Attention-Deficit Hyperactivity Disorder often presents differently in girls compared to boys, leading to underdiagnosis or misdiagnosis. While boys are more likely to display externalized symptoms like hyperactivity and impulsivity, girls with ADHD often show internalized symptoms that can be mistaken for being anxious, shy (or the opposite – overly social), or unmotivated. Also, understanding girls with ADHD and anxiety (since symptoms are often interwoven) requires knowing the inner strength and resilience girls have, often overcoming symptoms enough to achieve well enough to escape notice. Knowing early ADHD symptoms in general and the signs of ADHD in girls is key.
It should be noted, of course, that whenever we talk about gender-specific signs or symptoms, there is always overlap. Some girls present with “traditional” symptoms, while many boys present in the ways described below. I would happily discuss your child’s needs and what therapy could provide. Feel free to contact me or schedule a consultation anytime.
Girls with ADHD Overview
The following is an overview of ADHD symptoms in girls, their challenges, and strengths. Understanding girls with ADHD involves knowing these facets of their experience.
Common ADHD Symptoms in Girls
Girls with ADHD and anxiety often have unique symptoms, including:
- Inattention: Difficulty focusing, easily distracted, daydreaming, trouble completing tasks.
- Hyperactivity (less obvious): More likely to show restlessness (e.g., fidgeting, tapping) rather than running or climbing excessively.
- Impulsivity: Speaking without thinking, interrupting conversations, emotional outbursts.
- Emotional Dysregulation: Intense emotions, mood swings, difficulty managing frustration.
- Perfectionism: Overcompensating for struggles by trying to meet unrealistic standards.
- Masking: Girls with ADHD often become experts at hiding their symptoms to fit in socially.
Challenges Girls with ADHD Face
Girls with ADHD and anxiety often face challenges that can go unnoticed or under-appreciated.
- Social Struggles: Early signs of ADHD in girls include difficulty maintaining friendships and feeling left out.
- Low Self-Esteem: Frequent undeserved criticism or feelings of failure can damage self-confidence.
- Academic Challenges: ADHD symptoms in girls lead to trouble staying organized, following instructions, or completing homework.
- Late Diagnosis: Many are not diagnosed until adolescence or adulthood because too few adults truly understand the diagnosis and the early ADHD symptoms.
Strengths Often Seen in Girls with ADHD
Understanding girls with ADHD requires knowing the strengths and advantages many girls with the diagnosis have. This is just a partial list.
- Creativity and out-of-the-box thinking
- Strong empathy and emotional insight
- High energy and enthusiasm
- Adaptability to new situations
Support Strategies
Designing an effective support strategy also involves understanding girls with ADHD and their unique challenges.
- Structure and Routine: Consistent daily schedules.
- Positive Reinforcement: Celebrate successes and small achievements.
- Break Tasks into Steps: Manage overwhelm by tackling smaller tasks.
- Therapy or Coaching: Behavioral therapy and coaching can help build coping mechanisms. For older girls, cognitive-behavioral therapy or mindfulness-based treatment can be a good choice.
- Medication (if needed): Stimulants or non-stimulants may help manage symptoms.
Understanding Girls with ADHD
The key to understanding girls with ADHD is recognizing that their symptoms often present differently from the stereotypical image (typically based on hyperactive boys). This difference can lead to late diagnoses, misunderstandings, and struggles with self-esteem.
Signs of ADHD in Girls
1. Inattention (The Quiet Symptom)
- One of the most prominent signs of ADHD in girls is difficulty focusing on tasks or conversations, though it is often missed.
- Easily distracted, daydreaming, or zoning out
- One of the early signs of ADHD in girls is that they have trouble following multi-step instructions despite high intelligence.
- Frequently losing items (e.g., keys, homework)
- One of the most misunderstood signs of ADHD in girls is procrastination and difficulty starting tasks, leading to unwarranted negative feedback.
2. Hyperactivity (Often Internalized)
- Instead of being outwardly hyperactive (like running or climbing), girls might:
- Talk excessively
- Fidget (e.g., tapping, doodling, playing with hair)
- Feel intense internal restlessness, even if they manage it
3. Emotional Dysregulation
- Intense emotional reactions to minor setbacks
- Frequent mood swings are common signs of ADHD in girls
- Difficulty calming down after emotional outbursts
4. Social Struggles
- Difficulty maintaining friendships due to impulsivity (e.g., blurting things out, interrupting)
- Trouble reading social cues are signs of ADHD in girls, especially when social skills are otherwise good
- Understanding girls with ADHD includes realizing where their fear of rejection or social anxiety comes from
5. Masking
- Girls often become skilled at masking their symptoms to fit in socially or meet expectations.
- They might over-prepare, over-apologize, or mimic others to hide their struggles.
- Masking is exhausting and can lead to burnout or anxiety.
- These are core signs of ADHD in girls that keep the diagnosis hidden
Common Misunderstandings About Girls with ADHD
- “She’s just shy or quiet.” → Understanding girls with ADHD means knowing that inattention is mistaken for being introverted.
- “She’s just emotional.” → Emotional dysregulation is seen as over-sensitivity.
- “She’s lazy or not trying hard enough.” → Executive dysfunction makes starting or finishing tasks hard, but it’s not about effort.
- “She’s a perfectionist.” → Overcompensating for struggles can lead to burnout.
Strengths of Girls with ADHD
- Creativity: Unique problem-solving and artistic talents
- Empathy: Strong emotional intelligence and ability to connect with others
- Hyperfocus: When engaged in something they love, they can achieve deep focus and productivity
- Adaptability: Ability to thrive in dynamic or changing environments
Supporting Girls with ADHD
- Listen Without Judgment: Create a safe space for them to share their experiences.
- Encourage Breaks: Short breaks during tasks can improve focus.
- Provide Clear Instructions: Break down tasks into smaller, manageable steps.
- Normalize Conversations: Help them understand their symptoms are not a flaw but a different way of thinking.
- Seek Professional Help: Counseling, therapy, or coaching can provide valuable tools.
Early ADHD Symptoms in Girls
Symptoms often appear in early childhood, typically before age 12. Early recognition and overall understanding of girls with ADHD are crucial for effective support and intervention.
Early ADHD Symptoms in Girls in Preschool
1. Inattention Symptoms:
- Difficulty focusing on tasks or activities, even those they enjoy
- Easily distracted by noises, sights, or other stimuli
- Trouble following instructions or completing multi-step tasks
- Frequently losing toys, school supplies, or personal items
- Avoiding tasks that require sustained mental effort (e.g., homework, puzzles)
2. Hyperactivity Symptoms:
- Constant movement (e.g., running, climbing in inappropriate places)
- Difficulty sitting still (e.g., fidgeting, tapping, squirming)
- Talking excessively, often interrupting others
- Seeming “on the go” or unable to relax
- Trouble playing quietly or engaging in calm activities
3. Impulsivity Symptoms:
- Acting without thinking about the consequences
- Interrupting conversations or games
- Difficulty waiting their turn in group activities or conversations
- Blurting out answers before a question is finished
- Emotional outbursts and difficulty managing frustration
How Symptoms Differ in Girls vs. Boys Early On:
- Boys: Often show more hyperactive-impulsive behaviors (e.g., running, climbing, acting out).
- Girls: More likely to display inattentive symptoms (e.g., daydreaming, trouble focusing) and emotional sensitivity.
- Girls are more prone to masking behaviors to fit social expectations.
Signs of ADHD in Girls to Watch For:
- Preschool Age (3-5 years): Early ADHD symptoms include hyperactivity, trouble following simple instructions, impulsive behavior
- Early Elementary (6-9 years): Difficulty focusing on schoolwork, emotional outbursts, poor organizational skills
- Middle Childhood (10-12 years): Forgetfulness, low frustration tolerance, academic struggles despite effort
What to Do if You Notice Early ADHD Symptoms
- Document Behaviors: Keep track of patterns and triggers to those early ADHD symptoms.
- Talk to Teachers or Caregivers: Share observations to see if early ADHD symptoms occur in multiple settings.
- Consult a Pediatrician or Specialist: Early evaluation can lead to proper diagnosis and intervention.
- Explore Support Strategies: Tools like timers, visual schedules, and task lists can help with focus and structure.
Girls with ADHD and Anxiety: A Complex Overlap
Attention-Deficit Disorder and anxiety often co-occur in girls, creating a unique set of challenges. The emotional struggles linked to the attention deficit (e.g., impulsivity, forgetfulness, disorganization) can lead to anxiety, while anxiety can worsen attention deficit symptoms by increasing overthinking and indecision. Understanding girls with ADHD involves realizing this vicious cycle.
Girls with ADHD and Anxiety: Why Symptoms Co-Exist
- Late Diagnosis: Many girls are diagnosed later in life because people miss the early symptoms, leading to years of unmet needs and emotional stress.
- Masking Symptoms: Constantly trying to hide symptoms (e.g., inattentiveness, impulsivity) creates chronic stress and anxiety.
- Fear of Failure: Struggling to meet academic or social expectations can lead to performance anxiety.
- Emotional Sensitivity: Both diagnoses heighten emotional responses, making everyday stressors feel overwhelming.
Girls with ADHD and Anxiety: How Symptoms Overlap
| Attentional Symptoms | Anxiety Symptoms |
|---|---|
| Easily distracted | Excessive worry about making mistakes |
| Procrastination | Overthinking simple decisions |
| Impulsivity | Fear of consequences |
| Emotional outbursts | Irritability, nervousness |
| Trouble starting or finishing tasks | Avoidance of tasks due to fear of failure |
Girls with ADHD and anxiety often feel mentally exhausted from trying to meet expectations while managing their symptoms.
Unique Challenges Faced by Girls with ADHD and Anxiety
- Social Anxiety: Fear of saying the wrong thing or being judged.
- Perfectionism: Obsessive focus on avoiding mistakes to prevent criticism.
- Sleep Issues: Racing thoughts combined with hyperactivity can make falling asleep difficult.
- Low Self-Esteem: Constantly feeling like they are “not good enough.”
Strategies for Managing Both Sets of Symptoms
1. Build Structure and Predictability
- Use planners, visual schedules, and reminders.
- Break tasks into smaller, manageable steps.
2. Emotional Regulation Techniques
- Practice mindfulness exercises (e.g., deep breathing, grounding techniques).
- I often teach girls with ADHD and anxiety coping strategies like journaling or using fidget tools.
3. Cognitive Behavioral Therapy (CBT)
- Helps girls with ADHD and anxiety manage negative thought patterns.
- Teaches girls with ADHD and anxiety problem-solving skills and emotional regulation.
4. Medication (if recommended)
- Some medications (e.g., stimulants or SSRIs for anxiety) can help manage symptoms.
5. Encourage Open Communication
- Create a safe space for girls with ADHD and anxiety to talk about feelings without judgment.
- Validate their experiences and emotions.
Strengths of Girls with ADHD and Anxiety
- Empathy: They often have a deep emotional understanding of others’ feelings.
- Creativity: Innovative problem-solving skills and imagination.
- Resilience: Adaptability and determination despite challenges.
Understanding girls with ADHD and anxiety requires patience, empathy, and tailored strategies.
Case Example: 14-Year-Old Emma
Background:
Emma is a 14-year-old middle school student who has always been described as “bright but scattered.” Her teachers noticed she often seemed lost in thought during lessons, forgot to turn in her homework, and struggled with following multi-step instructions. Her parents observed her constant procrastination, messy room, and frequent emotional outbursts at home over seemingly small issues.
Early ADHD Symptoms
- She has difficulty focusing on schoolwork unless it’s a topic she’s deeply interested in.
- She frequently loses her school supplies and forgets assignments.
- Early ADHD symptoms included restlessness, fidgeting with her hair, or tapping her pencil during class.
- She struggles to start tasks and feels overwhelmed by large projects.
Anxiety Presentation:
- She worries excessively about grades and being liked by her peers.
- She avoids participating in class discussions for fear of saying the wrong thing.
- Overthinks simple decisions, such as choosing what to wear to school.
- Experiences stomachaches and trouble sleeping before tests or presentations.
Masking:
Emma is highly aware of her struggles and works hard to hide them. She writes detailed to-do lists but becomes paralyzed by fear of forgetting something. At school, she avoids asking for help to prevent looking “stupid.”
Impact on Daily Life:
- Academics: Falling behind in assignments despite spending hours on homework.
- Friendships: Feels socially anxious, afraid her friends will reject her if she says the wrong thing.
- Self-Esteem: Frequently calls herself “lazy” and “dumb.”
Intervention Plan:
- Academic Accommodations for ADHD:
- Extra time on assignments and tests.
- Seat placement in a low-distraction area.
- Clear, step-by-step instructions for tasks.
- Therapy (CBT for ADHD):
- Help Emma challenge negative thought patterns (e.g., “If I don’t get this perfect, I’ll fail.”).
- Teach coping strategies for anxiety (e.g., deep breathing, grounding exercises).
- Home Support:
- Use a visual schedule for daily routines.
- Break chores and homework into smaller steps.
- Praise effort over outcomes to reduce fear of failure.
- Medication:
- After consultation with a pediatric psychiatrist, Emma starts a low-dose stimulant for attention and an SSRI for anxiety.
Progress After 6 Months:
- Emma feels more confident asking for help when she doesn’t understand something.
- Her academic performance improves with structure and reduced anxiety.
- She reports fewer emotional breakdowns and enjoys spending time with friends without constant worry.
This case highlights how important understanding girls with ADHD is, in this case, how anxiety and attentional symptoms can intertwine, creating a cycle of frustration and self-blame. Addressing both conditions simultaneously through therapy, accommodations, and support can lead to meaningful improvement. Knowing the signs of ADHD in girls provided an important first step.
My Work with Girls with ADHD
I provide specialized therapy for girls with ADHD and consultation to parents and teachers about early ADHD symptoms and signs in girls. I can also arrange psychological testing to provide a detailed assessment. For college students and over, please refer to my post about ADHD in women. Individual therapy can be effective virtually, depending on the child’s age and comfort with virtual methods. However, with younger children, the services I provide often revolve around family therapy or parent consultation.
If you want more information about understanding ADHD in girls or would like to talk about therapy for your child, please contact me or schedule a consultation anytime..
