Gender Differences in ADHD Subtypes

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

Last Update: September 17th, 2025, Estimated Read Time: 8 min

Why Gender Matters in ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most studied neurodevelopmental conditions, yet its presentation across genders has historically been misunderstood. For decades, ADHD was primarily associated with hyperactive boys, which shaped both diagnostic criteria and cultural perceptions. This bias meant that girls and women with ADHD, who often present with inattentive symptoms, were overlooked or diagnosed later in life.

Today, research demonstrates clear gender differences in ADHD subtypes, symptom expression, and outcomes (Gershon & Gershon, 2002). Understanding these differences is critical for accurate diagnosis, tailored treatment, and reducing stigma.

ADHD Subtypes: A Quick Overview

According to the DSM-5, ADHD is categorized into three subtypes, also called presentations:

• Predominantly Inattentive: Challenges with focus, organization, forgetfulness, and sustaining attention.
  
  
• Predominantly Hyperactive-Impulsive: Restlessness, difficulty waiting, impulsive actions, and excessive energy.
  
  
• Combined Presentation: A mix of inattentive and hyperactive-impulsive symptoms.

While these categories apply across genders, the way symptoms manifest often differs between males and females, influencing who gets diagnosed and when.

Gender Differences in Diagnosis

Historically, boys have been diagnosed with ADHD at much higher rates than girls, with ratios reported as high as 3:1 in childhood populations (Willcutt, 2012). However, this gap narrows in adulthood, suggesting that girls with ADHD were often missed early on and diagnosed later in life (Quinn & Madhoo, 2014).

One explanation is that boys are more likely to display overt hyperactive-impulsive behaviours, such as fidgeting, interrupting, or disruptive classroom behaviour, that draw adult attention. Girls, on the other hand, are more likely to exhibit inattentive symptoms such as daydreaming, disorganization, or difficulty completing assignments, which can be misinterpreted as shyness or laziness.

This diagnostic bias means many girls with ADHD grow up without recognition or support, leading to academic, emotional, and social consequences that persist into adulthood.

Symptom Differences Across Subtypes

Inattentive Presentation

Girls and women are more frequently diagnosed with the inattentive subtype. Symptoms may include difficulty sustaining focus, frequent forgetfulness, and challenges with organization. While less disruptive than hyperactivity, these symptoms still undermine academic and occupational success.

Hyperactive-Impulsive Presentation

Boys are more likely to present with hyperactive-impulsive behaviours. In childhood, this can manifest as difficulty sitting still, frequent interruptions, or impulsive risk-taking. However, research shows that hyperactivity tends to decline with age for both genders, often evolving into restlessness or impatience in adulthood (Barkley, Murphy, & Fischer, 2008).

Combined Presentation

The combined subtype is common in both genders, but girls with combined ADHD are often identified later, as inattentive symptoms may overshadow impulsive ones. By adulthood, combined ADHD is one of the most impairing presentations, contributing to difficulties in work, relationships, and emotional health.

The Impact of Gendered Expectations

Cultural and gendered expectations play a role in how ADHD is perceived. Boys are often expected to be energetic and assertive, which may normalize hyperactivity. Girls, however, may feel pressured to be quiet, organized, and compliant. As a result, when girls struggle, they may internalize symptoms, leading to higher rates of anxiety and depression (Quinn & Madhoo, 2014).

These expectations also influence how teachers, parents, and clinicians interpret behaviour. A distracted boy may be flagged for ADHD testing, while a distracted girl may be encouraged simply to “try harder.”

Consequences of Misdiagnosis and Delay

Delayed or missed diagnosis has significant implications:

• Academic difficulties: Inattentive symptoms can undermine school performance, often mistaken for lack of effort.
  
  
• Emotional toll: Internalizing struggles leads to low self-esteem and higher risk of mood disorders.
  
  
• Social challenges: Peer rejection or difficulty forming friendships may occur when symptoms are misunderstood.
  
  
• Delayed treatment: Without recognition, girls and women often miss out on early interventions that could improve outcomes.

Research shows that adult women with ADHD often report decades of confusion before receiving a diagnosis, which can affect their careers, relationships, and mental health (Quinn & Madhoo, 2014).

Strengths Across Subtypes and Genders

While ADHD presents challenges, both men and women with ADHD also exhibit strengths.

• Inattentive type: Strong listening skills, creativity, and sensitivity to detail.
  
  
• Hyperactive-Impulsive type: Enthusiasm, quick thinking, and energy for active pursuits.
  
  
• Combined type: Adaptability and resilience developed from navigating complex challenges.

Recognizing these strengths helps reframe ADHD not as a deficit but as a unique profile with both challenges and advantages.

Moving Toward Gender-Inclusive Care

To better support individuals with ADHD, clinicians and communities must:

1. Increase awareness of gender differences so inattentive symptoms are not overlooked.
   
   
2. Screen broadly in schools and clinics to capture both disruptive and subtle presentations.
   
   
3. Tailor interventions by gender and subtype, recognizing that emotional regulation may be a larger focus for women.
   
   
4. Encourage self-advocacy for those diagnosed later in life, empowering individuals to seek accommodations and strategies.

Final Thoughts

Gender differences in ADHD subtypes highlight the importance of looking beyond stereotypes. While boys often display hyperactive-impulsive symptoms that attract attention, girls may quietly struggle with inattentiveness, leading to delayed diagnosis and unmet needs.

Understanding these differences fosters more accurate assessment, timely support, and compassion. Regardless of gender or subtype, every individual with ADHD deserves recognition of both challenges and strengths.

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

Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. New York: Guilford Press. Link

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

Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: Uncovering this hidden diagnosis. The Primary Care Companion for CNS Disorders, 16(3). Link

Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics, 9(3), 490–499. Link