Unmasking ADHD: How Symptoms Differ Between Genders

As awareness of ADHD continues to grow, so does the conversation around who gets diagnosed—and who doesn’t. While it's true that more children and adults are being evaluated for attention-deficit/hyperactivity disorder (ADHD) than previous decades, the picture is far from complete. Environmental factors like increased screen time and overstimulation may be contributing to the rise in diagnoses, but many individuals still go undiagnosed or misdiagnosed for years.

This is especially true for females, as ADHD has historically been perceived as a “boys disorder.” This is largely because boys tend to exhibit more outwardly disruptive symptoms like hyperactivity and impulsivity, behaviors that are more likely to draw attention from parents and teachers. In contrast, girls often display inattentive symptoms (such as disorganization, forgetfulness, and daydreaming) that are subtler and more easily overlooked. As a result, many girls and women are diagnosed much later in life, often after years of struggling with academic, emotional, or professional challenges. Research also shows that ADHD is underdiagnosed more in women than in other gender identities or children.

This gender gap in diagnosis raises a critical question: Are males truly more prone to ADHD, or are we simply better at recognizing it in them? In this article, we’ll explore how ADHD symptoms can differ between males and females, why these differences matter, and how psychological assessment tools can help bridge the diagnostic divide.

Understanding ADHD and Its Symptoms

Once considered a childhood disorder, ADHD is now recognized as a lifelong neurodevelopmental condition that can affect individuals at any age. While symptoms often emerge in early childhood, many people continue to experience them well into adolescence and adulthood. In fact, adults with ADHD may not even realize they have it until they begin struggling with work, relationships, or daily responsibilities.

One reason for this delayed recognition is that individuals with ADHD often learn to “mask” their symptoms—developing coping strategies that help them blend in, especially in professional or social settings. Many people develop these strategies to prevent issues in their close relationships, and they may do so consciously or unconsciously. These strategies don’t eliminate the underlying challenges, however, and women in particular are likely to bear the weight of these masking behaviors.

ADHD Symptoms

ADHD is no longer viewed solely as a childhood disorder. Today, experts recognize that ADHD can persist across the lifespan, often evolving in how it presents. While children may exhibit more overt behavioral symptoms, adults often experience more internalized challenges—many of which are masked or misattributed to personality traits or stress.

In children, ADHD symptoms typically include:

• Frequent daydreaming
• Excessive talking
• Forgetting or losing things often
• Having trouble focusing, especially on schoolwork or homework that is disinteresting
• Squirming or fidgeting
• Taking impulsive actions or having difficulty resisting temptation
• Making careless mistakes
• Having trouble taking turns
• Struggling to get along with others

These behaviors are more than just occasional lapses in attention or energy—they are persistent and disruptive, often continuing into adulthood if not properly addressed.

While hyperactivity may decrease with age, symptoms like inattention, disorganization, and impulsivity often persist in adults. Adults with ADHD may struggle with time management, meeting deadlines, maintaining focus in meetings, or remembering appointments.

Types of ADHD

ADHD is not a one-size-fits-all diagnosis. The condition is categorized into three primary presentations, based on the dominant symptoms:

• Predominantly Inattentive: Individuals often have trouble organizing tasks, following instructions, and maintaining focus. They may appear forgetful, easily distracted, or disinterested, even when they are trying to engage.
• Predominantly Hyperactive-Impulsive: This type is marked by excessive movement, talking, restlessness, and impulsive behavior. People may interrupt others, struggle to wait their turn, or act without considering consequences.
• Combined: The most common form, this type of ADHD includes symptoms of both inattention and hyperactivity-impulsivity.

Understanding these distinctions is crucial for accurate diagnosis and effective treatment planning, as well as for unraveling the gender gap that persists in ADHD diagnoses.

How ADHD Symptoms Differ Between Males and Females

As more women—particularly adult women—begin seeking ADHD evaluations, a natural question arises: Why now? Why weren’t their symptoms recognized earlier?

The answer lies in both evolving awareness and the way ADHD symptoms manifest differently across genders. Common gender-based symptom patterns show that males are more likely to exhibit:

• Hyperactivity (e.g., constant movement, fidgeting)
• Impulsivity (e.g., blurting out answers, interrupting)
• Behavioral issues that are disruptive in group settings

In contrast, females are more likely to exhibit:

• Inattentiveness (e.g., difficulty focusing, forgetfulness)
• Disorganization and trouble following through on tasks
• Emotional dysregulation, including anxiety or low self-esteem
• Social withdrawal or excessive effort to “mask” symptoms

These differences can lead to misdiagnosis or delayed diagnosis in females. These differences can lead to misdiagnosis or delayed diagnosis in females. For example, a girl who struggles with focus and organization may be labeled as anxious, shy, or even lazy—while the underlying ADHD remains unrecognized. Hormonal fluctuations—such as those related to puberty, menstruation, or menopause—can also influence symptom severity in females, further complicating diagnosis.

The Cost of Being Overlooked

The consequences of underdiagnosing ADHD in females are significant. Without proper support, girls and women may experience chronic stress, academic underachievement, strained relationships, and increased risk for co-occurring conditions like depression or anxiety. Many adult women with ADHD report feeling as though they’ve been “failing” for years without understanding why. When they do receive a diagnosis, the clarity that comes with it can be life changing.

As awareness grows, so does the rate of diagnosis among females. Between 2003 and 2015, the number of U.S. women aged 15–44 who filled prescriptions for ADHD medication increased by 344%, according to the CDC. This shift reflects a growing recognition of how ADHD manifests differently across genders—and the importance of tailoring assessment and treatment accordingly.

Bridging the Gap: The Role of Assessment Tools in ADHD Diagnosis

Accurate diagnosis is the cornerstone of effective ADHD treatment, but the tools used to assess the condition can sometimes reinforce the very biases they aim to overcome. Many of the most widely used diagnostic criteria and screening tools were developed based on studies of young boys, whose symptoms tend to be more externalized and disruptive. As a result, these tools may be less sensitive to the internalized symptoms more common in females, such as inattentiveness, anxiety, or emotional dysregulation.

This diagnostic gap has real consequences. Research presented at the American Psychiatric Nurses Association conference in 2020 found that women with ADHD are one-third less likely to be diagnosed than men, despite similar prevalence rates and often more severe functional impairments. Girls and women are also more likely to be misdiagnosed with mood or anxiety disorders before ADHD is even considered.

Standardized assessment tools are commonly used to evaluate symptoms across age groups. These tools rely on input from parents, teachers, or the individuals themselves and are designed to measure behaviors aligned with DSM-5 criteria. While these tools are valuable for identifying core symptoms, they may not fully capture the nuanced ways ADHD presents in different populations. For example:

• Girls may score lower on hyperactivity scales, even if they struggle significantly with focus and organization.
• Adults may underreport symptoms due to years of masking or internalizing their struggles.
• Cultural and gender norms may influence how behaviors are perceived and reported by others

To address these limitations, clinicians are increasingly encouraged to take a holistic approach to ADHD assessment. Strategies and tools that assist with this approach include:

Using Age-Specific Screening Tools

Children and adolescents often present ADHD symptoms differently than adults, and symptom expression can vary widely even within the same age group. Tools like the Clinical Assessment of Attention Deficit-Adult (CAT-A) and Clinical Assessment of Attention Deficit-Child (CAT-C) are standardized on age-specific sample groups, giving clinicians clear data that is essential for evaluating ADHD. These instruments are designed to evaluate symptoms in a thorough manner that suits the age group they are intended for.

Factoring in Executive Functioning

Executive function challenges—such as difficulty with planning, organization, and emotional regulation—are central to ADHD but may be misattributed to personality traits, especially in females. The Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) and its adult counterpart, the BRIEF2A, offer a window into how these challenges manifest in daily life. By collecting input from parents, teachers, or the individual, these tools help clinicians understand how executive dysfunction affects functioning across settings, making them especially useful for identifying ADHD in individuals whose symptoms are more internalized.

Evaluating Cognitive Flexibility and Problem-Solving

Cognitive flexibility, or the ability to adapt to new rules or shift strategies, is also often impaired in individuals with ADHD. The Wisconsin Card Sorting Test (WCST) is a well-established neuropsychological tool that assesses this skill, along with abstract reasoning and problem-solving. It’s particularly valuable in adult assessments, as hyperactivity may no longer be prominent, but executive dysfunction persists. The WCST is frequently used by clinicians as part of a neuropsychological battery to help differentiate ADHD from other conditions with overlapping symptoms, such as anxiety or learning disorders.

Recognizing the Full Spectrum of ADHD Symptoms

ADHD is a complex, multifaceted condition that doesn’t look the same in everyone. Gender, age, and individual coping strategies all influence how symptoms appear—and how likely they are to be recognized. While boys have historically been diagnosed more frequently, growing awareness is helping to uncover the many ways ADHD manifests in girls and women, too.

By using a holistic, evidence-based approach to assessment—one that includes age-appropriate tools, executive function evaluation, and performance-based testing—clinicians can better identify ADHD in all its forms. Tools like the CAT-C, CAT-A, BRIEF2/BRIEF2A, and WCST offer valuable insights that go beyond surface-level behaviors, helping to ensure that no one is overlooked simply because their symptoms don’t fit the traditional mold.

As we continue to expand our understanding of ADHD, it’s critical to advocate for inclusive assessment practices, educate others about gender-based differences, and empower individuals to seek the support they need—at any age, and regardless of how their symptoms show up.