ADHD in girls: the signs that are easy to miss

ADHD in girls is one of the most commonly missed conditions in childhood. Many girls are not recognised until their teens, and some not until adulthood, because their ADHD does not look like the picture most people carry in their heads. If you have a daughter who is bright but scattered, anxious, exhausted after school, or "fine in class" but struggling at home, this guide is for you.

Why is ADHD in girls missed so often?

Both the NHS and NICE recognise that ADHD is under-recognised in girls. NICE guidance asks professionals to be aware that girls are less likely to be referred for an assessment, more likely to have ADHD that goes undiagnosed, and more likely to be given the wrong diagnosis, such as another mental health condition.

A 2020 expert consensus statement on girls and women with ADHD, written by UK and international specialists, describes how boys far outnumber girls among children referred to clinics, while the gap is much smaller among children in the general population. The authors conclude that many girls with ADHD are going unidentified.

There are a few reasons for this:

• Girls more often have quieter, inattentive symptoms that rarely disrupt a classroom.
• Many girls work very hard to fit in and hide their difficulties.
• Anxiety or low mood may be noticed first, and ADHD underneath is missed.
• The image of ADHD as a "naughty boy" condition still shapes who gets referred.

ADHD symptoms in girls

The core signs of ADHD are the same for girls and boys: inattention, hyperactivity and impulsivity. What differs is how they tend to show, and how other people read them. Every girl is different, and some girls with ADHD are very physically active and impulsive. But there are patterns that come up again and again.

Inattentive ADHD in girls

The NHS notes that girls more often have inattentive symptoms, which can be harder to spot. In everyday life, this might look like:

• daydreaming, staring out of the window, "away with the fairies"
• missing instructions and then copying what others do
• being disorganised: a messy bag, lost belongings, forgotten homework
• taking a very long time to start or finish tasks
• making careless mistakes despite knowing the work
• being described as lacking effort or motivation, when she is in fact trying very hard
• feeling overwhelmed by multi-step tasks or busy environments

Hyperactive and impulsive signs in girls

Hyperactivity in girls is often less boisterous. It may show as:

• talking a great deal, chatting in class, or giggling at the wrong moments
• fiddling with hair, clothes or objects
• interrupting, blurting things out, or saying something hurtful in the heat of the moment
• restlessness that is felt inside more than seen

Strong emotions are common too: quick frustration, tears, irritability, and a big reaction to criticism or rejection.

Masking: when a girl holds it together at school

Many parents describe the same pattern. At school, their daughter is quiet, polite and compliant. At home, she melts down, cries, shouts or simply collapses with exhaustion. This is sometimes called masking: working hard to hide difficulties and appear "normal" in front of others.

Masking can involve copying friends, over-preparing, staying up late to finish work, or keeping very quiet to avoid getting things wrong. It takes a great deal of energy. It can also mean that teachers, and sometimes doctors, underestimate how much a girl is struggling.

If this sounds familiar, it is not a sign that your daughter is fine at school and difficult at home because of something you are doing. It is a well-recognised pattern, and it is worth telling the doctor about.

Why teachers may not see it

Teachers are juggling a whole class. A girl who sits quietly, does not disrupt others and hands in something, even if it is unfinished, may not stand out. School reports may mention daydreaming, chattiness or "could try harder" rather than anything that sounds like a medical concern.

Girls in very structured or well-supported settings may also manage for a long time. Difficulties often surface at transitions, especially the move to secondary school, when there are more teachers, more rooms and more to organise.

That is why a good assessment asks school specific questions about effort, organisation and how long tasks take, not just about behaviour.

If you are raising concerns with school, it can help to be specific. Ask whether your daughter finishes work in the time given, how often she needs instructions repeated, whether she seems tired or tearful, and how she gets on with friends at break time. Share what you see at home too, such as hours spent on homework or meltdowns after school. Teachers often notice more than appears in reports once they know what to look for, and their observations will be useful later if you go on to an assessment.

Anxiety, low mood and ADHD in girls

Girls with ADHD often also experience anxiety or low mood. Sometimes this is a separate condition. Sometimes it grows out of years of struggling, being told off or feeling different. Either way, the anxiety can be the first thing anyone notices, and the ADHD underneath can be missed.

NICE warns that girls may be more likely to receive an incorrect diagnosis of another mental health or neurodevelopmental condition. Girls with ADHD may also have friendship difficulties and be at greater risk of bullying, which can affect self-esteem.

If you are ever worried that your daughter may be harming herself or is not safe, please speak to your GP the same day, or call 111. In an emergency, call 999.

ADHD in young girls

In young girls, aged 5 or 6, ADHD can look like a child who is very chatty, finds it hard to sit on the carpet, drifts off during stories, takes ages to get ready, or has big emotional reactions at the end of the school day. Some are very active and physical. Because so many young children behave like this some of the time, the key questions are how often, in how many settings, and how much it is affecting her. BZ Clinic sees children from age 5. For younger children, see our guide to ADHD in young children.

ADHD in teenage girls

For many girls, the teenage years are when ADHD becomes impossible to ignore. Schoolwork becomes more demanding, there is much less structure, and friendships become more complicated. Puberty adds hormonal changes, which some girls feel make their symptoms harder to manage.

Signs of ADHD in teenage girls can include:

• falling behind with homework and coursework, despite being capable
• chronic lateness, lost belongings and missed deadlines
• exhaustion, irritability and emotional ups and downs
• friendship fallouts, feeling left out, or being bullied
• low self-esteem: "I'm stupid", "I'm lazy", "what's wrong with me?"
• anxiety, low mood, difficulty sleeping, or more risk-taking

Our page on ADHD assessments for teenagers explains how we assess this age group, including hearing from the young person themselves.

ADHD in girls checklist

This short checklist is not a test, but if many of these sound like your daughter, and have done for a long time, it is worth looking into:

• She often seems to be in a world of her own.
• She loses or forgets things far more than her friends.
• Homework takes hours, or does not get started at all.
• She is described as chatty, dreamy or disorganised at school.
• She holds it together at school and falls apart at home.
• Her emotions are big and change quickly.
• She works much harder than others to achieve the same result.
• She has started to feel she is "not clever" or "not good enough".

Next, try our free ADHD questionnaire, which is based on the SNAP-IV rating scale. Girls who mask may score lower than their difficulties deserve, so take your own observations seriously too.

How an assessment helps girls

Because girls' ADHD is easy to miss, a careful assessment matters. NICE guidance says a diagnosis should be made by a specialist using a full history, information from more than one setting, and reports from people who know the child, and never on questionnaires alone.

At BZ Clinic, every new assessment includes questionnaires from parents, school and, where appropriate, the young person, plus a QbCheck. QbCheck is a computer-based test of attention, activity and impulsivity, usually done at home before the appointment. It is one part of the picture, never used on its own, and is not pass or fail. It can be particularly useful for girls, because it measures attention and activity directly rather than relying only on what others have noticed.

Our doctors are consultant paediatricians, so they also look at your daughter's general health, including sleep, mood and other conditions that can look like ADHD or sit alongside it. They screen for autism and learning difficulties too, and signpost if needed.

To book a private ADHD assessment for your daughter in West Byfleet, Surrey, call Camille on 07957 909754 or email admin@bzclinic.org. No GP referral is needed. You can read what to expect first.

Questions parents ask