ADHD and Autism in Young Girls: Exploring Gender Bias in Healthcare

Writer: Kimberly Arinton

Editor: Maha Berrada

Introduction

Autism Spectrum Disorder, often abbreviated as ASD, and Attention Deficit Hyperactivity Disorder (ADHD) are conditions that many are familiar with in passing. Formally, they are classified as neurodevelopmental disorders and can be associated with opposing traits. For example, autism is typically associated with restricted and repetitive behaviors [1], while ADHD tends to be associated with impulsivity and hyperactivity [2]. However, research shows that there are high chances of someone with one condition meeting the criteria for both [1], colloquially shortened as AuDHD. Both autism and ADHD also tend to be diagnosed later in life for women versus men [2,3], leading us to question the underlying similarities in these conditions and why these trends exist.

AuDHD and Diagnosis Rates

ADHD and autism share some significant overlap, with similar difficulties in self-regulation and self-directed behaviors such as planning and executing ideas, largely referred to as difficulties in executive function [1]. The Diagnostic and Statistical Manual of Mental Disorders, a system used for diagnosing mental disorders, recently classified ADHD and autism under the same family of disorders, and made the co-diagnosis of these conditions easier. About 13% of children diagnosed with ADHD are eventually also diagnosed with ASD, and in children diagnosed with ASD, a follow-up ADHD diagnosis falls in the range of 40-70% [1].

Incidentally, there is also an overlap in the frequency of diagnosing both of these conditions in men versus women (based on sex assigned at birth). Recent studies show men and women are almost equally likely to be diagnosed with autism in adulthood [4], yet there remains a clear disparity in childhood diagnosis. Women tend to be diagnosed significantly later in life, with mean ranges falling between 16.3 to 28.6 years for women and 11.2 to 22.7 years for men [2]. This same issue prevails in ADHD diagnosis rates, which tend to even out in adulthood, but leave young girls anywhere from two to four times less likely to be diagnosed than young boys [3].

The parallels between the nature of AuDHD and female versus male diagnosis rates are no coincidence. There is a clear correlation between what is causing young girls with neurodevelopmental disorders such as autism and ADHD to go undiagnosed or misdiagnosed for so much longer than their male counterparts, and the cause is multifaceted and ingrained into our cultural standards.

Why the Diagnosis Gap Exists

Why does this gap in diagnoses by sex exist? Interestingly, ADHD has been found to manifest similarly in men and women, though differences in autism symptomatics are a little more inconclusive [2]. Still, if the underlying symptoms are similar, what is causing this disparity?

Research suggests that these differences might be due to the masking of symptoms by women with ASD or ADHD [2,5], which refers to the intentional or unintentional camouflaging of symptoms to fit into social expectations. This has been found to occur more frequently in women than in men, which is, in part, related to the societal pressures faced by women to conform to gender roles [5]. However, there may be other factors that cause women to be overlooked.

ASD and ADHD have historically been thought of as male-dominant disorders [2, 6], even though this is not necessarily the case. Part of the delay in proper diagnosis is then a result of clinical bias from healthcare professionals that retain this belief [2]. Furthermore, women’s symptoms often go under the radar because of how they are perceived culturally. The repetitive interests often associated with ASD may manifest in women as more ‘socially acceptable’– with celebrities, literature, and fashion reasonably falling into that category– where this heightened level of engrossment is overlooked due to the ‘fashion-obsessed’, ‘boyband-obsessed’, “fangirl” stereotypes often assigned to young girls. For boys on the other hand, interests are usually more commonly associated with widespread portrayals of autism in media and popular culture, such as fixations on trains or computers, for example [6].

For women with ADHD, defining traits can be labelled as ‘anxiety’ or ‘daydreaming’ behaviors [3]. Outward displays of hyperactivity, restlessness, and impulsivity in boys, on the other hand, are typically seen as markers for ADHD, and autism is similarly tracked through externalizing behaviors such as aggression, hyperactivity, and ‘stereotypical’ interests [1]. By using a male baseline for female patients, clinicians contribute to the misdiagnosis and late diagnosis of these conditions in women.

Evidently, symptoms of ADHD and autism in women are often minimized and ignored, despite already being more difficult to catch due to behaviors like masking. Women are forced to put more ‘work’ into expressing traits that can lead to a diagnosis. This means that women with autism and ADHD spend more of their lives undiagnosed and untreated, severely impeding their quality of life. This occurs not only in conditions like ADHD and autism, where symptoms can have different outward presentation based on sex, but in diseases that affect solely biologically female individuals as well, such as PMDD and PCOS. Women’s health is a historically underfunded and under-researched area of medicine [7]. It begs the question of whether the issue is simply understanding what symptoms to look out for, or if the gap in diagnosing these conditions is a larger reflection of systemic sexism in healthcare.

Conclusion

The disparities in diagnosing young women versus men with ADHD and autism are representative of larger issues that must be tackled in medical care. The labelling of female ASD and ADHD traits as unproblematic or unindicative of these disorders directly relate to outdated and sexist ideas about women’s health and behavior. Additionally, models for diagnosing physiological and psychological problems have long been based on male standards. Symptoms can often present differently for different groups, but even when traits are similar, existing biases in healthcare make it difficult to recognize these conditions.

Women, alongside racial minority groups and the LGBTQ community, regularly face marginalization, late diagnosis, and discrimination in the medical world [7,8]. At the end of the day, facing this gap in ADHD and autism diagnoses is only one part of the bigger picture. It is imperative to work towards changing longstanding, harmful, and outdated ideas that have become engrained in our society. Perhaps most urgently, it is important to elevate female voices in medicine to work towards a future where attentive, equitable care is available for all.

References:

1. Martinez, S., Stoyanov, K., & Carcache, L. (2024). Unraveling the spectrum: overlap, distinctions, and nuances of ADHD and ASD in children. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1387179

2. Platania, N. M., Daniëlle E. J. Starreveld, Wynchank, D., Beekman, F., & Kooij, S. (2025). Bias by gender: exploring gender-based differences in the endorsement of ADHD symptoms and impairment among adult patients. Frontiers in Global Women’s Health, 6. https://doi.org/10.3389/fgwh.2025.1549028

3. Martin, J. (2024). Why are females less likely to be diagnosed with ADHD in childhood than males? The Lancet Psychiatry, 11(4), 303–310. https://doi.org/10.1016/s2215-0366(24)00010-5

4. Mogensen, J. F. (2026, February 4). Women and men are almost equally as likely to be diagnosed as autistic by adulthood, new study finds. Scientific American. https://www.scientificamerican.com/article/women-and-men-are-almost-equally-as-likely-to-be-diagnosed-as-autistic-by/

5. Schuck, R. K., Flores, R. E., & Fung, L. K. (2019). Brief Report: Sex/Gender Differences in Symptomology and Camouflaging in Adults with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 49(6), 2597–2604. https://doi.org/10.1007/s10803-019-03998-y

6. Hull, L., Petrides, K. V., & Mandy, W. (2020). The Female Autism Phenotype and Camouflaging: a Narrative Review. Review Journal of Autism and Developmental Disorders, 7(4), 306–317. https://doi.org/10.1007/s40489-020-00197-9

7. Lee, C. (n.d.). The gender gap in health research funding is hurting all of us. Northwell Health.https://www.northwell.edu/katz-institute-for-womens-health/articles/gender-gap-in-health-research

8. Casanova-Perez, R., Apodaca, C., Bascom, E., Deepthi Mohanraj, Lane, C., Drishti Vidyarthi, Beneteau, E., Sabin, J., Pratt, W., Weibel, N., & Hartzler, A. L. (2022). Broken down by bias: Healthcare Biases Experienced by BIPOC and LGBTQ+ Patients. AMIA Annual Symposium Proceedings, 2021, 275. https://pmc.ncbi.nlm.nih.gov/articles/PMC8861755/