On TikTok, thousands of women are sharing something that used to stay hidden: their struggles with undiagnosed ADHD. In viral clips that rack up millions of views, they talk about zoning out during conversations, forgetting appointments, and masking their symptoms so well that even they didn't realize what was going on. This surge in online storytelling is helping many women recognize themselves in others' experiences, raising serious questions about why they were overlooked in the first place.

ADHD diagnoses are more common than ever. According to the Centers for Disease Control and Prevention, one million more children had received an ADHD diagnosis in 2022 than in 2016. But even as awareness grows, a gender gap persists. Boys are still far more likely to be diagnosed than girls, often years earlier.

ADHD Advisor recently looked into what's behind this disparity, examining how diagnostic criteria were written, who gets taken seriously in clinical settings, and how culture influences whose behavior gets flagged as possibly being a sign of ADHD. This article breaks down the differences in symptoms, shares expert insights, and explores how underserved communities face even greater gaps.

The evolution of the ADHD gender gap

ADHD has long been seen as a "boy problem." Early studies, classroom interventions, and even diagnostic guidelines were shaped around young boys who couldn't sit still or stay quiet. That narrow view left little room for recognizing how attention-deficit hyperactivity disorder might show up differently in girls and young women. Much of that framing comes from how the condition was originally conceptualized, as something defined by external behaviors like interrupting, fidgeting, or acting out.

That framing had consequences. Boys are nearly twice as likely to receive a diagnosis, even though research now shows that girls experience ADHD at similar rates. Their symptoms just tend to look different: more internalized, more easily masked, and more likely to be misinterpreted as laziness or anxiety. According to the CDC, 15% of boys in the U.S. between 3 and 17 have been diagnosed with ADHD, compared to just 8% of girls.

This gap hasn't gone unnoticed. Between 2020 and 2022, ADHD diagnoses among adult women 23 to 49 doubled. What changed? In part, social media. Women began openly sharing their experiences on platforms like TikTok, describing symptoms they'd struggled with for years. That wave of visibility is changing how many people, including providers, understand what ADHD looks like in women.

A limitation of the CDC data is their more broad view on gender, focusing on male and female individuals specifically and not on non-binary individuals. However, initial research suggests that there is a connection between ADHD and gender identity. While ADHD isn’t a cause for gender dysphoria, a negative reaction to gender identity, children facing ADHD are, “predisposed to reject the rigidity of gendered expectations placed on them by society.” 

Different symptom presentations across genders

ADHD doesn't show up the same way in everyone. In boys, it often presents as hyperactivity, impulsivity, and disruptive behavior, traits that are loud, visible, and tough to ignore. This male-typical presentation tends to trigger early referrals for testing because it disrupts classrooms and draws adult attention.

In contrast, girls are more likely to experience ADHD in quieter ways, with symptoms like inattention, disorganization, and zoning out. These internalized traits can look like daydreaming or laziness, often going unnoticed or misread as character flaws rather than clinical symptoms.

Research supports this distinction. Girls are more frequently diagnosed with ADHD-I, the inattentive subtype. Boys are more likely to receive a diagnosis of ADHD-HI, the hyperactive/impulsive type.

One study noted: "In part, the underrecognition of ADHD in women and girls may be due to a symptom profile (i.e., more inattentive and less hyperactive/impulsive than males) that is less likely to be disruptive in the class or the workplace." These differences shape the diagnostic process from the start.

Dr. Janis Guthy is an an advisor with Medistik and has a Ph.D in Psychophysiology connecting the stress response to physical and mental well being also explains that some studies have indicated that women and children with ADHD can often show a higher intolerance to pain management.

In schools, teachers often notice the child who can't sit still before they spot the one quietly falling behind. In clinics, providers still rely on tools centered around male behavior patterns. As a result, girls and women frequently miss out on early identification and support.

Co-occurring conditions and their impact

ADHD rarely shows up alone. The CDC reports that nearly 78% of children with ADHD have at least one co-occurring condition. That number climbs even higher for girls (82%) compared to boys (76%). These overlapping conditions add complexity, especially during the diagnostic process.

The chart above highlights clear gender trends. Girls with ADHD are more likely than boys to also be diagnosed with anxiety (53% vs. 32%) and depression (29% vs. 14%). These internalizing disorders can cloud the picture. Clinicians may attribute a girl's focus issues or forgetfulness to mood rather than attention. That's a phenomenon known as diagnostic overshadowing, where one visible condition draws all the attention, leaving others undetected.

Girls are also more likely to show symptoms of ADHD-I, which adds another layer. As one study explains, "Symptoms of ADHD-I, more characteristic of females, are often reflected in mood or emotional dysregulation, making differentiated diagnostics quite difficult, leading to misdiagnosis with internalizing disorders such as mood- or anxiety disorders, or depression."

In short, anxiety and depression don't just co-occur with ADHD in girls; they can mask it. That makes an accurate diagnosis much harder. Many women spend years being treated for anxiety or depression before anyone questions whether ADHD might be part of the story. The earlier that possibility is recognized, the sooner they can receive support that addresses the full picture, not just part of it.

The role of cultural and societal factors

ADHD doesn't exist in a vacuum. It plays out within the expectations, norms, and biases of the world around us. And those societal pressures can shape how symptoms are seen—or ignored.

Girls are often expected to be quiet, polite, and well-behaved. When they show signs of inattention, it's brushed off as daydreaming. When they struggle with executive function, it's chalked up to being disorganized or emotional. These gender-based societal expectations skew the lens through which ADHD symptoms are interpreted, often minimizing how disruptive or impairing they actually are.

This also plays out in school, where teachers are more likely to refer boys for ADHD evaluations. Parents may also be quicker to seek help when a son is acting out, compared to a daughter who's simply "spacing out." These perceptions and referral patterns contribute to a cycle of underdiagnosis.

The same biases carry into the doctor's office. As a recent study explained, "Clinicians may be unaware that the majority of girls with ADHD still fall through gaps in the literature. Diagnostic accuracy depends upon familiarity with the widest continuum of ADHD presentations, since they represent a variety of developmental trajectories and associated risks. Until there are more studies reflecting the diversity of individuals with ADHD, some routine additions to standard evaluation techniques could provide valuable insights."

Cultural biases also impact diagnosis rates across racial and socioeconomic lines. According to the CDC, Hispanic children are less likely to receive ADHD diagnoses than white children. In communities with limited health care access or language barriers, ADHD may go entirely unrecognized, especially in girls, whose symptoms already fly under the radar.

Consequences of missed or delayed diagnosis

When ADHD goes unnoticed, the impact can last for years. Girls with undiagnosed ADHD often fall behind in class. They have lower rates of high school graduation than their peers without it. With less support and fewer accommodations, frustration builds, grades drop, and confidence takes a dive.

It's not just about trouble in school. Self-esteem, relationships, and future goals can all take a hit. Women with ADHD may have trouble managing deadlines, staying organized, or navigating office dynamics in the workplace. These career challenges often go unrecognized by employers, and women may internalize their struggles as personal failures rather than signs of an undiagnosed condition.

The mental health toll is significant. According to one study, women with ADHD report lower self-esteem and higher levels of anxiety than women without ADHD. That's not surprising when you consider how long they may go without answers or support.

Undiagnosed ADHD can also affect personal relationships. Women with ADHD are more likely to experience relationship instability, risky behaviors, and social difficulties, especially if their symptoms have never been explained or managed.

As researchers note, "The short-term effects of undiagnosed or undertreated ADHD in girls sets the stage for the range of academic and social problems during childhood and adolescence … In addition, the symptomatology and functional impairments present during the formative years are likely to continue into adulthood."

These aren't just individual hardships. They're systemic failures to recognize and respond to how ADHD affects girls and women differently.

Improving Diagnosis and Treatment

Closing the ADHD gender gap means changing more than just awareness. It requires fixing how we assess, diagnose, and treat the condition. For starters, clinicians need gender-sensitive diagnostic tools that reflect the full range of ADHD symptoms, not just the ones that tend to appear in boys. Checklists focused on hyperactivity miss the girls who are zoning out, overcompensating, or quietly overwhelmed.

Medication approaches also need refinement. Research suggests that girls and women may respond differently to standard ADHD treatments. Doctors commonly prescribe stimulants like methylphenidate (MPH), but they may not always be the best fit. MPH is a stimulant that works rapidly by blocking the reuptake of dopamine and norepinephrine, while atomoxetine (ATX) is a non-stimulant medication that selectively inhibits norepinephrine reuptake and takes several weeks to reach full effectiveness. This fundamental difference in mechanism and onset may contribute to varying response patterns observed in female patients. One study on the female side of pharmacotherapy for ADHD noted: "A single daily use of MPH may possibly not be optimal for girls with ADHD, and ATX may be a promising medication for girls and women with ADHD."

Hormonal changes add more complexity. Estrogen appears to affect how some stimulant medications work. Researchers have found that the presence of estrogen may require adjusting dosages throughout the menstrual cycle to manage symptoms effectively.

To make meaningful change, everyone involved in a child's life needs better information. That means more training for teachers, parents, and health care providers to recognize gendered ADHD symptoms early and respond with appropriate care. Understanding alternative treatments for ADHD such as animal-assisted therapy or mindfulness practices can also help with exploring other ways to cope with symptoms of ADHD. 

Diagnosing ADHD in girls and women takes better tools, personalized treatment, and more education across the board. The good news? People are finally talking about it. Now we just need to follow through.