Although ADHD is diagnosed far more often in boys, research shows that many girls are living with the condition unnoticed. Girls with ADHD often present differently, showing signs such as daydreaming, internal restlessness, or emotional sensitivity rather than the more obvious hyperactive behaviours typically seen in boys. As a result, their symptoms are frequently overlooked by parents, teachers, and even healthcare professionals. This underdiagnosis can have lasting consequences, with girls missing out on the support, understanding, and treatment they need during their school years and into adulthood.
Studies show a striking difference in how ADHD appears in boys compared to girls. In one large study of over 2,300 twins and siblings, Dr Anne Arnett, a clinical child psychologist at the University of Washington, found that the gap in diagnosis rates is partly due to differences in symptom severity. Boys often display more intense and wide-ranging symptoms, making ADHD easier to spot, while girls may show subtler signs that are overlooked. According to Arnett, this reflects a real neurobiological difference between the sexes. Although the exact reason remains unclear, some evidence suggests that girls may have a form of genetic “protective effect,” which can mask the condition until later in life.
Neurobiological differences
Studies show a striking difference in how ADHD appears in boys compared to girls. In one large study of over 2,300 twins and siblings, Dr Anne Arnett, a clinical child psychologist at the University of Washington, found that the gap in diagnosis rates is partly due to differences in symptom severity. Boys often display more intense and wide-ranging symptoms, making ADHD easier to spot, while girls may show subtler signs that are overlooked. According to Arnett, this reflects a real neurobiological difference between the sexes. Although the exact reason remains unclear, some evidence suggests that girls may have a form of genetic “protective effect,” which can mask the condition until later in life.
Recent neurobiological research underscores that ADHD manifests differently in boys and girls, rooted in distinct brain development patterns. Functional MRI studies reveal sex-related disparities in brain connectivity: for instance, males with ADHD show reduced functional connectivity between the external globus pallidus and regions such as the frontal pole, whereas females often present with more subtle but widespread executive function impairments (Frontiers in Psychiatry, 2022). Other studies suggest that girls demonstrate earlier maturation in frontal–striatal and cerebellar systems, which may mask hyperactive symptoms but lead to difficulties with working memory and emotional regulation (PMC, 2013).
At The Doctor Clinics in Manchester, our private ADHD assessments are designed with these neurobiological differences in mind. We don’t rely solely on traditional, behaviour-focused screening tools that often miss the female presentation of ADHD. Instead, we take a comprehensive, lifespan approach—considering both cognitive and emotional patterns, as well as the subtle ways ADHD presents in girls and women. This ensures that patients receive an accurate diagnosis and an individualised treatment plan that reflects the latest scientific evidence.
The exact size of the gender gap in ADHD remains uncertain. In clinical practice, boys are diagnosed far more frequently than girls. Yet when researchers look at population studies—assessing who actually meets the criteria for ADHD—the difference is smaller, though boys still outnumber girls. Depending on the study, the ratio of boys to girls with ADHD ranges anywhere from 2:1 to 10:1.
This suggests that many more girls may be affected than official diagnoses show. As Florence Mowlem, associate at healthcare consultancy Aquarius Population Health, explains: “For some reason that we don’t fully understand, girls aren’t receiving clinical diagnoses as often as boys.” Research also indicates that girls often need to present with more severe or outwardly obvious symptoms before their ADHD is recognised. In one study of 283 children aged 7–12, Mowlem and colleagues found that both boys and girls who were diagnosed had more extreme symptoms than those who displayed ADHD traits but did not meet the diagnostic threshold.
Dr Nash, who works as a Consultant Psychiatrist on a part-time basis for The Doctor Clinics, often refers to a paper published in BMC Psychiatry titled “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” which demonstrates numerous causes on why ADHD os frequently under diagnosed in females.
Different Behaviours
The study found that Teenage girls with ADHD do experience more behavioural and oppositional problems than their peers, but these often look different from the difficulties seen in boys. While boys are more likely to display overt aggression or disruptive outbursts, girls’ behaviours are often socially driven. This can include being spiteful, manipulative, verbally threatening, or lashing out within friendships. One reason for this difference is that girls tend to channel their hyperactivity and impulsivity into social relationships rather than external aggression.
Because of this, their challenges may go unnoticed or be misinterpreted as “bad attitude” rather than symptoms of ADHD. Unfortunately, these patterns can still lead to detentions, suspensions, or exclusions from school. Interventions that focus on social and emotional skills are therefore crucial—helping girls learn to regulate emotions, build confidence, and manage the complex peer dynamics of adolescence.
Discussion
For more than 30 years, experts have warned that girls with ADHD represent a “silent minority.” Unlike boys, who often show more disruptive behaviour, girls are more likely to display internalised symptoms such as inattentiveness or emotional sensitivity. This makes them less likely to be referred for assessment, leaving many without a diagnosis or treatment.
“Girls are much less likely to be disruptive in the classroom by running around, arguing with teachers, or clashing with classmates,” explains Helen Read, Consultant Psychiatrist and ADHD lead at a large London NHS Trust. “If a girl did behave that way, the social criticism from peers and adults would be so strong that it becomes far harder for girls to express their hyperactivity in that form.”
Instead, when hyperactive, girls may be more inclined to talk excessively, appear rebellious, or be seen as a “wild child.” These behaviours, however, are not always recognised by parents or teachers as potential signs of ADHD.
Several barriers contribute to this under-recognition, including gender stereotypes, comorbid mental health conditions, and girls’ ability to mask symptoms. ADHD in girls is still widely misunderstood, with public perception focusing on hyperactive boys rather than the more subtle ways it presents in females. Even when hyperactivity is present in girls, it tends to manifest in social or relational difficulties rather than overt aggression.
Unrecognised ADHD can have serious consequences for women and girls, including difficulties in relationships, risky sexual behaviours, higher rates of self-harm and substance use, and reduced educational or career opportunities. Girls with ADHD are also at greater risk of victimisation and unhealthy relationships, further compounding their challenges.
Treatment can reduce these risks, but research suggests that girls and women may benefit from closer monitoring, tailored psychoeducation, and support during key life transitions such as puberty, pregnancy, and menopause. Experts also highlight the need for wider training across schools, healthcare, and social services to improve recognition and reduce stigma.
Finally, there is a call for more research into ADHD in females, including how hormonal changes interact with symptoms, and for studies to separate data by gender. Better awareness, research, and tailored care are essential to improve long-term outcomes for women and girls living with
Summary
The consensus highlights the need to move beyond the outdated stereotype of ADHD as a “disruptive boy’s disorder” and recognise the more subtle, internalised symptoms often seen in girls and women. Effective care should follow a lifespan approach, adapting to the complex and changing ways ADHD presents at different stages of life. With the right support and treatment, outcomes can be significantly improved—not only for girls and women with ADHD, but also for their families and wider society, through better wellbeing, increased productivity, and reduced strain on services.
