ADHD and the Gender Diagnosis Gap

Attention Deficit Hyperactivity Disorder (ADHD) has long been perceived primarily as a condition affecting boys, yet recent figures suggest that girls are increasingly being recognised and treated. According to NHS Business Services Authority (NHS BSA) data, the number of girls aged 10-19 who received NHS prescriptions for ADHD-related medications rose from 10,198 in 2016 to 31,392 in 2024 – a 208% increase over eight years. In 2022 and 2023, prescriptions for adolescent girls jumped by 26% and 20% respectively. This was compared with increases of 11.8% and 9% for boys over the same period. Despite this growth, boys still account for nearly three-quarters of all ADHD prescriptions in the 10-19 age bracket, indicating that girls remain under-represented in clinical diagnosis and treatment statistics.

Understanding the Gender Diagnosis Gap.

The discrepancy between male and female ADHD diagnosis is not due to a lower prevalence among girls, but rather to differences in how ADHD manifests and is identified. While boys often display overt hyperactive and impulsive behaviours that draw the attention of teachers and paediatricians, girls are more likely to present with internalising signs such as inattentiveness, emotional dysregulation and difficulties with working memory. These symptoms can go unnoticed in typical screening tools. The National Institute for Health and Care Excellence (NICE) explicitly warns that ADHD is under-recognised in girls and women, as they may be less likely to be referred for assessment and more likely to receive alternative diagnoses despite exhibiting core symptoms before age 12.

Clinicians assess ADHD against core symptoms related to hyperactivity/impulsivity and to inattention. Impulsivity may manifest as speaking over others or engaging in risky decision-making, whereas hyperactivity can involve restlessness and constant fidgeting. Inattention often reflects executive function deficits, encompassing difficulties with working memory, task prioritisation, and emotional regulation. In young girls, emotional dysregulation and alexithymia (difficulty identifying and expressing emotions) frequently dominate the clinical picture, but these traits are not explicitly captured by many traditional rating scales.

The Role of Emotional Dysregulation and Alexithymia.

At Beyond Clinics, a private ADHD assessment and treatment centre in Greater Manchester, our clinicians are used to recognising the differences between the genders when it comes to ADHD. Girls with ADHD often internalise their experiences. They may struggle to articulate feelings and become overwhelmed during life transitions such as moving from primary to secondary school or when external support structures become less prominent. It’s not uncommon for girls’ ADHD presentations to be more complex and this means that strong support networks – such as in school or from parents – can lead to ADHD going undetected. Further, because NHS guidelines stipulate that symptoms must be evident before age 12, girls whose challenges only become pronounced post-puberty are frequently missed.

Diagnostic Tools and Social Factors.

A significant contribution to missed diagnoses in girls arises from the limitations of screening instruments. Widely used tools, such as the Conners Rating Scale, were developed around the classic hyperactive and externalising behaviours predominantly seen in boys. Emotional dysregulation, a cardinal feature of ADHD in girls, is not captured by the Conners questionnaire, leading to false negatives. For this reason, it’s important to use tools which offer a more comprehensive picture of a young person’s emotional and psychological state and are therefore more effective for identifying ADHD in girls. Beyond diagnostic tools, societal awareness of ADHD is also skewed. Teachers and educational psychologists may be less attuned to how ADHD presents in girls. This can lead to girls struggling to maintain their academic commitments, with ADHD going unrecognised as the cause.

Rising Demand for Diagnosis and Medication.

Despite concerns about diagnostic oversights, overall ADHD diagnoses and prescriptions have surged. A BBC investigation revealed that, as of mid-2024, approximately 196,000 adults waited at least 13 weeks for an ADHD assessment, with some areas facing eight-year backlogs due to a fourfold increase in referrals since 2019. London alone has seen NHS spending on ADHD medications triple since 2020, rising from £650,855 in August 2020 to nearly £2 million by February 2024. Between April and June 2024, prescriptions for CNS stimulants and ADHD drugs in England increased by 5% (with costs up 6%), marking the largest quarterly jump among all mental health drug groups. The explosion in demand for ADHD medication has contributed to UK-wide shortages of methylphenidate, a cornerstone CNS stimulant. Meanwhile, long NHS waiting lists have left many waiting for assessment and treatment. This is where private clinics like Beyond can help to bridge the gap and make sure that children and adults navigating life with ADHD get the diagnoses and support that they need. It’s no surprise then that more and more people are utilising private services. In 2023-24, nearly 400,000 private prescriptions for ADHD medications were issued – a dramatic rise from 28,439 in 2018-19.

Moving Forward: A Call for Gender-Inclusive Practices.

Addressing the gender diagnosis gap requires multiple, concerted efforts. First, awareness campaigns must emphasise that ADHD is as common in girls as in boys – often with similar prevalence rates of around 5% in school-aged children, despite lower prescription rates for girls. Clinicians and educators need training to recognise inattentive and internalising presentations whilst screening tools must evolve to capture emotional dysregulation. Whether this is done through updates to existing scales or the adoption of new gender-sensitive instruments, diagnostic sensitivity for girls can improve. Schools should also foster environments where non-disruptive signs, such as persistent disorganisation or withdrawal, prompt consideration of ADHD, rather than default judgments about student effort or motivation.

Finally, expanding service capacity is essential to meet the rising demand. At Beyond Clinics, we believe that private ADHD clinics can play a huge role in bridging the gender diagnosis gap. Our clinicians are specially trained to help improve diagnostic accuracy across genders. By acknowledging that ADHD can present differently in girls, refining diagnostic tools, and improving professional and societal awareness, we can work towards equitable recognition and support for all individuals with ADHD – regardless of gender. Contact us today to find out how we can help.