ADHD in Girls (The BGALS)

 The Berkeley Girls with ADHD Longitudinal Study (BGALS), led by Stephen P. Hinshaw, is one of the most important ADHD studies ever conducted because it followed girls with ADHD from childhood into adulthood for decades. It began in the late 1990s with 140 girls diagnosed with ADHD and 88 comparison girls without ADHD. (Hinshaw Lab)

The findings that changed how we think about ADHD in girls

1. ADHD in girls is not a mild condition

For many years clinicians assumed girls had a less severe form of ADHD than boys. The Berkeley study showed that girls with ADHD experienced significant impairment in academics, friendships, family relationships, self-esteem, and later occupational functioning. These difficulties persisted well beyond childhood. (OUP Academic)

2. Hyperactivity often decreases, but impairment remains

Many girls became less outwardly hyperactive and disruptive as they matured. However, the ADHD did not disappear. Instead, difficulties often shifted into:

• disorganization

• poor executive functioning

• academic underachievement

• relationship problems

• emotional distress

This challenged the myth that girls simply "outgrow" ADHD. (Berkeley News)

3. Inattentive ADHD is not benign

One of the most important findings for clinicians is that girls with predominantly inattentive presentations still experienced serious long-term impairment. They were often overlooked because they were not disruptive. (PMC)

As an ADHD specialist, this finding is particularly relevant because many women diagnosed in adulthood fit this pattern.

4. Emotional problems become more prominent over time

As girls entered adolescence and young adulthood, external symptoms often became less visible while internal struggles increased.

Researchers found elevated rates of:

• anxiety

• depression

• low self-worth

• social rejection

• emotional dysregulation

The difficulties frequently became more internalized rather than disappearing. (PubMed)

5. The most alarming finding: self-harm and suicide risk

This is probably the study's most cited finding.

Girls with childhood ADHD had substantially higher rates of:

• non-suicidal self-injury (cutting, burning, etc.)

• suicide attempts

The risk was especially high for girls with Combined Type ADHD (inattention plus impulsivity/hyperactivity). (PMC)

Hinshaw has described this as one of the most important public health findings to emerge from the study.

6. Social rejection was a major predictor of later problems

One fascinating finding was that peer rejection in childhood predicted later difficulties even more strongly than some ADHD symptoms themselves.

Girls who experienced chronic peer rejection were more likely to struggle later with:

• depression

• self-harm

• poor self-esteem

• social difficulties

This highlighted that ADHD is not only an attention disorder—it is also a social-developmental disorder. (Duke Psychiatry)

7. ADHD affects women differently than men

The study helped establish that females with ADHD often show:

• more inattention

• more internalizing symptoms

• fewer obvious behavior problems

• more compensatory masking

As a result, girls and women are frequently underdiagnosed or diagnosed later. (PubMed)

What I think is the biggest clinical takeaway

For therapists working with adult women, the Berkeley findings suggest that ADHD often follows a developmental pathway like:

Childhood
→ distractibility, disorganization, social awkwardness

Adolescence
→ academic struggles, rejection sensitivity, self-esteem problems

Young adulthood
→ anxiety, depression, self-criticism, relationship difficulties, self-harm risk

The ADHD may look less obvious on the surface, but the impairment can actually become more psychologically costly. (Berkeley News)

This is one reason so many women in their 40s, 50s, and 60s—especially intelligent, hardworking women who compensated for years—are only now recognizing ADHD after a child or grandchild receives a diagnosis. The symptoms may have been masked, but the lifelong pattern of executive dysfunction, overwhelm, shame, and inconsistent performance was often there all along. (PubMed)

For someone like you who frequently evaluates women for ADHD, the Berkeley study is one of the strongest pieces of evidence that female ADHD is both real and highly impairing, even when it does not look like the stereotypical hyperactive boy presentation.