. From an early age, girls are often socialized to be compliant and emotionally restrained, leading them to internalize their distress. This can result in:

• Masking of symptoms to maintain social acceptance
• Increased feelings of inadequacy and guilt
• Lower likelihood of being referred for diagnostic evaluation

Consequently, many females with ADHD do not receive a diagnosis until adolescence or adulthood, often after experiencing academic or emotional difficulties.

Consequences of Missed Diagnosis

Delayed or missed diagnosis of ADHD, particularly in females, can lead to a range of negative outcomes. Many women report a persistent sense of failure despite considerable effort, which may precipitate co-occurring conditions such as anxiety, depression, eating disorders, and self-harming behaviours.

A longitudinal study conducted by Hinshaw et al. (2022) demonstrated that females with ADHD are at significantly increased risk for academic underachievement, interpersonal difficulties, and mental health challenges in early adulthood. Timely recognition and intervention are essential in mitigating these long-term effects.

Real-World Symptom Expression

Understanding how ADHD may appear in daily life can enhance early recognition and validation of individuals' experiences.

In females:

• Excessive time spent on simple tasks due to overthinking
• Frequent self-blame or apologizing for forgetfulness
• Emotional exhaustion from sustained masking or people-pleasing
• Heightened emotional reactivity to minor setbacks
• Academic success in highly structured environments followed by difficulties in unstructured settings

In males:

• Impulsive speech followed by regret
• Repeated disciplinary action for rule-breaking or disruptions
• Persistent physical restlessness
• Misperceptions of laziness or lack of effort despite intentions to perform well

Recognizing these patterns may assist individuals and families in seeking timely and appropriate support.

Strategies for Support and Advocacy

Awareness is the cornerstone of effective support. The following strategies, grounded in psychological research and clinical best practices, can aid in managing both emotional and behavioural symptoms of ADHD:

1. Monitor Emotional Triggers‍

Maintain a record of contexts in which emotional dysregulation occurs. Identifying patterns facilitates the development of targeted coping strategies.

2. Validate Emotional Experiences‍

Acknowledging emotional responses without judgement promotes self-understanding and reduces shame.

3. Apply Cognitive Restructuring‍

Cognitive Behavioural Therapy (CBT) techniques can help reframe maladaptive thoughts and improve emotional resilience (Safren et al., 2005).

4. Encourage Physical Activity‍

Engaging in regular movement supports emotional regulation and can reduce hyperactive behaviours.

5. Seek Comprehensive Evaluation‍

A thorough ADHD assessment should consider both emotional and behavioural dimensions and include self-reports, observer ratings, and clinical interviews.

6. Engage with Peer Support‍

Connection with others who share similar experiences can foster validation and empowerment.

Conclusion: Advancing Gender-Inclusive ADHD Care

ADHD is a multifaceted condition that presents differently across genders. By acknowledging the prominence of emotional symptoms in females and behavioural symptoms in males, professionals and support networks can provide more accurate and compassionate care. Enhancing our understanding of these gender-based differences is essential for reducing diagnostic disparities and promoting positive outcomes.

Finding Focus Care Team

We are a group of nurse practitioners, continuous care specialists, creators, and writers, all committed to excellence in patient care and expertise in ADHD. We share content that illuminates aspects of ADHD and broader health care topics. Each article is medically verified and approved by the Finding Focus Care Team. You can contact us at Finding Focus Support if you have any questions!  

References

Gershon, J. (2002). A meta-analytic review of gender differences in ADHD. Journal of Attention Disorders, 5(3), 143–154. Link  

Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., & Arnold, L. E. (2022). Prospective follow-up of girls with ADHD into early adulthood: Continuing impairment includes elevated risk for suicide. Journal of Consulting and Clinical Psychology, 90(2), 100–115. Link

Mahone, E. M., & Wodka, E. L. (2008). The neurobiological profile of girls with ADHD. Developmental Disabilities Research Reviews, 14(4), 276–284. Link

Rucklidge, J. J. (2010). Gender differences in attention-deficit/hyperactivity disorder. Psychiatric Clinics of North America, 33(2), 357–373. Link