Clinical Spotlight: ADHD and Mental Health in School-Aged Girls
Words First introduced Clinical Spotlight Terms this academic year as an opportunity for various clinical areas and specialists to collaborate and share information. This Spring Term our Autism, ADHD and SEMH Pathways have been focusing on Neurodiversity and Mental Health along with one of our incredible Educational Psychologists.
Girls with ADHD continue to be under-identified in schools, misunderstood due to their behaviour, and often end up battling to understand their neurodivergence in addition to increasingly poorer mental health. We hope that, by shining a spotlight on the topic of ADHD and Mental Health in School-Aged Girls, we can start to promote actionable change.
Understanding Communication, Behaviour, and Mental Health
Across UK educational settings, the most prevalent Special Educational Needs support that children and young people receive is for speech, language and communication needs (25.7%), followed closely by support for social, emotional and mental health (SEMH) needs (23.6%). Speech and Language Therapists often refer to the idea that all behaviour is communication. When children and young people are not yet able to communicate their needs effectively, this connection between communication and mental health becomes especially clear.
Chevonne du Plessis, Highly Specialist Speech and Language Therapist, explains:
“When words fail, behaviour is all that is left. What we label as behaviour is very often an expression of unmet need, years of frustration and confusion, and difficulty finding the words to describe complex internal differences.”
Why ADHD in Girls Is Frequently Overlooked
The challenge, when considering girls with ADHD, is that their behaviours are also different. We can see external hyperactivity, external impulsivity, and external inattention. And what we can see, we can name and, hopefully, support.
However, many girls with ADHD manage their difficulties internally. Rather than drawing attention to their struggles through overt hyperactivity, they may appear compliant, conscientious, or shy and withdrawn. Over time, girls with ADHD learn to closely observe their peers and adapt their own behaviour in ways that attract minimal attention from adults.
Senior Educational Psychologist Linda Bresgi describes how this process may evolve:
“Many girls learn very early on that their restlessness, emotional intensity, or distractibility are not socially acceptable. So they adapt. They mask. They look calm and compliant, but the internal cost is enormous.”
Masking, Misinterpretation, and Delayed Recognition
Masking often leads to a disconnect between school and home. At school, girls may appear settled and engaged. At home, families may see exhaustion, emotional shutdown, or distress. This difference in presentation can result in ADHD being attributed to anxiety or mood-related difficulties rather than being recognised as a neurodevelopmental profile with co-occurring, complex differences.
As Linda notes:
“Masking does not protect girls. It delays recognition and increases vulnerability.”
Overlap, Misinterpretation, and Delayed Support
ADHD in girls frequently co-occurs with other neurodevelopmental conditions such as autism, dyspraxia, and specific learning differences. Additionally, individuals with ADHD present with language processing differences in many cases.
Repeated experiences of misunderstanding, academic strain, and social difficulty rooted in misunderstood or incomplete neurodivergent profiles can contribute to trauma responses. As a result, girls are more likely to be referred for emotional or mental health support, as this is what is most visible, while underlying neurodevelopmental needs remain unaddressed.
Linda emphasises the importance of holistic understanding:
“When ADHD, anxiety, trauma, and learning differences are considered separately, the overall picture is lost.”
ADHD, Puberty, and Emotional Health
Evidence increasingly shows that emotional symptoms in girls with ADHD rise sharply during puberty. This increase is significantly greater than that seen in boys with ADHD and neurotypical girls and women. Emerging research suggests these challenges often persist at clinically significant levels across much of girls’ and women’s lifespans.
Hormonal changes influence attention, regulation, sleep, energy levels, and emotional responsiveness. For girls with ADHD, these changes can intensify existing challenges and contribute to variability in day-to-day functioning at school. Medication does not remove this variability, and hormonal fluctuations can affect how medication is experienced at different points in the menstrual cycle.
Chevonne highlights the impact of this pattern:
“Girls with ADHD are rarely operating within what schools consider typical. When support does not adapt to that reality, emotional difficulties increase.”
What Schools Can Change
Schools do not need to wait for a diagnosis to adjust how they respond. Practical changes in understanding, expectations, and environments can reduce pressure and improve experiences for girls with ADHD.
Helpful approaches include:
- Interpreting behaviour as information rather than intent
- Reducing unnecessary cognitive, sensory, and emotional demands
- Acknowledging neurodivergent communication and regulation styles
- Developing shared understanding across staff teams through training and awareness
- Using interdisciplinary collaboration to inform support
Chevonne describes the impact of reframing adult responses:
“When we ask what a child needs and how we can help, the interaction changes. The response becomes supportive rather than corrective.”
Linda adds:
“When expectations shift and support matches need, emotional distress reduces and engagement improves.”
An Interdisciplinary Responsibility
ADHD affects communication, executive functioning, regulation, relationships, and emotional health. Effective support relies on joined-up working across education, intervention, and mental health services.
Early, neurodiversity-affirming identification reduces escalation and supports wellbeing over time. It also reduces the likelihood that girls are only recognised once difficulties become overwhelming and unmanageable.
As Chevonne explains:
“When professionals work together and share responsibility, children are less likely to carry the burden of explaining their needs alone.”
About Chevonne:
Chevonne is a highly specialist Speech and Language Therapist with advanced training in neurodevelopmental conditions, including Autism Spectrum Conditions (ASC) and Attention Deficit Hyperactivity Disorder (ADHD). After completing her Bachelor’s degree in Speech, Language, and Hearing Therapy at the University of Stellenbosch, she went on to achieve an MSc in Speech-Language Pathology (cum laude) from the University of Cape Town and a PG Diploma in Developmental Neuroscience and Psychopathology (with distinction) from University College London. A published researcher in neurodevelopmental disorders, Chevonne leads the ADHD Clinical Pathway at Words First, supporting fellow therapists to expand their expertise in this area. She currently works in schools supporting students with social, emotional, and mental health (SEMH) needs and is ADOS-trained, contributing to autism assessments within a multidisciplinary team.
About Linda:
Linda Bresgi is an Educational Psychologist with over four decades of experience across education and psychology, including 30 years as a preschool teacher and 10 years as an Educational Psychologist. Her combined background supports a strong understanding of child development, learning, and emotional wellbeing across a range of educational contexts.
Linda has worked in schools, private practice, and non-profit settings, and spent 20 months at the Neurodiversity Centre in South Africa developing specialist expertise in neurodiversity-affirming assessment and support. Her work focuses on recognising how emotional distress is communicated when feelings are difficult to identify or describe.
