Blog - Michelle H. Chen, PhD

Key Takeaways

ADHD is frequently missed in girls, women, and quiet or perfectionistic individuals who internalize their symptoms.
High-IQ or gifted individuals may mask ADHD symptoms with intelligence, leading to delayed recognition and mislabeling.
“Twice-exceptional” kids often struggle with organization, follow-through, and emotional control despite being bright.
ADHD can present without meeting full diagnostic criteria, but still cause major life impacts.
Diagnosis and support can help individuals understand their brains and unlock strategies that work with their strengths.

Many people with Attention-Deficit/Hyperactivity Disorder (ADHD) don’t fit the stereotypes. They may be quiet, high-achieving, or emotionally intense. Some fly under the radar because they don’t cause disruptions, but they’re still struggling on the inside.

In this post, we’ll explore how ADHD can be masked by intelligence, personality, or gender, and why so many people don’t get the help they need until much later.

Gender Differences in ADHD: Why Girls Are Often Missed

Girls and women with ADHD often look very different from their male counterparts. Instead of acting out, they may internalize their struggles, leading to:

Quiet inattention – Daydreaming, slow to complete tasks, easily overwhelmed.
Perfectionism or people-pleasing – Masking difficulties with overcompensation.
Social struggles – Excessive talking, sensitivity to rejection, or emotional intensity.

Because these symptoms don’t always cause disruptions in the classroom, girls are less likely to be referred for assessment. Many are first diagnosed as adults, often after years of being mislabeled as anxious, disorganized, or “just emotional.”

High Intelligence and ADHD: The Twice-Exceptional Dilemma

Children with average to high cognitive abilities, especially those who are gifted, may compensate for ADHD symptoms for a long time. These “twice-exceptional” students often:

Score well on tests but forget to turn in homework.
Hyperfocus on topics they love, yet neglect required tasks.
Struggle with organization, time management, or emotional control.
Appear lazy, oppositional, or inconsistent despite being very bright.

Their intelligence can mask their challenges, until academic demands increase and they can no longer compensate on their own. A comprehensive neuropsychological evaluation can identify these hidden challenges, allowing for appropriate supports while still honoring their strengths.

How ADHD Is Diagnosed and Why Some People Are Missed

ADHD is diagnosed using criteria from the DSM-5-TR, which outlines a persistent pattern of inattention and/or hyperactivity-impulsivity that:

Begins before age 12
Occurs in two or more settings (home, school, work)
Interferes with social, academic, or occupational functioning
Is not better explained by another mental health condition

There are three subtypes: inattentive, hyperactive-impulsive, and combined. But not everyone fits neatly into these categories. Some individuals experience subthreshold symptoms. They struggle in real and significant ways, even if they don’t meet full diagnostic criteria.

These individuals often benefit from support, even without a formal ADHD label. A comprehensive neuropsychological evaluation can uncover patterns of attention, executive functioning, memory, and processing speed that inform a more nuanced understanding.

Why These Differences Matter

Understanding how ADHD presents across different ages, genders, and ability levels is key to avoiding missed or misdiagnoses. Left unrecognized, ADHD can lead to years of underachievement, self-doubt, and mental health challenges like anxiety or depression.

With the right support, individuals with ADHD can thrive, not in spite of their brains, but with a better understanding of how they work.

You don’t have to wait for things to get worse before seeking answers. If you or your child are bright, sensitive, and struggling in ways others don’t see, it may be time to look beneath the surface.
→ Contact my office to schedule a consultation

Key Takeaways

ADHD symptoms often change over time, from hyperactivity and impulsivity in children to disorganization and emotional overwhelm in adults.
Many children “grow into” their symptoms as life demands increase, especially during school transitions.
Adults with ADHD may not appear hyperactive but still struggle with time management, focus, and emotional regulation.
ADHD often goes unrecognized in adults who developed coping strategies or weren’t diagnosed as kids.
A neuropsychological evaluation can identify patterns even if someone doesn’t meet “classic” criteria.

Attention-Deficit/Hyperactivity Disorder (ADHD) is often thought of as a childhood condition, hyperactive behavior, trouble focusing in class, and frequent interruptions. But ADHD is not just a childhood diagnosis. It often persists into adulthood, and its symptoms can shift dramatically over time.

What starts as hyperactivity or impulsivity in young children may evolve into chronic disorganization, emotional reactivity, or difficulty managing responsibilities in adulthood. Because these changes often happen gradually, ADHD can be overlooked, especially in individuals who were never diagnosed as kids.

In this post, we’ll take a closer look at how ADHD unfolds across different life stages, why symptoms often change from childhood to adulthood, and when to consider a neuropsychological evaluation.

ADHD in Children: Often Loud, Often Seen

In childhood, ADHD is often easier to spot, especially when it shows up as disruptive behavior. Teachers and parents might notice:

Inattention – Trouble focusing, easily distracted, losing items, or making careless mistakes.
Hyperactivity – Fidgeting, climbing, running around, or difficulty sitting still.
Impulsivity – Interrupting, blurting out answers, or difficulty waiting their turn.

These behaviors can affect academic performance and peer relationships, which often leads to early evaluation, especially in boys. However, not all children with ADHD are disruptive. Some are quietly struggling beneath the surface, which can delay support.

ADHD Symptoms Change Over Time

ADHD is a neurodevelopmental condition, which means it’s rooted in brain development, but how it shows up can shift dramatically over time.

Some Individuals “Grow Into” Their Deficits

Very young children may not show obvious ADHD symptoms if their environment is highly structured or not yet demanding. A child who seems “just energetic” in preschool may start to struggle once school requires sustained attention, independent work, and greater organization. This is known as “growing into” the diagnosis, symptoms become more visible as life becomes more complex.

Others May “Grow Out” of Overt Symptoms

On the other hand, some individuals, especially those with strong coping skills or supportive environments, experience a reduction in symptoms over time. Hyperactivity often decreases with age, and some adults find they are better able to manage focus and time with the right tools or strategies.

However, even those who “grow out of” the more visible symptoms may still struggle with:

Subtle attention difficulties
Emotional reactivity
Executive dysfunction under stress or transitions

It’s also common for symptoms to re-emerge at life stages that demand greater independence, such as entering high school, college, the workforce, or becoming a parent.

ADHD in Adults: Often Subtle, Often Missed

By adulthood, ADHD may look less like bouncing off the walls and more like chronic overwhelm. Common adult symptoms include:

Disorganization – Trouble managing time, appointments, or tasks.
Restlessness – A sense of mental or physical unease, even when “sitting still.”
Forgetfulness – Missing deadlines, losing track of conversations or details.
Emotional dysregulation – Quick frustration, mood swings, low stress tolerance.
Relationship strain – From being perceived as inattentive, unreliable, or reactive.

Many adults have spent years developing coping mechanisms, but still feel like they’re constantly “behind” or underperforming. A diagnosis later in life can bring a sense of relief, clarity, and a path forward.

When to Consider an Evaluation

You might consider a neuropsychological evaluation if:

Your child is bright but struggling to meet their potential.
You or your child are constantly overwhelmed, scattered, or emotionally reactive.
You see familiar patterns across generations in your family.
You want answers, not just labels.

If this sounds familiar – whether for you, your teen, or your child – it might be time to explore what’s underneath the struggle. A clear understanding can open the door to real, personalized support.
→ Contact my office to schedule a consultation