Over the past 20 or 30 years, the boys who ‘threw chairs in class’, who spent their lunch breaks in detention, and who were bright but didn’t reach their potential, got their diagnosis of ADHD. The impact of their behaviour meant that staff and families were compelled to react, and as a result, the numbers rose.
In the UK today, boys are about three times more likely to be diagnosed with ADHD than girls. The visibility of behaviours associated with ADHD in boys has resulted in increased numbers of diagnoses and treatment. In girls, ADHD is less visible and their behaviours impact self rather than others. This results in ADHD being missed.
From a young age, societal expectations are taught both explicitly and implicitly to girls, and so those with ADHD must become masters of disguise in order to meet them. They learn how to please others, finding workarounds so they can provide the bare minimum required to succeed across various metrics. In other words, they fly under the radar.
Girls are less likely to throw chairs, and more likely to throw on a mask. As Shakespeare said, ‘all the world’s a stage’. The ADHD actresses of the school, the home, the community, ‘they’re ‘fine’, in case you were wondering. They live with the mask for so long that no one knows what’s really underneath, least of all themselves. But if the mask slips, the girl messes up her lines and everything unravels.
Over time, self-esteem is eroded by remarks about the girl being lazy, disorganised, toxic or dramatic, or generally being too much or too difficult. This is because the bare minimum isn’t really enough to actually meet expectations. And those words stick. Lazy. Messy. Too much. Too dramatic. Too loud. Too forgetful. Girls with ADHD internalise these labels until they replace feelings of self-worth with feelings of shame.
All the while, the hyperactivity is silent but violent. Whereas some behaviours that result from hyperactivity can make us brutally aware of the needs of boys, hyperactivity in girls often manifests in the mind and is therefore less visible to others. People talk about being ‘overthinkers,’ and this is pervasive in the ADHD girl. Overthinking, rethinking, rehashing, rehearsing, ruminating. ‘Isn’t it cute, she’s so away with the fairies’. Actually, she hasn’t slept a wink and is running on fumes.
She may get a mental reprieve from scrolling on her phone, from some moments of hyperfocus on an interest, or from engagement with pets and friends because this may be about dopamine seeking. But instead of being properly medicated to hold on to that precious dopamine in the teenage years, she might self-medicate with drugs, alcohol and other vices.
The problem is that she herself doesn’t realise that things shouldn’t be this hard, and therefore doesn’t even realise that it is a need that could be supported. No one else is paying attention, and if they are, it is only to pass judgement. ‘She is so talented and brilliant, it’s a shame she is such a burn out’.
The stress of the constant masking, the fairly benign (but nevertheless constant) negative feedback and negative self-soothing is death by a thousand cuts. The missed ADHD becomes an apparition that begs for attention by appearing as anxiety, physical illness, pain, depression, eating disorders, addictions, burn out or breakdowns. When women are given a label that explains the symptom but not the cause, they don’t get the specific medication and the support strategies they need to be well.
‘All the world’s a stage’, but the play doesn’t need to end in tragedy.
When we understand the different ways ADHD presents in girls, we can notice earlier, intervene sooner, and foster strengths instead of punishing struggles. We allow the girl to explore her own identity and we help her to thrive by showing her understanding and support.
Our ADHD actresses may hide the signs, but the keen observer will start to see that it’s all an act. With curiosity and compassion, parents, teachers, carers and friends can look beyond the performance and with the right professional help, whether that’s coaching, therapy, or medical support, the story can take a new direction.
Girls with ADHD deserve more than a lifetime of masking…
Bridget Young is the Headteacher of The Holmewood School, London and has 20 years’ experience in education with 13 years in autism-specific education. She brings both personal and professional experience of neurodivergence, and has a special interest in coaching, habits, and wellness. In this powerful and deeply personal piece, Bridget shares her lived-experience perspective on how ADHD often goes unnoticed in girls, and the emotional toll that can take.
