ADHD in girls is often quieter and easier to miss than in boys, and many girls first seek help for anxiety, low mood or emotional overwhelm. Consultant Child and Adolescent Psychiatrist Dr Athina Zakynthinaki explains the signs to look for, why ADHD is often overlooked, and what an assessment involves.
When most people picture ADHD, they imagine a boy who can’t sit still in class. That picture is part of the reason so many girls with ADHD are missed. In my clinical practice, I regularly meet girls who were not recognised until their teens. By then, many have spent years believing that something is wrong with them.
This ADHD Awareness Month, I’d like to share what ADHD can look like in girls, and why recognising it matters.
Why are girls diagnosed later?
Several factors contribute:
Inattentive traits are less visible. A girl who daydreams quietly causes less disruption than a child who is hyperactive, so her difficulties are less likely to be flagged.
Girls often mask. Many work extremely hard to copy their peers, follow the rules and appear “fine”, which hides how much effort ordinary tasks take.
Emotional difficulties are noticed first. Anxiety, low mood, emotional overwhelm, school avoidance or friendship problems may be addressed without anyone asking what lies underneath.
Expectations differ. Chattiness, forgetfulness or emotional reactions in girls are often put down to personality or to being “dreamy” or “sensitive”.
Signs parents and teachers may notice
Drifting off, losing focus or missing instructions, especially in less engaging lessons
A busy, racing mind and difficulty switching off at bedtime
Starting tasks late, then rushing, or relying on perfectionism and last-minute bursts of effort
Forgetfulness and disorganisation with belongings, homework and plans
Strong emotions, quick frustration and deep sensitivity to criticism or feeling left out
Coping at school but becoming exhausted, tearful or explosive at home
Talking a lot, interrupting, or acting on impulse in social situations
Low self-esteem and a belief that she is “lazy”, “stupid” or “too much”
Puberty can intensify these traits, and moving to secondary school, with more teachers, more organisation and more independence, often brings difficulties to the surface.
When ADHD hides behind anxiety, low mood or emotional overwhelm
Many girls are not referred because of attention difficulties. They come to services because they are struggling emotionally, and ADHD is only recognised later, sometimes years later.
Emotional dysregulation is a core part of ADHD for many young people, although it is not yet part of the formal diagnostic criteria. Girls may experience feelings very intensely and find it hard to calm down once upset. They may react strongly to small frustrations or feel crushed by criticism or rejection. These reactions are easily misread as “drama”, oppositional behaviour or a mood problem.
Anxiety is one of the most common co-occurring difficulties. Constantly working to keep up, mask and avoid mistakes can leave girls feeling on edge, worried about school and fearful of letting people down. Sometimes the anxiety is a direct result of unrecognised ADHD. Sometimes the two exist alongside each other and both need support.
Low mood and depressive symptoms can develop after years of struggling without understanding why. Repeated experiences of feeling “not good enough”, friendship difficulties and exhaustion from masking can wear down self-esteem. Some girls become withdrawn, tearful, irritable or hopeless.
Other difficulties often occur alongside ADHD in girls, including:
Autism: the two frequently co-occur, and both can be masked in girls
Sleep difficulties: a mind that won’t switch off, or a delayed body clock
Specific learning difficulties, such as dyslexia
Eating difficulties: impulsivity and emotional regulation difficulties can affect eating patterns
Self-harm: some young people use it to cope with overwhelming feelings, so it always needs a prompt, caring response
When only the anxiety or low mood is treated, progress can be limited because the underlying ADHD hasn’t been recognised. A careful assessment looks at the whole picture, so that each difficulty is understood and supported in the right way.
Why recognition matters
An ADHD diagnosis is not a label of what a young person can’t do. It is a way of understanding how her brain works. With that understanding, families and schools can put the right support in place, and girls can begin to replace self-criticism with self-compassion. Many young people with ADHD are creative, curious, energetic and deeply empathetic, and they thrive when their needs are understood.
What does an ADHD assessment involve?
A good assessment looks at the whole young person, not just a checklist. In my practice, this includes:
A detailed developmental history with parents
Time with the young person to hear her own experience
Standardised questionnaires completed by parents and teachers
An objective attention test
Careful consideration of masking, and of co-occurring difficulties such as anxiety, low mood, emotional dysregulation and autism
The aim is to give families a clear, compassionate explanation and practical recommendations for home and school, whatever the outcome.
When to seek advice
If you’ve noticed some of these patterns, especially if your daughter is already receiving support for anxiety or low mood and something still doesn’t quite add up, trust your instincts. You don’t need to be certain before you ask for an assessment, and earlier understanding can make a real difference.