Are females underdiagnosed due to different genetic expression of ADHD?

PostedAugust 19, 2025

UpdatedSeptember 4, 2025

ByMy Patient Advice

Author: Lucia Alvarez, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Yes, research increasingly shows that ADHD underdiagnosis in females stems partly from differences in genetic expression and behavioural presentation. While males often display more visible hyperactive symptoms, females tend to internalise theirs, appearing inattentive or anxious rather than disruptive. This difference, combined with diagnostic models historically based on male traits, contributes to diagnostic bias that delays or overlooks ADHD in girls and women.

How genetic expression and gender influence ADHD visibility

A closer look at why ADHD in females is often missed.

Gene expression varies by sex

Emerging studies reveal that gene expression sex differences may impact how ADHD-related genes activate in females. This can alter symptom severity or shift presentation toward subtle traits like low self-esteem, disorganisation, or emotional dysregulation.

Female presentation is less disruptive

Girls with ADHD frequently present as daydreamy or withdrawn traits that fly under the radar compared to externalising behaviours. This female presentation mismatch with standard diagnostic criteria contributes to underrecognition in clinical settings.

Cultural expectations reinforce diagnostic gaps

Societal norms often expect girls to be compliant and attentive, causing parents, teachers, and clinicians to overlook or misinterpret ADHD signs in young females, even when the condition is genetically present.

Addressing ADHD underdiagnosis in females requires refining diagnostic frameworks and increasing awareness of how genetic and social dynamics intersect. Visit providers like ADHD Certify for comprehensive evaluations that consider gender-specific ADHD pathways.

For a deeper dive into the science, diagnosis, and full treatment landscape, read our complete guide to Genetic Factors in ADHD.

Lucia Alvarez, MSc

Author

Lucia Alvarez is a clinical psychologist with a Master’s in Clinical Psychology and extensive experience providing evidence-based therapy and psychological assessment to children, adolescents, and adults. Skilled in CBT, DBT, and other therapeutic interventions, she has worked in hospital, community, and residential care settings. Her expertise includes grief counseling, anxiety management, and resilience-building, with a strong focus on creating safe, supportive environments to improve mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.