Dear Dr. Sharon: “Can girls have ADHD if they’re not hyperactive or disruptive?”
Girls and women with ADHD are often hiding in plain sight — bright, capable, and caring, yet constantly battling self-doubt and exhaustion from trying to keep up. By expanding our understanding of what ADHD looks like beyond STEREOTYPICAL DEFINITIONS, we can identify and support girls earlier, helping them grow into confident, self-aware YOUNG adults.
Dear Dr. Sharon,
My 14-year-old daughter has always been bright, creative, and a little scattered. Lately, her teachers have mentioned that she seems distracted and forgetful, but they also say she’s “too polite and well-behaved” to have ADHD. I’m confused — can girls have ADHD even if they’re not hyperactive or disruptive?
-Lily, Texas
Dear Lily,
This is such an important question and one I hear often from parents like yourself, educators and clinicians. I also hear similar confusion from women who discover their ADHD diagnosis later in life. ADHD absolutely occurs in girls, but it often looks different than it does in boys, which is why so many girls slip through the cracks for years — sometimes decades — before receiving a diagnosis.
For generations, most of what we knew about ADHD came from research on boys (those assigned male at birth). The earliest studies focused on the externalizing symptoms of ADHD that people can see: hyperactivity, impulsivity, aggression, fidgeting, excessive movement, restlessness, disorganization, loudness and interrupting. These behaviors tend to draw attention from teachers, who often make referrals for evaluation during the elementary and middle school years. As a result, boys are diagnosed with ADHD at more than twice the rate of girls — about 12.9% compared to 5.6%.
But ADHD manifests differently in girls and often doesn’t emerge until later–during puberty, middle or high school, college transition years and afterwards. Instead of bouncing out of their seats or interrupting in class, many girls with ADHD struggle quietly with what we call internalizing symptoms — the ones that happen inside the mind and heart, and are less visible to others.
What ADHD Looks Like in Girls
Women and girls are far more likely to experience these internalizing symptoms of ADHD:
Disorganization, forgetfulness, or chronic lateness
Excessive talking or daydreaming
Inner restlessness that replaces physical fidgeting
Difficulty starting or finishing tasks
Overwhelm and anxiety
Perfectionism and people-pleasing
Emotional sensitivity or mood swings
Social awkwardness or “zoning out”
Early sexual activity or risk-taking behaviors
These traits are less disruptive in a classroom, so girls are less likely to be referred by educators for an evaluation. Teachers, clinicians and caregivers may interpret them as personality quirks or “emotional” tendencies rather than red flags for ADHD. A girl who’s chatty, imaginative, and disorganized might just be seen as “scattered but sweet.” A teen who spends hours rewriting essays or overstudying may be praised for her work ethic, even as she’s burning out.
The Masking Trap
Many girls and women develop strategies to compensate for inattention and mask their academic and/or social difficulties at a young age. Examples of being extra polite or too well-behaved that you shared are common. As girls mature, demands on their executive functioning skills intensify and social situations become more complicated to navigate. Masking as a coping mechanism becomes less effective. Underneath, they grow increasingly overwhelmed, anxious, or depressed.
Frequently, girls and women are referred for mood conditions, eating disorders or self-harming behaviors without any consideration of their attention issues. The underlying challenges with focus, organization, and self-regulation go overlooked and then untreated. Many girls and women end up feeling defective, confused, and exhausted by the constant effort to “keep it together.”
Why Diagnosis Comes Late — or Not at All
First, cultural expectations about being female play a significant role. Society often rewards girls for being compliant, quiet, and caring. When girls don’t fit that mold — when they speak up, move fast, or lose focus — they may be labeled as “too much,” “immature,” or “dramatic.” Meanwhile, the girls who do fit the mold but struggle internally are overlooked because their symptoms don’t cause problems for others.
Secondly, socially, throughout school years and beyond, females with ADHD regularly suffer from exclusion, rejection, and difficulty making and maintaining friendships. They may miss key social cues because they’ve "spaced out," or they don’t notice that they have been talking too long and peers have stopped listening.
Lastly, by the late teens or throughout adulthood, many women recognize themselves in ADHD descriptions and finally seek answers. They may describe lifelong feelings of being “different,” “lazy,” or “flaky,” when in truth, they’ve been living with an undiagnosed neurodevelopmental condition all along. It’s also important to acknowledge that hormonal shifts in the menstrual cycle, perimenopause and menopause affect the symptoms of ADHD, increasing distractibility, mood changes, and forgetfulness. All of these differences explain why many girls and women are delayed in receiving a diagnosis.
How to Better Support Girls and Women with ADHD
The good news is that awareness is growing with more effective ways to support girls and women in recognizing, understanding, and managing their ADHD. Here are five actionable strategies:
1. Learn the Signs of ADHD in Girls & Women
Start by familiarizing yourself with the less visible presentations of ADHD in girls :
Difficulty staying organized or remembering details
Chronic overwhelm, anxiety, or emotional ups and downs
Trouble finishing tasks, even when interested
Overthinking, perfectionism, and procrastination
Low self-esteem despite high effort
Recognizing these patterns early makes a big difference. If you suspect ADHD, seek a comprehensive evaluation with a clinician who understands gender, social, and other differences in ADHD presentation.
2. Validate Feelings and Reduce Shame
Many girls with ADHD grow up hearing that they’re “too sensitive,” “lazy,” or “not living up to potential.” Help counter these messages by acknowledging their effort and reinforcing their strengths. Validation–not reassurance–builds confidence and reduces the shame that so often accompanies undiagnosed ADHD.
Try saying things like:
“I see how hard you’re trying — that matters more than perfection.”
“It’s okay to ask for help; everyone’s brain works differently.”
3. Build Supportive Routines
Routines provide structure and predictability, helping to reduce overwhelm. When you keep routines flexible and collaborative, they support efforting and success and don’t feel punitive or rigid.
Work together to:
Create visual schedules or planners
Set phone alarms or reminders
Break big tasks into smaller chunks
4. Address Emotional Regulation
Girls and women with ADHD often experience strong emotions and rejection sensitivity. Encourage tools that help them pause, reflect, and reset — like deep breathing, yoga, journaling, or short movement breaks. Therapy that combines cognitive-behavioral strategies with self-compassion practices can be especially beneficial.
5. Advocate at School and Work
If a student is struggling, communicate with teachers or counselors about potential supports such as extended time, preferential seating, or assignment flexibility. For adults, workplace accommodations under the ADA — like written instructions, noise-reducing headphones, or flexible scheduling — can make a meaningful difference.
Final Thoughts
Lily, girls and women of all ages with ADHD are often hiding in plain sight — bright, capable, and caring, yet constantly battling self-doubt and exhaustion from trying to keep up. By expanding our understanding of what ADHD looks like beyond the traditional “boy in the back of the classroom bouncing off the walls,” we can identify and support more girls earlier, helping them grow into confident, self-aware adults. When we recognize ADHD in girls not as a personal failing but as a different way of thinking, feeling, and processing, we give them something invaluable: understanding, confidence, and the tools they will need to navigate their world.
Warmly,
Dr. Sharon
