ADHD in Teen Girls: Why So Many Are Missed

As a Clinical ADHD Nurse Specialist, I’ve worked with children, teens, and adults from all walks of life - each with their own version of what ADHD looks and feels like. But one group continues to be consistently under-identified and misunderstood: teenage girls.

At Bright Star ADHD, we’re increasingly seeing teenage girls and young women coming forward later in adolescence, often after years of struggling with undiagnosed symptoms. And research is finally beginning to catch up with what many families and professionals have been noticing for years: ADHD in girls often looks different - and it's frequently hidden behind something called masking.

What is ADHD Masking?

Masking refers to the conscious or unconscious act of hiding or minimising symptoms in order to blend in socially. This can include things like:

• Forcing themselves to sit still even when feeling restless

• Mimicking others' behaviour to avoid standing out

• Hiding confusion in lessons by copying peers

• Smiling or laughing even when feeling overwhelmed

• Over-preparing to hide disorganisation

• Shutting down emotionally in public but expressing distress at home

While masking can be an effective short-term strategy for coping in social or academic settings, it often leads to chronic exhaustion, anxiety, and emotional distress.

Why Is ADHD in Girls Often Missed?

For decades, ADHD was largely studied and diagnosed in young boys - particularly those who displayed hyperactivity and impulsivity. The inattentive presentation of ADHD, which is more common in girls, often includes symptoms like daydreaming, forgetfulness, internalised anxiety, and low self-esteem. These behaviours are less likely to disrupt the classroom and therefore less likely to raise concern.

Research now shows that many girls with ADHD are overlooked during childhood and only begin to be recognised once the demands of secondary school or adolescence become too great to manage.

Research highlights include:

• A 2020 study published in European Child & Adolescent Psychiatry found that girls with ADHD report significantly higher levels of internalising symptoms, such as anxiety and depression, compared to boys, and are less likely to be referred for diagnosis early on. (Reference: Mahone et al., 2020)

• A 2022 review in Child and Adolescent Mental Health noted that girls often mask symptoms, particularly in school settings, which can delay identification and support. (Reference: Coles et al., 2022)

• A 2023 survey conducted by the UK charity ADHD Foundation showed that 80% of women and girls diagnosed in adulthood believe they should have been identified earlier. Many reported feeling “invisible” or “misunderstood” during school years.

What Does ADHD Look Like in Teen Girls?

Symptoms often include:

• Chronic disorganisation

• Forgetfulness or frequent “zoning out”

• Emotional sensitivity or mood swings

• Difficulty starting or completing homework

• Low motivation despite high potential

• Fatigue from masking or overcompensating

• Anxiety, especially around school and social situations

• Perfectionism driven by fear of being “found out”

• Social struggles, including being “too intense” or withdrawing

Many of the teen girls I assess at Bright Star describe having felt "different" for years. Some are high achievers who have masked successfully but are now burning out. Others have been misdiagnosed with anxiety or depression, when ADHD was the underlying challenge all along

The Impact of Late or Missed Diagnosis

When ADHD in girls goes unnoticed or misunderstood, it can have far-reaching effects. These might include:

• Low self-esteem from years of perceived failure or underachievement

• Academic struggles, especially with GCSEs and A-levels

• Social isolation or difficulty maintaining friendships

• Mental health concerns, including anxiety, depression, and eating disorders

• Family conflict, especially around school performance or emotional regulation

Identifying ADHD in the teenage years can make a profound difference. It provides understanding, validation, and - most importantly - a roadmap for support and self-compassion.

How We Can Help at Bright Star

At Bright Star ADHD, we offer specialist ADHD assessments for young people aged 12 to 17, designed to recognise the subtle and often masked signs of ADHD in girls and young women.

Our assessments include:

• In-depth interviews with parents and carers

• Optional, age-appropriate child interviews

• Input from school settings

• Use of validated clinical tools

• A comprehensive diagnostic report with tailored recommendations

We take pride in creating a safe, respectful space where your daughter can feel heard, understood, and supported - whether in person at our Hastings clinic or through a Zoom-based assessment.

To begin the process or explore whether an assessment may be right for your teen, contact us directly.

As someone who has worked closely with young people for many years, I can say with confidence that girls with ADHD are not broken or less capable. In fact, many are incredibly resilient, creative, and insightful - they’ve simply been working twice as hard to appear “fine.”

Recognising ADHD in teen girls is not about labelling. It’s about giving them language, tools, and space to understand themselves - and the support to thrive on their terms.

If you’re a parent, carer, or educator noticing signs in a young person, trust your instincts. Ask the questions. We’re here to listen when you do.