Tue, February 3, 2026

The Invisible Struggle of Gifted Girls with ADHD

by Kimberly Busi, MD, Founder and Head of The Quad Preparatory School

She sits quietly in the back of the classroom, her notebook filled with perfect doodles instead of notes. Her classmates see a daydreamer who can never find what she is looking for in her backpack.  Her teachers describe her as a “very bright” student who just isn’t trying hard enough to meet her full potential.  Or worse, they see her as spacey and not all that academically inclined.  Her parents worry about signs of growing anxiety in their daughter and ruminate about how this will affect her future. Unfortunately, almost no one recognizes her ADHD hiding in plain sight.  

ADHD Presents Differently in Girls Than in Boys

ADHD (Attention-Deficit/Hyperactivity Disorder) is diagnosed in approximately eight percent of girls as opposed to almost fifteen percent of boys. In fact, girls with ADHD are diagnosed an average of five years later than boys. This is widely thought to be due to the lack of identification in girls as opposed to a true difference in prevalence. 

When one thinks of ADHD, one pictures a hyperactive boy who disrupts classroom discussions, impulsively grabs things out of classmates’ hands, and can’t wait his turn or stay in line. Because boys’ symptoms are primarily those consistent with hyperactivity and impulsivity, ADHD symptoms in boys are more obvious, are flagged early, and lead to referrals for comprehensive evaluation. And, because ADHD symptoms so obviously impact their functioning at school, boys are fast-tracked for intervention and therapeutic support. Indeed, receiving the right diagnosis of ADHD is essential for accessing resources, educational support, and treatment for neurodiverse students. These supports and treatments are known to significantly improve long-term outcomes.

In contrast, the average girl with ADHD has primarily inattentive symptoms—she may get distracted by a bird resting briefly on the windowsill and miss important parts of what is being said in class. Her mind can go off on interesting tangents during homework assignments, taking her longer to complete work that is otherwise easy for her. Her teachers may tell her that she makes careless mistakes. These girls themselves just find it harder than it should be to meet expectations. In any case, girls with ADHD do not cause outward disruptions in class, so they aren’t identified as needing support or referred out for evaluation.

In the meantime, girls with ADHD and other types of neurodiversity can become adept at creating compensatory strategies that mask symptoms. While these workarounds may offer temporary relief, increasing academic demands and social expectations make it progressively harder to keep up. Without a diagnosis to explain their difficulties, many girls internalize their struggles, interpreting them as personal failings rather than signs of an underlying condition. What may simply be social mismatches are often experienced as social rejection.

Paradoxically, the more “successful” neurodiverse girls are at masking, the greater their risk of entering a cycle of self-doubt and social anxiety over time. Declining self-esteem can eventually give rise to full-blown anxiety or depressive disorders—outcomes that might have been prevented had the underlying ADHD been identified earlier. 

ADHD in Twice-Exceptional Girls

The traits of giftedness compound the struggles of ADHD in twice-exceptional (2e) learners. Gifted learners are big picture thinkers—they have a conceptually advanced understanding of material and ask big questions to understand. They learn best when there is ample room for deep questioning and exploration of the material, and ultimately for exploring the relationships and connections among disciplines. Routine classroom work—especially repetitive drills or material they have already mastered—can feel tedious, making sustained attention even harder for a gifted girl with ADHD, whose mind naturally gravitates toward broader ideas. This is true in school settings—no matter how academically rigorous—that are not designed for gifted learners. Gifted educational classrooms utilize “curriculum compacting”, a technique that replaces this “busy work” with more material enriched with depth and complexity.

And, while masking in girls with ADHD carries a steep toll, it is even steeper for girls whose gifts themselves make it “easier” to mask their struggles. Thus, seemingly “fine” and high-performing girls are holding it together for longer periods of time, further delaying identification of their neurodivergent challenges. This, in turn, delays access to support and resources, which may include a more specialized school setting for neurodiverse learners. The Quad Preparatory School is one example of an independent school specifically designed for 2e students, where gifted girls with ADHD and other neurodiversity are met with academic rigor using gifted educational practices, deep social-emotional learning, and clinical supports that allow them to overcome their challenges and rise to meet their full potential.

Perhaps the most ubiquitous trait of being gifted is perfectionism. Gifted children are used to things coming easily. When faced, though, with a novel challenge or something that doesn’t come easily, gifted students can experience an intense fear of failing. This can look like students crumpling up work that isn’t perfect, avoiding work, or working slowly to make work perfect. This “not meeting expectations” (in this case, their own) in the face of their intolerance of imperfection leads to an even larger burden when faced with challenges that come with ADHD. 

It Doesn’t Have To Be This Way

Luckily, there is an evolving recognition of both the ways ADHD and other types of neurodiversity present in girls and the importance of responsive, strengths-based intervention. Many girls—sometimes identified as early as preschool—have been fortunate to receive an early diagnosis, though countless more remain undiagnosed. With access to the right support and responsive intervention, like those provided at The Quad Preparatory School, these girls seem to never doubt that they are smart, competent, and frankly awesome. This confidence greatly reduces the risk of low self-esteem and significantly lowers the likelihood of developing secondary mental health challenges. 

Responsive intervention in specialized school settings can help reverse distorted, negative beliefs that these students can develop in the absence of understanding their learning needs. As there is more awareness, there will hopefully be a higher index of suspicion and a lower threshold for the evaluation and diagnosis of ADHD in girls. The impact on the academic success, quality of life, and overall health and outcomes for these students cannot be overstated.

For the countless girls who stayed up until midnight finishing homework that should have taken an hour and internalized years of “not living up to potential,” a proper ADHD diagnosis can be transformative—not because it excuses struggle, but because it finally explains it. It’s time to rewrite the narrative and see these girls for who they really are—not daydreamers or underachievers, but young people with brilliant, fast-moving minds that simply work differently.

Kimberly Busi, MD, is the Founder and Head of The Quad Preparatory School, a K-12 independent school in New York City dedicated to transforming the experience of school for twice-exceptional students through a unique, personalized model that fully integrates social and emotional learning with challenging academics. Dr. Busi is widely recognized as a national leader in the field of 2e education. A highly-regarded psychiatrist and a former Clinical Assistant Professor of Psychiatry at the NYU School of Medicine, her medical background and experience as an educator have informed the fully integrated academic and clinical model at Quad Prep.