Do ADHD Symptoms Differ in Boys and Girls?

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that begins in childhood, but frequently persists into adulthood. People with ADHD exhibit behaviors associated with impulsiveness and hyperactivity, inattentiveness, or a combination.

According to the Centers for Disease Control and Prevention (CDC), as of 2016, approximately 6.1 million children (9.4%) in the United States had an ADHD diagnosis. The rate of diagnosis is higher for boys at 12.9% than for girls at 5.6%.

Researchers note that the difference in the rate of diagnosis between boys and girls is likely due to ADHD presenting differently in girls, which may lead to the condition being underdiagnosed in girls.

This article will explain how the symptoms of ADHD in girls vs. boys and when to talk to your healthcare provider.

ADHD in Children

ADHD is typically classified into three categories, which are:

• Impulsive and hyperactive type, such as fidgeting, talking a lot, interrupting, and not sitting still
• Inattentive type, such as difficulty paying attention, being easily distracted, and not finishing tasks
• Combination type

To be diagnosed with ADHD, a person must exhibit impulsive and hyperactive symptoms, inattentive symptoms, or a combination of symptoms from both categories. These symptoms must be ongoing and affect their ability to function in day-to-day life.

ADHD begins in childhood, but, depending on the type and severity of ADHD symptoms, it may persist into adulthood. Several studies have shown that up to 80% of children with ADHD will continue to have ADHD symptoms into adulthood, though this statistic varies widely from study to study.

Symptoms can also change over time. Outward hyperactivity in children may turn to inner restlessness in adults, for example.

ADHD in Boys vs. Girls

Boys are diagnosed with ADHD approximately 3 times as often as girls are, but the ratio of adult males to females is closer to 1-to-1. Researchers believe this is likely due to an underdiagnosis of girls rather than ADHD being more prevalent in boys.

There are a number of likely reasons for this discrepancy:

• Girls tend to show inattentive symptoms, while boys are more likely to show impulsive and hyperactive symptoms.
• Girls often develop compensatory adaptive behaviors and coping strategies that mask their symptoms.
• Girls often present more internally, while boys tend to present more externally.
• Girls with ADHD are often misdiagnosed with a different disorder such as anxiety or depression, or the ADHD is missed when they have a coexisting disorder.
• Inattentive symptoms are more likely to occur in a structured educational environment, such as in high school or college, making symptoms more noticeable when girls are adolescents and young women than children.

In general, boys with ADHD are more likely to have symptoms and behaviors that are more disruptive and, therefore, more noticeable. Not only does this have a "squeaky wheel" effect, but it reinforces the stereotype of a child with ADHD being a boy who "acts up" in class and is constantly on the go.

Because girls with ADHD are usually less disruptive, it may not be as obvious that they are struggling. Daydreaming is not going to raise flags that are difficult to miss or ignore like frequent interrupting or the inability to stay seated.

Even when girls do show similar symptoms as boys, ADHD may be missed or minimized because they don't fit the mental picture of a typical child with ADHD.

Two studies were performed in which teachers were given brief ADHD-like descriptions, but the names and pronouns of the child attached to them were varied. The teachers in the studies were more likely to suggest the child be referred for additional support and be better suited for treatment when the description had male names and pronouns.

Symptoms in Boys

While boys can exhibit symptoms of inattention, they are more likely than girls to show impulsive and hyperactive behaviors instead of or in addition to the inattentive ones.

Impulsive and hyperactive symptoms include:

• Fidgeting, tapping hands or feet, or squirming in their seat
• Difficulty staying seated when expected to, such as in a classroom
• Running around or climbing when or where it is inappropriate
• Inability to play or do activities quietly
• Constantly “on the go,” as if driven by a motor
• Talking excessively
• Blurting out responses before a question has been finished, finishing people’s sentences, difficulty waiting to speak in conversations
• Difficulty waiting their turn, such as while waiting in line
• Interrupting or intruding on others during conversations, games, and activities, taking over what others are doing, using other people's things without permission, etc.

Boys and men are more likely to display externalizing (outward) behavior and have comorbid (co-occurring) conditions. These can include:

• Oppositional defiant disorder (ODD)
• Conduct disorder (CD)
• Rule-breaking behavior
• Fights in school or aggressive behavior
• Antisocial behaviors characteristic of antisocial personality disorder (in adults)
  

Symptoms in Girls

Girls can have impulsive and hyperactive type ADHD, but more often they show symptoms for inattentive type.

Inattentive symptoms include:

• Lack of paying close attention to details
• Making "careless" mistakes in tasks such as schoolwork
• Difficulty staying focused on tasks or activities such as lectures, conversations, or reading for long periods
• Seeming not to listen, or "zoning out" when spoken to
• Not following through on instructions and not completing (or starting but losing focus on) tasks such as schoolwork, chores, or job duties
• Difficulty with organizing, such as poor time management, messy work, and living spaces, disorganized work (like homework), missed deadlines, etc.
• Avoiding or disliking tasks that require sustained mental effort
• Frequently losing needed belongings, such as school papers, books, cell phone, and glasses
• Easily distracted
• Forgetting common tasks like chores, or in teens and adults, running errands, returning phone calls, paying bills, and keeping appointments

Girls and women tend to have internalized symptoms, such as:

• Emotional problems/sensitivity
• Somatic (physical) symptoms
• Problems with self-esteem and self-image

Late or Missed Diagnosis

When an ADHD diagnosis is late or is missed in girls, and support is not given, they repeatedly have experiences of perceived failure, alienation, and inadequacy, which they frequently interpret as personal flaws rather than ADHD. This increases the risk of developing comorbid conditions such as:

• Depression
• Anxiety
• Sleep disorders
• Eating disorders
• Substance use disorder
• Low self-esteem

Many women are only diagnosed with ADHD as adults when they learn more about ADHD in general and how it presents in females. Some describe it as a light bulb moment, or as if they are checking off a list when looking at common tendencies of women with ADHD.

When looking back, most women who are diagnosed with ADHD as adults can identify experiences and behaviors in their childhoods that are examples of ADHD, though they ADHD wasn't recognized at the time.

When to Talk to Your Healthcare Provider

With support, ADHD can be managed. Getting an accurate diagnosis and appropriate treatment as early as possible can go a long way in terms of helping kids with ADHD function well both as children and into adulthood.

If you or your child's teachers notice signs of any type of ADHD, regardless of their gender, see their healthcare provider to discuss next steps.

Summary

ADHD is diagnosed three times more often in boys, but research suggests that girls may be under-diagnosed. That's because ADHD can manifest differently in boys than in girls. Boys tend to have impulsive, hyperactive, and externalized traits. Girls tend to have inattentive, internalized traits.

Because of these factors, girls are generally diagnosed at older ages than boys, often in adulthood. Girls are also less likely than boys to be sent for referrals for support or treatment. Research is needed on the effects of ADHD on people who are not cisgender.

A Word From Verywell

ADHD often presents differently in girls than in boys, but knowing what to look for means you can help your daughter or your female students who are struggling—or recognize the signs in yourself.

If you or your child is showing signs of ADHD, book an appointment with a healthcare provider. Treatments and support are available to help people of every gender manage their symptoms.