Growing up my grandfather would refer to boys with ADHD (Attention Deficit Hyperactivity Disorder) as ‘naughty boys’, which later changed to ‘you know, the asbo ones’. This was never used in malice, in fact he used to speak very fondly of the ‘naughty boys’ as they made him laugh and he showed great compassion toward them when they were struggling with their behaviour and emotions. I often wonder if this is because they reminded him of a younger version of himself, even as an adult he loved to be silly and always had that cheeky air about him. But ultimately these children were labelled as poorly behaved and difficult to manage.
It is incredibly frustrating that within the current societal climate, neurodiverse children are the target of what appears to be a hate campaign towards anyone who is different or has a need for adjustments. The side of ADHD that is being portrayed is the ‘poorly behaved’ side. They aren’t looking at the why.
I do not agree that behaviour should be a unit of measure placed upon children. The behaviour is in response to something. There is always a reason behind it. Often kids with ADHD struggle to communicate their needs, they find it hard to approach adults to express their needs as the adults are the ones telling them off or that they can’t have the things they need to help them learn. Rather than looking for the trigger, the reason behind the behaviour, the child gets punished for not being able to cope in an environment that was not built for them.
The way my grandfather referred to the boys with ADHD highlights rather well the misconception that they are just being naughty. It also demonstrates the thinking that only boys can have ADHD, there were never any girls referred to in the same way.
Although awareness has grown in recent years, ADHD is still under-diagnosed in girls and assumed that you need to show the physical ‘hyperactive’ behaviour. According to The ADHD Centre, only 1 in 5 children diagnosed with ADHD are girls. They continue to say “There are a number of diagnostic challenges around not recognising female ADHD at an earlier stage. In boys, hyperactive symptoms are more dominant and this ties in with what we’ve seen from studies, that often ADHD in boys is behavioural. Because these behavioural challenges affect other people, they are easy to identify and people take action more quickly to prevent further behavioural issues. In girls, symptoms of inattention are more dominant and these are often overlooked.” (The ADHD Centre, 2021)
This is why, when we are looking at ADHD, it is important to dissect it a little more, especially as the presentation in girls can make it so much harder to diagnose.
Attention Deficit – the inattentive side of ADHD, often misrepresented as being a day dreamer or ‘away with the fairies’. When in reality, symptoms display as the daily struggle to focus, issues motivating yourself, forgetfulness, executive dysfunction, losing interest in things halfway through. Commonly seen in girls with ADHD.
Hyperactivity – the hyperactive-impulsive side of ADHD that people incorrectly assume is the only form of ADHD. The ‘poorly behaved’, fidgety, impulsive, reckless and bouncing off the walls ADHD. Commonly shown by boys with ADHD.
There is a 3rd type of ADHD, Combined, where the individual displays symptoms of both inattentiveness and the hyperactive-impulsiveness. Again, another reason we need to break this down a little more because the treatment and reasonable adjustments that are required are different for each person.
Part of the issue with girls not being diagnosed with ADHD is a misunderstanding around the term ‘hyperactivity’. There is a misconception that hyperactivity needs to be an external form of exertion, when actually, the hyperactivity can be very much internalised. While they may not be bouncing off the walls with excess physical hyperactivity girls will quite often have internalised hyperactivity, where their brains have 450 tabs open and all of them are trying to load at the same time. This isn’t exclusive to girls, they are just less likely to show the hyperactivity externally.
According to an article, ADHD in Girls vs Boys: Key Differences in Symptoms, Diagnosis, and Treatment, on news-medical.net, ‘Studies have reported different grey and white matter patterns and default-mode task-positive interactions in girls as compared to boys’, which implies that ADHD may affect different neural structures. This may account for why females often show proportionally more inattentive symptoms and working-memory/executive challenges than overt hyperactivity, on average.’ They also go on to say that ‘Hormones such as estrogen and progesterone interact closely with dopamine and other neurotransmitters involved in attention and reward. In phases of relatively lower estrogen, dopamine tone and prefrontal efficiency may decline, thereby amplifying ADHD symptoms like distractibility, emotional lability, and executive-function ‘fog.’’ (Malesu, 2025) This suggests that there could be a fluctuation in the display of ADHD symptoms in girls, adding further complexity in trying to accurately diagnose them.
I also believe that ADHD is underdiagnosed in girls due their ability to construct a positive niche for themselves. In the book ‘The Power of Neurodiversity – 2nd edition’, Thomas Armstrong, PhD writes ‘Rather than fitting the person to the world, this approach seeks to change the world to fit it to the needs of each unique person.’ (Armstrong, 2025). In my experience, working closely with neurodivergent individuals, girls can identify where they struggle but more importantly where their strengths lie. They will have strong interests and lean into them, looking for solutions to help them reach their goals without letting their neurodivergence get in the way. Sadly, because the girls can find their strengths and push for their needs to be met at their level rather than changing themselves to fit with the world as it is, they are seen as difficult, demanding, bossy and inflexible.
Boys on the other hand, seem to seek the physical stimulation. They don’t look for their strengths as such, they look for what makes them feel good, the hit of dopamine. I also find that they do not know what they struggle with and often need support identifying where they could utilise additional help. The same goes for finding their strengths, it is quite upsetting to see how incredible they are but them not realising this and needing someone else to point it out for them.
It is great that more research is being done into girls with ADHD and I am hopeful this means they will look to amend the assessment process to include gender differences, especially as it has been suggested the neurotransmitters in boys and girls work differently and that hormones also play a part.
References
Armstrong, T. (2025). PhD. In T. Armstrong, The Power Of Neurodiversity (p. 16). New York: Hachette Book Group, INC.
Malesu, V. K. (2025, November 06). ADHD in Girls vs Boys: Key Differences in Symptoms, Diagnosis, and Treatment. Retrieved November 26, 2025, from News Medical Life Sciences: https://www.news-medical.net/health/ADHD-in-Girls-vs-Boys-Key-Differences-in-Symptoms-Diagnosis-and-Treatment.aspx#:~:text=Biological%20and%20neurological%20factors,-ADHD%20arises%20due&text=This%20may%20account%20for%20why,than%20overt%20hyperactivity%2C
The ADHD Centre. (2021, September 28). Why is ADHD Underdiagnosed In Women. Retrieved November 26, 2025, from The ADHD Centre: https://www.adhdcentre.co.uk/why-is-adhd-underdiagnosed-in-women/