ADHD in Girls: Why It’s Often Misdiagnosed as Anxiety
Understanding ADHD vs anxiety in girls is important because the two can look remarkably similar on the surface. Since the two diagnoses can present so similarly, and an inaccurate diagnosis can greatly influence how young women receive treatment, this page will explore:
Why ADHD in girls is overlooked and how it presents differently in girls vs. boys- Why clinicians tend to diagnose anxiety first
- Signs of ADHD in girls
- The importance of getting the right diagnosis and how clinicians evaluate ADHD
- Treatment approaches for girls with ADHD
- Where to find professional support
- Answers to the commonly asked questions about gender differences in ADHD
Understanding ADHD in Adolescent Girls
Let’s explore how ADHD shows in girls in more detail.
How ADHD Often Presents Differently in Girls
Rather than showing up as obvious hyperactivity or disruptive behavior, ADHD in adolescent girls is more likely to manifest as internalized ADHD symptoms, with lower levels of hyperactivity and externalizing behaviors.3 These patterns help explain why clinicians often overlook the condition in so many teen girls.Some signs of ADHD in girls that experts often miss include:
Inattentive ADHD in girls, marked by frequent daydreaming, mental drifting, or trouble staying focused during long tasks.- Subtle disorganization, such as losing school materials, forgetting deadlines, or struggling to break projects into manageable steps.
- Internalized ADHD symptoms, such as harsh self-criticism, withdrawing when overwhelmed, or assuming they are “bad at school.”
- Emotional sensitivity or becoming easily discouraged by feedback.
- Quietly working much harder than peers just to keep up.
- Difficulty starting tasks despite caring deeply about doing well.
- Mental exhaustion at the end of the school day from nonstop effort to concentrate.
However, it’s important to note that assuming girls only experience inattentive ADHD is inaccurate. Many girls describe being internally hyperactive and that the typical hyperactive behavior, like excessive talking, is often seen as them being very “social.”4
Anxiety Symptoms vs. ADHD Symptoms: Why Anxiety Is the More Visible Diagnosis
There also tends to be more emotional dysregulation in ADHD girls, which results in higher rates of them also having depression or anxiety.5 Both conditions can involve racing thoughts, difficulty concentrating, sleep problems, irritability, and feeling overwhelmed by everyday demands. For instance, a teen who can’t get started on homework because she feels frozen may appear anxious, even if the underlying issue is trouble organizing or sustaining attention. These are some of the reasons female ADHD and anxiety symptoms are so intertwined. Next, we’ll explore some other possibilities behind misdiagnoses.
Masking and Perfectionism
Another major factor in misdiagnosis is masking ADHD symptoms in girls, as experts suspect that many girls downplay or mask their symptoms.6 For example, they may over-prepare for tests, spend hours rewriting assignments, or rely heavily on rigid routines to avoid making mistakes. As a means of masking, girls may also develop coping mechanisms like perfectionism, people-pleasing, or overachievement. So, the connection between perfectionism and ADHD in girls may be more about coping rather than a personality trait.
Because of the higher rates of perfectionism and people-pleasing, clinicians may see girls as naturally more anxious, which is another reason why this diagnosis becomes the more visible one.7
Societal Norms
Social norms may play another role in the misdiagnosis of anxiety rather than ADHD in girls. From an early age, girls are often encouraged to be polite, organized, and emotionally attuned to others. This socialized behavior and ADHD in girls can make them overcompensate for their symptoms, or they may feel more emotionally distressed by their symptoms.These patterns contribute to the diagnostic bias against ADHD in females, in which clinicians identify anxiety or mood disorders first, while ADHD remains hidden in the background.
Why Getting the Diagnosis Right Matters
Getting an accurate diagnosis matters because when symptoms go unrecognized, your teen can spend years feeling confused about why strategies seem to help others but not them. They may try therapy techniques meant for worry alone, push themselves harder academically, or blame themselves for struggling with organization and focus. This can end up chipping away at confidence, making many teen girls wonder what’s wrong with them or think something just doesn’t seem “right.”
A delayed or incomplete diagnosis can affect many parts of your teen’s life. School may feel increasingly overwhelming as demands grow more complex. Friendships can suffer when emotional reactions feel unpredictable, or exhaustion leads to withdrawal. Some teens begin to internalize the idea that they are “lazy,” “broken,” or “too much,” when in reality their brain simply works differently.
When a professional accurately identifies ADHD, whether on its own or alongside anxiety, treatment can finally target the right challenges. Therapy becomes more practical and skill-based, and families gain a shared language for what their teen is experiencing.
Most importantly, many adolescents feel an enormous sense of relief. Instead of seeing their challenges as personal failures, they begin to understand themselves with more compassion and self-trust, which is often the first step toward meaningful, lasting progress.
Treatment Approaches for Girls With ADHD and Anxiety
When ADHD and anxiety overlap, effective care focuses on both the emotional experience and the practical skills teens need to navigate daily life. Rather than relying on a single strategy, clinicians often create individualized treatment plans that address attention regulation, stress responses, school demands, and family dynamics together. The following are some approaches commonly used to help teens with ADHD develop these skills.
Cognitive Behavioral Therapy (CBT)
One commonly used approach is CBT for ADHD in girls. While cognitive behavioral therapy is well known for helping with anxious thinking, it can also be adapted to support teens with ADHD.8 CBT teaches:
Skills for planning.- Breaking tasks into manageable steps.
- Managing frustration.
- Reframing the harsh self-talk that often develops after years of facing challenges.
For many girls, learning to challenge perfectionistic thoughts and reduce avoidance can ease anxiety while simultaneously improving follow-through.
Executive Functioning Coaching and Academic Supports
Girls with ADHD often experience a lot of rumination and executive dysfunction, which makes approaches that support executive function so effective.9 Executive functioning support for adolescents becomes especially important as academic expectations rise.This work focuses on practical, real-world tools, like time-management systems, organizational strategies, task-initiation techniques, and routines that reduce cognitive overload. When teens feel more capable of handling schoolwork and responsibilities, their overall stress levels often drop, which can soften anxious symptoms as well.
Emotion Regulation and Mindfulness Skills
Many treatment plans include structured work on emotional regulation and stress management. Teens learn to notice early signs of overwhelm, pause before reacting, and develop coping strategies that help them ride emotional waves more safely. Mindfulness practices, grounding techniques, and distress-tolerance skills are especially helpful for ADHD-related stress and worry.
Strengths-Based, Neurodiversity-Affirming Care
A growing number of programs also take a strengths-focused, neurodiversity-affirming ADHD care approach. Instead of framing ADHD only in terms of deficits, clinicians help teens recognize their creativity, curiosity, persistence, and problem-solving abilities while building systems that make daily life easier. For many adolescents, this shift reduces shame and supports long-term confidence.
How Mission Prep Supports Teens and Families
When a teen is coping with ADHD, anxiety, or both, or something else entirely, families often feel unsure about what step to take next. At Mission Prep, our care understands that each young person who comes to our program arrives with a unique mix of strengths, stressors, and needs.
We also know that girls may be finding it harder to cope more than they let on, making the right treatment feel like a lost cause. That’s why we offer multiple levels of care, including residential, outpatient, and intensive outpatient services, that are personalized to their unique needs and concerns.
Family involvement is also a major part of Mission Prep’s approach. We invite a collaborative partnership between teens, parents, and caregivers so families can better understand how ADHD and anxiety interact. Through education, communication, and ongoing contact with the treatment team, families will be able to respond more effectively to emotional moments at home and advocate for appropriate school supports.
If you’re noticing ongoing attention struggles, anxiety that hasn’t fully improved with treatment, or you’re just looking for an ADHD assessment for girls, reach out to Mission Prep. It will be an important first step toward getting your teen the clarity, care, and support they deserve.
FAQs About Gender Differences in ADHD
If you suspect that your daughter is coping with ADHD, you might have some ongoing questions about how to detect it and support them. This is why we’ve provided the following answers to FAQs we receive at Mission Prep.
What Are the Signs of ADHD in Girls?
The signs of ADHD in girls are often more internal than in boys. These can include difficulty following instructions or completing tasks, being disorganized or easily distracted, and frequent worries or getting overwhelmed easily.
Many girls experience quieter symptoms, such as constant mental chatter, people-pleasing, or withdrawing when they feel overstimulated, rather than outward hyperactivity. These are often the signs of ADHD in girls that get missed most often, especially when anxiety or perfectionism takes center stage.
When Are Girls Typically Diagnosed With ADHD?
Most people are diagnosed with ADHD around the age of 12 years old. But for girls, many of them don’t receive an ADHD diagnosis until adulthood. In fact, some research indicates that girls receive an ADHD diagnosis five years later than boys.10Can Girls Have Both ADHD and Anxiety?
Yes, girls can have both ADHD and anxiety. In fact, studies show that 37.7% of girls with ADHD also experience anxiety.5 So, it’s not an either/or situation because attention challenges can create stress, and chronic worry can make it harder to focus. This overlap is why getting an accurate diagnosis can be so hard.How Does Mission Prep Help Teens With ADHD?
We support teens with ADHD by providing them with the tools and skills needed to manage their symptoms. Using evidence-based therapy, like CBT, along with self-regulation strategies, your teen will be better able to think before acting, improve their behaviors, and learn that their diagnosis doesn’t have to hold them back. And by working closely with parents and caregivers, our team can help young people build confidence and strengthen their daily functioning.
References
- Skoglund, C., Poromaa, I. S., Leksell, D., Selling, K. E., Cars, T., Giacobini, M., Young, S., & Kallner, H. K. (2023). Time after time: failure to identify and support females with ADHD – a Swedish population register study. Journal of Child Psychology and Psychiatry, 65(6), 832–844. https://doi.org/10.1111/jcpp.13920
- Pelham, V. (2025, November 20). Why ADHD goes undetected in girls. Cedars-Sinai Medical Center. https://www.cedars-sinai.org/stories-and-insights/healthy-living/why-adhd-goes-undetected-in-girls
- Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of Attention Disorders, 27(7), 645–657. https://doi.org/10.1177/10870547231161533
- CHADD. (2024, February 7). Symptoms of ADHD in women and girls – CHADD. https://chadd.org/for-adults/symptoms-of-adhd-in-women-and-girls/
- Tung, I., Li, J. J., Meza, J. I., Jezior, K. L., Kianmahd, J. S., Hentschel, P. G., O’Neil, P. M., & Lee, S. S. (2016). Patterns of Comorbidity among Girls with ADHD: A Meta-analysis. PEDIATRICS, 138(4). https://doi.org/10.1542/peds.2016-0430
- Wilson, N. (2026). Why ADHD goes undiagnosed in girls. Nature. https://doi.org/10.1038/d41586-026-00098-7
- Sand, L., Bøe, T., Shafran, R., Stormark, K. M., & Hysing, M. (2021). Perfectionism in Adolescence: Associations with gender, age, and socioeconomic status in a Norwegian sample. Frontiers in Public Health, 9, 688811. https://doi.org/10.3389/fpubh.2021.688811
- Sprich, S. E., Burbridge, J., Lerner, J. A., & Safren, S. A. (2015). Cognitive-Behavioral therapy for ADHD in Adolescents: Clinical Considerations and a case series. Cognitive and Behavioral Practice, 22(2), 116–126. https://doi.org/10.1016/j.cbpra.2015.01.001
- Miller, M., Ho, J., & Hinshaw, S. P. (2012). Executive functions in girls with ADHD followed prospectively into young adulthood. Neuropsychology, 26(3), 278–287. https://doi.org/10.1037/a0027792
- Kuntz, L. (2025, October 13). Women are diagnosed with ADHD 5 years later than men. Psychiatric Times – Mental Health News, Clinical Insights. https://www.psychiatrictimes.com/view/women-are-diagnosed-with-adhd-5-years-later-than-men
