Not Just Restless: What Research Says About How ADHD Often Presents in Girls and Women

Byline: Chau Sir / chausir.com

This article summarises public research with AI assistance.

1. What the study looked at

Williams, Horstmann and colleagues from Cardiff University published an item-level systematic review online in February 2025 and in print in April 2025 in Neuroscience & Biobehavioral Reviews. The work compares how ADHD presents in females versus males, and in females with versus without ADHD, looking at individual symptom items and everyday impact. The team searched six databases and included 13 studies. Online publication was around February 2025, print April 2025, under CC BY 4.0. [1]

2. What the review found

In childhood, girls were more often associated with descriptions linked to sustained attention and distractibility (for example, difficulty sustaining attention on tasks, and being easily distracted). Boys were more often associated with descriptions linked to activity and impulsivity (for example, fidgeting, difficulty remaining seated, running about, difficulty waiting, blurting out answers, and interrupting others). In adulthood, females were more often associated with distractibility, difficulty organising tasks, blurting out, talking a lot, and reports of mind-wandering and impact on household routines.

The authors note that many earlier studies used total or subscale scores and may have missed how females present. Samples and methods in the current evidence are not consistent. The map reflects existing literature rather than proving that any presentation must appear in every girl, and it does not mean every child has the same experience. These are descriptive associations from the current literature. They do not prove that any single factor will bring a particular result. [1]

3. Reading with care

This is a systematic review. It uses existing literature to describe a map of item-level presentation of ADHD in girls and women. Samples and methods are not consistent. Overseas school rhythms and expectations also differ from those in Hong Kong, so the findings are a reference only. Do not assume that every girl with ADHD looks the same, and do not treat the findings as a message that “late recognition must be the school’s fault.” The review is not a complete picture of any one child. [1]

4. Small things Hong Kong parents can notice

Hong Kong parents and teachers sometimes link ADHD mainly with “can’t sit still, noisy, impulsive.” As a result, quiet girls who are often distracted, miss homework, or keep a chaotic home desk may be seen as “not trying hard enough” or “not focused.” This review is a reminder that, in the literature, presentation in girls and women can lean more toward attention and organisation difficulties than toward outward hyperactivity.

In everyday life, when you talk with the SENCO (special educational needs coordinator), you can ask not only whether she is noisy but also about distractibility, organisation, time management, and energy after school. With your child, open questions help: “What was hardest to keep up with today / what tired you most?” At parent meetings you can ask teachers to notice signals of “quiet but falling behind.” Chinese families sometimes worry that talking about SEN will lead to a label; you can start with concrete needs with the class teacher (for example, handing in work in stages, or a seat with fewer distractions) rather than saying everything at once.

From a CRP (Communication, Relationship, Parenting) point of view, you can start with communication and relationship: adults and the child talk through which moments feel hardest to follow and which feel most tiring, keep a predictable rhythm, and do not demand every area change at once. The research is a reference only. Every family has its own pace, and there is no need to blame yourself or your child. If the child has long periods of feeling “not good enough,” low mood, or refusing school, you can check with the school special educational needs coordinator or a trusted parent group about ways to walk alongside. If there is an immediate crisis, call 999 or the Mental Health Support Hotline 18111.

Sources

1. Williams, T., Horstmann, L., Kayani, L., Lim, A. X. H., Russell, A., Ford, T., John, A., Sayal, K., Thapar, A., Langley, K., & Martin, J. (2025). An item-level systematic review of the presentation of ADHD in females. Neuroscience & Biobehavioral Reviews, 171, Article 106064. https://doi.org/10.1016/j.neubiorev.2025.106064 (institutional OA: https://orca.cardiff.ac.uk/id/eprint/176107/)

Disclaimer

Educational information, not a diagnosis or medical advice.

Chau Sir's talks and articles are parent education. They do not provide diagnosis, assessment or treatment, and do not provide medical or medication advice. If needed, please consult a qualified professional.