What research supports underdiagnosis of ADHD in girls? 

Research into ADHD underdiagnosis reveals a consistent pattern: girls often slip through the cracks when clinical attention is skewed toward more overt, hyperactive presentations. Because their symptoms are more likely to be inattentive, quiet, or internal, girls may go undetected under traditional screening methods. This mismatch contributes to lifetime gaps in care and recognition. 

Several longitudinal and epidemiological studies show that while boys are more often referred and diagnosed in childhood, girls frequently get diagnosed later, or not at all. Many girls with ADHD display what’s called the inattentive ADHD girls profile: daydreaming, distractibility, disorganisation, and internal restlessness. These symptoms tend to be less disruptive to the classroom environment, making them less visible to teachers or caregivers. In contrast, boys are more likely to show girls ADHD detection bias against them, where their externalising behaviours, impulsivity, hyperactivity, acting out, trigger referrals earlier. 

Key findings from the research 

Here are some consistent patterns uncovered in studies of underdiagnosis: 

Lower referral and screening rates  

Girls are often less likely than boys to be referred for ADHD assessments, even when they meet the same threshold of symptoms. This is especially true when their behaviour doesn’t disrupt others. 

Symptom presentation differences  

Girls tend to present with inattentive and internal symptoms rather than externalising hyperactivity. Because these are less noticeable, clinicians and educators may attribute them to daydreaming, anxiety, or mood issues. 

Masking and compensation  

Many girls develop coping strategies, such as overpreparing, perfectionism, or suppressing impulses, to hide their struggles. Over time, those strategies become exhausting and less effective, but they may delay identification. 

Diagnostic criteria and assessment bias 

 The tools used to assess ADHD were often normed on male samples. As a result, girls are more likely to fall below the “red flags” that lead to diagnosis, even when their functioning is impaired. 

If you believe your (or your daughter’s) challenges have been overlooked, visit providers like ADHD Certify to explore tailored evaluation paths. 

For a deeper dive into the science, diagnosis, and full treatment landscape, read our complete guide to Late diagnosis and gender differences.