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Why ADHD Assessment Looks Different for Women and Girls

ADHD assessment can look and feel different depending on which presentation someone has, and the quieter, inattentive presentation is the one most often diagnosed later in life. Here is what that means and what the available evidence actually shows.

ADHD has three presentations under the DSM-5: predominantly inattentive (easily distracted, not hyperactive or impulsive), predominantly hyperactive-impulsive, and combined, which healthdirect describes as the most common and the one most associated with the general idea of ADHD. Which presentation someone has can shape how obvious ADHD is to the people around them, and how early it gets picked up.

The quieter presentation

Because the inattentive presentation does not include hyperactivity or impulsivity, it is easy to miss. And nothing about it reliably draws a teacher's or a parent's attention the way the hyperactive-impulsive presentation does. It is the presentation most often raised in conversations about women and girls being diagnosed later in life, sometimes not until adulthood, though that pattern is offered here as a general observation rather than a specific Australian statistic.

What one Australian clinic found

A peer-reviewed study of one private Australian clinic gives a concrete sense of how late recognition can come. Of 68 adults diagnosed with ADHD at that clinic between January 2023 and October 2024, referred through their GPs, fewer than 5 percent already had a childhood ADHD diagnosis, and 32 percent were diagnosed with the predominantly inattentive presentation against 68 percent combined. Ages in the sample ranged from 17 to 56, with a mean age of 28.35 at diagnosis, well past the school years when hyperactive-impulsive symptoms are usually spotted. That is one clinic's patients, not a national figure, but it shows a presentation can go unrecognised for decades before someone is assessed as an adult.

Proving it started in childhood

For anyone diagnosed as an adult, part of the assessment involves establishing that symptoms were present in childhood, per healthdirect, sometimes through old school reports. For someone with a quieter, inattentive presentation, that step can be harder: the behaviour that would have flagged it, being easily distracted, rarely showed up in a report card the way disruptive behaviour would have.

The same guideline, whichever presentation shows up

Whichever presentation someone has, the assessment is meant to follow the same national standard rather than a clinician's individual sense of what ADHD looks like. The AADPA's Australian Evidence-Based Clinical Practice Guideline for ADHD launched in October 2022, is NHMRC-approved for five years, and sets out 113 clinical recommendations developed for the more than 800,000 Australians estimated to have ADHD at the time. A psychologist, psychiatrist or paediatrician working from that guideline is meant to map symptoms against all three presentations before reaching a diagnosis, rather than starting from an assumption about what a person with ADHD looks like.

Common questions

Sources

• healthdirect Australia: Attention deficit disorder (ADD) or ADHD
• Mendonsa & Jayasooriya, European Psychiatry (2025): adult ADHD diagnosis at one Australian private clinic
• AADPA: guideline launch

Related reading

• The three types of ADHD explained
• Child ADHD assessment vs adult ADHD assessment
• The psychologist pathway to ADHD assessment