Why So Many Girls with ADHD Go Undiagnosed

ADHD in Girls vs Boys: What’s Different?

When most people think of ADHD (Attention-Deficit/Hyperactivity Disorder), they picture a
hyperactive boy bouncing off the walls, unable to sit still in class. That image has long shaped
how ADHD is understood—and misdiagnosed. What it fails to capture is the quiet, often hidden
experience of girls with ADHD, many of whom go undiagnosed well into adulthood. Early on,
ADHD in boys tends to manifest in more externalized behaviors that draw parent or teacher
attention, such as impulsivity, hyperactivity, and distracting others. Girls, on the other hand, are
more likely to experience the inattentive type of ADHD. They may daydream, have trouble
focusing, be disorganized, or struggle silently with anxiety and low self-esteem. Because their
symptoms are less disruptive, they often fly under the radar of parents, teachers, and even
doctors.

Masking in Girls with ADHD

Another aspect that hides detection in girls is often referred to as “masking.” Many girls with
ADHD often develop coping mechanisms to “mask” their symptoms. They may overcompensate
by becoming perfectionists, people-pleasers, or quiet rule-followers. They often internalize their
struggles, blaming themselves for not being able to meet expectations. This leads to a damaging
cycle of shame, anxiety, and self-doubt—sometimes even depression. As such, girls with ADHD
may be earning strong grades and well-liked by teachers, but furiously working to keep up with
academic demands and becoming drained from the effort. In this way, grades should not be the
only indicator in how a child is doing or whether or not there is something more worth looking
into. More importantly, take note of what it takes for the child to get those grades and how they
experience school.

Why Girls Are Overlooked

Often, parents start to suspect their daughter may have ADHD, or there may be a strong family
history. Approaching teachers can be met with skepticism since the child is performing well and
exhibits good behavior. Talking to her pediatrician can also feel like a dead-end, as
questionnaires used in medical practices are typically based on criteria that is more applicable to
boys with ADHD. Consequently, girls may be “assessed” for ADHD by their pediatrician and
not diagnosed or treated due to insufficient investigation. If any of these situations rings true for
a family, seeking a private evaluation will include more comprehensive testing and create a
better picture of how the child is functioning internally. Tutoring and executive functioning
support are also good interventions to try. In nearly every situation, there is no need to delay
seeking help if it seems needed, and at a minimum, consider consulting with an evaluator to see
if the signs you’re seeing could indicate a true need for testing.

ADHD or ADD? Understanding Terms for Girls with ADHD

One final note is on terminology. There is confusion between the terms “ADHD” and “ADD”
(Attention Deficit Disorder). Some parents or professionals may feel that a girl does not have
ADHD because of the lack of obvious hyperactivity, and instead believe ADD is what needs to be
assessed. In reality, the term “ADD” is no longer used diagnostically. It was removed from
diagnostic manuals and changed to ADHD many years ago. Instead, there is a distinction
between 3 different types of ADHD: Predominantly Inattentive Presentation, Predominantly
Hyperactive/Impulsive Presentation, and Combined Presentation (both inattentive and
hyperactive/impulsive symptoms). In this way, what was previously thought of as “ADD,” would
likely be “ADHD – Predominantly Inattentive Presentation” (or sometimes called “Inattentive ADHD”). There is no need to worry about these distinctions when seeking help; just know that
ADHD is how it will likely be categorized by an evaluator.

About the Author

This is a guest blog written by Stephanie Fox, PsyD, is a licensed psychologist at Four Corners Psychological Services, an educational testing practice offering assessment for children, teens, and adults. Dr. Fox conducts evaluations for dyslexia, dysgraphia, ADHD, and other types of learning and
emotional differences.

More information can be found at www.fourcorners-ps.com or by emailing Dr. Fox
at drfox@fourcorners-ps.com.