ADHD in Girls vs Boys: Why Gender Makes a Difference in Diagnosis and Treatment

A-depiction-of-a-young-boy-and-girl-illustrating-ADHD-symptom-differences

ADHD in girls vs boys is often misunderstood, shaped more by stereotypes than science. When we think of ADHD, we often picture a boy bouncing off the walls or interrupting his teacher — but that misses how ADHD shows up in girls. I was one of those quiet, “well-behaved” girls struggling with focus, scattered thoughts, and emotional overwhelm, only to be diagnosed years later. And let’s not forget those who don’t fit the binary at all. ADHD doesn’t care about gender — but our diagnostic systems often do. In this article, we’ll explore how gender affects both the recognition and treatment of ADHD.

Understanding ADHD in Girls vs Boys: Why Gender Shapes Symptoms

ADHD is a neurodevelopmental condition affecting inattention, hyperactivity, and impulsivity. While these traits sound universal, they often wear different disguises depending on the individual. Boys might be the “class clown” disrupting lessons, while girls are more likely to be the “daydreamer” lost in thought. Both are struggling, but only one might get noticed—and it’s not the quiet one doodling unicorns in her notebook.

Take my own experience, for example. Teachers always praised how “polite” and “mature” I was, while inside my brain was like a squirrel running on 12 different wheels. Let’s just say, maturity doesn’t help you find your math homework.

ADHD in Girls vs Boys: Different Presentations, Same Struggles

What ADHD Looks Like in Boys: The Classic Profile

Boys are often diagnosed earlier than girls, with symptoms that are, frankly, harder to miss. Hyperactivity and impulsivity—hallmarks of ADHD—frequently appear in boys as high-energy behaviour. They might climb on furniture, shout out answers, or test every boundary you never knew existed.

As one parent I worked with put it, “My son’s teacher knew his name by day two. He wasn’t the kind of kid you forgot!” And she wasn’t wrong—research shows that boys are diagnosed with ADHD at a rate nearly double that of girls (CDC, 2022).

ADHD in Girls: The Invisible Struggle

Girls, on the other hand, often show their ADHD through inattentiveness, emotional sensitivity, and internalised struggles. They’re more likely to be labelled as “shy,” “lazy,” or “spacey” rather than disruptive. Their symptoms may include:

Difficulty staying focused on tasks they don’t find engaging.
Tendency to daydream or “zone out.”
High emotional sensitivity, leading to frequent tears or frustration.

One mom once shared, “My daughter would spend hours working on an art project but couldn’t finish her math homework. Her teacher thought she was ‘just being difficult.’” Sound familiar? I’ve heard this story so many times I’ve started calling it the “ADHD art kid” phenomenon.

Key Differences

Studies have shown that girls with ADHD are more likely to experience comorbid conditions such as anxiety and depression, which can further complicate their diagnosis and treatment (Journal Watch, 2016).

Why Girls Are More Difficult to Diagnose

Societal Stereotypes

Let’s face it: society expects girls to be “good”—quiet, organised, and obedient. When a girl struggles to meet these expectations, it’s often chalked up to personality flaws rather than a neurological difference.

For example, research highlights that societal biases and stereotypes significantly contribute to the underdiagnosis of ADHD in girls (Sustainability, 2021).

As one frustrated dad said, “If my daughter had been loud and running around, she might have been diagnosed years ago. Instead, we were told she just needed to ‘try harder.’” Honestly, if “try harder” worked, I’d have a gold medal in focusing by now.

Masking Behaviours

Girls with ADHD often become experts at masking their symptoms. They work overtime to stay under the radar, mimicking peers or overcompensating in ways that exhaust them. This can delay diagnosis and lead to burnout.

One teen I coached described it perfectly: “It’s like I’m juggling flaming swords, and everyone just thinks I’m really into circus tricks.” My own daughter was the same way. To others, she seemed cheeky, charming, energetic, and confident or sometimes, just rude. It was hard to even start explaining that she was actually finding many things hard. Only as she approached puberty did her struggles become more apparent to others, as masking became harder for her to maintain.

Bias in Diagnostic Criteria

ADHD diagnostic criteria were initially developed based on studies of…you guessed it, boys! As a result, the subtle ways ADHD presents in girls often don’t make the cut. It’s like trying to use one-size-fits-all leggings—someone always gets left out.

Recognising ADHD in Gender-Diverse and Non-Binary Individuals

ADHD doesn’t care about societal norms, but unfortunately, diagnostic tools often do. For non-binary and gender-diverse individuals, symptoms might not align with traditional gendered expectations, leading to further underdiagnosis. This challenge can stem from the rigid frameworks used in diagnostic criteria, which often fail to account for diverse expressions of ADHD. As a result, many gender-diverse individuals may feel overlooked or misunderstood, adding to the stress of navigating a world that often doesn’t see or validate their struggles. Inclusive diagnostic practices are crucial to ensuring these individuals receive the recognition and support they need.

Diagnosis and Treatment Strategies Across Genders

Improving Diagnostic Practices

Awareness: Parents, teachers, and healthcare providers need training to recognise ADHD symptoms beyond stereotypes.
Updated Tools: Advocate for diagnostic criteria that reflect diverse presentations of ADHD.

Tailoring Treatment Plans

Treatment isn’t one-size-fits-all. Girls may need support managing emotional regulation, while boys might benefit from strategies to channel hyperactivity. This difference, however, is not a universal norm. Just because a child treated is a boy doesn’t mean the focus should solely be on hyperactivity. Treatment must always consider how symptoms manifest, with gender differences taken into account to ensure a tailored and effective approach.

Role of Parents and Educators

Parents can’t diagnose ADHD, but they can be fierce advocates. Encourage open conversations, provide structure at home, and seek professional guidance when needed. One mom I worked with said, “Once I stopped seeing my son’s behaviour as ‘bad’ and started seeing it as ADHD, everything changed. We finally became a team.”

Awareness of the differences in how ADHD symptoms manifest in girls is critical. Late diagnoses often mean girls grow up without understanding why they struggle. This can lead to a cascade of mental health challenges, such as anxiety and depression, as well as low self-esteem from years of being told they just need to “try harder.” As one teacher I worked with put it, “By the time we realised it wasn’t laziness, she’d already decided she was just bad at everything.” These feelings are harder to undo as they grow older, making early recognition vital.

Conclusion

ADHD doesn’t look the same for everyone, and it’s time we stopped expecting it to. Boys, girls, and non-binary individuals all deserve understanding, accurate diagnoses, and effective treatment.