Many girls with ADHD aren’t diagnosed until their late teens or adulthood. My recent research points to a possible explanation for this.
The study, published with my colleague Sorcha Walsh, found that while many of the women we interviewed may have displayed signs of ADHD while at school, these weren’t interpreted as such. This misrecognition not only meant that most waited years for a diagnosis – it also had long-term impacts on their sense of self.
The research involved in-depth interviews with 13 women aged 18-35 who had been officially diagnosed with ADHD either during childhood or, much more commonly, after leaving school.
We analysed their accounts to identify recurring patterns in their school experiences, pathways to diagnosis and the impact ADHD had on their wellbeing and identity.
A striking pattern emerged across the interviews: none of the girls were overlooked because they were invisible. Rather, they were overlooked because what adults noticed didn’t fit the stereotype of ADHD.
Teachers repeatedly flagged difficulties – such as the girls being too chatty, unfocused, disorganised, “quirky” or emotionally reactive in school. It seems teachers saw such behaviour as personality traits or as typical girls’ behaviour.
For instance, one participant told us: “I was always known as chatty in school … I just thought it was being a girl as it has always been a trait of being a young girl.”
Another participant said: “I think it’s easy with girls to just … say that they’re a bit chatty or contrary or a bit dreamy … rather than getting down and looking a bit deeper…”
Several participants described receiving school reports that essentially listed ADHD indicators without any suggestion the traits might be signs of the neurodevelopmental condition.
This misrecognition had long-term consequences. Almost all participants went through school believing they were lazy, careless, “too emotional” or that they were “not trying hard enough”.
The deepest impact they described wasn’t on their grades but on their sense of self. Many internalised the idea that something was wrong with them – and several were misdiagnosed with anxiety, depression or even personality disorders before finally receiving an ADHD diagnosis in adulthood.
One unexpected finding was that an early diagnosis didn’t automatically protect girls from these negative experiences. The few participants who were diagnosed during school still struggled – not because the diagnosis was wrong, but because teachers didn’t understand how ADHD presents in females.
Some received no meaningful support at all and others continued to be treated as if their behaviour was intentional rather than symptomatic.
This highlights an important nuance: timing of diagnosis matters, but understanding matters more.
Diagnostic culture
Our study sheds light on a broader issue within today’s diagnostic culture. We tend to diagnose what we already expect to see. When a condition is seen through a single stereotype, those who don’t fit that picture fall through the cracks.
For decades, ADHD has been culturally associated with the image of a young boy who can’t sit still, disrupts lessons or climbs on furniture. But our research showed that most of the girls we interviewed did not behave this way.
This also reveals something deeper about how society responds to girls’ behaviour. Many of the women in our study spoke about masking (concealing symptoms to fit in or avoid judgement), overcompensating, people pleasing and doing everything possible not to disrupt others. These behaviours were rewarded. Their ability to cope, or at least appear to cope, was taken as evidence that they were fine.
But coping is not the same as thriving. Masking and overcompensation are linked to higher rates of anxiety, depression, burnout and lower quality of life among women with ADHD.
Diagnostic systems for ADHD have historically been designed around identifying observable, behavioural signs of the condition – such as hyperactivity, rule-breaking and disruptive classroom behaviour – rather than the more internal forms of distress and impairment.
This means established criteria may struggle to detect internal difficulties – such as emotional dysregulation (having trouble managing emotions or feeling overwhelmed), cognitive overload (mental exhaustion when faced with a lot of information or demands) or quiet inattention – which can also be signs of the condition. This creates a systemic inequality: the children who are easiest to overlook are also those most likely to be misunderstood.
As our study was relatively small, it will be important for future studies to examine whether these patterns can be replicated in larger or more diverse samples.
However, our findings are consistent with others from the wider literature, showing that girls with ADHD are more likely to present with predominantly inattentive and internalising symptoms. Research has also shown they’re likely to have their difficulties misattributed to anxiety or mood problems and to be diagnosed later or overlooked altogether compared with boys.
Supporting girls with ADHD
The women we spoke with offered clear suggestions for what would have made a difference.
Schools can support girls with ADHD, and spot the condition earlier, by recognising non-stereotypical signs of ADHD (including daydreaming, talkativeness or restlessness) – and ensuring teachers are properly trained in identifying ADHD and how is manifests differently in girls.
Participants suggested that it would be helpful as well if positive strengths, such as creativity, humour, quick-thinking and the ability to hyperfocus, were seen as assets to be nurtured in school – rather than being overlooked.
Those who had been diagnosed with ADHD while they were still in school also suggested that meaningful accommodations would have improved their experiences – such as more structure, breaks for movement and mentorship for girls with ADHD.
In the end, girls with ADHD do not need to be louder to be recognised. They need a school system that knows what to look for. Recognising their experiences earlier could prevent years of misunderstanding, self-doubt and missed potential.
