Lived Experiences: How to Recognize ADHD in Girls and Women

The girl who daydreams. The one who can’t find her keys or her homework or her phone. The one who totals her car every 2 years. The one who burns through friends because she blurts out secrets and shows all the feelings. These people aren’t simply stereotypes. They could be girls and women with attention-deficit/hyperactivity disorder (ADHD)—flying under the diagnostic radar.   

Why ADHD in Girls and Women May Go Undiagnosed 

ADHD is complex, and its core symptoms are expressed in individual patterns. Here’s a brief look at why those patterns may be harder to recognize in women and girls.   

ADHD in Girls and Women Is Understudied 

For many years, including the years when diagnostic criteria were initially developed, what researchers knew about ADHD was based on studies involving boys, most of whom were White. Studies often involved populations already diagnosed with ADHD. Since so many more boys had been diagnosed, researchers were seeing how boys experienced the condition.  

More and more researchers are studying the symptoms and effects of ADHD in girls and women today. That means we are getting a clearer picture of what ADHD looks like across different populations. 

ADHD Symptoms Can Present Differently in Girls and Women  

Numerous studies have confirmed that girls and women are more likely to experience inattention than hyperactivity/impulsivity. Inattention may not be disruptive enough to prompt a referral for evaluation. In one recent study involving teachers in New South Wales, teachers had generally positive views of students with ADHD but found externalizing behaviors “irritating” (Mulholland et al., 2023).  

“Generally, if girls are hyperactive, they might not necessarily be tumbling around the room or fighting,” Dr. Rupert points out. “Impulsivity might show up as answering a question the teacher asked without raising their hand, or talking out of turn, or being impatient. These are not things that are going to get them sent to the office.” 

Symptoms like these can look like personality differences. For Black and Brown girls, symptoms are often misinterpreted as loudness, defiance, or a behavior disorder (Fadus et al., 2020).  

“When Black and Brown girls are having issues in school, people might think, ‘Oh, they’re from a broken home,’ or ‘Their parents don’t care about their grades,’” Dr. Rupert says. Assumptions and biases like these can lead to inequities in diagnosis. “Students may be seen for behavior issues, but people may not be looking for the reason behind the behavior,” she explains.  

How to Build Your Ability to Spot ADHD in Girls and Women   

As more research becomes available, practitioners are getting better at detecting the signs in girls and women. Here are a few expert recommendations to help sharpen your symptom-spotting skills. 

Look closely for clues in academic performance.   

Students with ADHD can have lower scores on reading and math achievement tests, lower overall grades, and higher chances of being placed in special education classes (Jangmo et al., 2020). Yet ADHD has a normal distribution pattern across a range of intellectual abilities.   

Fabio et al. (2022) think ADHD can affect learning in these ways: 

• Difficulties with self-control and inattention may keep students from building learning skills. 
• ADHD symptoms may interfere with a student’s ability to apply what they’ve learned. 
• ADHD symptoms may prevent students from using efficient test-taking skills.  

Executive function skills or even handwriting could be clues that ADHD is behind academic inconsistency (Eng et al., 2023).  

“I would get papers returned to me ungraded because a teacher couldn’t read my handwriting,” Dr. Rupert recalls. “Even when I had an A or B on a test, when I’d go back through and read the questions, I’d see that I missed questions I absolutely knew the answers to—but I hadn’t finished reading the question. So I would have had a higher grade had I been able to focus and pay attention.” 

Watch for changes during life transitions.    

ADHD symptoms don’t remain steady over the course of a lifetime. Many girls experience a big surge in symptoms as they enter adolescence.  

Learn more about ADHD symptoms across the lifespan. 

For some, the increase in symptoms comes at a time when supports are being withdrawn at school and at home. Families and educators encourage students to take more responsibility for their learning and behavior—just as girls are experiencing more symptoms. The result can be overwhelming.   

“A lot of times, girls and women can compensate until high school or college, when they’re having to juggle multiple classes,”  Dr. Rupert notes. “Some can compensate until they have to manage people other than themselves—for example, when they become a manager at work or become a parent.” 

Studies have shown that hormonal changes in puberty, pregnancy, and menopause can also worsen ADHD symptoms (Antoniou et al., 2021).  

Explore family and developmental histories.    

There’s a strong genetic component to ADHD. For that reason, experts recommend talking to caregivers and parents about anyone else in the family who experienced similar symptoms, even if they were never diagnosed with ADHD.  

It’s also important to look at when each type of symptom appeared. Were earlier symptoms there but overlooked? Have there been periods when symptoms worsened or seemed to improve? What other interventions have been tried? What were the outcomes? 

Knowing the answers to questions like these can help you plan more effectively for the girl or woman in your care (Murray et al., 2019). 

Consider the possibility of co-occurring conditions.    

“It’s rare that I work with a student who only has ADHD,” Dr. Rupert says. Some students may be contending with multiple conditions at the same time. According to Jogia et al. (2022), ADHD can overlap or co-occur with 

• autism 
• dyslexia and other learning disabilities 
• depression 
• anxiety 
• oppositional defiant disorder 
• epilepsy 
• sleep disturbance 
• developmental language disorder 
• motor disorder 
• intellectual disability 
• obsessive compulsive disorder 
• tic disorder   

It’s important to know that many girls are initially diagnosed with depression or anxiety before receiving an ADHD diagnosis later (Young et al., 2020). It’s also a good idea to ask whether another condition could be causing ADHD-like symptoms. Sleep disturbance, for example, can worsen executive-function difficulties.  

Ask questions that match the individual’s stage of life.      

ADHD symptoms can change as people mature. Dr. Rupert advises practitioners to adapt diagnostic questions to the individual. “The diagnostic criteria in the DSM-5 are written for kids, but we’re not going to ask an adult about their school assignments. We can ask about their job reviews at work, or whether they’re changing jobs often.” 

You might ask if a teenager loses their phone a lot. What does a bookbag, a locker, or a purse look like? What are the person’s driving habits?  

“If they’re not always looking for things, is it because they’ve compensated and come up with systems, finally, after years?” she asks. “Are systems there because the individual has such a problem with organization that they have to overdo it in order to be on time or know where things are? It’s important to ask those questions across the lifespan.” 

Consider how personal identities and experiences shape the process.  

Understanding how families and caregivers perceive ADHD and the diagnostic process can enable you to communicate in a helpful way. Not all families have the same expectations for children’s behavior. Some families may be sensitive to the stigma around ADHD. And some families have a skeptical view of psychological and medical processes.   

“Many families in communities of color have a valid distrust of medicine because of the horrific history of experiments on Black, indigenous, and Latino people,” Dr. Rupert says. “And psychiatry has a similar history with disabled and neurodiverse communities. For that reason, you may have parents who are concerned that their child is going to be ‘drugged up’ or labeled. There is a basis for those concerns.” 

Dr. Rupert recommends taking plenty of time to educate families. It can also help when families are able to work with practitioners who understand or share their backgrounds. 

Key Messages   

“Undiagnosed ADHD can cause so much stress and trauma,” Dr. Rupert notes. Girls and women with untreated ADHD are more likely to develop unhealthy substance use patterns, to have an unplanned pregnancy, and to have serious self-esteem problems (Young et al., 2020).  

More research and greater diagnostic accuracy are needed where girls and women are concerned. Still, Dr. Rupert is optimistic. When people have access to treatment, including medication, outcomes improve.   

“We need to use every tool we have available to us,” she says. “If medications are needed, we need to use them. But we also work on other skills—time management skills, interpersonal relationship skills, communication skills. Learning those skills, along with medication, is life changing.” 

Dr. Rupert says one of the most satisfying parts of being a psychiatrist is “seeing the trajectory of a kid’s life completely change.”  

“They’re doing great at school. They’re doing great at home. And it’s amazing to be part of that.” 

WPS Assessment Consultants can speak with you about assessments you can use in a comprehensive ADHD evaluation, such as:

• Conners 4th Edition (Conners 4™)
• Behavior Rating Inventory of Executive Function (BRIEF-2)
• Revised Children's Manifest Anxiety Scale, Second Edition (RCMAS™-2)
• Children’s Depression Inventory, Second Edition (CDI 2). 

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