Five Unexpected and Overlooked Ways That ADHD Shows up in Girls and Women

Catherine J. Mutti-Driscoll, PhD, author of The ADHD Workbook for Teen Girls

Girls are 75 percent less likely to receive an attention-deficit/hyperactivity (ADHD) diagnosis than boys (McCabe 2021). Historically, the criteria for diagnosing ADHD have overlooked some characteristic ADHD emotional experiences (Dodson 2022), and the characteristic ADHD diagnostic symptoms of inattention, hyperactivity, and impulsivity have been interpreted according to male presentations of these symptoms (Mutti-Driscoll, 2024).

Women are often diagnosed with ADHD when their children are, a phenomenon that Tracy Otsuka (2023) describes as “The Mommy Factor.” For girls, the consequences of being missed or diagnosed late include mental health challenges, low self-worth, feeling misunderstood and not knowing why, and inadequate support during critical phases of development. Early diagnosis is imperative for girls and women with ADHD. To recognize girls and women with ADHD earlier in their lives, we must understand how symptoms show up in girls, as well as how girls often exhibit historically overlooked emotional features of the condition. Here are some tips on how to recognize ADHD in girls and women:

Hyperactivity, Impulsivity, and Hyperactivity in Girls

Teachers, parents, and health providers often do not notice girls’ ADHD symptoms since they exhibit the characteristic symptoms of ADHD in nontraditional/non-male ways. Here are some tips that can help identify these possible symptoms in girls:

● Hyperactivity. In girls, hyperactivity manifests as verbal hyperactivity, fidgeting, or mental hyperactivity. Girls’ physical hyperactivity is likelier to appear as fidgeting, nail-biting, or playing with their hair. A girl who “talks too much” may also exhibit verbal hyperactivity. Finally, mental hyperactivity can also be quite common in girls, looking like daydreaming or ruminating on the same thoughts repeatedly.

● Impulsivity. Impulsivity in girls can be easy to miss since it is more likely to appear in social and family relationships. In contrast, teachers are more likely to flag boys’ ADHD symptoms since they exhibit more disruptive behavioral issues in school. Instead, girls with ADHD may have trouble with verbal aggression, interrupting, or blurting out things they did not mean to say before they can stop themselves.

● Inattention. Girls’ distractibility may also fly under the radar because it is more likely to involve daydreaming, spacing out, or ruminating. These private behaviors may appear to exhibit no negative consequences for others, so teachers and parents often miss them. These behaviors may be more likely to impact a girl’s experience at home or with friends than at school.

Overlooked Emotional Aspects of ADHD in Girls

Girls are very likely to exhibit commonly overlooked emotional aspects of ADHD, including sensitivity to rejection and emotional hyperarousal.

● Sensitivity to rejection. The cutting-edge research of William Dodson (2022) has helped to raise awareness that many people with ADHD struggle with sensitivity to rejection in profound ways. This rejection sensitivity can show up as an inability to accept feedback from others, experiencing seemingly benign situations as incredibly painful, and being very self-critical and often describing feelings of failure. Due to their deep desire to avoid criticism, girls and women with ADHD usually attempt to be perfect and please others.

● Emotional hyperarousal. Girls and women are likely to show signs of emotional hyperarousal in their behavior at home or with friends. Intense high and low moods characterize emotional hyperarousal. Someone with emotional hyperarousal may have difficulty relaxing, “getting over” upsets quickly, and struggle to wind down and sleep at the end of the day. The ADHD mood issues that women face are often misdiagnosed as anxiety and depression, sometimes delaying the access of women to ADHD treatment (however, some women have co-occurring depression and anxiety alongside their ADHD).

Raising awareness about what ADHD looks like in girls and women is critical for both improving the rates of diagnosis and treatment and lowering the age of initial diagnosis. When adults identify girls’ ADHD symptoms early, they can provide the support and resources girls with ADHD need to build a strong foundation of self-worth and confidence. Together, we can make sure that the next generation of girls and women with ADHD are identified and treated!

References

Dodson, W. 2022. “3 Defining Features of ADHD That Everyone Overlooks.” ADDitude Magazine. https://www.additudemag.com/symptoms-of-add-hyperarousal-rejection-sensitivity.

McCabe, J. 2021. “ADHD in Women.” How to ADHD (YouTube), August 31. https://www.youtube.com/watch?v =EMpt40zNK-w.

Mutti-Driscoll, C.J. (2024). The ADHD workbook for teen girls: Understand your neurodivergent brain, make the most of your strengths, and build confidence to thrive. New Harbinger, Inc.

Otsuka, T. (2023). ADHD for smart ass women: How to fall in love with your neurodivergent brain. William Morrow Publishers.

Catherine J. Mutti-Driscoll, PhD, is director of executive function coaching, and an attention-deficit/hyperactivity disorder (ADHD)/executive function coach at the Hallowell Todaro ADHD Center. She coaches clients of all ages, leads online support groups and webinars, and supervises a team of six ADHD/executive function coaches.