Attention-Deficit/Hyperactivity Disorder (ADHD) has historically been conceptualised as a predominantly male condition, contributing to delayed recognition and underdiagnosis in girls and women. Longitudinal research suggests that ADHD in females is associated with long-term risks, including internalising disorders, self-harm, and psychosocial impairment, particularly when symptoms go unrecognised and untreated (Hinshaw et al., 2020; Owens et al., 2020). Current evidence raises concerns about both over- and under-diagnosis, aiming for a better understanding of ADHD female presentation (NICE, 2023).
ADHD in girls and women is frequently under-recognised, with important implications for mental health and long-term outcomes.
Why ADHD in girls and women has been overlooked
ADHD affects individuals of all genders, yet clinical and research samples have historically been dominated by males. This imbalance has affected diagnostic criteria, referral patterns, and public perceptions of the condition (Hinshaw et al., 2022). Females are more likely to present with inattentive symptoms, internalising difficulties, and socially compliant behaviour, making difficulties less visible across settings. Longitudinal research has shown that this under-recognition is not without cost. Girls with ADHD experience substantial and persistent impairment across adolescence and adulthood, even when early symptoms appear subtle (Hinshaw et al., 2020; Owens et al., 2020).
Gendered expectations can obscure ADHD presentations in girls, delaying recognition and support.
Developmental trajectories and delayed recognition
Long-term prospective studies suggest that childhood ADHD in girls predicts adverse adult outcomes, including academic underachievement, occupational instability, relationship difficulties, and mental health disorders (Hinshaw et al., 2020; Owens et al., 2020). Delayed diagnosis appears to increase these risks by allowing difficulties to compound over time.
Delayed recognition of ADHD in girls can compound risk across key developmental stages.
Stigma, masking, and internalising risk
Girls with ADHD may internalise repeated experiences of failure and criticism, leading to masking behaviours and increased vulnerability to anxiety, depression, and self-harm. Longitudinal research highlights the role of stigma and gender norms in shaping these outcomes (Hinshaw et al., 2022). Emotion dysregulation has been identified as an important mediator linking ADHD symptoms and internalising difficulties in adolescent girls (Babinski et al., 2021).
Stigma and masking behaviours contribute to elevated internalising and self-harm risk.
ADHD and self-harm risk
Population-based and longitudinal studies suggest that ADHD is associated with elevated risk of self-harm and suicidal behaviour, with particularly strong associations observed among females (Hirvikoski et al., 2020; Hinshaw et al., 2020). These risks may persist into adulthood when ADHD remains impairing and untreated (Owens et al., 2020).
ADHD is associated with increased self-harm risk, particularly among girls and women.
Diagnostic bias and contemporary controversies
Public and academic debate around ADHD diagnosis has intensified, often focusing on concerns about over-diagnosis. However, longitudinal evidence suggests that increased identification may reflect improved recognition of previously overlooked populations, including girls and women (Hinshaw et al., 2022). Clinical guidelines emphasise that diagnosis should be based on persistent symptoms, functional impairment, and developmental history (NICE, 2023).
Diagnostic debates risk obscuring ongoing under-recognition of girls and women.
Assessment considerations across the lifespan
Assessment of ADHD in girls and women requires developmentally sensitive approaches, attention to functional impairment, and consideration of cumulative burden over time (NICE, 2023). Structured interviews and collateral information can support diagnostic clarity, particularly in retrospective adult assessments (Hinshaw et al., 2022).
Developmentally sensitive assessment is essential for identifying ADHD in girls and women.
Conclusion
ADHD in girls and women has long been under-recognised, with significant consequences for mental health and functioning. Longitudinal evidence underscores the importance of early identification, careful assessment, and supportive intervention to reduce inequities and improve long-term outcomes (Hinshaw et al., 2020; Owens et al., 2020). Recognising ADHD in girls and women is essential to improving equity and outcomes.
Where next?
Join us on 16 April for ‘Autism and ADHD: diagnosis and demand in neurodevelopmental care. Emanuel Miller International Online Conference‘. This conference will explore current debates around autism and ADHD, focusing on how scientific evidence, diagnostic practices, and rising demand for assessment intersect within contemporary neurodevelopmental care. Bringing together leading experts, the programme will examine how changes in diagnostic frameworks, service pressures, and social contexts shape who receives a diagnosis, when, and with what implications for young people, families, and services.
References
Babinski, D. E., Owens, E. B., Evans, S. W., & Hinshaw, S. P. (2021). Emotion dysregulation and internalising symptoms in adolescent girls with ADHD. Research on Child and Adolescent Psychopathology, 49(3), 331–344.
Hinshaw, S. P., Owens, E. B., Zalecki, C., et al. (2020). Prospective follow-up of girls with ADHD into early adulthood. Journal of Consulting and Clinical Psychology, 88(4), 352–364.
Hinshaw, S. P., Owens, E. B., & Zalecki, C. (2022). ADHD in girls: Developmental and social considerations. Current Psychiatry Reports, 24, 1–11.
Hirvikoski, T., et al. (2020). Premature mortality in ADHD. British Journal of Psychiatry, 216(5), 257–263.
Owens, E. B., Zalecki, C., Gillette, P., & Hinshaw, S. P. (2020). Adult outcomes for girls with childhood ADHD. Journal of Consulting and Clinical Psychology, 88(4), 336–351.
National Institute for Health and Care Excellence. (2023). Attention deficit hyperactivity disorder: Diagnosis and management (NG87).