Health
ADHD in males versus females: What you must know about the differences in symptoms and treatments
Attention-deficit/hyperactivity disorder (ADHD) may be common, but it’s also sometimes hard to spot.
ADHD is usually first diagnosed in childhood and is one of the most common neurodevelopmental disorders in children, according to the Centers for Disease Control and Prevention (CDC).
Symptoms of ADHD in kids can include trouble paying attention, difficulty controlling impulsive behaviors and displaying periods of hyperactivity.
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But how these symptoms show up in boys versus girls, and eventually in men versus women, can make a big difference in diagnosis.
Sabrina Nasta, a licensed mental health counselor in Orange Park, Florida, told Fox News Digital that ADHD can show up in three different ways: through inattention, hyperactivity and a combination of the two.
ADHD in males compared to females can means significantly different symptoms, experts say. (iStock)
In women, ADHD most commonly manifests as inattention, which includes an inability to pay attention, distractibility and lack of compliance, according to Nasta.
In men, ADHD occurs in a hyperactive way, causing issues with sitting still or wanting to be constantly “doing something,” said the expert.
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McCall Letterle, head of U.S. commercial operations for ADHD assessment company Qbtech, also commented on these differences in a conversation with Fox News Digital.
Athough many of the symptoms, including hyperactivity, inattention and impulsivity, are the same, it’s how the symptoms “manifest themselves” that causes a variation between males and females, the Atlanta-based expert noted.
Young girls with ADHD may sit still in the classroom, but they’re “not paying attention,” an expert said. (iStock)
A struggle with discipline seems to be a commonality of ADHD in men and women based on their lifestyle and age, Nasta added.
In young boys, for example, ADHD shows up as “unnecessary” hyperactive energy; they “don’t have the capacity to not do anything,” the expert said.
In girls, the same inattentiveness may arise, but it’s most likely internalized.
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“They may be sitting in the classroom, they may be sitting still, but they’re not paying attention,” Nasta said.
“It’s tough because for a girl, it looks like they’re rebelling or being disobedient, [but] for a boy, [it seems that] they’re just being ridiculous and hyper.”
Underdiagnosis in women
The differences in ADHD presentation have led to a “massive amount of underdiagnosed women,” according to Letterle.
“This [disorder] was first researched in males, and the criteria developed around symptoms most commonly seen in boys,” she told Fox News Digital.
Initial research on ADHD in boys and men could have led to the misdiagnosis in women, one mental health expert suggested. (iStock)
“These are also the most overtly obvious symptoms — like hyperactivity, inability to sit still, disruption and difficulty focusing, often in the classroom — that lead to associated behavioral issues,” Letterle added.
While some women do experience these hyperactive symptoms, they are not the most prevalent symptoms and they look different when they do occur, according to Letterle.
“Women tend to exhibit symptoms that are more internalized,” she said.
“For instance, their inattention is much harder to recognize than boys, as it can be displayed as daydreaming or inward distraction.”
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Letterle pointed out the “external fallout” of these ADHD symptoms in girls — which results in “high rates of anxiety” due to missed information at school.
In many cases, girls have to work twice as hard to retain information and meet academic standards as their peers, and they experience low levels of confidence stemming from these difficulties, she added.
Girls with ADHD can experience “high levels of anxiety,” said a mental health expert. (iStock)
“That is subjectively a lot harder to identify than distracted boys, who are poking the individual next to them as they struggle to maintain focus.”
These variants lead to a “massive difference in diagnostic rates” between young girls and boys, Letterle said.
Boys are often diagnosed and treated faster than girls because their symptoms are easier to identify, she added.
Personalized coping
One of the best ways to cope with ADHD is to educate yourself, or your child, on the best way to function in different environments, said Nasta.
Some of the strategies she recommended include practicing mindfulness and self-awareness, and coming up with the best game plan in any given situation.
Stress management is another great coping tool, especially for boys, added Nasta.
Allowing kids with ADHD the time to release stress is an important coping technique, experts say. (iStock)
For kids, stress management can mean participating in leisure activities or hobbies like playing video games or hanging out with friends.
“It’s about allowing them to let that energy go in a more supportive way,” Nasta said.
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ADHD in boys and girls can be difficult for caretakers — parents, guardians and even teachers — to identify when they lack the “appropriate tools” to make “more accurate referrals,” Letterle noted.
To overcome that challenge, Nasta encouraged caretakers to “listen more.”
“If you’re really paying attention and your kid’s trying, this could be a neurological or neurodevelopmental concern versus them just struggling with emotions,” she said.
In young boys, ADHD shows up as “unnecessary” hyperactive energy; they “don’t have the capacity to not do anything,” according to experts. (iStock)
It might be helpful for parents to “be more curious” and ask their children questions about their feelings when they are overwhelmed, Nasta suggested.
“What do you experience when you’re overwhelmed? Are you able to focus or pay attention to your teacher? Do you notice what your thoughts are doing?” she listed as example questions.
“If it sounds really concerning and intrusive, I would say that’s the point of … seeing a professional.”
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Early ADHD intervention is “critical for reducing suicide rates, job instability and substance abuse in those left untreated,” Letterle said.
“The diagnostic process has been left largely to subjective rating scales, creating a desperate need for clinicians to start adopting a more data-driven approach to symptom measurement,” she added.
Impairments in managing basic hygiene, finances, academic or communication skills could signal the need for ADHD evaluation, according to experts. (iStock)
“Objective data compares performance in the three core symptom areas against age- and sex-matched controls without ADHD — meaning women are compared to other women to improve the ability to accurately identify their diagnosis,” the expert said.
When to seek help
While the term “ADHD” is often tossed around to describe when someone is feeling unfocused, Nasta listed a few warning signs that could point to an actual diagnosis.
The expert said to monitor daily responsibilities such as hygiene, finances, academics and even basic social skills such as listening and communication.
“If you notice impairments and deficits in any of those, I would say that would be the time to talk to somebody,” she advised.
For people who are unsure of their symptoms, Letterle recommended seeking out a provider who uses objective data in a comprehensive evaluation.
“[This] would help to better ensure not only a more accurate diagnosis, but also one that helps eliminate the bias that often leads to high rates of underdiagnosis or misdiagnosis in women,” she said.
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Washington, DC – Medical victim Chloe Cole was at the center of the U.S. Department of Health and Human Services’ Thursday announcement of proposed regulatory actions to end “sex-rejecting procedures” on minors.
The proposed regulatory actions by the HHS are part of President Donald Trump‘s January executive order calling on the department to protect children from “chemical and surgical mutilation.”
The department is rolling out a series of policy updates and regulatory actions that would effectively defund hospitals that provide gender transition procedures, according to an HHS official.
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Cole, now 21 years old, went through the process of medical transition from female to male between the ages of 12 and 16.
The California native took to the stage alongside HHS Secretary Robert F. Kennedy Jr. and other officials Thursday to advocate for the protection of children. Afterward, she told Fox News Digital the puberty blockers, testosterone injections and double mastectomy she endured have irreversibly and permanently affected her health.
Detransitioner Chloe Cole joined HHS Secretary Robert F. Kennedy Jr. on Thursday as he announced proposed regulations ending gender treatments for children. (Fox News Digital)
“As soon as gender was in the picture, none of my doctors or psychologists asked the real questions that they should have,” said Cole. “The entire focus was on my feelings and what I wanted rather than what I really needed in that moment.”
What she needed, Cole said, was to be loved and affirmed for the way God created her — “as a young and yet tomboyish little girl.”
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She maintained that her doctors neglected to share risks, only touting the “benefits” of stopping female puberty and using testosterone to promote body hair growth, musculature and different fat distribution.
“There was nothing they could say to me that would make me understand the gravity of what I was about to go through, because I was still growing up,” said Cole. “I had very little experience in the world, and I simply would not be mature enough to be equipped to undergo such a life-changing procedure in every way.”
“I had very little experience in the world, and I simply would not be mature enough to be equipped to undergo such a life-changing procedure in every way,” Cole, pictured above in both pictures, told Fox News Digital. (Chloe Cole; Fox News Digital)
Cole noted that her parents never thought she was transgender, but felt like the odds were stacked against them.
“At the time when we started going through this as a family, there really were no resources that would speak to the reality of transgenderism, especially for children,” she said. “Most people were not aware then that this was something that was even happening in our hospital systems.”
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Cole said her parents were warned that if they did not allow her to transition, she would likely commit suicide.
“My legal guardians were forced to make this decision under duress,” she shared in a previous statement. “But even if my parents had supported transitioning medically from the start, no parent or any adult, ultimately, has a right to determine whether a child gets to be chemically sterilized or mutilated.”
“While there are only two sexes, there’s a million different ways that you can be yourself,” said Cole, pictured above during her surgeries. (Chloe Cole)
Cole said she’s suffered numerous complications from her medications and surgery. “My quality of life is still being impacted to this day,” she wrote in her statement.
Her fertility status now remains unknown, she said. She will not be able to breastfeed because her breasts were surgically removed.
“As an adult, I am now grieving, and on top of that, the areolar skin grafts they used in my surgery began to fail two years afterward. I must wear bandages on my chest every day,” Cole wrote.
“As an adult, I am now grieving.”
In 2023, Cole filed a lawsuit with the Center for American Liberty (CAL) against hospitals for pushing her into what she believes is medical mutilation.
Mark Trammell of CAL told Fox News Digital that Thursday’s HHS announcement “represents a critical acknowledgment that experimental medical interventions on children with gender distress have failed to meet basic standards of safety and effectiveness.”
Cole, who detransitioned after medical procedures, is warning others to wait and seek family support before transitioning. (Fox News Digital)
“It signals that medicine must return to its core ethical obligation: First, do no harm,” Trammell added.
“We will continue fighting to ensure accountability for the institutions that promoted these practices and to secure justice for the children and detransitioners whose lives were forever altered.”
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In a previous statement provided to Fox News Digital, Dr. Marc Siegel, Fox News senior medical analyst, said he is in favor of a “more conservative approach” for minors.
“Long-term effects of puberty blockers may include bone loss, trouble concentrating, interference with learning and interference with fertility,” he said. “I think it makes sense in most cases to treat underlying mental health concerns before jumping into treatments, including surgery, that may be difficult to reverse.”
“It makes sense in most cases to treat underlying mental health concerns before jumping into treatments.”
The doctor also emphasized that gender issues should not be overly politicized. “This means not superimposing an ideology or pushing physicians to act in a certain way or under pressure,” Siegel said.
Cole began the gender transition process at age 12 and received a double mastectomy surgery at 15 years old. (Fox News Digital)
“The welfare of the child must come first. In this case, it means going very slowly and providing support to a child or teen with gender dysphoria.”
Cole shared that she hopes any children who are questioning whether they should transition wait.
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“While there are only two sexes, there are a million different ways that you can be yourself,” she added.
“God is there for you. He is the one who has created you this way, and you can seek his counsel,” Cole went on.
“You can continue praying, and I think ultimately it’s connecting with your family, building your purpose in this world, and looking to the gospel and up to God.”
Fox News Digital’s Emma Colton contributed reporting.
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Those at risk of type 2 diabetes may be able to prevent heart problems later.
A new study published in The Lancet Diabetes & Endocrinology discovered that lowering the blood sugar of those with prediabetes could reduce the risk of heart attack by half.
Diabetes researchers and endocrine experts across Europe, China and the U.S. investigated how bringing blood sugar back to normal levels affected the chances of heart problems later in life, based on a 20-year American study and a 30-year Chinese study, according to a press release.
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In both studies, the prediabetic participants were coached to make appropriate lifestyle changes to lower blood sugar (the amount of glucose in the bloodstream) through diet and exercise, also targeting weight loss.
Participants worked to lower blood sugar through diet and exercise targeted at weight loss. (iStock)
The researchers split the participants into a remission group (where blood sugar returned to normal) and a non-remission group, which included those still in the prediabetes range. They then determined who in these groups had died from heart disease or were hospitalized for heart failure.
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Participants who went into remission had a 58% lower risk of dying from heart disease and being hospitalized for heart failure. This group also had a lower risk of other major heart events and lower overall death rates.
These heart-protective benefits lasted for decades after the program ended, the researchers found.
Those in prediabetes remission had their risk of a heart event reduced by more than half. (iStock)
“Reaching prediabetes remission is linked to a decades-long benefit, halving the risk of cardiovascular death or hospitalization for heart failure in diverse populations,” the researchers commented in the publication of the study. “Targeting remission might represent a new approach to cardiovascular prevention.”
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In an interview with Fox News Digital, Dr. Andreas Birkenfeld, study co-author and professor of medicine at the University Hospital Tübingen in Germany, reiterated that reaching prediabetes remission is not only relevant for reducing the progression of type 2 diabetes, but may also be associated with a “meaningful reduction in… heart attack risk, cardiac death and heart failure.”
“Importantly, this underscores that prediabetes is a modifiable stage where timely, evidence-based interventions (especially lifestyle measures, and in selected cases, medication) can make a real difference,” he added.
“Reaching prediabetes remission is linked to a decades-long benefit, halving the risk of cardiovascular death or hospitalization for heart failure in diverse populations,” the researchers commented. (iStock)
The study did have some limitations, including that it is based on analysis of trials not originally designed to measure cardiovascular outcomes, which means the results show association but cannot prove causation.
In addition, unmeasured lifestyle and health factors, population differences and lack of randomization for heart outcomes may have influenced the reduced cardiovascular risk, the researchers acknowledged.
“This underscores that prediabetes is a modifiable stage where timely, evidence-based interventions … can make a real difference.”
Birkenfeld suggested that those with prediabetes should ask their doctors the following questions: “What is my current status? What is my personal cardiovascular risk? What is my target blood glucose level?”
Patients should also inquire about the frequency of testing for blood sugar and key risk factors like blood pressure, cholesterol and other related conditions, such as kidney function or sleep apnea, he advised.
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“If lifestyle changes aren’t enough or my risk is high, would medication be appropriate for me — and what are the benefits and downsides?” the researcher asked as an example.
About 98 million American adults, more than one in three, have prediabetes, according to CDC data. Eight in 10 of these adults are unaware that they have the disease.
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