ADHD: Variability of Presentation
ADHD doesn't look the same in everyone. Girls, high-IQ children, and teenagers often present differently. Understanding this variability helps prevent missed or delayed diagnoses.
The "classic" image of ADHD - a hyperactive boy disrupting class - represents only one way the condition can present. Many children, particularly girls and those with high IQ, are missed because their ADHD looks different.
Research shows girls are diagnosed on average 2-3 years later than boys, and many aren't diagnosed until adulthood. This delay has real consequences: untreated ADHD is associated with higher rates of anxiety, depression, and academic underachievement.
ADHD in girls vs boys
- •More likely to have inattentive presentation
- •Hyperactivity often presents as talkativeness
- •More likely to internalise - anxiety, perfectionism
- •Better at masking symptoms in social situations
- •Often hyperfocused on social dynamics
- •Emotional dysregulation may look like "drama"
- •Often diagnosed later or misdiagnosed as anxiety
- •More likely to have combined or hyperactive presentation
- •Hyperactivity often more physical/disruptive
- •More likely to externalise - defiance, aggression
- •Symptoms more visible in classroom settings
- •Often identified earlier due to disruption
- •More likely to receive classroom accommodations
- •Diagnosed on average 2-3 years earlier than girls
Important: These are tendencies, not rules. Some girls are hyperactive and disruptive; some boys are quietly inattentive. The key is to look beyond stereotypes and assess based on the individual child's presentation.
ADHD in high-IQ children
Bright children with ADHD are often missed because their intelligence masks their difficulties. They may coast through primary school before struggling when demands increase.
High cognitive ability can compensate for ADHD difficulties, especially in less demanding environments. Problems may only emerge when demands exceed capacity to compensate.
Look for significant variability: brilliant one day, struggling the next. High ability in some areas but inexplicable failures in others.
If work is too easy, ADHD symptoms may worsen. The child may appear disruptive or disengaged because they're understimulated, not incapable.
Many gifted children with ADHD aren't diagnosed until secondary school or university when the environment demands more independent self-management.
Being "twice-exceptional" (gifted + ADHD) creates unique challenges. They may be too clever for support services but struggling too much to access gifted programmes.
How presentation changes with age
ADHD doesn't disappear with age, but it does change. Understanding these changes helps you know what to expect and watch for.
Hyperactivity and impulsivity most visible. May be dismissed as "just being young" or "active". Difficulty following instructions, waiting turns, or engaging in quiet play.
Watch for: Comparison with same-age peers is key - all preschoolers are active, but ADHD children stand out.
All three domains usually visible. Academic demands reveal attention difficulties. May struggle with homework, organisation, and peer relationships.
Watch for: This is when most diagnoses occur, particularly if there's hyperactive or disruptive behaviour.
Hyperactivity often decreases or becomes internalised restlessness. Inattention and executive dysfunction become more prominent as academic demands increase.
Watch for: Inattentive girls often diagnosed around this time. Emotional dysregulation may worsen with puberty.
Physical hyperactivity rare. Challenges with organisation, time management, emotional regulation, and life admin. May struggle with the transition to independent living.
Watch for: Many are diagnosed in university when support structures disappear and demands for self-management spike.
Context-dependent symptoms
ADHD symptoms vary dramatically depending on context. This can be confusing for parents and teachers - "If they can focus on games, why not homework?"
| Context | What you might see |
|---|---|
| One-on-one vs Groups | Often much better one-on-one. In a classroom of 30, ADHD symptoms are more apparent. |
| Novel vs Familiar | New activities often engage attention better. Problems emerge with routine, repetitive tasks. |
| Interesting vs Boring | Can hyperfocus on engaging activities. Struggles dramatically with tasks they find boring. |
| Low vs High Stakes | May perform well under pressure (exam day) but struggle with daily homework. |
| Morning vs Afternoon | Many children with ADHD perform better in mornings, with symptoms worsening as day progresses. |
| Home vs School | May present very differently. Parents and teachers often give contradictory accounts. |
Context variability isn't evidence against ADHD - it's actually a core feature. The ADHD brain struggles to regulate attention, not produce it. Attention is possible when the environment provides enough stimulation, novelty, or immediate reward.
This is why a child can hyperfocus on video games but can't sustain attention on homework. The games are designed to provide constant reward and novelty. The homework requires self-generated motivation that ADHD brains struggle to produce.