ADHD affects both males and females, yet it often presents differently across genders. Research has shown that males are more frequently diagnosed in childhood, while females tend to receive a diagnosis later in life, if at all. These differences in manifestations and diagnosis timing are influenced by biological, social, and cultural factors, leading to potential challenges in recognising and supporting females with ADHD (Quinn & Madhoo, 2014).
1. Differences in Symptom Presentation
The differences in ADHD manifestations between males and females often arise from variations in symptom types. Broadly speaking, ADHD symptoms fall into three main categories: inattention, hyperactivity, and impulsivity. However, females with ADHD tend to exhibit more inattentive symptoms, while males are more likely to display hyperactive and impulsive symptoms (Biederman et al., 2002).
- Inattentive Symptoms: ADHD females have a higher probability than males to experience inattentive ADHD symptoms, such as difficulty focusing, disorganisation, forgetfulness, and daydreaming. These symptoms may be less visible and disruptive, often leading to them being misinterpreted as a lack of motivation or “quietness.” As a result, inattentive ADHD in females often goes unnoticed in school and social settings.
- Hyperactive-Impulsive Symptoms: Males with ADHD are more likely to exhibit hyperactivity and impulsivity, such as fidgeting, excessive talking, difficulty remaining seated, and impulsive decision-making. These symptoms are more noticeable and can disrupt the classroom, which is why ADHD is often identified and diagnosed more readily in males (Hinshaw et al., 2006).
2. Impact of Societal Expectations and Gender Roles
Societal expectations play a significant role in shaping how ADHD is perceived in females versus males. Females with ADHD may struggle to meet these expectations, but they often internalise their challenges instead of displaying disruptive behaviours (Quinn, 2005). This internalisation can manifest as social withdrawal, anxiety, or perfectionism as they attempt to “mask” their symptoms to fit societal norms.
The need to conform to gender expectations often leads to “masking” or “camouflaging” ADHD symptoms. This can make symptoms harder to detect and delay diagnosis. Girls may develop compensatory strategies, such as over-preparation, excessive organisation efforts, or mimicking peer behaviours to cope, but these adaptations are exhausting and unsustainable, possibly leading to burnout or mental health issues over time (Young et al., 2020).
3. Emotional and Social Challenges
Females with ADHD tend to experience more emotional regulation difficulties and social challenges, often leading to issues with self-esteem, anxiety, and depression. Emotional dysregulation in ADHD can lead to heightened sensitivity, impulsivity in relationships, and difficulty managing stress, which may manifest in ways that are not immediately associated with ADHD (Rucklidge, 2010). Additionally, females are more likely to experience “Rejection Sensitive Dysphoria” (RSD), a heightened emotional response to perceived rejection, which can complicate social interactions and exacerbate feelings of inadequacy (Faraone et al., 2019).
Socially, females with ADHD may struggle to maintain friendships or feel different from their peers due to their challenges with focus, forgetfulness, and emotional regulation. While boys with ADHD may face similar difficulties, girls are more likely to internalise feelings of failure, leading to increased risks of anxiety, depression, and low self-esteem (Hinshaw et al., 2006).
4. Later Diagnosis in Females and Its Consequences
Due to these gender differences in ADHD presentation, females are often diagnosed much later than males. Boys with hyperactive and impulsive symptoms are more readily identified by teachers and parents, resulting in earlier referrals for assessment. However, girls’ symptoms are frequently overlooked or misdiagnosed as other conditions, such as anxiety or depression, due to their subtler manifestations (Gershon, 2002).
Later diagnosis means that many females do not receive early interventions that could help them develop coping skills, manage symptoms, and build self-esteem. By the time they are diagnosed, they may have developed secondary mental health issues like depression and anxiety, often due to years of struggling without support. Additionally, older females may face greater challenges in work, education, and relationships as they attempt to manage their ADHD without adequate resources (Young et al., 2020).
5. The Need for Gender-Sensitive ADHD Assessment and Support
Understanding these gender differences highlights the importance of gender-sensitive approaches in ADHD assessment and support. Early diagnosis can prevent many of the long-term impacts associated with undiagnosed ADHD, such as difficulties in school, lower self-esteem, and mental health issues. Educators, healthcare providers, and families should be aware of how ADHD can present differently in females and advocate for assessments that account for these variations.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Biederman, J., Mick, E., & Faraone, S. V. (2002). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: Impact of remission definition and symptom type. American Journal of Psychiatry, 157(5), 816-818.
Faraone, S. V., Rostain, A. L., Blader, J., Busch, B., Childress, A. C., Connor, D. F., & Newcorn, J. H. (2019). Practitioner review: Emotional dysregulation in attention‐deficit/hyperactivity disorder–implications for clinical recognition and intervention. Journal of Child Psychology and Psychiatry, 60(2), 133-150.
Gershon, J. (2002). A meta-analytic review of gender differences in ADHD. Journal of Attention Disorders, 5(3), 143-154.
Hinshaw, S. P., Owens, E. B., Sami, N., & Fargeon, S. (2006). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into adolescence: Evidence for continuing cross-domain impairment. Journal of Consulting and Clinical Psychology, 74(3), 489.
Quinn, P. O. (2005). Treating adolescent girls and women with ADHD: Gender‐specific issues. Journal of Clinical Psychology, 61(5), 579-587.
Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. The Primary Care Companion for CNS Disorders, 16(3).
Rucklidge, J. J. (2010). Gender differences in attention-deficit/hyperactivity disorder. Psychiatric Clinics of North America, 33(2), 357-373.
Young, S., Hollingdale, J., Absoud, M., Bolton, P., Branney, P., Colley, W., … & Woodhouse, E. (2020). Guidance for identifying and managing ADHD in children and young people: The UK ADHD Partnership Guide. Journal of Psychopharmacology, 34(5), 456-482.