Attention-Deficit/Hyperactivity Disorder (ADHD) affects an estimated 8.4% of children, making it one of the most common neurodevelopmental disorders of childhood. Typically diagnosed in childhood, ADHD may continue, get worse, or show symptoms differently in adulthood.

There is also a large diagnosis gap between boys and girls with ADHD. While 12.9% of boys are diagnosed with the disorder, just 5.6% are girls. The reason for this diagnosis gap is not because ADHD is more prevalent in boys but. as research is beginning to show, it is more complicated in girls. For example, most studies focus on how ADHD presents in boys, but it can manifest differently in girls. For example, Kyrie Speer wasn’t diagnosed with ADHD until she was 20 years old, while her brother was diagnosed in childhood. “My brother was very clearly ADHD, with extra hyperactivity,” Speer says. “For myself, I was able to do my schoolwork, I wasn’t as energized as my brother, and I was able to control myself more. In my parents’ eyes, that meant I didn’t have ADHD. For many years I didn’t think I did either.” Girls tend to get diagnosed with ADHD later in life, often in their twenties, Although a girl may be able to (or learn to) mask their ADHD symptoms throughout childhood, once the structure and familiarity is stripped away, it makes it harder to maintain that mask.

Additionally, girls are held to certain societal standards that boys are not. Since girls are often expected to be neat and chatty, these expectations can cause a girl with ADHD to either attempt to compensate for her differences (also referred to as “masking”) or may make ADHD symptoms easy to dismiss. For example, being “chatty” or talking too much, which is also a common ADHD trait, may be dismissed by adults as typical of a young girl, but flagged as unusual for a young boy. This was the case for Anjoulie Woodhead who was not diagnosed with ADHD until she was 16 years old, but always exhibited symptoms. “I feel as though if I were a male, I would have been diagnosed in childhood,” Woodhead says. “Because I’m a female I think that in elementary and middle school people just thought I was ‘unruly’ and probably came from a home where education wasn’t valued.” Woodhead recalls getting bad grades and frequently being yelled at by teachers for talking too much, but she couldn’t control it. During a parent teacher conference in 10th grade, Woodhead’s teacher told her mother, “You should get her brain checked, because something must be wrong.” Woodhead describes the comment as “horrible” but that it was what “prompted [her] to get tested for ADHD. “In essence, in my past I always felt inadequate and frankly, stupid.” Woodhead recalls. “It wasn’t until mid-10th grade [after the ADHD diagnosis] that I actually realized that I am smart and capable of doing things that everyone else can.”

Further, society views mood disorders that are regularly associated with ADHD (such as depression and anxiety) more skewed towards females. This means that although a girl may be experiencing both a mood disorder and ADHD in tandem, the girl could be diagnosed with only the mood disorder. Julianna Frisoli, who was diagnosed with combined type ADHD earlier this year, has personal experience with this issue. “ADHD and anxiety/depression are often linked together, and I feel like the way my ADHD affects my mood gets brushed off sometimes because I’m a woman, so people just think I’m more emotional when in reality being diagnosed with ADHD means that I don’t process my emotions the same way a neurotypical person would and it has more to do with my diagnosis than it does my gender,” Frisoli says. Recent research has begun to show that girls with ADHD do experience mood disorders more often than boys with ADHD, but this could be because of the difficulty of upholding societal standards while experiencing ADHD symptoms.

The longer ADHD goes undiagnosed and untreated, the more risks are involved. Often referred to as the “Lost Girls”, women whose ADHD went untreated are left to deal with their symptoms without help, diagnosis, or treatment. As previously mentioned, women with ADHD are more prone to masking, which can become emotionally and even physically exhausting over time. This can lead to anxiety, depression, sleep problems, and even physical symptoms such as stomachaches and headaches. These additional health issues can also lead to higher healthcare costs for women with untreated ADHD, which can wreak havoc in a woman’s personal life, leading to trouble in personal relationships, difficulty achieving academic and career goals, and can lead to lower self-esteem.

It is also important to understand that each person’s brain has individual strengths and weaknesses. One person may excel at math while barely being able to draw stick figures. Another person may be an incredible leader but not tech savvy. ADHD simply reflects a difference in a person’s brain’s wiring. Those with ADHD may also be more creative or see solutions or better ways of doing things than neurotypical people. Frisoli, for example, traded in her desk job to start her own business to better accommodate the way her brain worked. Some people with ADHD struggle in a desk job environment because of the repetitive structure it provides and prefer a career that caters more to their spontaneous and hyper-focused brains. “Not one person with ADHD will look like the next person with ADHD,” Speer says. “Once learning this, everyone else started to take me seriously. I finally wasn’t alone in my search for help.”

About the Author: Cheyenne Leonard is a fellow with The Loreen Arbus Accessibility is Fundamental Program, an inaugural fellowship created to train women with disabilities as professional journalists so that they may write, research and report on the most crucial issues impacting the disabilities community.