How ADHD Presents Differently in Girls and Women

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

Last Update: May 12th, 2025 | Estimated Read Time: 7 min

Introduction: Rethinking the ADHD Stereotype

Historically, the predominant image of Attention-Deficit/Hyperactivity Disorder (ADHD) has centred around young males demonstrating disruptive, hyperactive behaviour in classroom settings. This portrayal has significantly influenced both diagnostic practices and public understanding, resulting in an underdiagnosis and underrecognition of ADHD in females.

Girls and women are frequently overlooked due to a tendency to exhibit less overt symptoms, instead internalizing their difficulties. These differences in symptom expression are not merely anecdotal; they are supported by decades of emerging research indicating that ADHD presents differently across genders, particularly in terms of behavioural patterns, emotional regulation, and psychosocial impact.

The Inattentive Subtype and Internalized Distress

Females with ADHD are more likely to meet criteria for the inattentive presentation, characterized by distractibility, forgetfulness, disorganization, and difficulty sustaining attention. These manifestations, while impairing, are less disruptive in structured environments and may be mistakenly attributed to personality traits such as laziness, lack of motivation, or emotional sensitivity.

Moreover, girls and women with ADHD are prone to internalizing symptoms. They may experience chronic feelings of inadequacy, anxiety, and low self-worth as a result of repeated failures to meet expectations. The process of masking, consciously or unconsciously suppressing ADHD traits to conform to social norms, can be psychologically exhausting and significantly delay diagnosis. Research has shown that women with ADHD are more likely to receive diagnoses for mood and anxiety disorders prior to, or in place of, ADHD (Quinn & Madhoo, 2014).

Neuroscientific Insight: Functional neuroimaging studies have demonstrated altered activity in the prefrontal cortex and basal ganglia of individuals with ADHD, areas associated with executive functioning and impulse control. These neurodevelopmental variances affect males and females differently, contributing to the diversity in symptom profiles.

Developmental Considerations: Childhood Through Adolescence

In early childhood and primary education settings, girls with ADHD may appear shy, disengaged, or overly chatty. Unlike boys, whose hyperactivity often leads to disciplinary referrals, girls may quietly struggle with focus, task initiation, and organization. As such, their needs may go unmet, and their difficulties may be minimized or attributed to temperament.

During adolescence, increased academic demands and shifting social expectations can exacerbate symptoms. The hormonal fluctuations of puberty, particularly changes in oestrogen levels, have been shown to influence dopamine transmission, a neurotransmitter integral to attention regulation. These physiological changes may amplify existing difficulties with emotional regulation, impulse control, and cognitive endurance (Rucklidge, 2010).

Clinical note: Adolescents with undiagnosed ADHD are at elevated risk for developing comorbid conditions, including generalized anxiety disorder, major depressive disorder, and disordered eating. The emotional toll of perceived underachievement and chronic overwhelm often manifests in maladaptive coping strategies such as perfectionism, avoidance, or self-silencing.

Adulthood and the Hidden Burden

In adulthood, the impact of ADHD can extend across occupational, relational, and intrapersonal domains. Women may find themselves struggling to manage household responsibilities, career expectations, and caregiving roles, all while coping with persistent executive dysfunction. Common adult presentations include:

• Chronic disorganization and forgetfulness
  
  
• Difficulties with time management and prioritization
  
  
• Impulsivity in speech, spending, or decision-making
  
  
• Heightened emotional reactivity
  
  
• Feelings of guilt and perceived inadequacy

Notably, many women are only diagnosed after their child receives an ADHD diagnosis, prompting reflection on their own lifelong struggles. This revelation often brings relief, but also grief for the years spent mislabelled or misunderstood. Longitudinal studies highlight the substantial psychosocial burden of undiagnosed ADHD in women, including increased rates of relationship instability, lower academic attainment, and elevated risk of substance use disorders (Hinshaw et al., 2021).

Pathways to Support and Identification

1. Gender-Informed Assessment Tools

Traditional diagnostic criteria, based on male presentations, may fail to capture the nuanced experience of females with ADHD. Clinicians are encouraged to adopt gender-informed screening instruments that account for internalized symptoms and social masking.

2. Comprehensive, Multi-Modal Treatment Plans

Evidence supports the use of integrated treatment approaches for females with ADHD, including pharmacotherapy, cognitive-behavioural therapy (CBT), and ADHD coaching. These interventions are most effective when tailored to address both executive function challenges and the emotional sequelae of chronic self-doubt (Safren et al., 2005).

3. Psychoeducation and Strength-Based Interventions

Educational resources that frame ADHD through a neurodiversity lens can empower girls and women to reframe their struggles not as moral failings but as neurological differences. Strength-based approaches promote resilience, self-advocacy, and adaptive coping strategies.

Conclusion: Recognizing the Full Spectrum of ADHD

ADHD in girls and women is not rare, but it is frequently misrecognized. The prevailing diagnostic frameworks must evolve to encompass the full range of symptom expressions, including internalizing behaviours and social-emotional distress. By increasing awareness among clinicians, educators, and caregivers, we can bridge the gender gap in ADHD identification and ensure more equitable access to care.

Timely, gender-sensitive interventions not only improve functional outcomes but also affirm the lived experiences of those whose struggles have been invalidated for far too long.

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

Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., Schrodek, E., & Swanson, E. N. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of consulting and clinical psychology, 80(6), 1041–1051. Link  

Quinn, P. O., & Madhoo, M. (2014). A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls. The Primary Care Companion for CNS Disorders, 16(3). Link  

Rucklidge, J. J. (2010). Gender differences in Attention-Deficit/Hyperactivity Disorder. Psychiatric Clinics of North America, 33(2), 357–373. Link  

Safren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L., Groves, M., & Otto, M. W. (2005). Cognitive behavioural therapy for ADHD in medication-treated adults with continued symptoms. Behaviour Research and Therapy, 43(7), 831–842. Link