Why Are Girls With ADHD Flying Under The Radar?

It’s thought 5% of children have attention deficit hyperactivity disorder (ADHD), with boys more likely to receive a diagnosis than girls.

Yet when girls remain undiagnosed, it can harm their mental health and self-esteem.

Girls with undiagnosed ADHD are “more likely to blame themselves, turning their anger and pain inward”, according to the Child Mind Institute, which noted they’re also more likely to experience depression, anxiety and eating disorders than those without ADHD.

Dr Chris Abbott, chief medical officer at Care ADHD, told HuffPost UK his team regularly witnesses how early recognition can be “utterly life-changing” for girls who have ADHD, as “it reduces shame, helps girls understand how their brain works, and unlocks the right support so they can thrive”.

He noted that population research and reviews suggest ADHD is identified more often in boys in childhood at a ratio of 3:1 (males to females), while the ratio appears to even out in adulthood at 1:1, “which is consistent with the notion that many women are diagnosed later in life”.

There are a few key factors coming into play here, which we’ll break down with the help of experts.

A key piece of the puzzle is that many people still associate ADHD with visibly hyperactive children – perhaps they picture someone who is impulsive or disruptive in class, usually a boy.

Dr Mukesh Kripalani, a consultant psychiatrist for The ADHD Centre, told HuffPost UK: “Traditionally, diagnostic patterns show a distinct gender divide in how ADHD symptoms are expressed. Girls tend to demonstrate more inattentive symptoms and internalise their struggles significantly more than boys, who more frequently exhibit the hyperactive and impulsive behaviours that demand immediate attention from parents and teachers.

“Because boys are more likely to become oppositional, they are identified earlier.”

While girls and boys can present with hyperactivity, Dr Abbott noted that “many girls struggle in ways that are easier to overlook – difficulties with attention, organisation, working memory and time, that can look like daydreaming, forgetfulness, or quietly falling behind”.

“They may be seen as ‘coping’ because they’re not causing problems for others, even when the internal effort to keep up is huge,” he added.

Girls are often raised to be kind, obedient and put others’ needs first. Both experts noted the social expectations we place on girls can also factor into them slipping under the radar for diagnosis, quite simply because they learn to keep quiet and carry on.

“Many girls learn to be ‘good’, stay quiet and blend in, so ADHD is more likely to emerge as a hidden struggle: overwhelm, people-pleasing, perfectionism or anxiety, rather than disruption,” said Dr Abbott.

Both experts highlighted masking – where a person might act in a “socially acceptable” way to fit in with their neurotypical peers – as another factor in why girls slip through the diagnosis net.

“Many girls develop sophisticated strategies here: over-preparing, copying more organised peers, people-pleasing, or suppressing restlessness to meet social expectations,” said Dr Abbott.

“That can create an outward appearance of success, but it often comes at a cost: chronic stress, exhaustion, anxiety and low mood.

“Emerging research in early adolescence suggests higher masking is associated with poorer mental health in neurodivergent girls, reinforcing what many of our clinicians hear in consultations.”

Dr Kripalani added “the drive toward masking and conforming is notably higher in girls”. But telltale signs might begin to emerge over time.

“As these children grow older, the elements of Rejection Sensitive Dysphoria (RSD) often become prominent,” he noted.

RSD is where a person might feel strong emotional pain because of a failure or feeling rejected – as such, their reactions to criticism might be very intense.

Alex Partridge, the host of the ADHD Chatter podcast, previously described it as feeling like “a bull has charged at you and headbutted you in the chest”.

“It can be the smallest of criticisms, but my brain turns it into the most heart-wrenching comment ever uttered or heard,” he added.

Dr Abbott noted that girls may first present with anxiety, depression, sleep problems, or emotional dysregulation – yet the possibility of ADHD isn’t always explored, particularly if school reports focus on attainment rather than day-to-day functioning.

“In adult services, it’s not uncommon to meet women who’ve been treated for years for ‘mood’ symptoms without anyone stepping back to ask whether untreated ADHD is a driver,” he added.

Dr Kripalani noted that approximately 75% of the time, ADHD presents alongside at least one other mental health challenge.

Studies also consistently show that teachers tend to underrate symptoms in girls, sometimes misattributing their behaviours to primary anxiety or mood disorders.

“Anxiety remains the most common co-occurring condition, presenting a ‘chicken and egg’ clinical dilemma when trying to determine which is the primary driver,” he added.

Ultimately, better awareness of how girls are impacted – and the signs they might present with – is crucial.

“What would genuinely shift the needle is both practical and achievable: better awareness training in schools and primary care, and clearer SENCO and referral pathways that don’t rely on ‘disruption’ as the signal,” said Dr Abbott.

“It’s important to say this isn’t about blaming parents or schools. Recognition is a shared responsibility across families or carers, schools and the wider system – including the pathways and thresholds that determine who gets referred.”