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Why is hyperactive-impulsive ADHD sometimes underdiagnosed in girls? 

Posted
Updated
ByMy Patient Advice
Author: Lucia Alvarez, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Despite growing awareness, ADHD diagnosis in girls, especially those with hyperactive-impulsive traits, remains inconsistent. Many girls are overlooked or misdiagnosed because their symptoms don’t always match the stereotypical image of a disruptive, high-energy child. Instead, they may present as talkative, emotionally intense or socially impulsive, which can be mistaken for personality quirks rather than signs of hyperactive-impulsive ADHD . 

This underdiagnosis has lasting effects. Without support, many of these girls grow into women with undetected ADHD, only receiving a formal ADHD diagnosis in adulthood when stress, academic struggles or burnout become overwhelming. This delay in care can result in missed opportunities for intervention and support. 

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Why symptoms in girls are often missed 

Understanding how ADHD in adults and girls presents differently helps reduce bias and leads to better outcomes: 

  • Masking and compensation 
    Girls often work harder to hide symptoms by overcompensating or mimicking peers, which makes their challenges less visible. 
  • Emphasis on emotional expression 
    Emotional intensity, mood swings, or sensitivity can be signs of hyperactive-impulsive ADHD. But without context, they may be misread as anxiety or just “being dramatic,” missing the need for proper behaviour strategies. 
  • Social and academic expectations 
    Girls are more likely to be praised for compliance and punished for emotional expression. This dynamic can suppress signs of ADHD while increasing internal stress levels. 
  • Late emergence of symptoms 
    Many girls don’t struggle until their coping skills are overwhelmed by life changes, especially during puberty, university or early career stages. These patterns often emerge in cases of ADHD in adults. 

Building awareness is the first step toward better screening and earlier care. Mindful observation, validated tools, and mindfulness techniques can all help girls manage symptoms and improve emotional regulation. Visit providers like ADHD Certify for assessments and strategies that recognise how ADHD appears across genders. 

For a deeper dive into the science, diagnosis and full treatment landscape, read our complete guide to Hyperactive‑Impulsive ADHD . 

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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. 

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