Does ADHD Look Different in Boys and Girls?

Attention-deficit/hyperactivity disorder (ADHD) can show itself in very different ways. For some kids, especially boys, it can be loud and hard to miss. For others, girls in particular, it may be quieter and easier to overlook.

These differences play a significant role in how we view ADHD and who gets diagnosed with it. Developmental pediatrician Carrie Cuffman, MD, explains what that means in the big picture.

ADHD in boys vs. girls

Boys are nearly twice as likely as girls to receive an ADHD diagnosis — but that doesn’t necessarily mean the condition affects them more. Instead, it often comes down to recognizing it.

There are three basic presentations of ADHD:

• Hyperactive and impulsive
• Inattentive
• Combination of inattentive, hyperactive and impulsive

In general, boys with ADHD are more likely to exhibit hyperactive and impulsive behavior that’s easily noticed, says Dr. Cuffman. Girls tend to display more subtle signs of ADHD that land in the “inattentive” category.

Here’s a closer look at each.

Common ADHD symptoms in boys

ADHD symptoms in boys are often more disruptive and noticeable. Dr. Cuffman says this might show as:

• Hyperactivity (like running around) or unruly behavior that seems “wild”
• Physical aggression
• Difficulty sitting still
• Excessive talking
• “Acting out” in response to situations
• Interrupting conversations or events

“Boys with ADHD may seem to be always on the go and moving fast,” explains Dr. Cuffman. “Their behavior catches people’s attention, which may lead to more discipline concerns at home or in the classroom.”

But that’s not a hard and fast rule. Plenty of boys exhibit ADHD symptoms that lean toward the more restrained inattentive category.

Common ADHD symptoms in girls

Girls with ADHD often tend to seem withdrawn or inattentive, with symptoms that look more subtle. This could include:

• Daydreaming
• Difficulty focusing
• A lack of confidence
• Fidgeting
• Verbal aggression (like teasing)
• Trouble maintaining friendships
• Academic struggles

“These tend to be ‘quieter’ symptoms, which can make them easy to overlook,” says Dr. Cuffman. “Girls usually aren’t drawing attention to themselves with the disruptive behavior you often see in boys.”

But again, these are generalizations. Girls with ADHD may display hyperactive behavior that is more physical in nature.

Is ADHD underdiagnosed in girls?

Research shows that girls are far less likely than boys to be referred for an ADHD diagnosis. The difference in symptoms — particularly early in childhood — is one explanation for that disparity.

Social stereotypes also play a role. Many people expect girls to be quieter and more reserved, so ADHD symptoms that match that belief are often waved off.

“We’re clearly missing ADHD in many girls,” suggests Dr. Cuffman.

It should be noted that women are diagnosed with ADHD at roughly the same rate as men, she adds. That’s partly because those quieter inattentive symptoms often become more noticeable with age, given the many demands of adult life.

Challenges that undiagnosed girls may experience

Undiagnosed ADHD means untreated ADHD, which can create difficulties at home and school. Many girls with undiagnosed ADHD are unfairly labeled as “lazy.”

“If you have trouble paying attention, it can be harder to learn,” says Dr. Cuffman. “Girls with undiagnosed ADHD might be accused of not trying hard enough. Their self-esteem may start to suffer, and that can lead down a road toward depression and anxiety.”

That’s why it’s so important to identify signs of ADHD early.

“If you know a child has ADHD, you can treat it and provide support for it,” emphasizes Dr. Cuffman. “There are so many things that can be done to help these kids along so they can succeed. It’s just a matter of starting the process.”