Why it's Hard to Recognize ADHD in Girls

Do you believe your child might be showing symptoms of ADHD? When ADHD presents with the symptoms of hyperactivity and impulsivity, it can be disruptive and loud. These disruptions can be incredibly frustrating—for parents, teachers, other students, and the child themselves. The louder and more disruptive aspects of ADHD make it easier to identify at a younger age as the frequent disruptions draw attention to the challenging behaviors. It’s when the challenges with attention are presented quietly that they can be easier to miss. 

While both the hyperactive/impulsive and inattentive aspects of ADHD can present in both males and females, it is more common for females to present with inattentive ADHD, and with symptoms that are attributed to gender, other concerns, or simply overlooked. Overall, females are diagnosed less often and years later than males - which can result in delayed interventions and support, unnecessarily compounding the challenges.

The median age of diagnosing boys with ADHD is 7 according to the National Institute of Mental Health, however symptoms can be detected in some as young as 3 years of age. Girls, on the other hand, are often not diagnosed until 12 years of age. This is a 4-5 year delay for girls receiving an ADHD diagnosis. 4-5 years where interventions and supports are not in place during formative developmental years for academics, social, emotional, and self-esteem growth. This staggering gap can result in increases in frustration, anxiety, self-doubt, and shame. Feeling “What is wrong with me?” can persist throughout life. 

Understanding ADHD in Girls

Understanding that ADHD can present differently in girls is necessary to help raise awareness, understanding, and support for females of all ages. Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition affecting millions of children worldwide. It’s characterized by symptoms of inattention, impulsivity, and hyperactivity. While these three primary symptoms are the hallmarks of ADHD, it is important to understand that the impact of ADHD goes far beyond attention and behaviors. The ADHD brain has immature connectivity throughout multiple brain regions, impacting sensory processing, emotional regulation, physical coordination, as well as executive functions in addition to attention and behaviors. Immature development in these regions creates additional challenges and complications in everyday life, but may not be loud and disruptive, or are thought to be a separate concern not related to ADHD. 

While ADHD affects both boys and girls, the symptoms often manifest differently between our sons and daughters, making it challenging—especially for parents—to recognize ADHD in girls. Understanding these differences is crucial for early diagnosis and intervention, particularly for girls who may exhibit less noticeable symptoms.

Differences in ADHD Symptoms Between Boys and Girls

Boys with ADHD:

Boys tend to display more external behaviors that are easy to spot. In fact, it's also part of the reason we risk misdiagnosing. Symptoms like impulsivity, hyperactivity, and difficulty staying on task are common, leading to frequent disruptions at school and at home. These behaviors could be a result of ADHD or they could be a learning or developmental issue that needs to be helped along and resolved. But either way, these outward signals are simply more noticeable to teachers and parents, which means boys are more likely to be diagnosed early. 

Girls with ADHD:

In contrast, girls often exhibit symptoms that can be attributed to gender or personality. Symptoms such as inattention, or emotional reactivity can be explained away as daydreaming, or being dramatic “she’s just shy and lost in her own world, " or “she’s a drama queen.” Other symptoms can be more obvious, yet parents do not realize they can be attributed to ADHD. These symptoms can include dysregulation in sensory processing, task switching difficulty, and executive function challenges. All too often parents and teachers can interpret these complications as simply not trying hard enough, or not caring enough about the task or outcome. In fact, the opposite can be true - this may be a student who is working even harder than their peers, and cares deeply, yet still falls short of meeting expectations. 

Other complications in identifying ADHD challenges can occur when a child is intelligent but their work does not align with what parents and teachers perceive the child’s capability to be, or their work is inconsistent. When talking to the child they may be able to answer questions or demonstrate understanding of a topic, yet they may struggle to put their thoughts on paper or make errors or missteps in the directions. It's important to understand that ADHD and intelligence are separate, and in fact, this can be a red flag for concern. Knowledge is one thing, but the ability to demonstrate that knowledge often requires a higher degree of executive functions—the ability to direct your actions to achieve a goal. Executive functions include the ability to stay on task until an assignment is completed, to plan and organize your time as needed, and to prioritize your actions. When executive functions are immature a student will struggle more with getting back on task after a distraction, may misstep in directions, and will struggle more with organization. This can result in high test scores, but low homework grades, grades that fluctuate, or a downward trend in grades as the executive function demands of school increase. 

Impulsivity is another symptom that is classically thought of as loud - the child falling out of their chair in class, or pestering their peers, requiring reminders from parents and teachers to keep their hands to themselves and stop their behavior. Impulsivity can also be quiet or not directed outward. Impulsivity can be grabbing your phone to scroll social media instead of completing an assignment, doodling when you should be listening, or even self-harm behaviors. 

A girl with ADHD may appear shy or quiet, or loud and boisterous - it is not one or the other, but the quieter symptoms in girls lead to underdiagnosis because they are less disruptive and more easily attributed to personality traits rather than a medical condition. Teachers and parents might overlook these signs, thinking the girl is simply well-behaved, introverted, or not trying hard enough. 

Consequently, girls with ADHD are less likely to receive the timely support and interventions they need. As a result, parents and teachers may overlook her symptoms, leading to a delayed diagnosis.

Quiet symptoms of ADHD can include:

• Procrastination
• Work, projects, or activities left unfinished (starting things without completing them)
• Feelings of shame or inadequacy
• Self-harm behaviors
• Disorganization
• Frequent errors in work
• Inconsistent grades
• Tests high, but homework scores are lower
• Feels prepared yet tests low
• Struggle to follow multi-step directions
• Need directions or information to be repeated
• Turning in work late or incomplete
• Needing additional time to complete work
• Struggle to be on time
• Forgets information or items
• Need for additional reminders for daily routines (bring your water bottle, hang up your wet towel, don’t forget to turn in your completed assignment)
• Frequently experiencing hurt feelings
• Sensory sensitivity or dysregulation

The Role of Social Expectations

Social norms and expectations may also contribute to why ADHD symptoms in girls are often unnoticed. Girls are often expected to be more passive and well-behaved, which can make symptoms like inattention or emotional sensitivity seem like personality traits rather than indicators of ADHD. Being highly emotional, reactive, or dramatic can be attributed to being a girl. The reality may be that the child is emotional and reactive due to increased challenges in meeting the expectations and demands they are facing daily, regardless of gender.

Boys, on the other hand, are often expected to be more active and assertive. This can lead parents to think that their actions are “Signs of leadership” or “Having a big personality” rather than attributing the behaviors to lack of control or awareness of behaviors. These societal norms reinforce the perception that boys displaying disruptive behaviors need medical evaluation, while girls who are quiet or daydreaming are simply conforming to gender expectations. 

This disparity in societal expectations can lead to a significant gender bias in diagnosing ADHD, with boys receiving more attention and girls' symptoms being overlooked. As a result, girls with ADHD may struggle in silence, or be labeled as “lazy” or “unmotivated” when their symptoms are, in fact, complex.

Why Girls Are Often Diagnosed Later

The current diagnosis criteria is a contributing factor to the gender bias in ADHD with a focus of diagnosis being related to symptoms of hyperactivity and impulsivity. Girls with ADHD may not meet the traditional expectations for hyperactivity and impulsivity, but their struggles with attention, emotional regulation, and organization are just as real—and just as impactful. 

This underdiagnosis can lead to significant emotional consequences for girls. They may experience chronic low self-esteem, anxiety, and depression as they struggle to meet academic and social expectations without understanding why they find these tasks so challenging. The constant feeling of failure and frustration can further isolate them, exacerbating their symptoms and hindering their overall development.

Unfortunately, the tendency to misinterpret these symptoms means that girls with ADHD are often left without the support they need. They may be unfairly labeled as “lazy” or “disorganized” when, in reality, they’re battling a neurological condition that requires attention and care.

ADHD and Mental Health

Fifty-one percent of individuals with ADHD also experience one or more mental health disorders, with the most co-existing conditions being anxiety, depression, bipolar disorder, and obsessive-compulsive disorder. These overlapping conditions can confuse diagnosing the condition, as well as determining the appropriate interventions or support to help a child thrive. While each of these conditions is distinct, there can be overlapping symptoms and regions of the brain involved in the underlying condition, which is a contributing factor to an increased likelihood of an additional mental health disorder. The ability to direct and sustain attention and emotional regulation is impacted in all of the conditions mentioned.

The Brain Can Change

ADHD is not a matter of poor behavior, bad choices, or laziness. While these perceptions or symptoms may appear, they are more likely caused by differences in brain structure. ADHD is immaturity in connectivity in key regions in the brain that support the ability to direct and sustain attention, block out distractions, plan, organize, execute tasks, and process sensory input. When there are immaturities in these regions, individuals must exert extra effort to regulate their actions, thoughts, and behaviors.

Research over the past several decades has demonstrated the brain’s ability to change. Neuroplasticity is the ability for pathways in the brain to improve speed and organization in response to stimulation and engagement from the environment. This ability for brain pathways to become faster, stronger, and more efficient is key to reducing challenges associated with ADHD, regardless of gender. Dr. Jackson, Chief Programs Officer at Brain Balance shares, “Pathways in the brain are constantly evolving and improving—this is development, and we have the opportunity to enhance development in a targeted way when we understand what aspects of development are age-appropriate.” The Brain Balance program is an example of an intervention that provides targeted stimulation and exercise to strengthen the brain’s pathways involved in attention, impulse control, memory, emotional regulation, and executive functions. “The program drives consistent and significant change as reported by parents, teachers, and clinicians in attention and hyperactivity/impulsivity, as well as in measurable gains in inhibitory control, emotional regulation, and executive functions. Programs like Brain Balance can help kids with ADHD close the gap on their challenges.”

The Importance of Early Intervention

The more time that passes before an intervention or support is put in place, the greater the disparity between a child’s age and abilities. Dr. Jackson explains, “If aspects of development are progressing at a slower rate than body development, gaps in attention, emotional regulation, inhibitory control and executive functions can worsen over time, rather than reduce.” Dr. Jackson goes on to share, “All too often parents have a ‘Wait and see’ philosophy in the hopes that a different teacher or another year of development will make a difference. The reality is that the sooner brain pathways can be addressed, the better.” 

Neuroplasticity - the ability to change the brain, is possible at any age, there is a unique window of opportunity in the early years. Growth and development progress rapidly from the prenatal stage through the teenage years, with younger stages featuring specific windows of time marked by even greater growth surges. Parents can observe the surges in physical development when a child grows inches in mere months, or a child has a burst of emerging language or new skills. These surges occur not only in physical development but also in cognitive and social-emotional growth. Tapping into these critical windows of time can help accelerate the natural developmental process.

Without early intervention, undiagnosed girls are at risk of experiencing years of increased challenges that can result in lower self-esteem, academic performance, and difficulties in social relationships. When left untreated, ADHD can impact their emotional health and well-being as they grow into adulthood.

Parents play a crucial role in early intervention by recognizing the subtle signs of ADHD in our daughters and advocating for comprehensive evaluations. You can create supportive environments at home, fostering open communication and understanding, and encouraging your children to express their struggles without fear of judgment. Additionally, parents can work closely with educators and healthcare professionals to ensure their daughters receive the appropriate interventions and support needed to thrive academically and, socially and emotionally. 

It’s Never Too Late to Change the Brain 

The brain continues to change and adapt at all stages in life, which can be seen with executive function abilities peaking while people are in their 40s. A combination of genetics, experience, and the environment contribute to these changes. This provides an ongoing opportunity to provide targeted and specialized activities and stimulation to exercise the brain pathways involved in directing and sustaining attention, regulating emotions, and impacting executive functions. ADHD symptoms can be reduced for kids, teens, and adults when properly identified and addressed. 

How Brain Balance Can Help

At Brain Balance, we take a comprehensive approach to addressing the root causes of ADHD. Our personalized programs focus on providing specialized sensory, physical, cognitive exercise to target and strengthen key neural pathways. For both boys and girls, by improving the speed, efficiency and endurance of these pathways improvements occur in attention, inhibitory control, emotional regulation and executive functions—key areas often affected by ADHD.

Through our holistic, drug-free program, we’ve helped many children, including girls who may have been struggling with undiagnosed ADHD. By focusing on brain development, we aim to strengthen the areas where girls with ADHD often need the most support.

Success stories from our program highlight how girls have benefited from early intervention, or completing the program in their teens. They’ve seen improvements not only in academics but in self-confidence, emotional resilience, and social relationships. These positive changes give girls the tools they need to succeed long-term.

Take the Next Step for Your Child

If you’re concerned that your child may have ADHD or is showing signs of struggling with focus, organization, or emotional regulation, don’t wait. Early identification and intervention can make all the difference. At Brain Balance, we’re here to support you and your child with a personalized program designed to address their unique challenges.

Reach out to us today to learn more about how the Brain Balance program can help your child thrive. Let’s work together to create a brighter future for your child with ADHD.