Boys and Girls with Inattentive ADHD, Are They Different

There are not a lot of studies that have looked at the gender differences in people with Predominantly Inattentive ADHD (ADHD-PI) but there are studies that have looked at other things and have coincidently stumbled upon some interesting findings with regards to differences between males and females with ADHD.

Boys and Girls with Inattentive ADHD are the same when it comes to their response to stimulant treatment and they are the same with regards to the difficulties that they have in social situations. Both boys and girls with ADHD-PI tend to be shy and overwhelmed by group dynamics. Boys and girls with ADHD-PI find it difficult to engage in normal school social exchanges as they do not do well with school group bantering, teasing, and playing. Boys and girls with Inattentive ADHD will do much better in a one on one situation and many will end up socially ostracized because of their inability to engage in normal social school dynamics.
Girls may have it a bit easier than boys in this regard as all girls are often more shy than boys. Boys are expected to be sporty, loud, and outgoing and boys with ADHD-PI are generally not involved in sports and are not loud or extroverted.

There are a few other gender differences that have been discovered in Individuals with ADHD-PI. Studies have found differences in females and males when they have looked:

1. Hormone Fluctuations and the Symptoms of ADHD.
2. Brain Development and the Symptoms of ADHD.
4. Executive Function Impairments and the Symptoms of ADHD.
5. Motor Activity.
6. Mood Disorders.
7. Referral Rates for Medical Treatment.

Hormone fluctuations and the symptoms of ADHD.

Women and adolescent girls will have hormone fluctuations that will worsen their ADHD symptoms. Innumerable studies have demonstrated that estrogen improves memory, cognitive function, memory, and mood. During the second half of a women’s menstrual cycle, after the onset of menstrual bleeding, estrogen levels are higher than they are prior to menstrual bleeding. Girls with ADHD-PI will have premenstrual worsening of ADHD symptoms because of the low level of estrogen. Women who are going through menopause will also experience worsening of their ADHD symptoms as a result of their decreasing estrogen levels.

Brain development and the symptoms of ADHD.
Boys and girls have different rates of brain development and maturity. Some researchers have suggested that the earlier brain maturation of girls is somehow protective for the development of all types of ADHD including inattentive ADHD. The implication may be that a brain that develops faster is at less risk for environmental damage or other biological processses that may in some way worsen the symptoms of ADHD. This may also explain our next topic which shows that girls seem to have less executive function impairments than boys.

Executive function impairments and the symptoms of ADHD.
One study concluded that while both boys and girls have neuropsychological problems related to executive function deficits, when girls and boys were compared on tasks such as arithmetic achievement, reading achievement, and freedom from distractibility, boys were significantly more impaired than girls on these measurements of executive functioning. Another study looked at executive functioning in boys and girls and found that girls with ADHD-PI scored better on the executive function tasks measured than boys did on these same tasks.

Motor Activity

Boys are more active than girls and boys with ADHD-PI are more active than girls with ADHD-PI. The consequence of this is that ADHD-PI boys are more likely to be labeled as combined type ADHD (ADHD-C) even though they are not at all hyperactive. Boys with ADHD-PI are more active than ADHD-PI girls but are not more active than boys who are not diagnosed with ADHD.

Mood Disorders

Girls with all forms of ADHD have lower self esteem than boys with ADHD. Girls also have higher rates of anxiety and depression and often face worsening anxiety and depression as a result of puberty and fluctuating estrogen levels. Stimulant therapy can worsen anxiety symptoms in both men and women with ADHD-PI and providers should be on the lookout for side effects such as worsening anxiety when treating girls with pre-existing anxiety and ADHD-PI.

Referral Rates for Medical Treatment

Girls are less likely to be referred for treatment than boys. Girls with ADHD-PI are prone to be seen as shy, unintelligent, or un-motivated. They are more likely to be diagnosed with depression or anxiety before they are diagnosed with ADHD.  They are often perceived by teachers and parents as unlikely to be helped by medical intervention and are therefore less likely to be referred for medical care and less likely to be expeditiously or promptly treated for their ADHD symptoms.

Males and Females with ADHD-PI are similar in some ways and different in others. They are similar in that they share the same ADHD symptoms, they have similar social problems and they are similar in their response to ADHD treatment. They are different with regards to hormone fluctuations, brain development, executive function impairments, motor activity, rate of mood disorders, and referral rates for medical treatment.

There have been only a few studies that have looked at gender differences within the ADHD-PI subtype. More studies are needed in order that we may adequately treat both boys and girls and men and women with Predominantly Inattentive ADHD.


  1. Thank you for answering my question from the previous post. From where do you get all that information? Can you direct me to it?

    I still don't understand this statement: "Girls are less likely to be referred for treatment than boys. Girls with ADHD-PI are prone to be seen as shy, unintelligent, or un-motivated"

    I know PI is much more common with girls, yet all PIs (boys or girls) are more likely to be diagnosed only in adulthood if at all.

    In my opinion the fact that boys are expected to be extroverted (in appose to PI) doesn't help diagnosing PI boys more easily. This is because most people don't know what "inattentive" is. In fact I think that because girls are expected to be shy they are less likely to appear different in the eyes of their peers, and as a result less likely (even if by just a little) to have social problems.

  2. I find much of the information from studies that I read at PubMed. I do not think we fully understand why girls are referred less than boys. One study found that parents and teachers felt that girls would not be helped by medical treatment. It is true that very few people know about inattentive adhd. Even teachers often diagnose ADHD-Pi as combined type of anxiety or something else because they are not familiar with the ADHD-PI picture. Thanks for your comments!!


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