Silently Suffering: Unmasking the Hidden Symptoms of ADHD in Girls

In my previous article, "The 'Superpower' that's Making Girls Sick," I explored the immense pressure on girls to achieve an unattainable ideal. This pressure often forces them to adopt "high-functioning" coping mechanisms, such as perfectionism and people-pleasing, effectively masking deeper mental health struggles. While boys are often perceived as naturally possessing traits like intelligence and confidence, girls feel compelled to earn these qualities through relentless effort. This disparity leads to internalized struggles and makes conditions like ADHD far more difficult to recognize.

Unlike the stereotypical, outward-facing symptoms of ADHD in boys—think disruptive behavior and restlessness—girls often internalize their experiences. This internalization, coupled with perfectionism and people-pleasing, creates a facade of competence that hides underlying challenges. These "maladaptive coping mechanisms," while enabling girls to function, ultimately leave their symptoms undetected, potentially worsening their mental health. It's crucial to understand how internalization alters the presentation of conditions like ADHD, ensuring those who excel at masking their struggles receive the support they need.

To illustrate this, consider how core ADHD symptoms like inattention, hyperactivity/impulsivity, emotional dysregulation, and social challenges can manifest differently in girls. The following list provides examples of these internalized presentations. While comprehensive, it's essential to remember this is not a diagnostic tool. If you or someone you know identifies with many of these traits and is considering an ADHD assessment, please consult a qualified healthcare professional.

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Internalized Symptoms of ADHD in Girls

Inattention:

• Trouble remembering verbal instructions or following

  along while reading.

• Difficulty completing tasks, especially those requiring sustained effort.

• Easily distracted by external stimuli.

• Difficulty with task initiation and procrastination (especially when in a "potato" phase).

• Easily bored:

  • Daydreaming or doodling for more stimulation during menial tasks.

  • Difficulty paying attention to boring/uninteresting tasks and conversations.

• Easily overwhelmed:

  • Difficulty concentrating in distracting environments (i.e., parties with music and multiple conversations).

  • Zoning out frequently, especially after prolonged periods of activity or overstimulation.

• Lack of consistency:

  • Difficulty staying consistent with interests, habits, or hobbies, especially when they aren’t a current “hyper-fixation” or passion.

  • Struggling with organization, time management, and prioritization.

  • Tardiness and rushing/multitasking (the “tornado” phase).

  • Forgetfulness (e.g., entering a room and forgetting why, misplacing items, leaving keys in the door).

  • Over-reliance on to-do lists.

  • Forgetting to put things away.

  • Organized chaos and hidden clutter.

Hyperactivity/Impulsivity:

• Difficulty sitting still or relaxing.

• Fidgeting, hidden restlessness, skin picking, or other repetitive behaviors.

• Impulsive decision-making when emotionally charged.

• Talkativeness, when comfortable.

• Oversharing.

• Fluctuating energy levels, from lethargy (aka, "potato") to hyperactivity (aka, "tornado).

Emotional Dysregulation:

• Extreme sensitivity to rejection and criticism (Rejection Sensitivity Dysphoria, or RSD).

• Tendency to assume others dislike or judge you.

• Feelings of shame and self-criticism.

• Intense, internalized feelings of anxiety, sadness, or frustration.

• Difficulty regulating emotions, leading to outbursts or hidden self-harm.

• Hiding when emotionally distressed.

• Challenges asking for help or being vulnerable.

• Significant mood fluctuations, especially during the menstrual cycle (luteal phase).

• Feelings of hopelessness or helplessness.

Social Challenges:

• Difficulty making and maintaining relationships.

• Difficulty interpreting social cues.

• Clinging to a few close relationships, rather than many acquaintances.

• Feeling different or misunderstood.

• Social anxiety and discomfort in large groups.

• Conflict avoidance.

Academic/Occupational Challenges:

• Imposter syndrome.

• Difficulty achieving academic success despite effort.

• Late assignments.

• Struggling with tests, even after studying.

• Fluctuating academic performance.

• Mental exhaustion after school or work.

• Struggling to feel accomplished.

• Having brilliant ideas but lacking follow-through.

• Difficulty managing workload and feeling overwhelmed.

• Difficulty balancing work and home life.

• Difficulty managing finances.

Behavioral and Maladaptive Coping Strategies:

• Perfectionism or overcompensating behaviors to hide inattention.

• Compulsive fixing, checking, worrying, and rumination to cope with forgetfulness and memory lapses.

• People-pleasing to avoid criticism or rejection.

• Tendency to “shut down” or withdraw when emotional.

• Using food, alcohol, or other substances to regulate emotions.

• Daydreaming and fantasizing for stimulation when bored.

• Avoiding situations out of fear of rejection and social anxiety.

• Picking or repetitive behaviors to cope with restlessness and hyperactivity.

• Overthinking, anxiety, and obsessions due to a hyperactive mind (rather than a hyperactive body).

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The silent struggles of girls with ADHD are often hidden beneath societal expectations and internalized pressures. By raising awareness, we can break down the "good girl" paradigm and provide the necessary support. It's time to recognize and address these hidden challenges, empowering girls to thrive.

Written by: Megan Fordon, LLMSW

Date: 3/16/2025