I’m the mother of a wonderful son and daughter — both who’ve been diagnosed with ADHD combined type.

While some kids with ADHD are categorized as primarily inattentive, and others as primarily hyperactive-impulsive, my kids are both.

My unique situation has given me a chance to discover just exactly how different ADHD is measured and manifested in girls versus boys.

In the world of ADHD, not all things are created equal. Boys are three times more likely to receive a diagnosis than girls. And this disparity isn’t necessarily because girls are less likely to have the disorder. Instead, it’s likely because ADHD presents differently in girls. The symptoms are often subtler and, as a result, harder to identify.

Why do boys often get diagnosed before girls?

Girls are underdiagnosed or diagnosed at a later age because they often present with the inattentive type.

Inattentiveness is many times not noticed by parents until children go to school and have trouble learning, says Theodore Beauchaine, PhD, a professor of psychology at Ohio State University.

When it’s recognized, it’s generally because the child is daydreaming or not motivated to do her work. Parents and teachers often assume these children are lazy, and it may take years — if at all — before they consider seeking a diagnosis.

And because girls are more commonly inattentive rather than hyperactive, their behavior is less disruptive. This means teachers and parents are less likely to request ADHD testing.

Studies have shown that teachers more often refer boys than girls for testing — even when they have the same level of impairment. This in turn causes under-identification and a lack of treatment for girls.

Uniquely, my daughter’s ADHD was recognized much younger than my son’s. While this isn’t the norm, it makes sense because she’s combined-type: both hyperactive-impulsive and inattentive.

Think of it this way: “If 5-year-olds are equally hyperactive and impulsive, the girl will stand out more than [the] boy,” Dr. Beauchaine says. In this case, a girl might be diagnosed sooner, while a boy’s behavior might be written off under a catch-all like “boys will be boys.”

This situation doesn’t happen often, though, because girls are diagnosed with the hyperactive-impulsive type of ADHD less often than the inattentive type, Dr. Beauchaine says. “For the hyperactive-impulsive type, there are six or seven boys diagnosed for every one girl. For the inattentive type, the ratio is one to one.”

The differences between my son and daughter’s symptoms

While my son and daughter have the same diagnosis, I’ve noticed that some of their behaviors are different. This includes how they fidget, how they talk, and their level of hyperactivity.

Fidgeting and squirming

When I watch my children fidget in their seats, I notice that my daughter quietly changes her position constantly. At the dinner table, her napkin is torn into tiny bits almost every evening, and she must have some sort of fidget in her hands at school.

My son, however, is repeatedly told not to drum in class. So he’ll stop, but then he’ll begin tapping his hands or feet. His fidgeting seems to make a lot more noise.

During my daughter’s first week of school when she was 3, she got up from circle time, opened the classroom door, and left. She understood the lesson and felt there was no need to sit and listen to the teacher explain it several different ways until the rest of the class caught up.

With my son, the most common phrase out of my mouth during dinner is “tushie in the chair.”

Sometimes, he’s standing next to his seat, but often he’s jumping on the furniture. We joke about it, but getting him to sit down and eat — even if it’s ice cream — is challenging.

"Girls pay a much higher price for calling out than boys." – Dr. Theodore Beauchaine

Talking excessively

My daughter quietly talks to her peers in class. My son is not so quiet. If something pops into his head, he makes sure he’s loud enough so the entire class can hear. This, I imagine, must be common.

I also have examples from my own childhood. I’m also ADHD combined type and remember getting C’s in conduct even though I never yelled out loud like one of the boys in my class. Like my daughter, I talked quietly to my neighbors.

The reason for this might have to do with cultural expectations of girls versus boys. “Girls pay a much higher price for calling out than boys,” Dr. Beauchaine says.

My daughter’s “motor” is much subtler. The fidgeting and moving are done quietly, but are recognizable to the trained eye.

Acting as if driven by a motor

This is one of my favorite symptoms because it describes both of my kids perfectly, but I see it more in my son.

In fact, everyone sees it in my son.

He cannot remain still. When he tries, he’s clearly uncomfortable. Keeping up with this child is a challenge. He’s always moving or telling very long stories.

My daughter’s “motor” is much subtler. The fidgeting and moving are done quietly, but are recognizable to the trained eye.

Even my kids’ neurologist has commented on the difference.

"As they grow, girls have a high risk for self-injury and suicidal behavior, while boys are at risk for delinquency and substance abuse." – Dr. Theodore Beauchaine

Some symptoms appear the same, regardless of gender

In some ways, my son and daughter aren’t all that different. There are certain symptoms that show up in both of them.

Neither child can play quietly, and they both sing or create an external dialogue when attempting to play alone.

They’ll both blurt out answers before I’ve finished asking a question, as though they’re too impatient for me to say the last few words. Waiting their turn requires many reminders that they must be patient.

Both of my kids also have trouble sustaining attention in tasks and play, often aren’t listening when they’re spoken to, make careless mistakes with their schoolwork, have difficulty following through on tasks, have poor executive functioning skills, avoid things they dislike doing, and are easily distracted.

These similarities make me wonder if the differences between my kids’ symptoms are really due to socialization differences.

When I asked Dr. Beauchaine about this, he explained that as my kids get older, he expects my daughter’s symptoms will begin to diverge even further from what’s often seen in boys.

However, experts aren’t yet sure if this is because of specific gender differences in ADHD, or due to the different behavioral expectations of girls and boys.

Teens and young adults: Risks differ by gender

While the differences between my son and daughter’s symptoms are already noticeable to me, I’ve learned that as they get older, the behavioral outcomes of their ADHD will become even more diverse.

My children are still in elementary school. But by middle school — if their ADHD were left untreated — the consequences could be much different for each of them.

“As they grow, girls have a high risk for self-injury and suicidal behavior, while boys are at risk for delinquency and substance abuse,” Dr. Beauchaine notes.

“Boys will get into fights and begin hanging out with other boys who have ADHD. They will do things to show off for other boys. But those behaviors don’t work so well for girls.”

The good news is that a combination of treatment and good parental supervision can help. In addition to medication, treatment includes teaching self-control and long-term planning skills.

Learning emotional regulation through specific therapies such as cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT) can also be helpful.

Together, these interventions and treatments can help children, teens, and young adults learn to manage and control their ADHD.

So, is ADHD really that different for boys and girls?

As I work to prevent undesired futures for each of my children, I come back to my original question: Is ADHD different for boys and girls?

From a diagnostic standpoint, the answer is no. When a professional observes a child for diagnosis, there’s only one set of criteria the child must meet — regardless of gender.

Right now, not enough research has been done on girls to know if the symptoms truly appear differently in boys versus girls, or if there are just differences between individual children.

Because there are far fewer girls than boys diagnosed with ADHD, it’s harder to get a large enough sample to study the gender differences.

But Beauchaine and his colleagues are working hard to change that. “We know plenty about boys,” he tells me. “It’s time to study girls.”

I agree and am looking forward to learning more.


Gia Miller is a freelance journalist living in New York. She writes about health and wellness, medical news, parenting, divorce, and general lifestyle. Her work has been featured in publications including The Washington Post, Paste, Headspace, Healthday, and more. Follow her on Twitter.